Building Rural Age-Friendly Communities by Expanding CHW Training

From South Texas to the Gulf Coast of Alabama, NRHA has now trained 223 rural community health workers (CHWs) to strengthen age-friendly care for rural older adults through our National Rural Age-Friendly Initiative (NRAFI). What began during the initiative's planning grant has evolved into a growing national effort that equips trusted CHWs with practical tools to support healthy rural aging through the Age-Friendly Health Systems 4Ms Framework — What Matters, Medication, Mentation, and Mobility. 

Building on the success of the planning grant, which led to the award of the implementation grant from The John A. Hartford Foundation, the initiative expanded its rural CHW training during implementation year 1 in South Texas and year 2 in Mobile, Ala. The Alabama training not only introduced the 4Ms Framework to a new region but also helped expand partnerships, strengthen the curriculum through new educational activities, and broaden community engagement.

Building on a strong foundation

During the planning phase and year 1, NRHA collaborated with the University of Texas at Arlington (UTA) and the Institute for Healthcare Improvement (IHI) to develop the Age-Friendly 4Ms Framework curriculum and deliver the first NRAFI CHW training focused specifically on rural older adults rather than a disease state. Dr. Denise Hernandez with UTA facilitated the South Texas trainings using the original bilingual curriculum in both English and Spanish. The curriculum equipped CHWs with practical strategies for implementing the 4Ms while meeting the needs of the predominantly Spanish-speaking CHWs.
 
Building on that success, the year 2 grant shifted its geographic focus to Alabama, where the curriculum evolved to reflect local community needs. In June 2026, Janel Lowman, MHA, senior manager of community outreach at USA Health Mitchell Cancer Institute, led a 4Ms training for CHWs in Mobile, drawing on more than a decade of experience in community outreach, health education, and public health program development.

Lowman is an experienced CHW trainer, long-time NRHA partner, and a member of NRHA’s 2025 Rural Health Fellows cohort. She has contributed to several national rural health initiatives, including NRHA’s NIH-sponsored All of Us Research Program, rural CHW trainings in Mobile and Baton Rouge, La., NRHA's rural CHW oral health training developed in partnership with CareQuest Institute for Oral Health, and the NRHA/AARP/IHI Rural CHWs Community of Practice program on IHI’s My Health Checklist.   

Working collaboratively with NRHA, UTA, and IHI, Lowman adapted the existing English curriculum to reflect the needs of the Alabama communities while preserving the evidence-based 4Ms framework established during the planning phase. Because most participants primarily spoke English, the Alabama training was delivered entirely in English, unlike the bilingual South Texas sessions.
 
Held at the USA Health Strada Center, the training welcomed 28 individuals who identified as CHWs, community advocates, and volunteers and aimed to improve the lives of rural older adults. The group reflected remarkable demographics and diversity, with participants ranging from 20-year-old young adults beginning their CHW careers to an inspiring participant over 90 who had a practical reason for attending: her community continued to look to her for resources and answers, and she wanted to learn anything she could to help them.

Participants represented African American, Vietnamese, Cambodian, and other communities, as well as faith-based, public health, and other local organizations. Compared with the South Texas trainings, Alabama also demonstrated higher male participation. Five males attended (a father-son pair of CHWs, a social worker, a USA Health staffer, and a CHW who is an elder in his community). This reflects growing engagement from a broader cross-section of community leaders. The training also welcomed four parent-child pairs, illustrating the importance of intergenerational leadership in advancing healthy rural aging.

Like the South Texas trainings, the Alabama lasted four hours, during which participants examined each component of the 4Ms through pre- and post-tests, discussions, real-world examples, and collaborative activities. 

The Alabama training incorporated several enhancements as well. At Lowman's recommendation, the My Health Checklist assignment was added to the curriculum to encourage practical application of age-friendly principles, as the checklist was designed as a conversation starter to help older adults and their caregivers prepare for health care visits by introducing the 4Ms and encouraging conversations about personal priorities. The curriculum also introduced an expanded discussion around the meaning of age-friendly care that encouraged participants to reflect on person-centered care before exploring the 4Ms. Every participant received physical copies of the My Health Checklist booklet to support continued learning and implementation after the training.

Breakdown of 223 CHWs trained

Through the NRAFI, NRHA has trained 125 CHWs in 2024, 70 in 2025, and 28 so far in 2026, making a total of 223. Participant evaluations through the pre- and post-training assessments demonstrated meaningful knowledge gains and an increased understanding of rural age-friendly care concepts. The enthusiastic feedback from participants also reinforced the relevance, practicality, effectiveness, and value of the curriculum. 

With 223 CHWs trained across the planning phase and implementation years 1 and 2, the initiative continues to build a growing network of rural community leaders dedicated to advancing rural age-friendly care. To complete the year 2 grant cycle, NRHA plans to train an additional 30 rural CHWs in Alabama's Black Belt region in September 2026 to expand the initiative's reach and impact.

As the initiative enters year 3, NRHA remains committed to utilizing the 4Ms Framework to strengthen the rural health workforce, bolster rural health systems, expand access to age-friendly care, and improve the health, independence, and quality of life of rural older adults.

Additional age-friendly CHW resources, impact stories, and updates are available on the National Rural Age-Friendly Initiatives Resources Hub.

• Read the South Texas CHW training blog from the first two years of the initiative
• Read the 2024 planning grant South Texas CHW training report
• Read the 2025 implementation grant year 1 South Texas CHW training report 

For more information, contact NRHA’s NRAFI team: Laura Hudson, author Rebecca Yeboah, and Janel Loman with USA Health Mitchell Cancer Institute.

This blog was produced as part of the National Rural Age-Friendly Initiative, a partnership between NRHA and The John A. Hartford Foundation.