Common Implementation Challenges for Rural SDOH Programs
Rural communities implementing programs to address social determinants of health (SDOH) can experience unique challenges. Factors specific to the rural context can complicate the planning, implementation, and sustainability of rural SDOH initiatives. Some common challenges for rural SDOH programs include the complexity of SDOH, communication and messaging, community engagement, and readiness for change.
Complexity of SDOH
By nature, SDOH programs focus on complex issues. Progress occurs over a long period of time and is frequently not linear. Programs may experience setbacks, opposition, and funding gaps along their journey, which can be discouraging for program staff and leadership and can make it difficult to meet objectives on schedule. It is important that rural programs balance short-term and long-term work and goals. Measuring and celebrating early successes can help programs maintain momentum. Large-scale disruptions and shifts, such as economic downturns, policy changes, natural disasters, and other emergencies, can present new challenges and exacerbate existing issues related to program implementation efforts and the SDOH experienced in the community.
Communication and Messaging
When discussing SDOH in a rural community, it may be necessary to frame the program and topics in a way that resonates with community members, partners, and other key collaborators. Thoughtful messaging about SDOH can help gain support for SDOH programs in rural communities. Terms like SDOH and health-related social needs are commonly used in public health work, yet these phrases may not resonate with audiences in other sectors or industries. Program planners can work with community organizations, program leadership, and community members to ensure the language used to describe a program aligns with the shared priorities and values of the community.
Research into messages that work in rural areas finds that communications are effective when focused on key topics that people connect with. This includes concepts like access to broadband, access to healthcare, reliable jobs, and safe neighborhoods. Research has also shown that messages acknowledging the role of individual and personal responsibility appeal to rural communities. For example, one message that combines both notions states:
“Personal responsibility plays a key role in health, but the choices we make depend on the choices we have available to us. It's hard to be healthy without access to good jobs, good homes, and good schools.”
Program planners should consider careful framing when discussing attributing reasons for worse health outcomes in rural areas. For example, instead of framing rural residents as "sicker" than urban residents, messages can highlight the importance of addressing rural food insecurity and connecting rural residents with the transportation they need to receive preventive care. Being clear about the proposed changes also helps lessen feelings of hopelessness or concerns that SDOH are impossible to address.
Community Engagement
Successful SDOH programs rely on strong community and partner engagement. There are several factors, however, that can complicate efforts to engage rural communities. Program implementation timelines that are unrealistic about the time required for genuine community engagement can hinder progress. Mistrust or fear of government agencies, community organizations, or healthcare systems among groups with negative past experiences can create significant barriers and hinder progress. Practical issues like a lack of broadband can limit communication and resource sharing with community members, while existing tensions between organizations or subgroups in the community can also complicate collaboration.
Readiness for Change
Committed and accountable leadership and staff are foundational to the success of any program addressing SDOH. Conversely, a lack of support, political will, and buy-in from governmental entities, businesses, and other organizations can hinder progress and create additional challenges, such as resource and funding limitations. Building a shared understanding and commitment to addressing SDOH is essential for successful implementation, for which buy-in and readiness for change are needed.
Resources to Learn More
Strategic Messaging
Website
Provides toolkits for public health professionals to target and support strategic messaging about public health.
Includes a collaboration and storytelling toolkit that may assist in cross-sector collaboration.
Organization(s): Public Health Reaching Across Sectors, de Beaumont Foundation, The Aspen Institute