Improving public health in rural Indiana
Written by Marti LaChance

Senior nursing student Sierra Smith looked forward to revisiting Fayette County, a stone’s throw from her hometown of Laurel, in Franklin County. Her community assessment project would take her to this rural area about 70 miles east of Indianapolis, near the Ohio border.
For Smith and her public health nursing classmates at Purdue, it was a chance to improve the lives of more than 23,000 citizens.
That was the idea, says Carmen Jones, clinical assistant professor in nursing. For years, nursing students have made health assessments on Tippecanoe County and surrounding communities. “But they didn’t have the impact we wanted,” Jones says. So, for the Fall 2019 course, she and fellow instructor, Eric Palmer, brainstormed with Purdue University Health and Human Sciences Extension leaders. Together, they decided students should focus on Fayette County, which ranks 92nd out of 92 counties for health outcomes in Indiana — at the very bottom.
All told, 93 nursing students, in 11 teams, traveled to Fayette County to make physical observations and meet with citizens. Students would then analyze and report on their findings to county leaders.
Assessment surveys — and surprises
Each student team was assigned one or more of 12 leading health indicators from the federal government’s Healthy People 2020 initiative. Smith and her team investigated the sexual and reproductive health of Fayette County citizens.
As a local, Smith’s background came in handy for the team’s “windshield survey,” a drive through the county to record observations of things that might affect citizens’ health. The team then interviewed local stakeholders, including high school health teachers and the executive director of Fayette County’s Hope Center, which serves as a pregnancy health center.
Although Smith knew there were health-related problems in Fayette County, she and her team were surprised — and alarmed — at its poor state of reproductive health.
The rate of sexually transmitted infections was high. Even more concerning: The rate of teen pregnancy is 49 teen births per 1,000 people in this sparsely populated county. It was the third-highest in the state and quite a bit higher than the national average.
The team also learned that local schools offer little to no sex education. Schools provided abstinence-only education from as early as sixth grade. “But they don't learn about different types of birth control, or safe sex practices, at all,” Smith says. “It was eye-opening.”
Informing the community
Given the data, Smith’s team realized education was necessary. They created an informational flyer on safe sex practices, hoping local schools might use it.
Back on the Purdue campus, the student teams worked with Nursing faculty to interpret and analyze their data. Then they formulated nursing interventions based on their findings and gave that information in executive summaries for Fayette County leadership.
In November, Smith, along with professors Jones and Palmer, provided a detailed health evaluation for Fayette County in a talk at the Purdue Extension professional development conference. The student teams presented their assessments in a poster session.
Jones is pleased and surprised at the outcomes. To date, six other counties have requested assessments, which Jones has slated for upcoming semesters. Among many other positive outcomes, Fayette County is working with Purdue to implement the class’s recommendations and to apply for grants to aid local health initiatives.
“This project was a true collaboration,” Jones says. “A large number of individuals were involved, from Purdue nursing faculty and students to Extension leaders and staff — and Fayette County residents.”
As for Smith, the course resulted in tremendous practical experience and insight. “I want to be a women's health nurse, so learning about the public health aspects of reproductive and sexual health was helpful for my future career,” she says. “Women's health is still a taboo topic in a lot of ways. But as a nurse, you should be able to educate anyone, no matter their situation.”
