Understanding Appalchian Culture to Improve Health Outcomes

I have always had a deep love for the Appalachian region. Little did I know when I took an Introduction to Appalachia Course to meet a general education requirement for a Bachelor of Science degree in Nursing, that my life would turn completely upside down! This course covered the history, culture, and current events in the Appalachian region. It opened my eyes the importance of understanding Appalachian culture in order to improve  the outcomes of health and human services to  people in Appalachia.

Introduction to Appalachia Course

One week in the Introduction to Appalachia course, our discussion focused on healthcare in Appalachia. This discussion really opened my eyes to the tremendous needs in health and healthcare in the Appalachian region.  What came as an epiphany moment for me was a story by Anne Blakeney in our text, A Handbook to Appalachia: An Introduction to the Region.

“I Don’t Care To”

Anne Blakeney, a retired occupational therapy professor from Eastern Kentucky University, related a story about a young physical therapist (PT) who was not from the Appalachian region and was working in a hospital in Appalachia. The PT approached a post-op patient to assist with her exercises. She introduced herself to the patient and asked the patient if she was ready to do her exercises. The patient calmly replied, “I don’t care to!” The physical therapist was shocked and a little lost for words. She left the patient’s room, shaking her head. The following two days, she returned to instruct the patient in her post-op exercises and heard the same response, “I don’t care to.” This young therapist was very confused and couldn’t figure out why the patient was refusing to do the exercises. The physical therapist discharged the patient and wrote in the patient’s chart that the patient was unwilling to do her exercises.

An Epiphany

Several weeks later this young physical therapist was involved in a conversation with a more experienced physical therapist, when suddenly, a light turned on for the young therapist. She realized that it is very common for people from Appalachia to answer, “I don’t care to” in response to a request and mean, “Sure that is fine with me!”  For most people who are not from Appalachia, this is very surprising. Immediately after reading this, my life turned upside down! I realized how important it would be for health and human service providers to learn about the cultural values and beliefs and communication styles of the people to whom they are providing care.  I decided to continue my education and pursue a master’s degree in Appalachian Studies. My intent was to develop cultural competency workshops for health and human service providers in the South-Central Appalachian region.

Research Into Improving Health and Healthcare in Appalachia

While pursuing a master’s degree in Appalachian Studies at Appalachian State University, my research focused on how to improve health and healthcare in the Appalachian region. I read a tremendous number of books and research articles on Appalachian history, politics, culture, religion, music, and many other topics pertaining to Appalachia.  I not only spent time studying all my Appalachian Studies courses, but I also read as much as I could about cultural competency in the nursing literature. While conducting this research, I discovered the Transcultural Nursing Society (TCNS). The TCNS was started by the first nurse who studied nursing and anthropology. Much of what we know about cultural competency in health care we owe to Madeleine Leininger. In the 1960’s, Madeleine Leininger began to grow increasingly frustrated by the poor outcomes that were being obtained in providing mental health services to children. She began to question if nurses took into account the cultural backgrounds of each individual child, would it make a difference in the outcomes of their nursing care. Madeleine Leininger’s research led her to obtain a PhD in Anthropology. She developed the first Culture Care Theory. It has been used by many different health disciplines and many nurses who continue to do much research into providing culturally competent care.

Appalachian Healthcare Training and Consulting

I have developed workshops for health and human service providers in the South-Central Appalachian region in order to help improve their understanding of the rural Appalachian population. Appalachian Healthcare Training & Consulting is available to provide consultation and custom-tailored presentations for you and your agency.

No One Else Labeled Non-Compliant or Non-Adherent

My hope is that as health and human service providers learn more about the history, culture, values, and communication issues of the rural, native Appalachian population, communication will improve between provider and patient/client and no one else will be labeled as non-adherent and discharged from needed services simply because of a misunderstanding in communication.

Please come visit my blogs often as I talk not only about health and healthcare, but about all things Appalachian- culture, history, music, food, and many other things.