Inner-City Residents in Rochester, N.Y., Receive Community-Based Care

Establishing a community-wide family health development program

Project SHARED was a collaboration of four Rochester-based health and social service organizations (HCR Cares, Health Care Resources, The Health Association and Catholic Family Center) that developed a community-based project to enable chronically ill, low-income people in two inner-city neighborhoods to better manage their own health and to engage in behavior change that supported health.

Key Results

  • Project team members enrolled 527 residents who had, or were at risk for, diabetes, high blood pressure, asthma (and other respiratory diseases such as chronic obstructive pulmonary disease) or heart disease. They helped residents design and undertake personal action plans to improve their health. By the end of the project, 199 residents still were participating.

  • The four project partners worked with other community-based agencies to improve health and social program offerings in the two neighborhoods.

  • Participants became engaged in improving their own health and initiated a stress management workshop, a walking club and social gatherings.

    • Project staff wrote the Project SHARED Manual: How to Guide to Launching a Community Health Model for the Under-Served Chronically Ill that provides detailed information to help other communities develop and implement a similar program.

    Three Profiles are illustrative of the changes participants made.

Key Findings

  • Project staff reported the following findings to RWJF. The first two findings are based on data analysis by the Center for Governmental Research, a Rochester-based nonprofit organization that conducts policy analysis.

    • Two-thirds of participants moved forward by at least one stage of behavior change.
    • Some 39 percent of participants became engaged in tracking their health status.
    • Almost 90 percent of participants reported feeling better both physically and emotionally and said they could better manage their chronic diseases.