Health & Wellness in Rural and Medically Underserved Areas

Mona M. Counts, PhD, CRNP,FANP, FAANP

EmeritusPenn State University

Past PresidentAmerican Academy of Nurse

Practitioners

RURALFolk Culture

Folk culture refers to the localized lifestyle of a subsistence or otherwise inward looking culture. It is usually handed down through oral tradition and a strong sense of community, and values the "old ways" over novelty. Finally, folk culture is quite often imbued with a sense of place. If its elements are copied by, or removed to, a foreign locale, they will still carry strong connotations of their original place of creation.

Rural

Rural areas (also referred to as "the country", countryside) are sparsely settled places away from the influence of large cities. Such areas are distinct from more intensively settled urban and suburban areas, and also from unsettled lands such as outback, American Old West or wilderness. Inhabitants live in villages, hamlets, on farms and in other isolated houses

Wikipedia

Healthy Partneringfor

Rural Health Care Culturally Competent Care Community Empowerment Partners and Coalitions Technology Future “best practices”

Rural Areas

Agricultural character Characterized by an economy

based on– Logging– Mining– Petroleum– Natural gas– Tourism

Lifestyles in Rural Areas Lifestyles in rural areas are different Limited services, especially public services,

are available. Governmental services:

– Police– Schools– Fire stations– Libraries

Utilities:– Water– Sewerage– Street lighting– Waste managment.

Public Transport.

Rural Health

Rural health is the interdisciplinary study of health and health care delivery in the context of a rural environment or location

Population Density Geographic Location HPSA MUA

Rural Sterotype

Redneck, in modern usage, predominantly refers to a particular stereotype of people who may be found in many regions of the United States or Canada. Originally limited to the Appalachians and the American South, and later the Ozarks and Rocky Mountains, this stereotype is now widespread in other states and the Canadian provinces. The word can be used either as a pejorative or as a matter of pride.

Wikipedia

Cultural CompetentCare

APPALACHIANPATTERNS

GENESIS III

General Ethnographic Nursing Evaluation Studies in

the StateTarget Population Research

Findings for

Practice

Perceived needs “POWER” Resources Community Organizations Barriers

Appalachian Characteristics

• Hardiness

• Family

• Continuity

• Acceptance

• Spiritual

• Age

Appalachian Characteristics

• Self (We’ness)

• Time• Commitment• View of Health

ECONOMICS

Industry

Strengths, Barriers & Needs

Employment

Strengths --- Barriers&

Needs

Rural Family Health Patterns

Community-Based Research

Barriers– Small populations– Isolated settings– History of past experience with

researchers– Education (no middle)

Community-Based Research

Strategies for Success– Work within the context of the culture– Integrate “insiders” into all phases of

project (Planning, Implementation, Evaluation)

– Keep open to improving the model based on outcomes (quality improvement goals vs. end-point evaluation)

APPALACHIANOUTCOMES

Neighboring Dichotomies Health Empowerment Resolution Hope

NPs

Your Partnersfor

HEALTH

Community Empowerment

Findings for practice

• Value of Family and roots

• No insurance or underinsured

• Lack of confidence in large centers

Community Empowerment

Findings for practice

• Limited economic resources

• Significance of culturally specific care

• Consistency and continuity of care desired

IMPLICATIONSfor

Practice

How to achieve in rural Communities

• Integral part of community (providers and board)

• Life long resident (family ties or proven commitment)

• Female (in Appalachia)

IMPLICATIONSfor

Practice

How to achieve in rural Communities

Low key (accessing power)

• Caring (Professional Involvement)

• Perceived as knowledgeable (University)

Potential Coalitions

Technology Integration Access Development Quality Best Practice Improved Living

Primary Care Center of Mt Morris

6000 Patients Community Owned 4 Nurse Practitioners 7 Personnel Student Rotations Partnerships

Target Population Focus

Prevention of Diabetes in High Risk Rural Families– Translation of research evidence -

application in rural primary care– Design- Based on context of setting– Method- Culturally congruent– Outcomes Selection- measure health

lifestyle improvements

Outcomes

Teen Pregnancy Hgb A1c Hypertension Goal Lipid Control Weight Loss Tobacco Use Asthma and Lead Reduction Health Screenings (Health Promotion)

Outcomes

Increased Community Competence Skill Building (two edge sword) Awareness of opportunity Economic Additions Improved quality of life Adherence Facilitation of prescription

acquisition

Source of Revenue

Insurance Medicaid Medicare No Insurance Grants Other

FUTURE

IMAGES of Appalachia

APPALACHIA

APPALACHIA

ENVIRONMENT

Climate

HOME

APPALACHIA