children doing pe exercises

4 programs funded to improve health in SC

Duke Endowment provides $2.4 million to support child exercise, medical literacy, community health workers, empowering pharmacists

Four University of South Carolina projects to improve the health and well-being of South Carolinians are getting a boost from grants from The Duke Endowment.

The endowment, which seeks to enrich lives and communities in the Carolinas through children’s services, health care, higher education and rural churches, is providing $2.4 million in grant funding to the UofSC projects that will help preschoolers with motor skills, create a pool of skilled community health workers, improve patients’ health literacy and help pharmacists do more than dispense pills.

“The Duke Endowment is committed to improving health in the Carolinas and partners with University of South Carolina to contribute to the achievement of this objective,” says Chris Collins, associate director of Health Care for The Duke Endowment. “Though our primary focus is not funding academic research, we appreciate the unique resources and expertise the University of South Carolina is able to leverage to assist the endowment in achieving our strategic objectives.”

This year’s grant-winning programs represent the Arnold School of Public Health and — for the first time — the College of Education.

Getting kids to move — the right way

Ali Brian, physical education professor, is focused on creating interventions to improve gross motor skills for children.

“We are seeing a decline in gross motor development in young children, with and without diagnosed disabilities, across the country,” Brian says. “Children are just not moving as frequently or as well as they did 30, 40 years ago.”

Combating this decline in skills will take more than just teaching teachers how to address these issues. Parents must be part of the solution.

“Parents are the critical choice agents supporting or inhibiting children’s physical activity,” she says.

Brian has been working on this issue for years. In 2015, she and her team began partnering with the Lexington 4 Early Childhood Center to implement a new, integrative gross motor and physical activity intervention program. Brian’s program, called SKIP (“Successful Kinesthetic Instruction for Preschoolers”), works in conjunction with the child care center’s program and “Promoting: Academics, Learning and Success,” or PALS.

After just six weeks of twice-weekly motor skills interventions, almost all (95 percent) of the children showed improvements.

“We know SKIP works. We’ve seen the positive results,” Brian says.

Now, the task is to expand the program to include parents and guardians and to make the results replicable in other locations.

In May, the program received a $565,000 grant from The Duke Endowment, which will be used to implement SKIPping with PALS at Lexington 4 Early Childhood Center and analyze its effectiveness over the course of a year.

“The Duke Endowment recognizes that health extends beyond clinical care and includes the adoption of a healthy lifestyle,” Collins says. “Improving both the access and the ability to engage in physical activity is a key component in reducing obesity and future disease burdens. SKIPping with PALS offers an innovative opportunity for families with young children to improve their physical abilities that will carry forward throughout their development.”

The other Duke Endowment grantees are in more traditional clinical areas.

Community health workers

Julie Smithwick, founder and former executive director of PASOs, will lead a project that builds on the Arnold School of Public Health Community Health Worker Institute she launched in March with initial funding from the BlueCross BlueShield of South Carolina Foundation. The institute provides training and support for community health workers and the organizations that employ them.

“Community health workers work within their communities to connect individuals and families with resources, identify barriers, and provide solutions and ideas to improve the health and well-being of the entire community,” Smithwick says. “This model involves supporting leaders who are partnered with health and social service organizations, but who are more importantly rooted and vetted within the community itself.”


“The Duke Endowment is committed to improving health in the Carolinas and partners with University of South Carolina to contribute to the achievement of this objective.”

Chris Collins, associate director of Health Care for The Duke Endowment

The Community Health Worker Institute received a $697,000 grant from The Duke Endowment to train and equip workers from all communities, including rural and low-income communities that historically have had less access to health care. The workers can educate patients on how to manage chronic diseases, such as diabetes or high blood pressure, while also providing strategies to manage work-family stressors that could hinder that self-care.

“Community health workers are trusted members of the communities they serve, which allows them to be effective care team members and health change agents,” Smithwick says.

Patient literacy

“It is the duty of the sender of information to get it into a form that the reader can understand,” says Dr. David Isenhower, a physician in Greenwood, S.C. “And you have to verify that they understand.”

That is the crux of the project “Enhancing Quality of Care through Improved Health Literacy” that received $580,000 from The Duke Endowment with UofSC public health professor Daniela Friedman as principal investigator.

The goal, Friedman and Isenhower say, is to make sure that patients fully understand their medical conditions and their treatments.

Isenhower, an ear, nose and throat specialist, tells the story of an asthma patient who would get well in the hospital, but after being home a week or 10 days would have to be readmitted.

“This happened repeatedly,” Isenhower says, until a social worker discovered on a home visit that the patient could not read. “So, despite having multiple hospitalizations, no one picked up on the fact that she was illiterate. And that was where we got interested in this: How had we missed that on multiple hospital stays.”

Friedman says the program’s aim is to get all patients — even those who can read, but might still have trouble understanding medical terms — to ask questions until they understand what their doctors are saying.

To start, patients will be given printed material encouraging them to ask their doctors at least three questions. The “Ask Me 3” program is just one of the tools clinical staff will help patients use to better understand their conditions.

The program already has had a test run at one clinic with patients interviewed before and after the test period to see how providers did in communicating with them.

The next test will be expanded to about 20 or 30 hospital outpatient clinics with the goal of reaching 3,000 patients. “The ultimate goal is for this tool to go statewide,” Friedman says, adding that the South Carolina Hospital Association is a key partner in the project.

Pharmacy interventions

Many people with chronic health conditions, such as high blood pressure and diabetes, are likely to see their pharmacist more often than a physician — particularly in rural areas. These patients often have to deal with other issues, such as poor access to healthy foods or social isolation, that can hurt their ability to manage their conditions.

Public health professor Spencer Moore, who focuses on these social determinants of health, thinks the pharmacy might be the best place to address some of these issues.

“Community pharmacies are on the frontline of our health care system,” says Moore, who received a $550,000 grant to build the capacity of pharmacies to work with patients.

Moore will work with members of the South Carolina Community Pharmacy Enhanced Services Network to develop and implement a training program in key topic areas.

“Chronic diseases are the leading cause of death and disability worldwide with 60 percent of Americans having at least one chronic disease and 42 percent having two or more chronic diseases,” Moore says. “Intervening on the social determinants of health, such as social isolation, chronic stress and food insecurity, can have a tremendous impact on a person’s risk for multiple disease conditions.”  

Often pharmacists are doing this type of work now as patients seek them out. Moore’s goal is to make the assistance more uniform and sustainable.

“We will be working to develop a set of training modules for community pharmacists to assess social determinants of health and seek to address those determinants by suggesting social agencies patients might need,” Moore says, adding that finding a way for pharmacists to be compensated for their time will also be part of the program.

All of the programs receiving funding this year will focus on South Carolina in the beginning with a goal of becoming a model that can be duplicated in other states. These are just a few of many programs that UofSC is pursuing to improve health and wellness in South Carolina and beyond.

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