Strategies to Improve Health Outcomes and Advance Health Equity in Rural Populations

Funding Opportunity Number: RFA-NR-24-005

Deadline: May 17, 2024

Rural Americans make up around 20% of the U.S. population. By multiple measures, adults and children living in rural areas have worse health than those living in more urbanized areas. Adults are more likely to die from the five U.S. leading causes of death (heart disease, cancer, accidental injuries, chronic lower respiratory disease, and stroke) than their urban counterparts. Children in rural areas are less likely to be vaccinated and their parents are more likely to report difficulties meeting basic needs. Many resources to protect and improve health across the lifespan are less available to rural populations than more urbanized populations. Rural communities across the U.S. are diverse and vary greatly in multiple ways that impact health.

Research Objectives

This funding opportunity will support research to develop, adapt, or implement intervention strategies addressing SDOH to improve health and promote health equity in rural populations. Research must address social determinants of health, along with community priorities, needs, and preferences, in the development, adaptation, or implementation of interventions. Interventions or implementation strategies seeking to either mitigate or eliminate the impacts of adverse social determinants of health and/or bolster positive social determinants of health are of interest. Investigators are encouraged to leverage community strengths in intervention design. Community-based participatory research (CBPR) or other community-engaged approaches may be useful for understanding community priorities, needs, and preferences, as well as for leveraging strengths of and knowledge embedded in rural communities.

Research studies should seek to improve health outcomes and must be guided by a conceptual framework that identifies hypothesized pathways between the intervention and health outcome(s). The primary outcome may reflect health or functional status, health conditions, quality of life, well-being, morbidity and mortality, and/or health behaviors. Individual-, population-, system-, and multi-level interventions could be responsive to this NOFO. Successful, evidence-based interventions may be adapted to specific rural communities and tested for acceptability and efficacy or effectiveness. Pragmatic and implementation studies are welcome, including hybrid effectiveness/implementation studies of adapted interventions or intervention bundles.

Examples of topics of interest include, but are not limited to:

  • Intervention studies focused on improving outcomes in conditions or risks that occur at higher rates in rural populations
  • Development, adaptation, and implementation of interventions that address social determinants of health ( in marginalized populations living in rural or remote areas of the United States such as migrant workers, immigrants, people with disabilities, racial and ethnic minority groups, people of low income, and sexual and gender minority groups
  • Implementation studies to advance the reach, effectiveness, and sustainability of evidence-based interventions in rural communities or in identified marginalized rural populations
  • Adaptation of technologies to address structural barriers to health in rural areas (e.g., healthcare resource shortages and telecommunication limitations that affect access to specialty care or pharmacy services)
  • Interventions that seek to improve health by addressing limited access to healthy foods, places for physical activity, or housing options in rural communities
  • Studies that develop, test, and/or implement firearm injury prevention intervention(s) to address the disproportionate burden of morbidity and mortality due to firearm injury in rural communities
  • Service and care models that build upon places of social interaction in rural communities, such as churches, schools, libraries, and grocery stores

For more information, please see the opportunity website.