People of Appalachian Heritage

Mixer, Sandra J; Fornehed, Mary Lou Clark

doi:10.1007/978-3-030-51399-3_8

Cited by 6 publications

(11 citation statements)

References 39 publications

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“…In addition, the findings of this study and previous literature suggest that videos may improve health literacy challenges. 9,13 Study findings indicated that the intervention was culturally and theologically acceptable to participants. Other studies also found the importance of tailoring interventions that reflect people's values and beliefs to promote health and improve access to health care.…”

Section: Discussionmentioning

confidence: 90%

“…The East Tennessee region of rural Appalachia has some of the most impoverished counties in the state of Tennessee 8 . Residents reflect rural Appalachian cultural values and beliefs of strong family and community ties, firm faith, hard work ethic, fierce pride, and independence 9 . Unfortunately, there is also limited access to health care, with many counties designated as medically underserved 10 and health provider shortage areas 11 .…”

mentioning

confidence: 99%

“…In the county where the community-academic partnership was formed, approximately one-fifth (22%) of residents live in poverty 8 compared with 14% in Tennessee 8 and 12% in the United States 12 . Low health literacy, limited education, and rural and mountainous geographic terrain further limit residents' access to PEOLC services 1,2,9 . This article presents a community-academic partnership formed to address these PEOLC needs, intervention and evaluation tool development, and feasibility and cultural acceptability results.…”

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confidence: 99%

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Community-Academic Partnership

Mixer,

Smith,

Brown

et al. 2024

J Hosp Palliat Nurs

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Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-of-life care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility.

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Section: Discussionmentioning

confidence: 90%

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confidence: 99%

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confidence: 99%

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Community-Academic Partnership

Mixer,

Smith,

Brown

et al. 2024

J Hosp Palliat Nurs

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“…Many have a long-term relationship with their patients, especially among those with terminal illness. These physicians are typically trusted members of the community, who in many cases may be seen as a trusted friend 32,33 . These relationships may explain why rural Appalachian children more frequently visited their physician versus urban children.…”

Section: Discussionmentioning

confidence: 99%

“…These physicians are typically trusted members of the commu-nity, who in many cases may be seen as a trusted friend. 32,33 These relationships may explain why rural Appalachian children more frequently visited their physician versus urban children. Additional research exploring the relationship between the children, their family, and the primary care physician is needed.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Rural and Urban Appalachian Children in Hospice Care

Fornehed¹,

Svynarenko²,

Keim‐Malpass³

et al. 2022

Southern Medical Journal

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The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia.Methods: Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on the demographic, hospice, and clinical characteristics of children from Appalachia. Comparisons were calculated using Pearson χ 2 for proportions and the Student t test for means.Results: Less than half of the 1788 Appalachian children admitted to hospice care resided in rural areas (40%). Compared with children in urban areas of Appalachia, rural children were significantly younger (8 years vs 9.5 years) and more often had a complex chronic condition (56.0% vs 35.1%) and comorbidities (38.5% vs 17.0%) with technology dependence (32.6% vs 17.0%). Children in rural Appalachian were commonly from communities in the southern region of Appalachia (27.9% vs <10.0%), with median household incomes <$50,000/year (96.7% vs 22.4%). Significant differences were present in clinical care between rural and urban Appalachian children. Rural children had longer lengths of stay in hospice care (38 days vs 11 days) and were less likely to use the emergency department during hospice admission (19.0% vs 43.0%). These children more often visited their primary care provider (49.9% vs 31.3%) and sought care for symptoms from nonhospice providers (18.1% vs 10.0%) while admitted to hospice. Conclusions:Our results suggest that children admitted to hospice care in rural versus urban Appalachia have distinct characteristics. Rural children are admitted to hospice care with significant medical complexities and reside in areas of poverty. Hospice care for rural children suggests a continuity of care with longer hospice stays and fewer transitions to the emergency department; however, the potential for care fragmentation is present, with frequent visits to primary care and nonhospice providers for symptom management. Understanding the unique characteristics of children in Appalachia may be essential for advancing knowledge and care for these children at the end of life. Future research examining geographic variation in hospice care in Appalachia is warranted.

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