Texas CSTEP resident

Texas C-Step

The Texas Cancer Screening, Training, Education and Prevention Program, or Texas C-STEP, is conducted through the Texas A&M Physicians Family Medicine Center. Texas C-STEP provides critical safety-net services, such as cancer screenings and certain advanced diagnostics, to uninsured, underserved and low-income Texans through funding from the Cancer Prevention & Research Institute of Texas. The 17 counties served by Texas C-STEP are primarily rural counties.

diabetes patient with glucometer

Diabetes Education

The diabetes education kiosk (aka DIOSK) was developed by the Texas A&M Health Science Center School of Public Health as a self-management tool to provide diabetes education to persons with diabetes, caregivers, or those persons at risk for diabetes. Using touch-screen interactive technology, the DIOSK now consists of web-based modules on diabetes, asthma, and infectious diseases that can be viewed from any tablet, cell phone or computer. Dissemination of the DIOSK is currently funded through Healthy South Texas.

Other SRHRC Projects

In an effort to learn more about the distinctive health needs and priorities of rural communities in the Episcopal Diocese of Texas, the Episcopal Health Foundation selected the Southwest Rural Health Research Center to conduct a series of community planning and participatory group meetings in Grimes, Madison, and Robertson Counties. Currently in Year 2 of this project, the goal is to facilitate and support community champions’ efforts to lead sustainable Coalitions to address identified needs of their communities and to move county-specific projects towards fruition.

Malpractice Claims Among Rural and Urban Providers: Do State Telehealth Laws Make a Difference?

Alva O. Ferdinand, JD, DrPH

Michael A. Morrisey, PhD

This project examines trends in state telehealth laws in the U.S. and whether they have affected the malpractice environments of rural and urban environments differentially. Data from the National Practitioner Data Bank are used to determine whether changes in telehealth laws are associated with increased malpractice claims and other adverse actions among rural and urban healthcare providers.

Rural/Urban Differences in Chronic Diseases and Delay of Needed Care

Jane N. Bolin, PhD, JD, BSN


This project examines rural versus urban differences, among adults in the U.S., in the prevalence, incidence, stage and severity of selected chronic diseases including heart disease, stroke and several five types of cancers. There is a particular focus on examining foregone or delayed access to preventive or needed care, and whether rural residents present later and with more advanced disease states.

lawyer advising client

Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health 

Alva O. Ferdinand, JD, DrPH

Michael A. Morrisey, PhD

Many rural areas are classified as Health Professional Shortage Areas because of the lack of available professionals that can provide primary, dental, or mental health care. The litigiousness nature of health care in the U.S. may have some bearing on the healthcare workforce and the availability of healthcare providers in rural versus urban areas.

This project explores whether there are any differences between urban and rural health care providers in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions. This research also explores whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care. Data used for this project includes: National Practitioner Data Bank; National (Nationwide) Inpatient Sample; State Emergency Department Databases; and Area Health Resources File. 

young mother with baby

Are Rural Mothers and Infants Benefitting from Changes in National Women, Infants and Children (WIC) Policy?

E. Lisako J. McKyer, Ph.D., MPH

Ariun Ishdorj, PhD

A primary aim of the Women, Infants and Children (WIC) Program policy changes (i.e, new WIC Food Packages) is to improve infant health outcomes via incentivizing breastfeeding and other feeding/eating behaviors. Yet, it is not known if these changes to the WIC Program benefit low-income rural infants and women.

This study explores breastfeeding practices among rural WIC participants, and examine differences before and after a major federal policy change involving the WIC program.

Data from the National Food and Nutrition Survey, conducted before and after (repeated cross-section) implementation of the WIC policy changes, will be used to examine effects on breastfeeding rates, infant feeding practices, and food/beverage consumption among low-income infants and women in rural areas.

Evaluation of policy effects on outcomes among highly vulnerable populations such as low-income rural infants and their families is a critical step to improving health outcomes.

nurse examining elderly patient in hospital bed

Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds

Darcy McMaughan, PhD

Swing beds and skilled nursing facilities provide critical skilled nursing services in rural areas, which are often lacking appropriate options for long term care. While swing beds are important sources of care for rural residents, and increasingly essential sources of revenue for critical access hospitals, we have very little current information on characteristics of swing beds, swing bed providers, swing bed residents, and how swing beds compare to skilled nursing facilities in terms of location, care provision, and case mix.

The proposed study will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas, and the potential benefits of swing beds to rural communities, through development of a national picture of swing beds and skilled nursing facilities in rural areas of the U.S. and comparison of swing beds and skilled nursing facilities with regard to facility, resident, and care characteristics.

patient using glucometer

The purpose of this project is to determine rural versus urban differences in type 2 diabetes mellitus (T2DM) prevalence, morbidity and mortality in the U.S.

Diabetes prevalence is higher in rural areas than urban areas, with numerous studies demonstrating that rural persons with diabetes have higher morbidity from certain diabetes-related complications. Diabetes education may also be less accessible in rural areas.

This project will examine rural versus urban differences and disparities in T2DM rates and associated demographics pre-and post-Affordable Care Act implementation. We will include analyses of controlled and uncontrolled diabetes and associated complications across rural versus urban geographic regions of the U.S.

The project will be national in scope and will utilize data from the Behavioral Risk Factor Surveillance System and selected Healthcare Cost and Utilization Project state emergency department and inpatient survey databases.