Skip to main content
Rural Health Information Hub

Community Partners and Outreach for Rural Chronic Disease Management Programs

Working with Partners

In rural communities, partnerships can support chronic disease management programs by providing different types of support. Examples of how community partners can help rural chronic disease programs include:

  • Improving access to healthcare providers, including specialists
  • Sharing or exchanging limited resources
  • Coordinating outreach to potential program participants
  • Recruiting program participants
  • Networking and facilitating buy-in, commitment, and involvement from other partners, providers, and community members
  • Increasing community awareness for chronic disease-related opportunities and services
  • Delivering education, information, and resources

Examples of community partners that may support implementation of rural chronic disease management programs include:

  • Universities and university extension services
  • Community colleges
  • Local or state public health departments
  • Medical systems, hospitals, and chronic disease specialists
  • Community health centers and Rural Health Clinics
  • Emergency medical services associations and ambulance service providers
  • Corporations or businesses
  • Insurers
  • Schools
  • Nonprofit organizations
  • Recreation facilities or community centers, such as the YMCA
  • Faith-based organizations
  • Law enforcement
  • Rural health networks and associations
  • SHARE (state hospital records exchange)
  • Pharmacies

Community Outreach

Community outreach is an important component of many rural chronic disease management programs. Outreach can help raise awareness of programs and services and help increase access to care. Examples of program activities that may involve an outreach component include health education, care coordination, treatment planning, and case management. Some rural communities host outreach events to promote programs and deliver education. Examples of outreach events include community 5K walks or runs, outdoor group fitness classes, speakers at assisted living facilities or other venues, and healthy potlucks or cooking demonstrations.

Community outreach is also important for building trust with community members. Often, rural communities will partner with community-based organizations (CBOs) to share program information and build buy-in from community members. CBOs may also be helpful partners during program planning, by helping to gather community input in program design. Some rural communities have established a community advisory board or wellness council to help gather input and ensure programs are meeting community needs. Using a community-driven approach may help ensure culturally appropriate chronic disease management programs, build community capacity, develop rural leaders, and improve health equity. For more information on advancing health equity through community engagement, see the Rural Health Equity Toolkit.

Resources to Learn More

Advancing Health Equity Through Partnerships, Collaboration, and Community Engagement
Offers tools and examples for activating, engaging, and strengthening partnerships to address the health needs reported by communities, including rural and tribal, and to advance health equity.
Organization(s): National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

Community-Clinical Linkages for the Prevention and Control of Chronic Diseases: A Practitioner's Guide
Provides strategies, key considerations, action steps, and examples for public health practitioners implementing community-clinical linkages to support adults in their efforts to prevent and control chronic disease and improve population health.
Organization(s): Centers for Disease Control and Prevention
Date: 2016

Community-Clinical Linkages: Implementing an Operational Structure with a Health Equity Lens
Guides public health and clinical practitioners in their decision making on how to develop or adapt connections between community and clinical sectors to incorporate health equity, and prevent and manage chronic disease.
Organization(s): Centers for Disease Control and Prevention
Authors: Moeti, R., Lane, R., Mahalingam, M., & Taylor, L.
Date: 2020

Faith Leaders Toolkit – Diabetes Management and Type 2 Diabetes Prevention
Provides resources to help leaders from faith-based organizations promote diabetes prevention and management efforts. Covers organizing community-based education and outreach programs for people with, or at risk of diabetes, and creating healthy environments to support healthy food choices and safe physical activity.
Organization: National Diabetes Education Program, Centers for Disease Control and Prevention

Program Champion Strategy Toolkit
Resource offering information and resources for coaches and champions about identifying and engaging participants into the National Diabetes Prevention Program, a lifestyle change program. Includes tips for what makes successful champions and program partners.
Organization(s): Centers for Disease Control and Prevention