Results pretty much ‘in line’ with county demographics
 by Samantha White
Burns Times-Herald
More than 600 people throughout Harney County completed a survey recently, which was used to help assess the health needs of the community.
During a meeting held Thursday, March 14, the Community Advisory Committee discussed the results of the survey and some of the actions that could be taken in response to it.
Toni Siegner, the health information services coordinator for Harney District Hospital (HDH), said she thought the survey produced a “well-rounded group of results.”
“We covered the community as much as we could,” HDH Outreach Coordinator Sonni Svejcar added.
Siegner said the first five questions addressed the survey takers’ demographic information. Individuals taking the survey were asked about their residence, race and ethnicity, age, sex and whether they or someone in their household received “food stamps.”
Survey questions six through 15 addressed the survey takers’ diet, exercise and mental, emotional and overall health. Those taking the survey were also asked how many parks, bicycle paths and pedestrian paths were in their neighborhood.
The remaining questions addressed the survey takers’ health care, including the frequency with which they visited a hospital, which hospital they visited, the type of services received and their overall satisfaction. Survey takers were also asked whether they visited a primary care (family) doctor, physician’s assistant (PA) or nurse practitioner (NP). Those who did were asked to rate their level of satisfaction. People taking the survey were also asked whether they had health insurance and whether they had delayed health care due to lack of money or insurance. 
Survey results
Dana Ketcher, an AmeriCorps VISTA volunteer for the Harney County Health Department, said most people who took the survey were white women over the age of 50 who had health insurance, lived in Burns and did not receive “food stamps.”
Siegner said the survey was mostly “in line” with the county’s population demographics, except that men were under-represented, and the percentage of survey takers claiming to receive “food stamps” was lower than the county’s actual percentage.
Most of the people who took the survey said they exercised three or four times a week, and two of their meals or snacks included vegetables. Most said only one of their meals or snacks included fruit.
Siegner said most (44.8 percent) rated their overall health as “good,” and the second highest rating was “very good” (31.6 percent). Other options included “poor,” “fair” and “excellent.” 
Most (38.4 percent) ranked their overall mental and emotional health as “very good,” and the second highest rating was “good” (33 percent). 
On a scale of “much too many” to “much too few,” most said there were “much two few” bicycle and pedestrian paths in their neighborhood, but the second highest response was that there were “about the right number.” On a scale of “extremely satisfied” to “extremely dissatisfied,” most said they were “moderately satisfied” with the parks in their neighborhood, and most (34.6 percent) said they had a “moderately strong” sense of community in their neighborhood.
Most (77.8 percent) said they or someone in their household had used the services of a hospital in the last 24 months, and most (92.4 percent) said they received services at HDH. Of those who received healthcare services elsewhere, 50 percent said it was due to the availability of specialty care, and 35.7 percent said they were referred to another hospital by a physician. 
Most of the survey takers who went to HDH in the last two years said they were there for radiological imaging. On a scale of “extremely satisfied” to “extremely dissatisfied,” most (48.8 percent) ranked their overall level of satisfaction with HDH services as “extremely satisfied.”
Most (90.8 percent) said they used a family doctor, PA or NP for most of their routine health care, and most (90.5 percent) said the provider was in the local service area. Additionally, most (93.5 percent) said they were satisfied with the quality of care that they received, and 89.1 percent said they were able to get an appointment with a family doctor, PA or NP in the local service area.
Most of the survey takers who did not use a primary care doctor, PA or NP saw a specialist (32.3 percent) or received services from the health department (22.6 percent).
Most (67.7 percent) said neither they nor someone in their household delayed healthcare due to lack of money and/or insurance, but 29.1 percent said they did. The remainder said they didn’t know. Of those surveyed, 82.7 percent said they had some healthcare coverage, and 17.3 percent said they did not. 
Ketcher said most of the survey takers listed walking as their preferred form of exercise, but aerobics and cardiovascular activity, running or jogging, horseback riding, biking, and ranch or yard work were also popular responses. Ketcher said it was important to remember that activities such as ranch and yard work count as exercise. 
“It’s not just running,” she said. 
A way of thinking
According to Ketcher, a few of the people who took the survey said, “I don’t think we need to make any changes. It’s all about personal choice.”
Ketcher said she wanted to address this line of thinking. 
“There are so many barriers sometimes,” she said. “The path of least resistance needs to be the healthy one,” she added, explaining her philosophy that it is easier for individuals to be healthy if they are part of a healthy community. “If we want to be healthier, we need to all be healthier,” she said.
 She added that it’s all about finding balance and determining what exercises people would be willing to do.
 “Exercise should not be something that you dread,” she said.
Community concerns
Feedback from the surveys identified some of the barriers to obtaining adequate levels of exercise, nutrition and health care in the community.
One of the barriers to exercise that was identified was cold weather. 
“Cold weather makes it harder to exercise,” Ketcher said, explaining that it limits the availability of outdoor activities.
Other people said they had limited opportunities to exercise because their job required them to sit all day. 
Safety was another concern. Some said lack of adequate lighting, as well as speeding vehicles and loose dogs, prevented them from going jogging.
The cost of vegetables and other healthy foods was listed as one of the barriers to adequate nutrition.
Some concerns regarding local access to health care included costs, billing and a lack of health insurance. Others who were surveyed said they were concerned about a lack of options in terms of the services that HDH provides, expressing that they had to travel in order to see specialists. Other concerns included doctor turnover and the financial stability of HDH over time.
Community requests
Ketcher reported that many of the people surveyed requested an indoor pool or an affordable indoor gym with nice equipment. 
“That’s not surprising considering the winter here,” Siegner said.
Ketcher said better sidewalks and nature trails were the next most popular requests, and some requested a bowling alley. Others said they would like local restaurants to provide healthier menu options, and some requested classes that would teach them how to eat and prepare healthier foods. Exercise classes were also requested.
“A lot of people wanted a group of people to work out with,” Ketcher said.
There were also requests for bicycle paths, many of which came from people who lived in Crane, Svejcar said.
Those surveyed were also asked to provide feedback regarding the healthcare services that they would like to see HDH provide. Some said they would like the hospital to offer dialysis, as current dialysis patients have to travel to Bend. Others requested alternative forms of medicine, such as acupuncture, and preventative services, such as obesity management. Others requested assistance with tobacco cessation. One of the more humorous requests was for a clown that makes balloon animals. 
The next steps
After receiving the survey results, the Community Advisory Committee discussed the steps that could be taken in response to it.
HDH Chief Executive Officer Jim Bishop said he was worried about comments regarding the cost of hospital services. He said concerns about cost equate to concerns about access to the hospital’s services. However, he said the cost increase at HDH is lower than any hospital in central or eastern Oregon. 
Amy Starbuck, the Harney County Health Department office manager, suggested that HDH provide more education about the options available to people who do not have health insurance and cannot afford to pay their medical bills.
“People wait until their problem is catastrophic and then they have high ER bills,” she said.
Siegner said, “There really are a lot of financial options. There are programs and ways to get around virtually anything.”
Harney County Clerk Derrin (Dag) Robinson said, “There are ways to present financial options [to patients] in a warm and fuzzy way.” He added that many patients are already stressed when they come to the hospital.
The Community Advisory Committee also discussed the importance of maintaining patient privacy and confidentiality. 
Additionally, Svejcar said she has been working on establishing an indoor space for exercising, but she was unable to provide many details. 
Regarding the indoor pool, she asked, “Who will run it? Who will pay for it?”
Svejcar said a bowling alley would cost thousands of dollars per lane, and the alley would need 20 lanes in order to accommodate competitions, which is how bowling alleys make money. But she stressed the importance of explaining why certain services cannot be provided to the community.
The Community Advisory Committee discussed how the public perceives the hospital and the services it provides.
“The awareness thing is huge,” Harney EMS Director Jeff Sceirine said. “People in this community don’t realize how lucky they are in terms of health care. Most communities of this size don’t have the services we have.”
The Community Advisory Committee also discussed the programs and services that are available in the community as a whole. 
Robinson said the Bountiful Baskets program provides fresh fruits and vegetables to the community at an affordable rate, but people might not know about it.
Svejcar suggested that the hospital “put more information out there” about Bountiful Baskets and other similar programs. She added, “A lot of different entities are trying to accomplish the same thing,” and she suggested that someone work to bring similar organizations together. 
Ketcher suggested that the hospital establish a “community wellness coordinator” who could bring similar programs together and keep people informed about them. She said the coordinator could also help develop new programs aimed at preventing illness.
Robinson added that the coordinator could help develop worksite wellness programs, which could be used to help people with sedentary jobs get the exercise they need.
Ketcher said she and Svejcar discussed creating a “wellness committee,” which could be used to help establish and maintain wellness programs.
Svejcar said she had been working on mapping out routes for a walking program, and Ketcher said the health department had been working on establishing a tobacco cessation program.
Robinson said he would like to see programs like the “Melt Down” continue.
Ketcher said another idea could be to ask senior citizens to volunteer to walk students to school, providing them a safe route. 
Verna Pettyjohn, who volunteers at the Harney County Senior and Community Services Center, said she discussed the possibility of incorporating children into more center activities.
She added that, with the expansion of the center, more programs will be offered, and everyone is welcome to participate.
The Community Advisory Committee also discussed the possibility of having a wellness committee form a diabetes prevention and management program.
Harney County Chamber of Commerce Executive Director Jen Hoke said Slater Elementary School has a great physical education program through Alice Herauf. However, Svejcar said students’ physical education time is limited. Bureau of Land Management Administrative Officer Susie Hueckman added that all school time is limited due to the four-day school week.
“They are losing a whole day,” Hueckman said. 
HDH Development Coordinator Denise Rose asked about the availability of after-school activities. Hoke said High Desert Park & Recreation offers a lot of activities, but not a lot of people take advantage of them. Hueckman suggested that if a wellness committee is formed, it collaborate with Park & Recreation.
Ketcher said she would contact people who already expressed interest in being on a wellness committee and would continue to look for people who may be interested.

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