Programs
to Partnerships: A Brief Report on the Texas A&M AgriLife Extension Service
HealthTalk Express Program
Debra
K. Kellstedt1
1Family
& Community Health Unit, Texas A&M AgriLife Extension Service, College
Station, TX, U.S.A.
Abstract
Chronic diseases remain a
pressing issue in Texas, where high rates of obesity, diabetes, and
cardiovascular conditions challenge public health. The Texas A&M AgriLife
Extension Service addresses health by translating research into practice at the
community level through educational programming and resources created by
Extension Specialists and delivered by Extension Agents. This Practice Brief Report
describes the design and delivery of a simple, pre-prepared AgriLife Extension
program that addresses chronic conditions by encouraging healthy eating and
active living. The program, HealthTalk Express, delivers short,
science-based health presentations designed to inform and inspire behavior
change. Included are 12 modules, offering presentations on topics like stress
reduction, heart disease, diabetes prevention, and cancer screening. Innovative
evaluation methods allow for streamlined data collection and real-time
reporting. As of June 2025, the program reached over 2,000 adults in 43 Texas counties.
Post-surveys showed significant improvements in participant knowledge (+1.1 on
a 5-point scale) and strong intention to adopt healthier behaviors (average
score = 4.3 on a 5-point scale). The program fosters strategic partnerships by
connecting Extension Agents to local organizations like senior centers,
schools, and worksites. Agents have commented that providing one-shot and short
series programs like HealthTalk Express provides a gateway to future
programming. Also, its design enables delivery by trained Master Wellness Volunteers,
expanding reach and freeing up Agents to engage in broader community-based
solutions, like coalition-building. With continued development, HealthTalk Express
stands as a promising and scalable model for chronic disease prevention and
partnership development within the Cooperative Extension system.
Keywords: Extension, Chronic disease
prevention, Community, Partnerships
Chronic diseases like cancer, heart
disease, and diabetes continue to plague over half of United States adults and
are the leading causes of sickness and death (Centers for Disease Control and
Prevention, 2024). The physical and mental toll of these diseases are
compounded by annual health care costs of $4.5 trillion. In Texas, heart
disease is the leading cause of death with 5.2% of Texans experiencing this
chronic condition and 3.1% having had a stroke (Texas Department of State
Health Services, n.d.b.). Just as alarming, 12.7% of Texan adults have been
diagnosed with diabetes (Texas Department of State Health Services, n.d.a.).
These problems in Texas are exacerbated by high levels of obesity (35.7%) and
low levels of physical activity (27.8%) (Texas Department of State Health
Services, n.d.c.; America’s Health Rankings, n.d.). Clearly, a need in Texas
communities is helping our diverse and large population overcome these health
hurdles.
The
U.S. Cooperative Extension System
The U.S. Cooperative Extension
(Extension) system has had a long history of addressing local need. While this
century-old system may be more commonly known to help farmers and agriculture
production, Extension included health promotion and chronic disease prevention
as foci as far back as the mid-1900s, when chronic disease problems became more
prevalent across the U.S. (Buys & Rennekamp, 2020). Since its inception in
1914, Extension’s system of translating statewide university-led research into
local-level practice through educational programming and skill-building has
proven to be a successful model (Franz et al., 2015). Currently, there are
approximately 2,900 Extension offices with reach in almost every county,
borough, parish, and territory across the U.S. (Land Grant Impacts, n.d.). One
strength of this dissemination system lies in the connections and partnerships
of the workforce at the local level (Strayer et al., 2020; Holston et al.,
2020).
The Texas A&M AgriLife Extension
Service (AgriLife) is a Cooperative Extension agency housed within the Texas
A&M University system that helps Texans thrive by providing educational
programs, tools, and resources on a local and statewide level (Texas
A&M AgriLife Extension, n.d.b.). AgriLife’s expansive charge is to promote
health, improve agriculture and food production, protect the environment,
strengthen local economies, and engage youth. With 250 county offices serving
Texans in all 254 counties, county Extension Agents (Agents) serve families,
youth, communities and businesses throughout the state. Agents are professional
educators employed by AgriLife to bring research-based information and programs
to their local communities.
Subject matter specialists with
advanced degrees within AgriLife at Texas A&M University conduct research
and develop, evaluate, and provide training in evidence-based programming to be
delivered at the county level by Agents or trained Master Wellness Volunteers
(MWVs). The Family & Community Health Unit (FCH) within AgriLife aims to
“improve the health and wellness of individuals, families, and communities in
Texas, one healthy choice at a time” (Texas A&M AgriLife Extension Family
and Community Health, n.d.). FCH faculty—Extension Specialists—hold expertise
in areas such as active living, aging, chronic disease prevention, and child
development. FCH faculty provide subject matter expertise and program
implementation support through monthly online or in-person professional
development trainings to FCH-specific Agents and through annual training
webinars to cohorts of MWVs. FCH supports a web-based platform called Howdy
Health (howdyhealth.tamu.edu) that provides community access to programs and
resources supporting health-related behaviors and collects participant
demographic and health behavior information (Howdy Health, n.d.). The platform
also generates real-time data files and aggregate reports for Agents and
Specialists. This Practice Brief Report will describe the design, delivery, and
partnership potential of a tried-and-true FCH program utilizing the FCH Howdy
Health platform. The Texas A&M University Institutional Review Board determined
that this research meets the criteria for exemption (IRB #2025-1146).
Method
HealthTalk Express is a
collection of 30-minute or less health presentations aimed at preventing
chronic disease that use a persuasive public speaking approach called Monroe’s
Motivated Sequence. Monroe’s Motivated Sequence involves gaining the audience’s
attention, identifying a need, and energizing an audience to take action
(Monroe & Ehninger, 1935). HealthTalk Express applies this framework
by starting each presentation by sharing an individual’s story and then
presents the current statistics about a health topic and evidence for
addressing the issue. Participants are encouraged to engage in discussion
during the talk, and by the end of the presentation are offered steps for
taking action to make positive behavior changes. Handouts are provided to aid
in these action steps.
Context
The HealthTalk Express program was designed to be easy to prepare and simple to
deliver, thereby increasing Agent reach across counties. The program was
revamped by an FCH Specialist in 2022-2023 with updated health statistics,
AgriLife-branded design, and streamlined evaluation methods using the Howdy
Health platform. Because of this, program delivery results in this brief report
only include data from January 2023 to June 2025.
Participants
Agents recruit and deliver the program (usually in
person) to adults of all ages in the community by partnering with places like
senior centers, worksites, hospitals, and government agencies. Often, HealthTalk
Express is delivered in the form of a community lunch and learn session.
Program
Structure
HealthTalk Express
presentations can be delivered individually or in a short series program.
Currently, there are 12 HealthTalk Express modules developed on the
following topics: cancer screening; diabetes prevention; understanding heart
disease; reducing stress; older adult health; and life balance. Nine of the
modules have been translated into Spanish. Agents have access to an AgriLife
HealthTalk Express intranet page where they can download the
science-based PowerPoint slides; a detailed instructor guide that includes a
presenter script, references, handouts, a printable evaluation survey, and a
sign-in sheet; and an editable promotional flyer.
Program
Evaluation, Measures, and Feedback
Participants complete a brief evaluation survey after the
presentation is complete. They can access the survey (housed at the Howdy
Health platform) by scanning a QR code displayed on the last PowerPoint slide
of each module. If participants prefer, they can fill out a printed version of
the evaluation survey.
The evaluation first measures knowledge change by
asking participants on 5-point scales how much they knew about the given topic
before the presentation and how much they know after the presentation (from
none to a great deal). The evaluation next measures intention to change
behavior by asking participants on a 5-point scale a health-related action
they will take in the future (specific to each module) (from strongly disagree
to strongly agree). Additional measures include whether the participation learned
new information (strongly disagree to strongly agree); whether they will use
the information (strongly disagree to strongly agree); their evaluation of
the overall teaching (very poor to excellent); their evaluation of the speaker’s
knowledge of the subject matter (very poor to excellent); and their
evaluation of the value of the handout (very poor to excellent).
Finally, participants are asked to write comments or suggestions about the
presentation and are prompted to provide demographic information on county,
sex, race/ethnicity, age, and education.
The Specialist managing the HealthTalk Express program
offered statewide online and in-person professional development trainings to
Agents and MWVs between 2023 and 2025 to inform them about the redesigned
program and to teach them how to implement using updated evaluation methods. Agents
and MWVs were given opportunity to ask questions and provide feedback during
these trainings.
Procedure
and Analysis
Agents
manually enter paper and pencil evaluation survey data in a fillable form on
the HealthTalk Express intranet page. These data are combined
with participant data that was collected electronically via the module QR code.
Agents and Specialists can access program data instantly in a portal within the
Howdy Health platform. They can filter the data by
module, date, region, and county and generate CSV files and aggregate reports.
Reports provide demographic data in counts and percentages and display knowledge,
intention, and satisfaction measures in counts, percentages, and averages.
Knowledge change is calculated by subtracting the average knowledge score
before the presentation from the average knowledge score after the
presentation. These aggregate reports are used to describe impact, show
reach, and to satisfy state and federal grant requirements. Further analysis
included paired t-tests to assess the significance of changes in participant
knowledge.
Results
Program
Reach and Impact
Between January 2023 and June 2025
HealthTalk Express has been implemented in 43 Texas counties—reaching
2026 adults. The average age of participants was 56, and 84.1% reported they
were women. Almost 60% of participants were White (n=1187); 22% were
Hispanic/Latino (n=450); 13% were Black (n=255); 3% were Asian (n=51); and 0.8%
were American Indian/Alaskan Native (n=17). Twenty-six percent of participants
have a Bachelor’s degree (n=527) and 23% reported having attended some college
but with no degree (n=470), while 20% have a high school degree or less than a
high school degree (n=412). Only 14% of participants hold an advanced degree
(n=279). Table 1 results were pulled from the Howdy
Health HealthTalk Express portal on June 11, 2025, and include data
starting from January 1, 2023. Paired t-tests were conducted on pre- and
post-knowledge items and show a statistically significant increase (+1.1) in
participant knowledge on topics after having attended a presentation.
Participants reported an average score of 4.3 (SD=1.5) on intention to take
future action to improve health behaviors (5-point scale). Results also show
high program satisfaction scores on the level of the teaching (average=4.8,
SD=0.9), the speaker’s knowledge (average=4.8, SD=0.9), and the value of the
handout (average=4.7, SD=1.1).
Table 1. HealthTalk Express
Program Results, January 2023 – June 2025.
|
Measure
|
Response
|
Count
|
Percent
|
Average
(S.D.)
|
Difference
|
|
Knowledge before the talk
|
A great deal
|
352
|
17.4%
|
3.3
(2.0)
|
*+1.1
|
|
|
Much
|
454
|
22.4%
|
|
|
Some
|
732
|
36.1%
|
|
|
A little
|
395
|
19.5%
|
|
|
None
|
93
|
4.6%
|
|
Knowledge after the talk
|
A great deal
|
1137
|
56.1%
|
4.4
(1.5)
|
|
|
Much
|
608
|
30%
|
|
|
Some
|
220
|
10.9%
|
|
|
A little
|
52
|
2.6%
|
|
|
None
|
9
|
0.4%
|
|
Intention to take future
action
|
Strongly agree
|
944
|
46.6%
|
4.3
(1.5)
|
|
|
|
Agree
|
822
|
40.6%
|
|
|
Undecided
|
186
|
9.2%
|
|
|
Disagree
|
29
|
1.4%
|
|
|
Strongly disagree
|
45
|
2.2%
|
|
Learned new information
|
Strongly agree
|
1074
|
53%
|
4.4
(1.4)
|
|
|
Agree
|
806
|
39.8%
|
|
|
Undecided
|
69
|
3.4%
|
|
|
Disagree
|
28
|
1.4%
|
|
|
Strongly disagree
|
49
|
2.4%
|
|
Intention to use
information
|
Strongly agree
|
1212
|
59.8%
|
4.5
(1.2)
|
|
|
Agree
|
727
|
35.9%
|
|
|
Undecided
|
40
|
2%
|
|
|
Disagree
|
6
|
0.3%
|
|
|
Strongly disagree
|
41
|
2%
|
|
Rating of teaching
|
Excellent
|
1599
|
78.9%
|
4.8
(0.9)
|
|
|
Good
|
380
|
18.8%
|
|
|
Fair
|
38
|
1.9%
|
|
|
Poor
|
6
|
0.3%
|
|
|
Very poor
|
0
|
0%
|
|
Rating of speaker’s
knowledge
|
Excellent
|
1656
|
81.7%
|
4.8
(0.9)
|
|
|
Good
|
332
|
16.4%
|
|
|
Fair
|
36
|
1.8%
|
|
|
Poor
|
1
|
0%
|
|
|
Very poor
|
0
|
0%
|
|
Rating of handout value
|
Excellent
|
1431
|
70.6%
|
4.7
(1.1)
|
|
|
Good
|
518
|
25.6%
|
|
|
Fair
|
64
|
3.2%
|
|
|
Poor
|
5
|
0.2%
|
|
|
Very poor
|
0
|
0%
|
*p<0.05.
Participant
and Agent Feedback
Participant open-ended responses from the evaluation
surveys indicated how the program increased not only their awareness of chronic
diseases but also their power to make positive life changes. Select responses
are shared below.
[The Presenter] is
always open to questions. [They] try to explain things in a way that we can
relate that information to our everyday lives.
Power to Prevent
Diabetes Presentation
Participant
I liked the case study and up-to-date
information.
STRESS LESS: Mind
Matters Presentation
Participant
[The Presenter]
said amazing things that I didn’t know and more when it comes to stress. I
myself stress a lot no matter the situation. I really appreciate everything
[they] said…
STRESS LESS: Mind
Matters Presentation
Participant
The information
discussed today will motivate me to get moving!
Go-4-30: Take
Action to Be Active Presentation
Participant
I thought this
session was wonderful. I’ve dealt with anxiety and depression and I’ve learned
that being outdoors in nature (either at the beach…or hiking…) I always feel
better. Find it my safe space and my anxiety and depression goes down.
Nurtured by Nature Presentation
Participant
Feedback from
Agents during meetings and professional development trainings revealed that
implementing the HealthTalk Express program can be a gateway into new
organizations and a great way to build partnerships in their communities. They
also reported that since all of the preparation of the program is done for
them, it is a program that can easily utilize time from AgriLife’s Master
Wellness Volunteers.
Discussion
HealthTalk
Express is a successful AgriLife Extension program that holds promise in
preventing chronic disease at the county level in Texas. Post-survey data from
2023-2025 indicated that participants increased their knowledge and expressed
intention to make behavior changes. Feedback from participants indicated that
the presentations were informative and motivated them to take action. More
modules are in development to cover topics like where to find health
information, the importance of sleep, and sun safety.
An added
benefit of delivering the HealthTalk Express program is fostering partnership
development. Extension is a unique agency, and Agents offer a service in their
communities like no other. Community stakeholders like school superintendents,
business leaders, and government officials are often seeking support to address
needs and promote health among their workforces. Agents report that stepping in
to meet these local needs with science-based one-shot or short series health
presentations can open a door to future health programming. The HealthTalk
Express program could be a great starter program for early career Agents or
those new to their counties and delivering it may result in new or strengthened
partnerships and increased participation in other Extension programs.
Attaching the HealthTalk
Express program to the Howdy Health platform has provided important real-time
evaluation and instant feedback. This method has proved successful with other
FCH programs like Walk Across Texas (Faries et al., 2019). Agents are required
to report the outcomes of their programmatic work within Extension, and they
can easily prepare aggregate reports using Howdy Health to complete this task.
Allowing participants to complete a survey either by pencil and paper or by
scanning a QR code with a mobile device has made this process of collected
participant data much more streamlined and flexible. Aggregate reports could be
used to present real-time health data back to stakeholders and to, again,
address local needs and strengthen community partnerships. Real-time health
data can also inform future programming needs.
The design of the HealthTalk
Express program makes it simple to tap into the Extension volunteer workforce,
thus increasing reach and freeing up Agent time in their communities. Having premade, science-based, PowerPoint slides with
scripts and accompanying handouts requires minimal preparation. AgriLife’s Master
Wellness Volunteer program provides 40 hours of training to volunteers,
equipping them to assist Agents in teaching, distributing information, and
implementing programs (Texas A&M AgriLife Extension, n.d.a.). This training
includes delivery of the HealthTalk Express program. With the support of
MWVs, more presentations could be delivered in a given county. This would allow
Agents to spend more of their time addressing higher level solutions like
participating in community coalitions, developing important partnerships, and
contributing to key decisions (Holston et al., 2020). More and more, Extension leadership is recognizing the
role of Agents as community convenors and the importance of Extension having a
“seat at the table” in local decision-making (Buys & Rennekamp, 2020;
Strayer et al., 2020).
Limitations
of the Present Program
The HealthTalk Express program has the potential
to reach even more counties and participants. AgriLife Extension Agents have
autonomy in deciding which programs to implement in their counties, and only 43
counties (out of 250) are currently utilizing the program. Given the prevalence
of chronic diseases across the state, more efforts are being made to educate
Agents and to encourage them to consider delivering this easy-to-use program.
The current program measures knowledge and intention to take action immediately
after the program is delivered. A long-term follow-up is necessary to assess
retention of knowledge and maintenance of healthy behaviors.
Conclusion
With
continued development, HealthTalk Express stands as a promising and
scalable model for chronic disease prevention and partnership development
within the Cooperative Extension system.
Correspondence
should be addressed to
Debra K. Kellstedt
Family & Community
Health Unit, Texas A&M AgriLife Extension Service
2137 TAMU, College
Station, TX 77843-2137
Email: debra.kellstedt@ag.tamu.edu
Phone: 979-321-5007
Debra K. Kellstedt:0000-0002-3737-8627
Acknowledgements
The author would like to acknowledge staff
members in the AgriLife Extension Office of Data and Accountability, Treye Rice
and Wesley Faires, for their technical support in creating the HealthTalk Express
portal within the Howdy Health platform. The author also acknowledges the
developer of the original HealthTalk Express program, former Extension
Specialist, Ninfa Peña-Purcell.
Conflict of
interest statement
I have no conflicts of interest to
disclose.
Creative Commons License:
This work is licensed under a Creative Commons
Attribution-Noncommercial 4.0 International License (CC BY-NC 4.0).
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