The Alabama Rural Health Association, in effort to learn more about the needs of its members, conducted a four-part information gathering roadshow during the month of November, 2022. Traveling to four locations, Montgomery, Hartselle, Atmore, and Livingston, more than 150 rural constituents and stakeholders participated in a series of listening sessions.
During these sessions, they were presented with data regarding rural health in Alabama, and then broke into four groups to discuss what their experiences have been and what improvements could be made to policies and strategy to rural health. Each group wrote their desired policy improvements on tear-away white pages and then all attendees marked their top 10 preferred improvements with a sticky dot. The results of each roadshow were tabulated by the association and amalgamated into a single tabulation, with similar categories combined for each of viewing.
The results are as follows:
| Policy Needs | Results |
| Medicaid expansion | 41 |
| Mental health access | 34 |
| Workforce Improvement (recruitment, retention, compliance, scope of practice) | 29 |
| Rural transportation | 29 |
| Healthy literacy / health education issues | 27 |
| Increase in telehealth utilization, coordination and support | 20 |
| Social determinants of health (food insecurity, poverty, housing) | 15 |
| Broadband access | 11 |
| Increase provider rates with Medicaid | 9 |
| Coordination of services especially transportation | 9 |
| NPs/CNM increased scope | 8 |
| Food insecurities / food deserts | 8 |
| Standardized credentialing | 7 |
| Increase provider rates with Medicare | 7 |
| Expose students to health professions | 6 |
| Comprehensive sex education in k-12 | 6 |
| Not having enough doctors | 6 |
| Taking tools and skills away from rural/primary physicians (sending everything to specialists) | 6 |
| Rural residency training | 6 |
| Apprenticeships w/in health prof- tech schools, shadowing | 5 |
| Price gouging | 5 |
| Pharmaceutical cost | 5 |
| Family Support | 5 |
| Elder/Disabled services | 5 |
| Too many people without insurance | 5 |
| Utilization of community health advocates | 5 |
| Increase state funding for ARMSA | 4 |
| Relationship building | 4 |
| Focus on multidisciplinary approach to PT care | 4 |
| Hospital vulnerability | 4 |
| EMS service availability | 4 |
| Physician fee schedule issues | 3 |
| High administration cost | 3 |
| Standardized claims filing | 3 |
| Safety in Schools | 3 |
| Community transportation | 3 |
| Knowing the community that’s being worked in | 3 |
| Funding | 3 |
| Awareness of resources | 3 |
| Health equity | 3 |
| Maintain Sources of income (post covid) | 3 |
| Not having docs in the correction locations in the state (incentive issues) | 3 |
| Delay in seeking services cost | 3 |
| Encourage physicians to recruit local | 2 |
| More cohesion w/ reg. agencies | 2 |
| Substance Abuse (opioid, ETOH) | 2 |
One week after the conclusion of the roadshow, the Alabama Rural Health Association board of directors met at a special in-person session in Clanton to discuss these results and the strategy for the association moving forward. After significant discussion, the following action items will be taken.
- The Alabama Rural Health Association will continue its advocacy toward Medicaid expansion, with the most immediate action being a letter sent to Governor Ivey corresponding with National Rural Health Day declaring the need for this expanded coverage for the state’s working poor.
- The Alabama Rural Health Association will have a renewed focus on mental and behavioral health services, with a more direct need to providing collaboration with these services and primary care in the state. This may consist of increased educational sessions, connection for direct partnerships, or grant opportunities.
- The Alabama Rural Health Association will establish a new effort to recruit rural constituents into its contact lists in order to directly assist with health literacy and education efforts. Establishing a list of constituents will provide the association with an outlet to educate the public. The education may consist of each-to-view flyers, video, and other materials that help the public to navigate the healthcare system and understand the complexities of the system. The association may pursue grant-funding to produce these videos and other marketing efforts.
The Association is appreciative to its constituents for providing this direct feedback and helping to guide policy in 2023 and beyond. We know that these efforts to continue to improve rural health will take time, but the end result will be worth the effort.