Improving Health Within a Cultural Context

    • November 13, 2013

Debbie Chatman Bryant—an award-winning nurse who is working to prevent cancer in medically underserved communities—traces her current work to the early days of her career as a medical-surgical nurse in South Carolina’s coastal region.

In those days, Bryant, RN, DNP, was struck by what seemed like a revolving door at the hospital where she worked. “I saw patients I knew come back over and over again,” she says. “They were almost like family.”

One patient in particular—a woman with diabetes—stands out in her memory. Bryant had counseled the woman about proper dietary goals and self-care, but members of her family would visit her and bring the kind of high-fat, high-sugar foods she was told she should avoid: fried chicken, macaroni and cheese, cakes, and pies. The family was supportive, but the food they brought was not helpful to the patient or the family, and the woman kept coming back with avoidable complications, Bryant said.

The patient’s family saw food as a way to express love rather than as a way to nourish the body, Bryant realized. And that, she thought, needed to change. But Bryant—herself a native of South Carolina’s Lowcountry and a devotee of the region’s cuisine and culture—knew change would only come with a culturally sensitive approach to health care. Bryant’s patients, in other words, were not about to overhaul their entire diet to meet certain health goals, but they might be willing to tweak their favorite foods to make them more healthy.

Armed with that epiphany, Bryant pursued a doctoral degree in the practice of nursing and took a position as assistant director of Cancer Control and Outreach at Hollings Cancer Center Medical University of South Carolina in Charleston, S.C. The program addresses population-based research that will lead to a reduction in cancer morbidity and mortality in South Carolina through focused efforts in tobacco control and cancer health disparities.

“I’ve seen families provide incredible support to one another in sickness,” she said. “Now we need to support each other in health. And that means making healthy foods part of our family traditions, or taking a walk together after a family meal. We can do this. We have to.”

Bryant is also an assistant professor at the college of nursing at the Medical University of South Carolina; president of the Charleston Chapter of the Alliance for Digital Equality; president of the Tri-County National Black Nurses Association; and a 2012 recipient of the Robert Wood Johnson Foundation (RWJF) Community Health Leaders Award, which honors exceptional men and women who have overcome significant obstacles to tackle some of the most challenging health and health care problems facing their communities.

Targeting Medically Underserved Communities

In her role at Hollings, Bryant aims to help medically underserved communities overcome the many barriers to health and health care in a culturally sensitive way. To do so, she:

  • has expanded outreach efforts and changed the center’s approach to communication;
  • organizes and trains lay patient navigators to help with diagnostic follow-up visits and treatment;
  • developed a voucher system to cover the cost of co-payments and eliminate financial barriers;
  • utilizes mobile screening vans to provide care in non-traditional sites and help address patients’ fears of costs and distrust of the existing systems; and
  • has shared information about opportunities to participate in clinical trials and to take advantage of other treatment options.

"A lot of the problems involved infrastructure,” she said. “We’re trying to get the systems in place to make this work.”

Bryant’s ultimate goal, however, is to reach healthy individuals in a culturally sensitive way to prevent health problems from occurring in the first place, and to educate them about how to control and treat them when they do arise.

The work has paid off. The number of the center’s mobile unit screenings increased from 1,300 in 2006 to more than 2,000 yearly since 2010. More than half the patients screened were uninsured or underinsured, and nearly two-thirds of those served say they would not have been screened without access to the mobile van. The program has decreased the number of patients who do not return for care following an abnormal screening test from 11 percent in 2009 to fewer than 5 percent since 2010.

She has also successfully launched “Community Compass: Navigating Toward Healthy Living,” a series of grassroots health information sessions. The first, which took place in 2011, drew nearly 300 people. Guest speakers educated the audience about the importance of reducing their risk of cancer, healthy lifestyle choices, and opportunities to participate in clinical trials.

That “phenomenal” event led to efforts to ban smoking in a local community, and to tailored nutrition and active-living interventions to address obesity and healthy lifestyles. In 2014, Community Compass will focus on increasing physical activity through dance. “Dancing and music are rich to our culture,” she said. “We’re thinking about exercise through non-traditional means but in a way that is important to our culture.”

Recognition as a 2012 RWJF Community Health Leader is certainly helping Bryant achieve her mission. The award carries a prize of $125,000: $105,000 to enhance the leader’s work and $20,000 as a direct award for the leader’s accomplishments. Bryant is using the personal award to pay off her student loans and is using the rest to help local organizations meet area needs.

“I’m very passionate about what I try and do every day,” she said. “I hope the family I used to see in the hospital has taken a different approach to health and health care as a result of our work. I hope a new message is delivered about how to stay out of the hospital, rather than what to bring when visiting.”


Related Websites

Read more about the RWJF Community Health Leaders program here and here.
For an overview of RWJF scholar and fellow opportunities, visit