Reaching and Working with Special Populations


AF Southern California Chapter Reaches New Population With the Program De Manejo Personal De La Arthritis (Spanish Arthritis Self-Management Program)
Outreach Into the Chatham and North Lawndale Communities of Greater Chicago
Rural and Plain Communities Targeted for Outreach in Indiana
Indiana Finds Success in Reaching the African-American Population
AF Michigan Chapter Reaches Out to the Jewish Communities of Detroit
AF New York Chapter Offers Self-Help and Exercise Classes to Spanish-Speaking Communities
Partnership with Extension Services Provides AF Programs in Rural Counties in Tennessee



AF Southern California Chapter Reaches New Population With the Program De Manejo Personal De La Arthritis (Spanish Arthritis Self-Management Program)


  • The purpose of this program was to increase the number of bilingual/bicultural Hispanic promotoras (community-based lay health educators) who could become instructors and trainers for the Spanish Arthritis Self-Management Program.
  • The chapter targeted a low-income, medically underserved, Spanish-speaking population. This group is often unable to participate in traditional self-help programs due to language barriers.
  • Through a collaborative effort among three chapter branches (AF, Orange County, Inland Empire and Greater Los Angeles Area Chapters), the Spanish program was offered at no cost or reduced cost to the target population.
  • In January 2005, a Spanish Arthritis Self-Management Program instructor training was held for 20 new instructors. In June 2005, the first -ever Spanish Train – the – Trainer workshop was held for 13 people. 
  • To find partnering agencies, the three branch’s program staff canvassed their communities via phones, meetings, etc. Community partners that were enlisted to host the AF program included churches, senior centers, schools and health care clinics.
  • The site partners helped to recruit participants, using radio interviews, newspaper, flyers, etc.
  • Roles and responsibilities were negotiated and documented through collaborative site agreements and verbal agreements. These were arranged by branch program staff and emphasized instructor trainings. Instructors were recruited by working with sites and networking opportunities with promotoras.
  • The chapter has sustained the program sites by training the Spanish program instructors to do other programs. For example, the chapter has enlisted instructors for Spanish versions of the AF Exercise Program and the Tai Chi program.




  • Within six months of training, the new instructors led 16 six-week courses throughout Southern California and reached approximately 232 participants. Among Spanish-speaking participants, 175 completed the program.
  • The chapters found new site partners who are willing to offer additional AF programs and also had some participants join in the Arthritis Walk.
  • Three of the newly trained Trainers have led trainings to date.
  • The chapters tapped into a market that the AF has not traditionally served and made programs widely available by building an infrastructure. 


 Key Learnings/ Tips


  • Securing funding from the state California Arthritis Partnership Program provided needed resources to build the program.
  • Selecting the right staff who can maneuver in the targeted community is essential to the success of the program.
  • Utilize the AF branch staff’s knowledge of communities and best practices to streamline efforts and take advantage of existing knowledge.


Additional success in reaching special populations:


  • Through NAAP grants, the chapter tapped into the African American population in Los Angeles and developed programs that still exist. For example, the chapter provided training of new leaders for the AF Exercise Program and hired a part-time community liaison for this community.
  • The chapter offered the AF Self-Help Program to two Native American community tribes through a partnership through a medical center, enlisted a volunteer community liaison and implemented exercise programs that still exist.

For further information, see the CDC Spanish Report and Presentation

Contact: Mireya Pena/AF Southern California Chapter/323-954-5760 x 246


Outreach Into the Chatham and North Lawndale Communities of Greater Chicago


  • The chapter’s goals included increasing quality and years of healthy life and to eliminate health disparities through increasing awareness of AF services and programs to underserved and socio-economically challenged areas.
  • The AF Greater Chicago Chapter determined that two neighborhoods, Chatham and North Lawndale, would be the focus of outreach based on health surveys done by partnering local institutions. Evidence showed high prevalence of arthritis in these areas.
  • Examples of previous outreach in these communities include dissemination of the CDC Physical Activity Campaign, dissemination of general information on arthritis and AF programs and presentations about AF and arthritis. There is also continued presence in these communities by offering seminars and health fairs.
  • The chapter designated a devoted staff person and representative of the targeted population to coordinate outreach efforts within these communities. 
  • The chapter largely collaborated with faith-based communities, but also worked with libraries, senior centers, community centers, etc.
  • The chapter partnered with the Sinai Institute for Urban Health to gather data and gain access to the North Lawndale community. The chapter has a good relationship with an epidemiologist working there.
  • The chapter also partnered with the Rehabilitation Institute of Chicago to gather data and gain access to the Chatham community.
  • Positive relationships with rheumatologists in the Chicago area provided additional access into these communities.
  • An ongoing partnership with Sinai Health System will include additional programming funded through an Illinois Department of Public Health (IDPH) grant.




  • The chapter implemented the AF Exercise Program at six subsidized senior housing facilities in collaboration with the Chicago Department of Aging.
  • The AF Self-Help Program was implemented at the North Lawndale Christian Center and the YMCA in Chatham.
  • Classes were held for free or at reduced cost via grants from the IDPH.
  • Additional program collaborations are being explored.


Key Learnings/ Tips


  • Having a staff person devoted to implementing activities within these underserved communities is critical to the success of the program.
  • Collaborations with the Sinai Institute and the Rehabilitation Institute provided rich source of data and entry into the communities. See the Web site for copies of the data reports.
  • Collaboration with the Illinois Department of Health provided needed seed money.

Also see the chapter’s  Chatham Report and  North Lawndale Report community profile reports.


Contact:  Michele Pfeilschifter/AF Greater Chicago Chapter/312-372-2080 x27




Rural and Plain Communities Targeted for Outreach in Indiana


Note: This example does not involve the AF Life Improvement Series Programs, but it does illustrate how to develop materials that are relevant to a rural population and how to involve relevant agencies in information dissemination activities


  • The chapter disseminated culturally sensitive brochures about arthritis called “Agriculture and Arthritis” (for rural populations) and “Plain Facts about Arthritis” (for Amish communities).
  • The chapter partnered with Purdue University’s Breaking New Ground Resource Center. Working with a land grant based university allowed the AF easier access to the rural communities in Indiana.
  • The funding was made possible by an AgrAbility partnership grant linking Purdue University’s, Indiana’s Extension Services and the AF. AgrAbility links extension services through land grants to land grant based universities.
  • The Extension Services helped to disseminate information to the targeted communities by utilizing resources like local libraries, local physicians, and local weed and feed stores where many people living in the rural communities buy farming supplies and equipment.
  • In 2007, the chapter released a new DVD entitled “Gaining Ground on Arthritis, Managing Arthritis in the Agricultural Workplace.” The DVD was also developed in partnership with Purdue University.




  • The program increased reach to rural communities that do not have adequate access to health information.
  • The AF and Purdue University brought the information to the targeted population through means that were easier for the target population to access.
  • The brochure was not technical and is easily readable. Other chapters and agencies across the country have contacted the chapter for information on obtaining the brochure.
  • Information to the Plain community and farming communities was disseminated to approximately 14,000 people nationwide.


Key Learnings/ Tips


  • Effective communication among the partners regarding the direction of the project is essential.
  • Having one person manage the project provides consistency.
  • Allow enough time to see the project done well. The brochure was published in 2004, but the partnership started in 2002. 
  • Linking with an agra-based agency allowed the chapter to gain access to the Plain and rural communities.

Contact: Jenny Conder-Haskamp/AF Indiana Chapter/317-879-0321 x206


Indiana Finds Success in Reaching the African-American Population


Note: This example shows how you can build relationships within a specific population using health promotion activities. Such activities can help you get your foot in the door so that, as appropriate, you can later provide the more intensive AF Life Improvement Series Programs.


  • The AF Indiana Chapter approached president of the Community Centers of Indiana about reaching the population served in the centers to increase arthritis awareness.
  • The chapter received small funding, from a local foundation (~$20,000)
  • The project lasted for four years.
  • The chapter put together training for presenters who already worked in the community centers. At the training, topics like inclusiveness, ways to deal and how to empathize with participants who may be dealing with external pressures (economic, societal, etc.) were covered.
  • The chapter polled community centers to find out what information they wanted to hear at presentations.
  • The presentations were offered in the evening and included topics such as nutrition, Arthritis 101, Osteoarthritis, RA, Kids & Arthritis (geared to aged 30-50 yr)
  • The chapter targeted two sets of the population: a) Aged 30-50 yrs. b) Aged 50+ years
  • The centers served mostly African American audiences
  • The chapter provided the program for free.
  • The chapter offered child care within the centers during the programs.
  • The attendees were offered small incentives. For example, the AF hosted five programs at each center, so attendees had a chance to enter their name in a drawing for a door prize using a card that was hole-punched after every program. They got incentives if attended all programs.
  • The participants had food and goodie bags at each program.
  • Community centers helped with marketing by using flyers, PSAs and newsletters at community centers and the AF.


Key Learnings/ Tips


  • Relationship cultivation is key. The chapter had the relationship with the president of the Community Centers of Indiana. He, in turn, had relationships with each of the executive directors of the centers, which helped the implementation of the programs.
  • Presenters were careful not to stereotype groups attending the programs.


Contact: Marva Stanford Chief Field Operations- AF National Office/317-849-9832/

AF Michigan Chapter Reaches Out to the Jewish Communities of Detroit

  • The initiative was called L’Chaim: Living the Good Life with Arthritis, designed to reach out to Jewish population, currently underserved by AF, in the Oakland Community in suburban Detroit.
  • The major source of grant funding was from the Jewish Fund. The Jewish Fund was approached by the chapter for a two year grant.
  • Program sites and agencies were contacted separately such as synagogues, Jewish Aging Services, National Council of Jewish Women, Jewish Federation
  • The chapter hired a part-time coordinator who was Jewish with grant funds.
  • The chapter offered the AF Exercise Program, AF Aquatic Program, Tai Chi from the AF, and the AF Self-Help Program at various sites.




  • The chapter recruited two AF Self-Help Program leaders to be trained from the Jewish communities to lead the Russian-speaking groups.
  • The chapter delivered 13 AF Self-Help classes in various sites, including two in Russian.
  • The chapter started AF Aquatic Programs at two Jewish community centers.
  • The chapter offered the Tai Chi for Arthritis program at eight locations, including a class for Orthodox Jewish women and a class at a day care center for people with dementia.


Key Learnings Tips


  • Be flexible with the plan.
  • Have a dedicated staff person for the project.
  • It DID NOT work well to translate AF Self-Help Program materials directly from English to Russian. For example, the leader reads the English manual and translates it as she is leading the group.  So, the chapter obtained permission from Stanford University to adapt the materials and used grant funds to formally translate the leader’s manual and participants material.
  • Allowing enough time to build trust took much more time than anticipated with this community since this was first formal approach by the chapter into the Jewish communities, because of cultural differences, and because this community is accustomed to relying on other Jewish agencies for resources.


Additional success in reaching an African American population:


  • The chapter conducted an eight-year program called Arthritis Awareness Urban Outreach from 1995 through 2003.
  • The program reached 1199 participants.
  • The chapter received funding for first five years from various sources.
  • The chapter delivered AF Self-Help Program at 70 churches of all denominations, three senior centers and two senior residences in Detroit.
  • The project coordinator was a retired African American nurse.  She was instrumental in getting the church personnel to buy into the program.
  • The church recruited program leaders. People from the congregation and retired nurses were recruited to team to co-teach. The church also handled marketing and registrations.
  • The chapter was able to get a key minister to support the project who convened a meeting with other ministers in the target area learn about the programs.
  • All classes and leader trainings were free.
  • Program leaders were paid a small stipend.


See: Arthritis Awareness Urban Outreach project summary


Contact – Barbara Spreitzer-Berent /AF Michigan Chapter/248-649-2891 x 224


AF New York Chapter Offers Self-Help and Exercise Classes to Spanish-Speaking Communities


  • The chapter piloted this initiative in two boroughs.  They made connections with the community boards within the two boroughs that helped the chapter with community data and linking them to other local community /social services organizations.
  • The project was supported by funds from Pfizer.
  • The chapter trained 25 new bilingual promotores to deliver either the Spanish Arthritis Self-Management Program or the AF Exercise Program. The promotores were recruited through community boards/local social services organizations and other community agencies.  The chapter’s Patient Services Committee also assisted in identifying instructors.
  • Pre- and post-tests were administered to all course participants during the first and last sessions.
  • The chapter created an extensive marketing campaign to disseminate information about the programs including Arthritis Sundays and distributed Spanish language materials at health fairs, community events, physicians’ offices, clinics, etc.
  • The programs targeted Spanish-speaking populations in five boroughs.
  • In 2005-2006, the chapter conducted 22 Spanish disease management courses at 19 different community sites in Manhattan, Brooklyn, Queens, the Bronx and Westchester.
  • The chapter worked with eight coalitions, some serving Spanish speaking populations, as partners to implement the programs throughout the targeted communities




  • In 2005-06, the chapter recruited and trained 25 new bilingual promotores and reached more than 300 class participants.
  • Since the beginning of outreach efforts in 2000, more than 1400 people have attended 129 classes at 81 sites.
  • The program had a very low attrition rate.
  • Out of the group of promotores, some became program trainers.  


Key Learnings/ Tips


  • Recruiting and training the promotores is crucial to coalition building efforts in the Spanish-speaking communities.
  • It is crucial to engage in coalition building.
  • Take programs to where people naturally congregate in the communities.
  • Devote a staff person to the initiative.
  • You must obtain buy-in from community and promotores and stay involved in the community and with the instructors.
  • The key is getting people to the first class.
  • The chapter initially immersed itself in targeted communities.
  • Make the right contacts in the community.
  • Word of mouth is very important.

Also see the Spanish evaluation report


 Contact – Helen Levine /AF New York Chapter/ 212-984-8710


Partnership with Extension Services Provides AF Programs in Rural Counties in Tennessee


  • The AF Tennessee Chapter began a partnership with the University of Tennessee Extension Services in 2001 with the assistance of the Tennessee Department of Health Arthritis Program Director. 
  • They began offering the AF Self-Help Program and later trained AF Exercise Program instructors.
  • This was a statewide system approach to delivering the AF programs throughout the state using trained extension services educators.




  • Since 2005, more than 200 people have participated in the AF Self-Help Program.
  • The partnership has reached participants in 50 counties in Tennessee with the AF Self-Help, AF Exercise and AF Tai Chi Programs.
  • Since 2005, 55 Extension agents (out of a possible 100) have been trained and are in the process of becoming certified.
  • The UT Extension Services added information to their Web site about the AF and the AF programs. See


Key Learnings Tips


  • Get the buy-in of the directors or the right person at the agency or head of the partnership.
  • Show data of measurable behavioral modifications for participants in the AF Self-Help Program.
  • Coordinate AF trainings exclusively for the Extension Services agents.
  • Forge a strong relationship with the State Arthritis Program Director.
  • Be flexible, and work within the structure and organization of the partners.
  • Make it simple for extensive service agents to incorporate their work as AF program leaders into their existing plan of work.
  • Require consistent follow up from everybody involved.


Contact: Carrie Thompson/AF Tennessee Chapter/615-254-6795



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