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Rural Health Information Hub

Rural Project Examples: Wellness, health promotion, and disease prevention

Effective Examples

The Pacific Care Model: Charting the Course for Non-communicable Disease Prevention and Management

Updated/reviewed October 2025

  • Need: The U.S. Associated Pacific Islands (USAPI) needed an efficient, effective, integrated method to improve primary care services that addressed the increased rates of non-communicable disease (NCD), the regional-specific phrase designating chronic disease.
  • Intervention: Through specialized training, multidisciplinary teams from five of the region's health systems implemented the Chronic Care Model (CCM), an approach that targets healthcare system improvements, uses information technology, incorporates evidence-based disease management, and includes self-management support strengthened by community resources.
  • Results: Aimed at diabetes management, teams developed a regional, culturally-relevant Non-Communicable Disease Collaborative Initiative that addresses chronic disease management challenges and strengthens healthcare quality and outcomes.

Meadows Diabetes Education Program

funded by the Federal Office of Rural Health Policy

Updated/reviewed September 2025

  • Need: To provide diabetes care and education services to those in rural southeast Georgia.
  • Intervention: Diabetes outreach screening, education, and clinical care services were provided to participants in Toombs, Tattnall, and Montgomery counties. The program is no longer active.
  • Results: Patients successfully learned self-management skills to lower their blood sugar, cholesterol, and blood pressure.

Spit It Out-West Virginia

Updated/reviewed March 2025

  • Need: Due to West Virginia's high ranking for its use of smokeless tobacco, prevention and cessation education efforts were needed.
  • Intervention: Development and implementation of the Spit It Out-West Virginia program.
  • Results: Supported by a 2008-2010 grant allowing the program to be delivered to hundreds of people, 5 workplaces became tobacco free. The program continues to be delivered across the state and reaches hundreds with its face-to-face presentations and thousands with its specific media prevention and cessation messages.

The Health-able Communities Program

funded by the Federal Office of Rural Health Policy

Updated/reviewed August 2024

  • Need: Expand healthcare access for the more remote residents of 3 frontier counties in north central Idaho.
  • Intervention: With early federal grant-funding, a consortium of healthcare providers and community agencies used a hybrid Community Health Worker model to augment traditional healthcare delivery services in order to offer a comprehensive set of health-related interventions to frontier area residents.
  • Results: With additional private grant funding, success continued to build into the current model of an established and separate CHW division within the health system's population health department.

I Got You: Healthy Life Choices for Teens (IGU)

funded by the Federal Office of Rural Health Policy

Updated/reviewed February 2024

  • Need: To improve awareness of behavioral and mental health issues by students in rural, east central Mississippi.
  • Intervention: An intensive community mental health outreach program was implemented for students in rural Mississippi.
  • Results: As of 2018 and on a yearly basis, 6,000 7th and 8th grade students receive mental health education on a variety of topics which improves their ability to recognize mental health issues, high risk behaviors, and manage their own choices.

Trinity Hospital Twin City's Fit for Life

funded by the Federal Office of Rural Health Policy

Updated/reviewed November 2018

  • Need: To reduce obesity among adults in rural east central Ohio.
  • Intervention: Fit for Life Replication Project for Expansion was developed to make it possible to lose weight through practicing healthier lifestyle behaviors.
  • Results: Out of the 443 adults who have completed the program, 81% experienced weight loss, a tangible result of the program's overarching goal to enhance levels of health and fitness.

Promising Examples

Contingency Management Smoking Cessation in Appalachia

Updated/reviewed March 2026

  • Need: To reduce smoking rates of pregnant adult and adolescent women in Appalachian regions of eastern Kentucky and Ohio.
  • Intervention: In 2009, a web-based smoking cessation program offered monetary incentives to reduce smoking.
  • Results: Participants significantly reduced smoking rates or quit altogether.

Step Into Cuba

Updated/reviewed February 2026

  • Need: To increase physical activity and quality of life in rural Cuba, New Mexico.
  • Intervention: Step Into Cuba works to make the community more pedestrian-friendly by creating and improving hiking trails and other places to walk.
  • Results: This program has led to new or improved trails, sidewalks and crosswalks, lighting on streets, walking groups, and walking events, among other achievements.

School-Based Health Center Dental Outreach

funded by the Federal Office of Rural Health Policy

Updated/reviewed January 2026

  • Need: Improve the oral health of children age 3-17 in rural areas of Louisiana.
  • Intervention: Leveraging 2012-2018 federal grant support, participating Federally Qualified Health Centers with school-based nurse practitioners were trained in oral health assessments and fluoride varnish application. When needed, dental referrals were also made. Interventions were tracked by dental case managers.
  • Results: After grant cycle completion, these oral health interventions are now fully integrated into routine school-based care health examinations with intervention data included in required annual reporting.

Communities that Care Coalition

Updated/reviewed September 2025

  • Need: To improve the health and well-being of young people in the rural area of Massachusetts's Franklin County and North Quabbin, and to reduce youth drug and alcohol use.
  • Intervention: A community-based prevention coalition was formed to improve youth health and well-being and reduce youth drug and alcohol use. The coalition brings together stakeholders from across the community and uses the Communities That Care evidence-based community planning system.
  • Results: CTC has seen significant reductions in substance abuse among local youth in the 30 rural towns they serve.