All communities need to be engaged in their health and wellbeing, and all communities define health and wellbeing in different ways. In this post, we speak specifically to health engagement in Appalachian communities, though the lessons from this post are relevant to all.Appalachian communities are incredibly diverse in terms of socio-economic status, educational attainment, race, language practices, and health status. And yet…
“Individuals living in rural areas have traditionally been underserved with regard to health care access. The reasons for this are multiple and varied, but mainly stem from the need to travel long distances to health care facilities, lack of health insurance, lack of specialized care and an inadequate number of health care providers working in rural areas.” VHA Office of Rural Health
Listen to the emphasis on distance in the above quote. Health in Appalachia, especially within its most rural areas, is greatly impacted by physical separation from resources. According to Appalachian health experts, the underlying cause of poor health outcomes in Appalachian is “the general absence of community-linked and community-responsive systems of health care across the region” (Ch. 4 of Appalachian Health and Wellbeing by Joel A. Halverson, Gilbert H. Friedell, Eleanor Sue Cantrell, and Bruce A. Behringer).
Beyond distance alone, the communication efforts between health professionals, health systems, patients and populations with low health literacy in Appalachia is inadequate. Educational and literacy differences create challenges, since many mountain communities are served by health professionals from outside the region, often international medical school graduates. The use of medical terminology for those with limited health literacy often affects communication, whether the providers are from Appalachia or from foreign countries. Providers’ understanding and acceptance of local behaviors and preferences also affect the delivery and acceptance of health care by Appalachian communities.
How to Improve Appalachia’s Health Disparities
The effective resolution of Appalachia’s health disparities should be based on four propositions (from Ch. 4 of Appalachian Health and Wellbeing):
- Integration between local communities and health services and systems;
- Collaboration between schools, businesses, civic organizations, religious communities, government entities, health professionals, and the media to view health as a shared responsibility;
- Community Action, including efforts to communicate and connect people on issues of health; and
- Attention to Local Conditions, including using local assets to link individuals, communities, and health services and systems to address local health disparities.
Overall, the experts agree that, “The recipe for success lies in community engagement in defining a ‘healthy community’ and determining the level of health care availability and quality.”
How to Engage Appalachian Communities in Health and Wellbeing
Engaging communities in health and wellbeing starts from the ground-up—listening to community voices and catalyzing community-based conversations around health is key to improving health literacy among communities and generating greater awareness of the community’s perspectives on health among providers.
One key method for increasing engagement is community-based participatory research (CBPR). Here are some key strategies for using CBPR to engage Appalachian communities in health and wellbeing:
- Create culturally relevant materials: Cincinnati’s urban Appalachian neighborhoods have created comic books for kids and booklets for adults about healthy eating. The visual nature of these books appeals to a broad range of readers and literacy levels.
- Host events in community centers, churches, & kitchens: In Lower Price Hill, an urban Appalachian neighborhood in Cincinnati, Ohio, we hosted Zumba workshops and diabetes story circles in local churches to meet communities where they live.
- Use verbal, visual, and aural methods: We’ve seen amazing results with the use of story circles and group poems, where community members talk together and express themselves verbally before engaging in writing.
- Inspire community residents to create studies, surveys, initiatives, & media themselves: An amazing example is the Hollow Project, an online documentary composed of videos, images, and text created by residents in a small county in Appalachia. The amount of community conversation and participation inspired by this project was astounding, and an excellent example of how communities are empowered by participatory research.
Appalachian health issues are best addressed with full community participation. Communities want to play an active part in creating health initiatives, surveys, media & materials. Listen deeply to the stories from our communities. Engage us in the creation of materials. Meet us where we live, work, worship, play, and socialize.
Recommended Readings on Appalachian Health and Well-Being
- Health. Appalachian Bibliography. WVU. https://lib.wvu.edu/collections/bibliography/health/
- Health. Appalachian Regional Commission. http://www.arc.gov/health
- Hollow: An Interactive Documentary. http://hollowdocumentary.com/.
- Keefe, Susan E. Appalachian Cultural Competency: A Guide for Medical, Mental Health, and Social Service Professionals. Knoxville, TN: Univ. Tennessee Press, 2005. http://www.amazon.com/Appalachian-Cultural-Competency-Medical-Professionals/dp/1572333332
- Ludke, Robert and Phillip J. Obermiller, Eds. Appalachian Health and Well-Being. Lexington, KY: UP of Kentucky, 2012. http://www.kentuckypress.com/live/title_detail.php?titleid=2822#.VWivGtNViko
- Welch, Wendy, Ed. Public Health in Appalachia: Essays from the Clinic and the Field. Jefferson, NC: McFarland & Company, Inc., 2014. https://library.ohio.gov/books/public-health-in-appalachia-essays-from-the-clinic-and-the-field/