Promoting Healthy Eating and Active Lifestyles in Rural South Carolina

    • October 16, 2015

Originally posted: March 20, 2015
Last updated: October 16, 2015

Position at time of the award: Assistant Director, Cancer Prevention, Control, and Outreach, Hollings Cancer Center, Medical University of South Carolina, Charleston

Current position: Director, Partnership for Healthcare Quality Research; and Director of Outreach and Community Relations, Hollings Cancer Center, Medical University of South Carolina, Charleston

In 2012, the Robert Wood Johnson Foundation (RWJF) named Debbie Chatman Bryant, DNP, RN, an RWJF Community Health Leader in recognition of her work in overcoming barriers to cancer screening, early diagnosis, and treatment among poor and underserved people in South Carolina.

Bryant also spearheaded a community effort to help 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 if they do arise.

Health care: too little, too late. For people living in South Carolina’s coastal lowcountry, health care often comes “too little and too late.” Barriers to care are many, from practical considerations such as underinsurance and lack of transportation, to more subtle issues, such as providers’ cultural insensitivity and patients’ lack of education and fear.

Left unattended, chronic diseases such as hypertension and diabetes can escalate into serious health problems that affect the quality and length of life. This downward trajectory affects communities of color disproportionately.

Learning to fight in the segregated South. Debbie Chatman Bryant grew up in Moncks Corner, a small town 40 miles north of Charleston, S.C., the youngest of six siblings. “It was the segregated South,” Bryant says, “but the elders in the community protected us. Being in my world of home and church, I didn’t know how bad things really were.”

Bryant would find out, though, when she and two of her siblings were transferred to what was then called the white school. “Our parents wanted us to get the best education,” Bryant says, “and really believed what Dr. [Martin Luther] King had said about black children and white children standing together and learning together.”

The sole black student in her 2nd-grade classroom, Bryant was shunned by her classmates and ignored by her teachers. It was not until middle school during the days of mandatory desegregation that Bryant once again found her voice and friends.

“I went to classrooms where once again, many of the students looked like me.” But Bryant realized suffering many indignities during her formative years had nibbled away at her self-esteem. After high school, she enrolled in college but soon dropped out, laid low by both a serious physical illness and depression. “Honestly, I lost who I was for a while,” Bryant says.

Lost—and found. Bryant eventually returned to college and got a job in the state department of transportation. But even as she rose through the ranks from car registration clerk to manager of one of the branch offices, and even after marrying her husband and moving with him as he completed his military duty, and even after getting a real estate license, Bryant could hear a dim voice inside saying: “You really want to be a nurse.”

“I remember vividly as a young girl being ill and going into the hospital,” she says. “My parents got little respect and the health care workers were speaking at them, not to them, and over me, not to me.”

“Growing up I remember being around family members who were dying because they didn’t know about their disease,” Bryant says. “The elders would say, ‘I didn’t even know they were sick,’ and it turned out they had been sick for a long time.”

Her own encounters with the health care system as a sickly child also had left their mark. “I remember vividly as a young girl being ill and going into the hospital,” she says. “My parents got little respect and the health care workers were speaking at them, not to them, and over me, not to me.”

Bryant imagined herself one day being a chief nurse with the power to change how care was delivered at the bedside. But while getting her associate’s degree in nursing at Armstrong State College in Savannah, Ga., and then her bachelor’s and master’s degrees in nursing at the Medical University of South Carolina (MUSC) in Charleston, Bryant became excited about a new model of care—community nursing.

Making a difference for African-Americans. Once completing her master’s degree, Bryant realized that instead of making a difference for one patient at a time, she could impact health outcomes at the population level, at the community level, at the state level, and even the national level. “I could make a difference for African-Americans in the community in a whole different way.”

When MUSC started a new doctoral program in the practice of nursing, with a focus on health policy and administrative leadership, Bryant enrolled. In 2010, she was promoted to assistant director of Cancer Prevention, Control, and Outreach at Hollings Cancer Center at MUSC. The program addresses population-based research aimed at reducing cancer morbidity and mortality in South Carolina through focused efforts in tobacco control and cancer health disparities.

Bryant received her doctorate in 2011. In 2013, she was named director, partnership for healthcare quality research, MUSC; and director of outreach and community relations, Hollings Cancer Center, MUSC.

Reaching underserved communities...with sensitivity. 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. A key part of Hollings outreach program is a mobile screening van that goes out to areas where there are very few cancer screening resources. Once patients get screened for breast cancer and have an abnormal test, “lay patient navigators” make sure they come in for diagnostic follow-up and treatment appointments. “These are folks who look like them, are like them, understand them, and can then build rapport and trust so they can get in for the care they need,” Bryant says.

Working with a colleague at the University of Chicago, Bryant facilitated the standardization of lay navigation training “to insure a level of quality is maintained” she says.

To help eliminate financial barriers to care, the Hollings outreach program has also instituted a voucher program developed by Bryant to cover many co-payments costs for uninsured patient who are unable to pay.

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.

Preventing health problems before they occur. Out in rural South Carolina, Bryant encountered many people who were ill with preventable conditions, such as diabetes, hypertension, and obesity. “We were only talking to people when they’re sick,” she says. “What do we do to ensure that you can take care of yourself, that you are doing what you can do before the time when you need care?”

The Community Compass program, launched in 2011, was one answer to that question. Working with minority community organizations, such as churches, fraternal groups, and civic groups, the cancer center offers an annual Community Compass event to focus on three areas: helping people improve their diets, increase their activity levels, and quit smoking.

The goal is “to create an environment where healthy choices are easy choices,” while being sensitive to cultural differences and preferences. For example, in 2014 Community Compass promoted dance as a physical activity of choice for African-Americans. That year, we also developed a dance called the “Community Compass slide” as reported in this video, to increase the appeal physical activity might otherwise not have.

“Dancing and music are rich to our culture,” Bryant says. “We’re thinking about exercise through nontraditional means but in a way that is important to our culture.”

Other Community Compass strategies over the years encouraged changes in lifestyle, including a healthy recipe contest (with recipes compiled in an online cookbook) and text messages with motivational health tips sent bi-weekly to interested participants.

Becoming a Community Health Leader. Bryant was named an RWJF Community Health Leader in 2012 in recognition of her innovative and effective community work in improving access to care and promoting health lifestyles. She used the $105,000 project portion of the award to help community organizations involved in Community Compass to further embed health projects in their groups’ regular activities.

The project, called HEAL, for Tri-County Healthy Eating and Active Living, worked with five community organizations—three churches (two in urban communities and one rural), a neighborhood association (within a poor urban community), and an organization representing five churches in an extremely rural area—to design their own projects to promote the health of their communities. Experts in the areas of physical activity, nutrition, meal planning, smoking cessation, and communication offered consultation.

The groups’ project is having rippled effects. One of HEALS’s organization, Nazareth Reformed Episcopal Church in rural Moncks Corner, S.C., Bryant’s home town and a town with no smoke-free policies, decided to make their entire church grounds smoke-free. Nazareth also asked the Reformed Episcopal Church Diocese of the Southeast to consider adopting a similar smoke-free policy on all Reformed Episcopal Church grounds. Other rural churches are also following Nazareth lead by planting community gardens on the church grounds. This is a great example of promoting natural and human resources to improve the general well-being of a rural church community.

“We are looking at things that are sustainable,” Bryant says. “That is what is important. That goes right back to myself as a little girl who wanted to do something to ensure her community could be healthy. We’re doing those things at the personal level, at the community level, at the institutional level, and at the state level of South Carolina. I really have come full circle.”

A Community Health Leader becomes an Executive Nurse Fellow. Being a Community Health Leader has enhanced Bryant’s reputation as “a voice of reason, a voice of intelligence, a voice that is respected enough to be invited to be part of the conversation,” she says. “We really may be effecting change.”

Being a leader has also provided a steppingstone to other opportunities to lead. At the 2013 annual meeting of Community Health Leaders, RWJF’s Sallie George, MPH, encouraged Bryant to apply for the RWJF Executive Nurse Fellows program, a three-year leadership development program aimed at enhancing the effectiveness of nurse leaders who are working to improve the nation’s health care system. Bryant was accepted into the program’s last cohort of fellows in 2014. See the Program Results Report on the RWJF Executive Nurse Fellows program.

“Academic medical centers are always looking for ways to effectively partner with community health centers that see underrepresented minorities, the uninsured, and underinsured,” Bryant says. “What tends to happen is we go into those communities, do our research, and then we’re out. We are often not respectful of how we partner with the community.”

As a fellow, and now in her position as director of partnerships for healthcare quality research at MUSC, Bryant wants to continue to build the structures that make those collaborations work well—and reinforce the importance of nurse leaders in guiding those conversations. “That is the role that I have put forward as it relates to the fellows program,” she says. “It brings all those pieces together.”

In July, 2014, Bryant was invited to appear at an RWJF-sponsored congressional briefing in Washington for the Congressional Caucus for Women’s Issues, the Women’s Health Task Force, other women’s business, and labor organizations, and the press to address the rising mortality rates among women in the United States and the challenges faced by women living with chronic disease.

Postscript. Bryant is an assistant professor in MUSC’s College of Nursing and has extensive experience in community-based outreach programs. In her role at Hollings Cancer Center, she oversees outreach services, including the mobile health unit and patient navigation services. She also provides administrative leadership within the Cancer Control research program.

RWJF perspective: The Foundation recognized the first 10 RWJF Community Health Leaders in 1993—unsung and inspiring individuals who work in their communities, often among the most disenfranchised populations, to address some of the nation’s most intractable health care problems. The last round of leaders was chosen in the fall of 2012. The program closed at the end of 2014. For more information, see the Special Report.

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Nurse Debbie Bryant uses lay navigators to help people in South Carolina's coastal lowcountry get care.