Collaborative Research

Envisioning Elemental Care: Multimedia Messages of Community Health Workers

This short film (~7 min) was presented as a Lightning Talk at The Imagining America 2023 National Gathering: Radical Reckoning – Invoking the Elements for Collective Change

The film depicts the impact and experiences of community health workers (CHWs) across Western North Carolina. The research team curated images and voices that illustrate how CHWs evoke the elements (as invited by this conference theme) and cast a circle, a traditional healing and prayer practice. The session title plays on how the care provided by community health workers addresses the most essential and fundamental needs we have as humans and also aligns with the energies around us.

These multimedia results were compiled from the third year of a community-based participatory research and action (CBPRA) evaluation, led by the Culture of Results Initiative of the North Carolina Center for Health and Wellness (NCCHW) in partnership with our community research team and community agencies. Information was collected through observations and interviews of CHWs and clients.

An extended cut (~12 min) of the film is also available here.

BOLD NC 2023 Dementia Caregiver Data Brief

In 2020, the NC Division of Aging and Adult Services (DAAS) was awarded a three-year grant by the Centers for Disease Control and Prevention to build capacity statewide to address dementia through the Building Our Largest Dementia Infrastructure (BOLD) Initiative. NCCHW partnered with DAAS to provide program evaluation and data visualization products for the project. Louise Noble, a member of our Culture of Results team, produced a report titled “2023 North Carolina Dementia Caregiver Data Brief: Costs, Unique Challenges and Future Implications.” Its aim is to increase awareness about the unique and significant challenges faced by North Carolina caregivers caring for a loved one with dementia.The incidence of Alzheimer’s disease and related dementias in North Carolina is increasing as are healthcare costs and the costs of both formal and informal care. Numerous studies have documented the disproportionately higher costs of caring for a person with dementia compared with other conditions and the wider array of challenges that are unique to caregiving for someone with dementia. As the state continues its efforts to address ADRD, consideration should be given to the undue costs and additional challenges which may be encountered by those with dementia and their families and caregivers.

SBP Feb 2023 Intergenerational Social Connectedness Report

As part of an ongoing partnership with the Mountain Area Health Education Center (MAHEC) on an initiative called the Social Bridging Project, the Center produced a report titled “Social Bridging Project Brief February 2023 – Intergenerational Social Connectedness: A Multi-Pronged Strategy to Address Social Isolation and Loneliness, Reduce Ageism and Increase the Older Adult Workforce.” The brief details the evaluation of the project’s staff and student callers and discusses the symbiotic nature of intergenerational programming and its interface with, and potential impact on, social isolation and loneliness, ageism and older adult health care workforce shortages. The Social Bridging Project was formed in May 2020 as a response to concerns about the potential impact of social isolation on older adults as a result of the pandemic. Its aim was to provide older adults who were isolated or lonely with a source of social connection, technology support and referrals to needed resources. High rates of social isolation and loneliness in multiple age groups across the state indicate the need for continued post-pandemic programming of this kind. We are pleased to announce that the NC Division of Aging and Adult Services (DAAS) will extend its partnership with us in 2023 in support of the Social Bridging Project.

“Evaluation of the Western North Carolina (WNC) Community Health Workers (CHWs) Initiative “Community Health Workers provide comprehensive care and comprehensively care””

The Culture of Results Team led this program evaluation in partnership with UNCA Faculty, Mountain Area Health Education Center (MAHEC) and community partner Asheville Buncombe Institute for Parity Achievement (ABIPA). The evaluation sought to understand the work of 12 organizations who are part of the Dogwood Health Trust (DHT) Community Health Worker Chronic Disease Initiative as well as the ways in which they collaborated with other organizations in Western North Carolina. This evaluation utilized a mixed methods, Community Based Participatory Research and Action model. The final report can be found here.

“McDowell Substance Use Task Force Strategic Plan”

From 2019 to 2021 the Culture of Results (CoR) team partnered with the North Carolina Institute for Public Health (NCIPH) to lead the McDowell Substance Use Task force through a strategic planning process. In partnership with the MSUTF, CoR and NCIPH: conducted an environmental scan of substance use; led a Results-based Accountability (RBA) process for planning and measuring change; facilitated and coordinated ongoing meetings and action planning processes; and supported the MSUTF in identifying key focus areas, measures and strategies, which are detailed in this plan and also captured in a Clear Impact Scorecard. The plan can be accessed here.


“Reach and Impact of In-Person and Remote Delivery Formats of Walk with Ease”

This descriptive study retrospectively evaluates the reach and impact of cohorts enrolled in Group (in-person, 2017-2020) and Self-Directed (remote, 2019-2020) delivery formats of the evidenced-based health promotion program, Walk with Ease, implemented statewide in North Carolina. An existing dataset consisting of pre- and post-surveys were analyzed for 1,890 participants; 454 (24%) from the Group format and 1,436 (76%) from Self-Directed. Self-Directed participants were younger, had more years of education, represented more Black/African American and multi-racial participants, and participated in more locations than Group, though a higher percentage of Group participants were from rural counties. Self-Directed participants were less likely to report having arthritis, cancer, chronic pain, diabetes, heart disease, high cholesterol, hypertension, kidney disease, stroke, or osteoporosis, though more likely to report being obese or having anxiety or depression. All participants walked more and expressed higher confidence in managing joint pain following the program. These results promote opportunities for enhancing engagement in Walk with Ease with diverse populations. The article can be found here.

“The Social Bridging Project: Intergenerational Phone-Based Connections With Older Adults During the COVID-19 Pandemic”

As part of an ongoing partnership with the Mountain Area Health Education Center (MAHEC) on an initiative called the Social Bridging Project, several members of the NCCHW Healthy Aging team and Tasha Woodall (MAHEC) have published a manuscript detailing their evaluation of the initiative. The Social Bridging Project was formed in May 2020 as a response to concerns about the potential impact of social isolation on older adults as a result of the pandemic. Its aim was to provide older adults who were isolated or lonely with a source of social connection, technology support and referrals to needed resources. The manuscript, titled “The Social Bridging Project: Intergenerational Phone-Based Connections With Older Adults During the COVID-19 Pandemic,” was selected for publication in the Journal of Gerontology and Geriatric Medicine and was published in April 2022. It can be found here.

“Initiative to Address Childhood Obesity in McDowell County, NC”

The Culture of Results team is providing technical assistance to McDowell Community Centered Health (CCH), a Blue Cross Blue Shield NC funded initiative to address childhood obesity in McDowell County, NC. As part of their work they have collaboratively designed a billboard to draw attention to the issue of food insecurity in the county. The billboard depicts 5 children, of different racial and ethnic backgrounds, with the statistic “1 in 5 children is food insecure in McDowell County” in both English and Spanish. This measure was collectively selected as a headline community indicator and is a great example of making equity focused research accessible to community. The billboard was conceptualized by Kathy Arriola, Coordinator for Equity in Health for West Marion Community Forum, Inc, and a member of the CCH Core Team. Kathy provided expertise in translation and language justice to ensure the messaging of the billboard is accessible to both Spanish and English readers. The design was executed by Emily Roberts, a member of the CCH core team and freelance graphic designer

“2020 Subjective Cognitive Decline Data Brief – North Carolina”

In 2020, the NC Division of Aging and Adult Services (DAAS) was awarded a three-year grant by the Centers for Disease Control and Prevention to build capacity statewide to address Alzheimer’s Disease and Related Dementias (ADRD) through the Building Our Largest Dementia Infrastructure (BOLD) Initiative. NCCHW partnered with DAAS to provide program evaluation, data visualization products and other grant activity support for the project. Louise Noble produced this data brief titled “2020 Subjective Cognitive Decline Data Brief – North Carolina” and we are pleased to post it on our website. The aim of the brief is to increase awareness about cognitive decline and ADRD in order to expand support for addressing this critical and growing health concern. ADRD prevalence in North Carolina is expected to increase 16.7% from 2020 to 2025 and, although deaths resulting from heart disease decreased 7.3% nationwide between 2000 and 2019, deaths from Alzheimer’s increased 145% during the same period. A growing body of evidence suggests that certain health behaviors and chronic medical conditions such as poorly controlled hypertension can impact an individual’s risk of developing mild cognitive impairment or dementia. In light of this data, the BOLD NC Steering Committee encourages a broadening of our approach to dementia to include key aspects of risk reduction in addition to supportive management. The integration of the public health workforce as a key partner in our ADRD efforts across the state will greatly enhance and strengthen our collective work.  Through collaborations and risk reduction efforts we aim to improve the cognitive health of North Carolinians across the lifespan, delay the onset of ADRD and, ultimately, reduce its prevalence.

“Student Health Ambassadors at Residential Campuses Contribute to Safer Campus Living and Learning During the COVID-19 Pandemic”

In summer 2020, the NC Center for Health and Wellness supported a collaboration between six residential institutions of higher education (IHE) and the Mountain Area Health Education Center (MAHEC) in Western North Carolina dedicated to mitigating COVID-19 infection rates on campus. This approach shares the practices and successes of this concerted effort with a focus on a large public, medium public, and small private IHE. The campuses promoted a healthy and safe culture through a rigorous and transformational learning experience and focused on engaging Student Health Ambassadors (SHAs) in applying the Diffusion of Innovations model to peer-to peer gain-framed messaging for health. Three institutions’ programs are presented and cross-case analysis is used to illuminate transferable promising practices. Promising transferable practices across the schools include: selecting the right students, strong institutional support, the three Ps (positive, proactive and prevention-focused), building leadership skills, and peer-led campus culture change. Transferable insights from the practices at three campuses focused on the role and impact of peer-to-peer student health ambassadors on campus to mitigate the spread of COVID-19.

“Existimos para ellos/We exist for them”: An Evaluation of the Community Health Workers (CHWs) as Culturally-Responsive COVID Support in WNC Communities Initiative

The Culture of Results Team led this program evaluation in partnership with UNCA Faculty, Mountain Area Health Education Center (MAHEC) and community partner Asheville Buncombe Institute for Parity Achievement (ABIPA). The evaluation sought to understand the work that Community Health Workers performed as part of the “Community Health Workers as Culturally-Responsive COVID Support in WNC Communities” initiative as well as their impact on the communities they served through a complex data collection process and modified Community-Based Participatory Research (CBPR) design.

“Sidebar: Regional Relationships: Creative Collaboration for Prevention and Mitigation Among Western North Carolina Learning Institutions”

A column by Bryan Hodge and Amy Joy Lanou was recently published in the North Carolina Medical Journal. The article describes the collaborative work of the six residential colleges and universities in the 18 WNC counties in response to Covid-19, further demonstrating the collective impact of public-private partnerships among higher education and health care on maintaining in-person education while keeping infection rates low.

“A Statewide Approach to Falls Prevention: Widespread Implementation of A Matter of Balance in North Carolina, 2014–2019”

Thanks to the Healthy Aging NC team, NCCHW has published our first article in the Journal of Applied Gerontology, “A Statewide Approach to Falls Prevention: Widespread Implementation of A Matter of Balance in North Carolina, 2014-2019.” This article, written by Nadia Z. Mazza, Ellen Bailey, Amy Joy Lanou, and Nicolle Miller, showcases the statewide strategies used to implement and sustain an evidence-based fall prevention program, A Matter of Balance.


“2020-2021 Health and Wellness Community Assessment Update: Impact of COVID-19 and resilience factors for pregnant persons and families with young children in Buncombe County, North Carolina”

The COR team recently finished a community assessment in partnership with the Verner Center for Early Learning. The assessment focused on strengths, assets, challenges, and opportunities for pregnant people and families in Buncombe County, particularly as related to COVID-19 and to resilience.

“Rainbow In My Tummy Expansion Feasibility Study: Increasing Access to Healthy Foods and Wellness in Early Care and Education Programs across Buncombe County”

This Feasibility Study was a collaborative effort led by the North Carolina Center for Health and Wellness at UNC Asheville on behalf of The Verner Center for Early Learning. It was funded by the Western North Carolina Bridge Foundation. The desired results of this feasibility study were to understand the impact of the Rainbow In My Tummy™ comprehensive nutrition program on key customers, identify recommendations for improvement and growth, and explore whether and how core components of the program could be expanded into early childhood education centers across Buncombe County and beyond. You can view the full report here.


“City of Asheville RBA 101”

The Culture of Results team is currently providing training in Results-Based Accountability to the City of Asheville staff. This is an example of an introductory video that has come out of that training. Due to this being a customized training, there may be some terms that are not traditionally used in RBA.

“Leveraging Cross-institutional Academic Collaboration to Build Collective Impact within a Community-based Substance Misuse Coalition” From the American Public Health Association’s Annual Meeting 2020

Substance misuse continues to impact the health of communities across the United States, particularly in small metro and rural areas. While national policy evolves, community coalitions are forming to address substance misuse as people seek help for their family members, neighbors, and communities. These coalitions are typically comprised of grassroots organizations in need of technical support beyond the immediate community, but it is critical that the community maintain autonomy and decision-making power in order to effect sustainable change.

Through a grantmaking initiative to provide technical support to rural communities in North Carolina, the community-led McDowell County Substance Use Workgroup formed a collaborative relationship with academic partners from the North Carolina Institute for Public Health at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill (NCIPH) and the North Carolina Center for Health and Wellness at the University of North Carolina Asheville (NCCHW). As outside organizations, the academic partners reviewed community-developed reports and recommendations for implementation strategies to address substance misuse issues, synthesized the findings and facilitated strategic planning sessions to prioritize the implementation of selected strategies. In meetings facilitated by the community’s support partner (Rural Forward NC), this collaboration leveraged different partner strengths: the academic partners contributed community-engagement skills utilizing a Results-Based Accountability framework to magnify the collective voice of the workgroup in decision making, and the collection and synthesis of data and metrics to inform workgroup priorities and performance measures. The Workgroup brought their deep knowledge of their community, connections with stakeholders, their lived experience, and their understanding of context and place.

Collective impact relies on alignment of cross-sector stakeholders around a unifying goal to generate synergy and create community-based partnerships that are strong and sustainable. In contrast to academic approaches that prescribe interventions, this approach follows the community’s lead with the academic institutions playing a supportive role. The use of the collective impact and action framework is necessary for outside partners supporting grassroots community initiatives, ensuring that efforts will lift up community voices and guide them through implementation of initiatives that they choose through self-determination and sustain through self-efficacy.

You can view the slides from this presentation here.


“Racism is an Adverse Childhood Experience (ACE)”

The NCCHW contributed to this blog post in partnership with the UNC Chapel Hill School of Social Work Jordan Institute for Families.


“COVID-19 and Health Disparities in WNC”

The NCCHW contributed to the development of the WNC Health Network’s brief COVID-19 and Health Disparities in WNC in late spring of 2020. The data highlights preliminary results from an exploratory data analysis of the WNC Healthy Impact Community Health Survey 2012, 2015, 2018 that illuminates inequities in our region. WNC Health Network chose to release this report to give communities information for use in COVID-19 planning and response and in hope these numbers will prompt deeper questioning into the root causes of these issues.

“Buncombe County Attitudes Towards Violence Survey”

The Attitudes Towards Violence Survey was developed from 2017-2020 through a partnership between the North Carolina Center for Health and Wellness, University of North Carolina Asheville, Mountain Area Health Education Center and nonprofit agencies including OurVoice, Helpmate, and the Mountain Child Advocacy Center. The format of the initial questionnaire was adapted from validated surveys from New Hanover County and the Illinois Rape Myth survey, and later additional questions were included from other validated sources. The purpose of the project is to longitudinally measure attitudes and perceptions about social norms, types of violence, and communities affected by violence in Buncombe County, North Carolina. The data that is collected annually from this survey informs targeted prevention, education, outreach, and advocacy activities. The final version of the survey is currently being distributed, and the data will be analyzed in the coming months. Here is a link to the survey in PDF.

If you are a Buncombe County resident, please complete the survey HERE:

If you are interested in implementing this survey in your community, please contact us for additional information.

For additional information about the survey and process of development, please see the attached slides from the October 2020 Oral Session presentation to the American Public Health Association National Conference entitled:

Cross-agency collaboration to develop the “attitudes towards violence survey” and inform prevention and treatment efforts

You can also see the Buncombe County specific fact sheets in more detail by clicking: the Buncombe County Sexual Assault Fact Sheet 2020, the Buncombe County DV Fact Sheet 2020, and the Buncombe County Child Abuse Fact Sheet 2020.


“Arts For Life Program Evaluation Methods and Results”

In 2019, Arts for Life (AFL) partnered with the Culture of Results (COR) Initiative of the North Carolina Center for Health and Wellness to complete a program evaluation. The COR team applied an empowerment model of evaluation to iteratively develop performance measures and draft a survey to evaluate AFL’s programs. The purpose of this evaluation was to understand how AFL services impact key customers and to support AFL in growing their programs, improving services, and building sustainability.

You can view the Final Report here.

“Verner Center for Early Learning Community Assessment”

The Verner Center for Early Learning partnered with Culture of Results Initiative of the North Carolina Center for Health and Wellness to complete the required 2019 “Community wide strategic planning and needs assessment.” This Assessment reports on the strengths, assets and needs of families currently or potentially served by Verner Center for Early Learning in Buncombe County, North Carolina. Through community engagement, key stakeholder input, and rigorous data collection and analysis, seven key focus areas were identified related to the well-being of pregnant mothers and families with young children in Buncombe County: education, health and mental health, food and nutrition, housing, income and employment, social services, and social support. Inequities in accessibility of services and outcomes, particularly for children and families of color, are evident throughout this community assessment.

Findings from community engagement and data collection were synthesized with previous community reports and other local sources to present recommendations for each key focus area in support of pregnant mothers and families with young children in the community.

Read the full assessment here


“Building the Bridge between Clinic and Community: Using Results-based Accountability to Help Improve Birth Outcomes”

The Culture of Results Initiative is co-presenting with our partners from Mothering Asheville and SistasCaring4Sistas at the All In Data for Health Conference. This presentation will provide an overview of how the Results-based Accountability (RBA) planning and evaluation framework was used to support the Mothering Asheville Movement over three years. The presenters will discuss and model the ways that RBA has helped advance Mothering Asheville efforts to plan strategically, evaluate impact, align community measures across partners, and communicate results effectively. Presenters will show how performance measures reflecting the work of community-based doulas, clinical shifts, and advocacy efforts are contributing to “turning the curve” on disparities in infant mortality rates in Buncombe County. The audience will learn about RBA tools and processes they can apply to their own work.

To view the full presentation, please click HERE.

View the full sample RBA Elevator Speech HERE.


“Introduction to Results-based Accountability”

In May 2019, The NC Center for Health and Wellness partnered with the WNC Health Network and Results Work Consulting to provide an “Introduction to Results-based Accountability” training in three locations across the state. The trainings were arranged by the NC Department of Public Health and sponsored in part by the Foundation for Health Leadership and Innovation. Participants included health educators leading their community health assessments and improvement plans, direct service providers, administrators, systems strengtheners and others. Here are the slides and handouts from these trainings.

You can find the rest of the PowerPoint here.

WNCHealthyImpact handout for “My RBA Speech”

RBA Framework: Common Language For Today

Performance Measures Grid


“Beyond Awareness: Raising Resilience in WNC”

ACE Training was presented to WNC Healthy Impact partners (hospitals, health departments, and community health organizations) to accompany the Adverse Childhood Experiences data collected as part of the Community Health Assessment 2018. It focuses on how we can implement interventions across various levels of a socio-ecological model to bring a trauma informed lens to community health improvement.

To view the full slideshow, click here.


“Maximize Your Health and Wellness: Health promotion on and off campus”

Jeanne Dairaghi, Healthy Aging NC Initiative of the NC Center for Health and Wellness, and Jordan Perry, Healthy Campus Initiative, partnered in February 2018 to provide a Brown Bag discussion on the UNC Asheville campus to discuss ways to support health and well-being on- and off-campus. Below is Jeanne’s presentation that focuses on healthy aging research, evidence-based programs, and community resources.

To view the full slideshow, click here.



“The Joyful Complexity of Measuring Social Determinants of Health”

This presentation was provided to the NC Institute of Medicine Accountable Care Communities Task Force as they work to provide guidelines for communities across the state working to improve health and wellness. It provides an overview of how NC Center for Health and Wellness works to understand and address social determinants of health, the conditions that affect people where they live, learn, work, play and pray. We showcase several partnerships and approaches and provide some lessons learned and example measures.

To view the full slideshow, click here.


“Data as Storytelling: Using Data to Improve Program Quality”

This presentation was provided to attendees of the National Council on Aging Healthy Aging Annual Meeting in Arlington, VA in 2018. The presentation detailed how Healthy Aging NC collaborates with the state health department and hospitals to identify areas of the state facing the greatest burden of falls-related injuries and deaths to support evidence-based program implementation and growth. In addition, the presentation shares how Healthy Aging NC captures programmatic data on Results-Based Accountability scorecards to share with funders and support sustainability of efforts.

To view the full slideshow, click here.


“Communicating Resiliency”

Over the summer of 2018, Kenneth Roche produced this research as an intern with NCCHW in partnership with MAHEC. His project was to aid in producing a health communication campaign centered on raising awareness about trauma. This Powerpoint was presented to the Communicating Resiliency (CR) Advisory Group in order to prioritize the next steps and move the CR campaign forward. The Powerpoint contains information regarding state, regional, and local data and he is available to respond to any inquiries.

To view the full slideshow, click here.

Click the links below to view the Communicating Resiliency Video Series:


“Getting Urban Kids in Nature: An Evaluation of the Kids in Parks TRACK Trail”

From 2014-2015, the NCCHW, Blue Ridge Parkway Foundation and Blue Cross Blue Shield NC Foundation partnered to assess the use of Kids in Parks Trails in Charlotte, NC. Please see the attached poster for key findings about the effects of program promotion.

To view the poster, click here.


“A Training Academy Model: Bringing CDSME to the Community and State”

North Carolina was invited to present at the National Council on Aging’s Annual Conference on Healthy Aging in Washington DC. This presentation was presented by Jeanne Dairaghi, NCCHW; Stephanie Stewart, Land of Sky AAA; with input from Angel Stoy, Centralina AAA.

To view the full slideshow, click here.


“Finding Focus in the Joyful Complexity”

This poster depicts methods and lessons learned in the partnership between the N.C. Center for Health and Wellness and Mothering Asheville to address health disparities and social determinants. It was presented at the Society for Public Health Education (SOPHE) National Conference and is a modified version of the full Joyful Complexity presentation linked below.

To view the poster, click here.