How on-site delivery closes health gaps in low-access areas

Social media emerges as a cost-effective way to reach dispersed or rural audiences, while printed materials still matter in places with limited access to information. Bilingual communication, online and in person, strengthens inclusivity and supports behavior change.

A new peer-reviewed field study maps the practical conditions that make community health promotion work, and last, for underserved populations on the U.S.–Mexico border. The research distills concrete lessons from a five-year, university–community program that delivers mobile, bilingual health education and screening across El Paso County, Texas.

The paper, “Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement,” is published in Sustainability. The study identifies four core themes, what activities communities value; how to tailor outreach; how partnerships succeed; and which barriers must be overcome, to guide programs serving disadvantaged border communities.

What problem does the study tackle and why here?

The study focuses on a border setting where health gaps persist, insurance coverage lags, language obstacles are common, and chronic and infectious diseases exceed national levels. These conditions, combined with poverty and limited access to healthy food and recreational space, make proactive, community-based health promotion a necessity rather than a choice.

El Paso County’s demographics underscore the need for culturally and linguistically responsive models: a majority Hispanic population with a large share of monolingual Spanish speakers and lower levels of educational attainment than state and national benchmarks. Rural and semi-rural pockets face social and geographic isolation that can depress investment in infrastructure and healthcare services.

The Healthy Families Healthy Kids Initiative (HFHKI), the program at the center of the study, was created in 2021 to increase access to health education, hands-on learning, and preventive screening. The project distinguishes itself by taking services directly to shelters, schools, and other community sites, reducing transport barriers. At the time of writing, the team reports more than 450 workshops and ~40 screening events across diverse locations, indicating sustained operations and reach.

Methodologically, the article draws on 30 semi-structured interviews, 15 community partners (including shelters, schools, and an after-school program) and 15 program participants who had attended multiple events, conducted May to October 2024 under IRB approval. Interviews probed collaboration experience, barriers, and improvement ideas; participants received a small incentive. The initiative is supported by a USD 250,000 HRSA award, with the study cleared as an IRB-exempt protocol at the University of Texas at El Paso.

What works on the ground and how should programs be tailored?

Across interviews, respondents pointed to a set of activity attributes that consistently deliver value: closing information gaps, supporting both physical and mental health, and translating lessons into daily routines. These preferences favor interactive sessions, practical demonstrations, and continuity in delivery, especially in trusted settings close to where people live.

The tailoring imperative is equally clear. The team emphasizes responsiveness to culture, logistics, and environment, particularly in transient or loosely structured sites, so that content, language, and scheduling align with residents’ realities. Mobility, bilingual delivery, and co-planning with host facilities are presented as non-negotiables for reaching populations facing transport barriers or time constraints.

The border context requires additional adaptation. Limited access to affordable fresh food in some neighborhoods means nutrition education must be practical and sensitive to supply constraints; the paper argues that cross-sector collaboration with food banks and markets can help close these gaps.

The study also highlights multi-channel outreach. Social media emerges as a cost-effective way to reach dispersed or rural audiences, while printed materials still matter in places with limited access to information. Bilingual communication, online and in person, strengthens inclusivity and supports behavior change.

What keeps partnerships strong and what still blocks progress?

The authors frame partnership quality as the decisive variable for sustainability. Clear goals, reliable communication, and early involvement of facility staff build trust and support continuity. University–community collaborations are most resilient when they create shared ownership, align with host organizations’ missions, and maintain consistent presence across the project lifecycle.

Crucially, the paper identifies a recurring barrier set that repeatedly erodes partnerships: funding and staffing shortages, high staff turnover at partner sites, and the administrative frictions that force teams to reconsolidate relationships when personnel changes occur. The authors recommend strengthening boundary-spanning roles and joint pathways that preserve institutional memory and speed coordination.

The findings coalesce into four thematic areas that programs can use as a checklist: community-valued activities; tailored engagement; strategies for successful partnerships; and enhancements with barriers to overcome. The structure makes the lessons highly portable for other underserved settings seeking to improve implementation efficiency and collaboration.

Notably, the small, localized sample and English-only interviews restrict generalizability, and selection or social desirability bias may be present. The study is positioned as exploratory rather than causal, with the goal of informing practice and pointing to avenues for external evaluation and broader replication.

What the study changes for practitioners and funders

The article’s most actionable claims cut across design, delivery, and governance:

• Design for accessibility. Take services to where people already are; schedule around work and caregiving; deliver in preferred languages; embed practical, hands-on content. These steps directly address structural barriers prevalent in border communities.
• Invest in the partnership fabric. Prioritize routine communication, joint planning, and continuity of staff involvement to build trust and sustain engagement.
• Anticipate resource and context constraints. Budget for staffing stability and boundary-spanning roles; coordinate with food access networks and local institutions to ground programs in residents’ lived environments.
• Use multi-channel communication. Combine social media with print to normalize healthy behaviors and reach audiences that digital campaigns miss.