Health & Wellness in Rural and Medically Underserved Areas

1. Health & Wellness in Rural and Medically Underserved Areas

2. Mona M. Counts, PhD, CRNP,FANP, FAANP Emeritus Penn State University Past President American Academy of Nurse Practitioners

3. 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.

4. 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

5. Healthy Partneringfor Rural Health Care • Culturally Competent Care • Community Empowerment • Partners and Coalitions • Technology • Future “best practices”

6. Rural Areas • Agricultural character • Characterized by an economy based on • Logging • Mining • Petroleum • Natural gas • Tourism

7. 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.

8. 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

9. 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

10. Cultural CompetentCare APPALACHIANPATTERNS GENESIS III General Ethnographic Nursing Evaluation Studies in the State Target Population Research

11. Findings forPractice • Perceived needs • “POWER” • Resources • Community Organizations • Barriers

12. Hardiness Family Continuity Acceptance Spiritual Age Appalachian Characteristics

13. Appalachian Characteristics • Self (We’ness) • Time • Commitment • View of Health

14. Strengths, Barriers & Needs ECONOMICS Employment Industry

15. Strengths --- Barriers & Needs

16. Rural Family Health Patterns

17. Community-Based Research • Barriers • Small populations • Isolated settings • History of past experience with researchers • Education (no middle)

18. 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)

20. APPALACHIANOUTCOMES • Neighboring • Dichotomies • Health • Empowerment • Resolution • Hope

21. NPsYour PartnersforHEALTH

22. Community Empowerment Findings for practice • Value of Family and roots • No insurance or underinsured • Lack of confidence in large centers

23. Community Empowerment Findings for practice • Limited economic resources • Significance of culturally specific care • Consistency and continuity of care desired

24. IMPLICATIONSforPractice How to achieve in rural Communities • Integral part of community (providers and board) • Life long resident (family ties or proven commitment) • Female (in Appalachia)

25. IMPLICATIONSforPractice How to achieve in rural Communities • Low key (accessing power) • Caring (Professional Involvement) • Perceived as knowledgeable (University)

26. Potential Coalitions • Technology • Integration • Access • Development • Quality • Best Practice • Improved Living

27. Primary Care Center of Mt Morris • 6000 Patients • Community Owned • 4 Nurse Practitioners • 7 Personnel • Student Rotations • Partnerships

28. 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

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

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

31. Source of Revenue • Insurance • Medicaid • Medicare • No Insurance • Grants • Other

32. FUTURE

33. IMAGES of Appalachia

34. APPALACHIA

35. APPALACHIA

36. ENVIRONMENT

37. Climate

38. HOME

41. APPALACHIA