Health Seeking Behaviors of Appalachian Culture Term Paper

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Health Seeking Behaviors of Appalachian Culture

An Analysis of Health Seeking Behaviors of Current Appalachian Culture

Because resources are by definition scarce it is important for health care providers to ensure that they are making the most of what is available to deliver the high quality care. Therefore, understanding the cultural aspects of health care seeking behaviors in a given region can help both practitioners and consumers alike improve the process and provide improved quality of care. Furthermore, clinicians who are culturally sensitive have been shown time and again to be more effective health care providers. In this regard, Koenig, Larson and McCullough (2001) emphasize that, "Because interest in caring for oneself is so strongly influenced by mental health and social support, anything that reduces depression, discouragement, and social isolation or increases hope, optimism, and social support will likely promote more appropriate health care-seeking behaviors" (p. 433). To this end, this paper provides a critical review of five recent journal articles concerning the cultural diversity that characterizes the region and the relevant health care seeking behaviors identified among people living in Appalachia. A summary of the research and salient findings will be provided in the conclusion.

Review and Analysis

By any measure, people with more money enjoy improved access to quality medical care. Therefore, the average income levels of the people in a given region of the country could reasonably be expected to play an important part in when and where they seek medical care, and to some degree even why they would seek out these services. Cultural diversity can also be either a direct or indirect reflection of income levels across the country and impoverished people of any culture without health care insurance are unlikely to use the same health care facilities as their more affluent counterparts, and the people of the Appalachian region have more than their fair share of poor people (Bauer & Growick, 2003). According a study by Lohri-Possey (2006), "Understanding the experiences of low-income Appalachians is needed to provide culturally sensitive care" (p. 214). In this regard, Baur and Growick (2003) report some startling statistics concerning the condition of health care in the Appalachian region today:

in 5 Appalachian children live in poverty ($14,630 or less a year for a family of three in 2001).

Over 28% of Appalachian children receive health care through Medicaid.

84% of the children enrolled in Medicaid live with working parents.

Almost 40,000 Appalachian children lack health insurance (1998).

7.6% of Appalachian children are born at low birth weight in 1999, up from 6.3% in 1990.

Nearly 30% of third graders in Appalachia either have not seen a dentist in the past year, or have never had a dental exam.

In one county in Appalachian Tennessee, more than one fifth of a county is disabled from work and a large number of children receive public funds because of their mental, emotional, and physical disabilities.

In one Appalachian County in Morgan, Ohio, sixteen children die per 1,000 births, compared to the national average of only 7.8 deaths per 1,000 births (Bauer & Growick, 2003).

Even though the United States does not have a comprehensive national health care insurance program in place, though, there are some resources available for those without other recourse. According to Giffords, Guercia, Kass, Weiss and Wenze (2005), "Free care is medical care provided by a hospital without the expectation of payment. Sometimes it includes discounted services for patients who are able to pay some of the cost of their care. In exchange for this service, nonprofit hospitals are classified as charities and receive millions of dollars in tax benefits" (p. 213). Many people in the Appalachians, though, may be reluctant to seek medical care at such "charity" facilities based on their cultural heritage that stresses independence, self-reliance, and a grudging acceptance of their condition. According to a study by Coyne, Demian-Popescu, and Friend (2006), "Social, cultural, and economic environments are associated with high rates of disease incidence and mortality in poor Appalachian regions of the United States" (p. 37). While a number of other historical studies has suggested that some features of Appalachian culture (e.g., fatalism, patriarchy) include those values and beliefs that may place Appalachians at increased risk for poor health, these authors also note that there are some cultural features that may provide protective elements as well (e.g., strong social ties) (Coyne et al., 2006). The authors concluded that, "Both men and women in the focus groups have a sense of place, strong family ties, and a strong spiritual belief or faith in God. Patriarchy as a cultural value was not a strong factor" (Coyne et al., 2006, p. 37). These authors, and the others reviewed herein, all emphasize the dearth of timely research in this area.

Throughout the country, studies have also shown time and again that age and ethnicity are also important indicators of what types of health seeking behaviors people will tend to pursue. For example, in 1999, 42.1 million non-elderly people were without health insurance in the United States; while there were more white, non-Hispanic people among the uninsured in terms of total numbers because they make up a greater percentage of the population, as a group they are also less likely to be uninsured. Likewise, among all Hispanic-Americans, 35% are uninsured; among non-Hispanic African-Americans, 22.8 are without insurance and almost one-third (32.8%) of Native Americans and Alaska Natives do not have any type of health insurance today (Giffords et al., 2005). Furthermore, among Asian/Pacific Islander Americans, the probability of being without health insurance is 22%. For white non-Hispanic adults this likelihood is 12.7% compared with 17.5% in the general population; the authors conclude that, "Racial and ethnic minority groups' lack of access to health services and barriers to the health system infrastructure and information result in consistent disparities in race and ethnic health statistics" (p. 213).

Ethnicity, then, is inextricably related to an individual culture, which has profound implications for the nursing profession throughout Appalachia. As Bauer and Growick (2003) point out, "Living in rural Appalachia has its minority features by virtue of geography, unemployment rates, lack of medical services, and limited economic growth" (p. 18). To gain a more comprehensive understanding of the term, Anguiano and Harrison (2002), advise that, "Family ethnicity is the sum total of a person's ancestry and cultural dimensions, as families collectively identify the core of their beings. In essence, family ethnicity has come to mean the interaction of all elements such as: language, traditions, customs and values that occur within ethnic family constellations" (p. 152). Therefore, even when people have health insurance or otherwise have free health care services available, powerful cultural factors may influence their decision as to when and where to seek out such services. For instance, a study by Jesse and Reed (2004) concerning health risk behaviors of pregnant Appalachian women found that increased levels of spirituality and lower levels of stress were associated with decreased health risk behaviors. "Increasing spiritual resources and decreasing stress during pregnancy offer the potential to improve health promotion efforts in pregnancy with women from Appalachia," the authors conclude (Jesse & Ray, 2004, p. 739).

According to Ray (1993), Appalachian culture is also a force to be reckoned with among the older residents in particular, and cites the case of one man who attempted to deal with life changes after the sudden death of his wife. "Cultural norms prevail, and later conflict, in both his choices of coping strategies and his ability to seek help before he becomes ill," Ray notes (p. xviii). A strong sense of independence and self-reliance characterizes the Appalachian culture as well that influences many people's decision as to when and where to seek out health care services. These issues emerged from a recent study of rural older Appalachian women's decision-making processes regarding use of, and experiences with, formal health care services. In this regard, Brown and May (2005) report that, "Nineteen rural Appalachian women living alone were interviewed using a semi-structured interview format. Interviews were then reviewed to identify patterns and themes. Decision making themes included: "anticipating possibilities," "doing what is needed," "listening to and valuing the views of others," and "seeing no other choice." Utilization themes were: "using on my own terms," "dealing with barriers," and "meeting a need" (p. 2). A number of the older women in this study reported that when they really needed medical care, whatever medication, physician, surgery, or therapy they employed tended to restore their health and functioning and allowed them to continue to live and function in their homes (Brown & May, 2005). The authors suggest that the results of this study emphasize the importance of such Appalachian cultural issues on the health seeking behaviors that can typically be expected from this segment of the population: "This study demonstrated that even when resources were available, cultural values, attitudes and beliefs, including mistrust of strangers, independence, pride, hardiness, loyalty, family-orientation and self-reliance were found to constitute significant barriers to use of services" (Brown & May,… [END OF PREVIEW]

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