Health wellness in rural and medically underserved areas
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Health & Wellness in Rural and Medically Underserved Areas. Mona M. Counts, PhD, CRNP,FANP, FAANP. Emeritus Penn State University Past President American Academy of Nurse Practitioners. RURAL Folk Culture.

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Health & Wellness in Rural and Medically Underserved Areas

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Health & Wellness in Rural and Medically Underserved Areas

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


Penn State University

Past President

American 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 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


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.


Cultural CompetentCare



General Ethnographic Nursing Evaluation Studies in the State

Target Population Research

Findings forPractice

  • Perceived needs

  • “POWER”

  • Resources

  • Community Organizations

  • Barriers







Appalachian Characteristics

Appalachian Characteristics

  • Self (We’ness)

  • Time

  • Commitment

  • View of Health

Strengths, Barriers & Needs




Strengths --- Barriers



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)


  • Neighboring

  • Dichotomies

  • Health

  • Empowerment

  • Resolution

  • Hope

NPsYour PartnersforHEALTH

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


How to achieve in rural Communities

  • Integral part of community (providers and board)

  • Life long resident (family ties or proven commitment)

  • Female (in Appalachia)


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


  • Teen Pregnancy

  • Hgb A1c

  • Hypertension Goal

  • Lipid Control

  • Weight Loss

  • Tobacco Use

  • Asthma and Lead Reduction

  • Health Screenings (Health Promotion)


  • 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


IMAGES of Appalachia







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