Inequities in rural health care are ever-present in these often-isolated communities that lack access to doctors, specialists, even decent internet to get treatment virtually. But the specific challenges facing rural residents hinge on a host of unique factors, that range from the topography to affordable housing.
In Breaking Point, four INN member newsrooms who participate in the Rural News Network (RNN) collaborated to highlight this prolific problem and identify possible solutions in their neck of the woods.
Read the stories:
In Rural Areas, Including Shasta County, the Lack of Specialist Doctors Hurts Patients, Families and the Community, Shasta Scout – October 20, 2022
Why This Hawaiian Island Has To Outsource Psychiatric Care, Honolulu Civil Beat – October 19, 2022
No internet, no telehealth: Rural North Carolina residents struggle to connect with doctors virtually, Carolina Public Press – October 18, 2022
Specialists, Broadband and the Fight for Health Equity in Rural America, The Daily Yonder – October 17, 2022
The storytelling reinforces just how nuanced these areas of the country are, that while they encounter some of the same challenges, “rural” is not a monolith.
With help from The National Institute for Health Care Management (NIHCM), reporters spent three months flushing out the most pressing angles of the issue that included a trip to a far off Hawaiian island, treks into the mountainous region of North Carolina and travel up through remote areas of northern California.
For Honolulu Civil Beat, it meant investing a few thousand dollars to fly reporter Brittany Lyte to the island of Lanai where she’d spend several days earning the trust of mentally ill patients who recently lost in-person psychiatric care.
Back East, what started as a story about the challenges millions of North Carolinians face accessing telehealth services, turned into one of accountability for Carolina Public Press reporter Shelby Harris when she learned the state lacked concrete data on the issue.
access to high-speed internet, but most parts of the mountainous, western region of the state
have little broadband infrastructure. Credit: Mark Darrough / Carolina Public Press
Annelise Pierce, who runs Shasta Scout – a one-person newsroom in Redding, California – knows firsthand how hard it is to get an appointment with a specialist, and so does her audience. Rather than tell them about the problem they’re all too familiar with, she sought to showcase the solutions local groups are working on.
The Daily Yonder, a prominent national rural news platform, served as editorial lead on the project. Reporter Kristi Eaton took the findings from the regional outlets and put them into a broader perspective to kick off the series. Daily Yonder also got the series adapted for a national radio audience, with hundreds of thousands of listeners, through its partnership with Public News Service.
Tim Marema, editor of The Daily Yonder, hired Sharon McGowan as editor of Breaking Point. McGowan guided the reporters throughout to ensure series cohesiveness. She worked with Alana Rocha, editor of the Rural News Network, who managed the project, coordinated schedules and oversaw logistics.
Process
This was not the product of parachute journalism. At RNN’s core is the fact that the reporters covering these human-centered stories, in this case for Carolina Public Press, Honolulu Civil Beat and Shasta Scout, are locals.
They have the potential of experiencing firsthand the same struggles they’re writing about. They too might find it nearly impossible to see specialists in person, or get a strong enough signal to visit one virtually, that is if telehealth even makes sense for treatment.
“Collaborations such as Breaking Point allow relatively small nonprofit newsrooms to expand their audience and magnify their impact,” said veteran journalist McGowan. “They also create valuable relationships among participating newsrooms that can extend long beyond the original project.”
Marema echoed that sentiment. “Getting to work with other INN members who provided detailed stories about specific communities was just a delight. It stretched our capacity to cover rural communities in a national context.”
Results
Through the Rural News Network, INN is focused on expanding the reach and impact of the journalism produced, while working with members to sustain their operations.
REACH
The Daily Yonder featured each of the series stories, in addition to its overview piece. The other series participants republished the Breaking Point stories online as they saw fit.
Angie Newsome – founder and executive director of Carolina Public Press – relayed in a post-production survey that “the telehealth story did exceedingly well holding its own and securing the #10 spot in our top stories” the week it published.
Mindful of the readers in rural areas featured in Harris’ reporting who rely on mobile data to access the internet, CPP successfully launched its news-to-text program, which texts out information and links.
Pierce noted her series piece was the most read on Shasta Scout the week it published. She said a key benefit of her participation in the project “is the visibility that this collaboration has given our emerging news organization with statewide health media, statewide health policymakers, and local health leaders and collaborators who are more likely to share information and stories with us in (the) future, deepening our ability for continued impact.” Shasta Scout launched less than two years ago.
A number of state news organizations republished the Shasta Scout report on health inequities. Nationally, in addition to The Daily Yonder, Public News Service featured their coverage online and on the radio, which led to more shares and listens from an estimated audience of more than 240,000. Metrics reporting by outlet and a full list of republication partners are available in the appendix.
IMPACT
The Rural News Network’s Breaking Point series examining health inequities in communities across the country almost immediately led to meaningful change.
Following Honolulu Civil Beat reporter Brittany Lyte’s coverage of the lack of mental
health services on the island of Lanai:
● Psychiatrist Dr. Chad Koyanagi offered his services to help close the gap in in-person care until the state Adult Mental Health Division can fill vacant positions.
● Jill Tokuda – the Democratic candidate for the 2nd Congressional District, which covers rural Oahu and the neighbor islands – and lobbyist Jennifer Sabas visited Lanai to better understand the community’s mental health access issues in-person.
● The National Alliance on Mental Illness (NAMI) in Hawaii announced that because of Civil Beat’s coverage, it would be scheduling its first-ever event on Lanai. NAMI specializes in offering support groups for friends and family members with mental illness.
● Oracle, the company co-founded by billionaire Larry Ellison, owns 98 percent of Lanai. In response to Lyte’s story, the company agreed to save a couple of rooms/housing units for mental health care workers.
Harris writes about the lack of state and federal data available on how many rural North Carolina residents want to access telehealth, but can’t due to lack of internet. And she notes the absurdity of one survey the Mayo Clinic Health System research team conducted online in 2021, “effectively omitting the perspectives of the 19 million people the FCC reports lack access to a solid internet connection.”
Following her series piece in Shasta Scout, Pierce says readers have expressed an increased understanding of the shortage of specialists in the area, and the current efforts being made to address it. The visibility the collaboration gave her emerging news organization with local and state stakeholders, who are more likely to share story ideas with her moving forward, was another notable impact.
SUSTAINABILITY
The NIHCM grant provided each of the newsrooms a stipend, without which all said much of the reporting, related travel and photography would not have been possible.
Rocha’s work with national partners got the stories in front of new audiences.
Additionally, series participants benefited from McGowan’s expertise and feedback, which meant the outlets’ editors could keep their focus on their daily coverage.
“Having your work edited by an editor our reporters don’t usually work with was a blessing,” Newsome said.
Pierce noted the funding and editorial support the collaboration enabled her to go more in-depth and establish connections with important leaders in the health realm in Shasta County. “Yes, we’re tiny and emerging, but we do have a voice.”
COMMUNITY ENGAGEMENT
All of the newsrooms who took part in the Breaking Point series engaged with their audiences in the weeks and months that followed the reporting.
For Carolina Public Press and Shasta Scout, that engagement came in the form of a survey.
CPP created a brief form that included questions pertaining to rural telehealth, its usage, barriers and opportunities. It made it available in both English and Spanish, and delivered it digitally and via text. CPP also worked with AMEXCAN, a statewide Latino organization based in Greenville, N.C., to gain feedback from Spanish-speaking and bilingual residents.
The majority of North Carolinians who are satisfied with their telehealth, or accessing medical care virtually, also have access to high-speed internet, according to the 60 residents who responded. Respondents were asked to rank their telehealth experiences on a scale of 1 to 5 before answering questions about their access to both telehealth and the internet.
Some said they would not use telehealth because they prefer the human connection associated with an in-person visit. “I’m old. New technology is not user-friendly to older people, especially when we are sick,” one Charlotte woman wrote.
Others who took the survey called telehealth a practical option and said that the technology has made it possible for them to safely access more doctors.
For its survey, Shasta Scout sought to learn more about the challenges for locals accessing specialty care – specifically what kinds of health care, how long they’ve had to wait, and what resources would be most helpful.
About a hundred people responded, with roughly two thirds expressing struggles accessing a primary care doctor. Others highlighted long wait times at pharmacies, and having to travel lengthy distances to receive specialty care. About 15 people indicated an interest in having a Shasta Scout reporter follow up directly about their health care experience accessing local health care.
In Hawaii, Honolulu Civil Beat has attracted attention in the industry for hosting pop-up newsrooms at public libraries across the state that bring groups of staffers to work from the libraries. The goals: to give Hawaii residents a chance to learn about how Civil Beat works, while letting staff hear about issues important to communities around the state.
It organized one such event at the Lanai Public Library in January that included Lyte and five news colleagues. Gamel said they had a steady stream of people all day, including both the director of the only clinic in town and the lone MD, each staying at least a half hour, to “talk story” as they call it in Hawaii. Hot topics that emerged included the lack of affordable housing and the difficulties recruiting and retaining health care workers and teachers.
Breaking Point was further proof that this growing news alliance of large and small newsrooms embedded in sparsely populated parts of America works to accurately convey the issues and show how they relate to what’s happening nationally.
Appendix
Outlets that republished stories:
More than 22 publications that included digital, newspapers, newsletters, radio and TV, republished stories from the Breaking Point series.
National
The Daily Yonder
Public Health Watch
Public News Service
Kaiser Health News
Regional
High Country News
State/Local
California
Bay Area News Service
California Health Report
California Healthline
California News Service
Central Valley Journalism Collaborative
North State Public Radio
Hawaii
Hawaii News Now
North Carolina
Asheville Watchdog
NC Health News
Oregon
Alsea School District 7J
The Lund Report
Texas
Mineral Wells Area News
Wisconsin
Wausau Pilot & Review
Nearly two dozen national and local news organizations shared the series stories with their audiences. And several others conducted interviews with participating journalists, including:
● Hawaii News Now
○ Featured Civil Beat’s Chad Blair on air to discuss Brittany Lyte’s
eye-opening reporting on Lanai, state leaders’ response and possible
solutions during a 4-minute segment on its morning show.
● Public News Watch
● Kaiser Health News
○ Highlighted a few of the stories in its KHN Morning Briefing newsletter
that has more than 60,000 subscribers.
● Public News Service
○ CPP
○ Shasta Scout
● North State Public Radio
The stories were also picked up across a variety of social media accounts, including the following Facebook pages:
How did we find this data?
We asked participants to provide engagement data from their sites and social accounts for web metrics and qualitative feedback via a survey.
For content distribution, we ran reports on CrowdTangle and Meltwater and communicated directly with publishing partners and searched Google News alerts for variations of the series attribution and the first sentence of each story.
