Title : Responding to extreme heat and poor air quality in community health centers: Perspectives from staff and patients
Abstract:
Context: Extreme heat and poor air quality events are increasing in frequency and severity and pose significant health risks. Patients served by community health centers (CHCs) experience these weather exposures disproportionately due to adverse contextual drivers of health. CHCs have a crucial role in alleviating the health impacts of extreme heat and air quality events but lack evidence of effective interventions to implement.
Objective: To explore how extreme heat and poor air quality impact CHC staff and patients and to describe current CHC and community responses.
Study Design and Analysis: Qualitative study using semi-structured interviews, patient focus groups, and direct observation, analyzed thematically.
Setting: CHCs in a multi-state U.S. collaborative sharing a common electronic health record system.
Population Studied: CHC providers, staff, and patients.
Intervention/Instrument: Observation of CHC operations; interviews with CHC providers and staff; focus group with CHC patients.
Outcome Measures: Thematic outcomes characterized patient experiences, CHC responses, and care processes related to extreme heat and poor air quality.
Results: Patients reported health impacts from extreme heat and poor air quality, most commonly asthma exacerbations and diabetes management challenges. Many clinic staff had limited experience addressing weather-related health impacts directly, though those working with highly affected populations-such as patients with asthma or those experiencing homelessness-reported greater involvement. CHCs lacked formal weather-specific programs but provided indirect support through contextual needs screening and resource navigation and targeted support for high-risk patients, including education and medication adjustments. Partnerships primarily involved community-based organizations addressing contextual drivers and local coalitions focused on emergency preparedness and weather exposure planning.
Conclusions: Findings will be integrated with advisory committee input, stakeholder interviews, and quantitative analyses of extreme heat, poor air quality, and EHR data to identify promising CHC-led interventions. This evidence will inform intervention selection, design, and prioritization in future primary care-based efforts to alleviate the impacts of extreme weather.
