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Rural Health Information Hub

Population Considerations for Rural Chronic Disease Management Programs

Chronic disease disproportionately impacts certain rural populations. Knowing which populations are at higher risk for chronic disease can help direct strategies and tailor programs to these patients. Rural chronic disease management programs may need to consider unique needs of groups such as older adults, people with disabilities, people experiencing poverty, and tribal communities. Designing programs to address the needs of these populations can help ensure successful implementation.

Older Adults

Older adults tend to experience declining health status, decreasing levels of physical functioning, and cumulative impacts of risk factors. For example, an individual who has smoked cigarettes for 30 years will manifest greater signs of lung damage due to tobacco smoke compared to an individual who has only smoked for five years. Rural healthcare providers should screen older adults for chronic diseases to identify cases and initiate care as early as possible. Programs for older adults may also consider integrating certain activities and services, such as transportation to medical appointments.

People with Disabilities

People with disabilities often face unique barriers to accessing chronic disease care and may need accommodations. For example, people with intellectual and developmental disabilities may depend on caregivers to accompany them to appointments, administer treatments, or help with care coordination. Rural programs should be aware of potential need for accommodations and seek to create an accessible and comfortable environment for all patients. This may involve specific transportation considerations and other adaptations to ensure accessible treatment. Programs may also consider offering support services for caregivers when possible.

People Experiencing Poverty

Individuals with lower incomes face increased exposure to risk factors for chronic disease and additional barriers to accessing and affording treatment. Many chronic disease management strategies require a multi-pronged approach that includes prescription medications and regular appointments with providers. Adhering to all treatments can be costly, but is important for successful management. Rural programs should consider approaches for helping patients address challenges with affordability of treatments.

Indigenous Communities

American Indian/Alaska Native and Native Hawaiian (AI/AN/NH) adults have higher rates of chronic disease. Evidence-based and promising approaches for managing chronic diseases, like the Chronic Disease Self-Management Program (CDSMP), have been successful with AI/AN/NH adults. Each tribe is autonomous and has its own culture, beliefs, and health customs. Communities can tailor programs so they are responsive to unique cultural needs. Involving tribal members in program planning, implementation, and evaluation can help ensure programs are culturally responsive.

The National Council on Aging has compiled strategies for collaborating with tribal communities to design and implement CDSMP. Several strategies include:

  • Building trust and understanding about the tribal community
  • Conducting research and asking questions about community needs and goals
  • Building understanding about tribal structure and government
  • Making sure that program workforce is culturally competent
  • Using culturally relevant program materials with input from tribal champions and members

More information on implementation considerations for specific rural populations can be found in the Rural Health Equity, Rural Health Literacy, and Social Determinants of Health toolkits. 

Resources to Learn More

Faces of Work-Related COPD
A series of videos featuring a pulmonologist and individuals diagnosed with COPD as a result of occupational exposures. Participants discuss work-related exposures causing COPD, impacts of COPD on quality of life, and minimizing the risks for developing work-related COPD.
Organization(s): CDC National Occupational Research Agenda, Respiratory Health Cross-Sector Council

Rural Residence and Poverty Are Independent Risk Factors for Chronic Obstructive Pulmonary Disease in the United States
Reports on a study of adults participating in the National Health Interview Survey 2012-2015 linked with the U.S. Census Bureau American Community Survey and data from the National Center for Health Statistics Urban-Rural Classification Scheme to determine the impact of urban-rural status, poverty, and other factors to understand COPD prevalence among non-smokers.
Author(s): Raju, S., Keet, C., Paulin, L., et al.
Citation: American Journal of Respiratory and Critical Care Medicine, 199(8), 961-969
Date: 4/2019

Successful Strategies & Lessons Learned from Implementing Evidence-Based Programs in American Indian, Alaska Native, and Native Hawaiian Communities
Highlights evidence-based programs implemented and adapted to meet unique challenges and experiences of AI/AN/NH communities including chronic disease self-management programs to improve overall health and well-being.
Organization(s): National Council on Aging
Date: 2021