Managing Chronic Conditions in Stone County, MO

Monica Spittler, MA ED, MS ED

Community Health Educator, Stone County Health Department

Stone County Health Department wanted to help their community take charge of their chronic disease conditions, but they faced some considerable barriers. Stone County is a long, skinny county in Missouri that borders Arkansas with a population of 32,154, stretched over approximately 511 square miles. It is also an older county, with the population median age resting at 49.9 years according to the 2016 Stone County Community Health Coalition Community Health Assessment. To address the challenges of serving this older and dispersed population, the Stone County Health Department formed the Stone County Community Health Coalition in April 2014. Formed of 30 participating agencies and 45 members, the health coalition sought to address this challenge through a chronic-disease self-management class.


The National Association of County and City Health Officials awarded the Stone County Health Department’s Medical Reserve Corps (MRC) the 2014–2015 MRC Challenge Award for the Chronic Disease Self-Management Program. The Stanford University School of Medicine developed the Chronic Disease Self-Management Program in 1996 via a grant from the federal Agency for Health Care Research and Policy and the State of California Tobacco-Related Diseases Office. The Stone County Health Department MRC attended a four-day training to teach the course via the Regional Arthritis Center for Southwest Missouri.  Thanks to a grant from Stanford University, the course along with its book, Living a Healthy Life with Chronic Conditions, were free.

Instructors, including an MRC volunteer, taught the course for six weeks. The main objective of the self-directed class is for participants to set goals, create an action plan, and receive trainings on health topics and action plan creation. The class included individuals with diabetes, lupus, stroke, Alzheimer’s, bipolar disorder, and other chronic diseases. To encourage engagement, every class included a 15-20 minute break for interaction among the participants. To incentivize continued attendance, every session included a complimentary gift. Each incentive corresponded with a topic area covered in the class session. For example, pedometers were handed out when discussing physical activity and a relaxation CD when instructing on mindfulness. Other giveaways included a journal, a shopping list, and a reusable shopping bag. The class also partnered with Taney County’s community health educator to help teach the class.

The long term goal of the course is for participants to gain the ability to manage their conditions and work with their healthcare provider on their care. After the first session, every class opens with a review of participants’ action plans and discussion on how to improve them. The course begins with an overview of how to use the self-management toolbox and an introduction to creating an action plan and positive change. Some of the topics participants discuss throughout the six weeks include: (1) healthy eating; (2) physical activity; (3) communication skills; (4) dealing with difficult emotions; (5) working with your healthcare professional; and (6) avoiding falls.

The class saw participants’ transition from indifference to their condition to engagement and commitment to lifestyle changes. This success is the direct result for the commitment of the MRC volunteers and the focus on offering a limited number of classes a year. Going forward, Stone County Health Department will offer two classes a year; one in Stone County and one in Taney County. Community members from either county are allowed to take the classes. The Stone County Community Health Coalition is dedicated to helping county residents live happier and healthier lives by taking charge of their health.

Learn more about NACCHO’s MRC Challenge Awards at




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