If You’ve Seen One Rural Community, You’ve Seen One Rural Community

Perspectives of a Rural Health Advocate

Guest Blog by Ronnie Rom, MSPH, CPHQ, Massachusetts Office of Rural Health

While I didn’t grow up in a rural area, I lived for a few years on an asparagus farm (for real!) and have spent time in many isolated parts of America – tribal, ranching, mining, and farm-worker communities among them – via immersive travel, as well as through running a national healthcare network.

So, when I first got involved in advocating for rural hospitals and for the health of rural communities, it wasn’t hard to see the commonalities among them – self-reliance, cooperation, and resourcefulness, along with lack of transportation, food and housing insecurity, and distrust of outsiders. Less obvious, but just as important, were the nuances of local history, geography, economics, politics, culture, and demographics. All of these factors make rural communities unique and not just small urban entities.

Grasping this multi-dimensionality is key to reaching greater numbers of rural residents for vaccine access. I spoke with one of the leaders of our statewide Rural Vaccine Equity Initiative, who shared with me the importance of conversing with community-based organizations, coalitions and partners when determining the most successful approaches for their regions. What worked in one rural location – school-based events, or a Town Hall forum – may or may not work in others.

At the same time, there are several strategies worth considering for more isolated areas. These include incorporating Community Health Workers (CHWs) alongside public health nurses to engage in deeper conversations with residents about vaccine hesitancy. Another is to fold in non-clinical concerns as part of the vaccination effort. This might include providing gift card incentives that match the resources of that community. Some successful efforts have offered a choice of purchasing options – ex: gift cards that may be used in-person or on-line for one or a combination of either groceries, gas, school supplies, or clothing.

Another helpful strategy has included training providers and community organizations in motivational interviewing strategies, recognizing that it may take many conversations to move people toward change when it comes to vaccination. Further, it has been important to understand that intersectionality – the interconnectedness of race, class, gender, sexuality, and ethnicity in individuals and groups – may require even more frequent and nuanced efforts in rural communities, as there may be multiple layers of distrust to address.

All in all, though, the most successful rural vaccination events have been those where locations and strategies were self-directed by local communities. When we appreciate rural communities as distinctive, rather than generic, and as self-aware rather than uninformed, we come one step closer to building trust.