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Well-documented associations between lifestyle behaviors and disease outcomes necessitate evidence-based health promotion interventions. To enhance potential efficacy and effectiveness, interventionists increasingly respond to community priorities, employ comprehensive theoretical frameworks, invest heavily to ensure cultural fit, implement evidence-based programming, and deploy research gold standards. We describe a project that followed all of these recommended strategies, but did not achieve desired outcomes. This community-based participatory research (CBPR) energy balance (diet and physical activity) intervention, conducted in Appalachian Kentucky among 900+ residents, employed a wait list control cluster randomized design. We engaged faith institutions, took an intergenerational approach, and modified two existing evidence-based interventions to enhance cultural relevance. Despite these efforts, fruit and vegetable consumption and physical activity did not change from baseline to post-test or differed significantly between intervention and wait list control groups. Barriers to engaging in optimal energy balance focused more on motivation and attitude than on structural and material barriers. The complex interplay of psychosocial, structural, and physiological processes offers significant challenges to groups with entrenched health challenges.Despite following rigorous intervention standards, our diet and physical activity intervention conducted among 900+ rural Appalachian residents did not change behavior. We explore possible reasons for this lack of change.

Researchers, policymakers, and community members increasingly recognize the potential to leverage faith-based organizations (FBOs) to improve health. This commentary complements Leyva and colleagues' article on whether and how members of FBOs view such a role. The commentary draws on our 13+ years operating a faith-based and community-based research organization, Faith Moves Mountains, in the Appalachian context. Issues to be addressed in the further development of faith-based health promotion include sustainability; adherence to the evidence-based operations of interventions, training, and privacy and protection protocols; and understanding the changing landscape of American public life.

Colorectal cancer (CRC) is 1 of the leading causes of cancer-related deaths among residents of rural Appalachia. Rates of guideline-consistent CRC screening in Appalachian Kentucky are suboptimal.

Purpose. Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians.Design. Eight focus groups and seven group key informant interviews were conducted.Setting. This study was conducted in eastern Kentucky, in central Appalachia.Subjects. One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated.Measures. Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked.Analysis. Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%.Results. In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agriculture's Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities.Conclusions. When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.

In this article, we explore the flexible configuration of a local knowledge system about hypertension symptoms, foregrounding it against prevailing biomedical assertions regarding the asymptomatic or "silent" nature of hypertension. The complex and coherent knowledge system held by older African Americans living in a southern, rural community stands in contrast to the current scientific discourse and local biomedical perspectives on hypertension symptomatology. The older African American participants in this study apply local knowledge of hypertension symptomatology to make health decisions nearly every day. Despite this, most biomedical practitioners maintain a distance from these lay sources of knowledge, often remaining stalwart in their refusal to recognize the existence or influence of symptoms. We conclude that authoritative knowledge ultimately lies in the minds and bodies of the elders, who have encountered symptoms as guideposts that direct action, rather than with a biomedical "reality" that is yet unresolved, [hypertension, knowledge, symptomatology, treatment decision–making, African Americans]

ABSTRACT: The Kentucky Homeplace Project (KHP) is a state‐legislated program designed to address well‐documented deficits in the health status of and health resources available to many of Kentucky's rural residents. Since its inception in 1994, the KHP has served approximately 80,000 clients, primarily through home visits by trained, locally residing paraprofes‐sionals known as family health care advisers. These family health care advisers employ culturally appropriate strategies to meet immediate needs as well as to foster long‐term client empowerment and the adoption of health prevention strategies. This descriptive examination of KHP provides information regarding (a) the advantages of the program, with specific attention to its orientation toward provision of culturally appropriate health services; (b) the disadvantages of KHP, including competing budgetary priorities and its vulnerability to local economic and political trends; and (c) the potential application of similar programs for other rural, difficult‐to‐reach populations.

In the United States, the increasing life expectancy and burgeoning older population have raised concerns about the adequate provision of health care for chronic medical conditions. One fundamental factor in the prevention and management of medical conditions is optimal dietary intake, which is notably lacking among older adults. Most researchers investigating factors associated with suboptimal diets limit their studies to developing nutritional risk profiles, and many conclude by advocating patient education. Using telephone surveys and in-depth interviews, this article identifies particularly vulnerable elders and explores the contextual and experiential pathways that place individuals at nutritional risk. Surveys of African American and white elders indicate that rural African American elders are disproportionately at risk of inadequate nutrition. In-depth interviews revealed four pathways to nutritional risk, including transitions in the social and physical significance of food, inaccessibility of resources, increased physical limitations, and inadequate or inappropriate dietary advice. Informants also identified a number of creative approaches to ensure a modicum of food security, including relying on supportive others, purchasing and preparation strategies, and hoarding. The article concludes by offering recommendations for improving nutritional status among elders that extend beyond the development of risk profiles and nutritional education.

Background Access to cognitive screening in rural underserved communities is limited and was further diminished during the COVID-19 pandemic. We examined whether a telephone-based cognitive screening intervention would be effective in increasing ADRD knowledge, detecting the need for further cognitive evaluation, and making and tracking the results of referrals.Method Using a dependent t-test design, older, largely African American and Afro-Caribbean participants completed a brief educational intervention, pre/post AD knowledge measure, and cognitive screening.Results Sixty of 85 eligible individuals consented. Seventy-percent of the sample self-reported as African American, Haitian Creole, or Hispanic, and 75% were female, with an average age of 70. AD knowledge pre-post scores improved significantly (t(49) = −3.4, p< .001). Of the 11 referred after positive cognitive screening, 72% completed follow-up with their provider. Five were newly diagnosed with dementia. Three reported no change in diagnosis or treatment. Ninety-percent consented to enrolling in a registry for future research.Conclusion Remote engagement is feasible for recruiting, educating, and conducting cognitive screening with rural older adults during a pandemic.

This study assessed the influence of health beliefs on prescribed dietary behaviors in chronic hypertension management among forty-one rural Southern African-Americans age 65+. Despite the overwhelming prevalence of hypertension-related morbidity and mortality, research efforts to determine what accounts for decisions to follow physician’s recommendations have been fragmented, interventions inappropriate, and adherence to these recommendations reportedly limited. Adherence was evaluated through a 24-hour dietary recall, food frequency, and physician’s consultation. Health beliefs were assessed through various structured questionnaires and unstructured interviews. Results indicate that the influence of health beliefs on the decision to follow treatment recommendations is complex, as study members tend to maintain both “traditional” and biomedical health orientations and practices. The author concludes by making substantive recommendations to researchers, providers and planners designed to improve health outcomes.

African American women have a disproportionate risk of diabetes-related morbidity and mortality. Despite this risk, evidence indicates that educational interventions are not aimed at this population. We also currently lack basic information about the source of diabetes information for African American women and how such sources might affect their knowledge of the disease. We interviewed 51 women with diabetes to address such deficits in our understanding and, conceivably, to contribute culturally sensitive recommendations to enhance glucose control. To detect ethnic variations in knowledge and information source, half of our selected sample was African American and half was white. Results indicate that African American respondents achieved lower scores on the Diabetes Knowledge Test than their white counterparts. However, few differences were noted in the source of diabetes information, with both groups receiving their information from a wide variety of sources. Implications for health providers and educators are discussed.

The purpose of this research was to examine the association between community context (rural versus urban residence) and the reasons older adults (65+) decide to enter a nursing home. Personal interviews were conducted using open-ended questions with a sample of new admissions, or their proxies, in nine rural and nine urban nursing homes (N = 113). Responses were subjected to content analysis, which identified five categories of reasons that we labeled as: (1) Experiencing Sudden Events: some elders described a sudden unexpected event (such as a fall or serious illness) that caused them to be unable to continue to live in a community setting; (2) Changing Family Circumstances: some elders described family changes that reduced family members' capacity to meet their needs ; (3) Needing Skilled Care; some elders reported an increased need for skilled health care providers, like nurses and rehabilitative therapists; (4) Receiving Pressure from Others: some elders reported being "told to" enter a nursing home by a "significant other;" and (5) Living in Fear: some elders expressed apprehension about continuing to live in their community. Residential differences emerged in the frequency with which specific reasons were cited for nursing home admissions. These findings improve our understanding of the reasons for entering a nursing home described by older adults, highlighting the influence of residence .

Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings.Data Source: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia.Study Inclusion and Exclusion Criteria: Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings.Data Extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest.Data Synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework.Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels.Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.

BackgroundThe purpose of this study was to learn community members’ perspectives about digital storytelling after viewing a digital story created by a Community Health Aide/Practitioner (CHA/P).MethodsUsing a qualitative research design, we explored digital storytelling likeability as a health-messaging tool, health information viewers reported learning and, if viewing, cancer-related digital stories facilitated increased comfort in talking about cancer. In addition, we enquired if the digital stories affected how viewers felt about cancer, as well as if viewing the digital stories resulted in health behaviour change or intent to change health behaviour.FindingsA total of 15 adult community members participated in a 30–45 minute interview, 1–5 months post-viewing of a CHA/P digital story. The majority (13) of viewers interviewed were female, all were Alaska Native and they ranged in age from 25 to 54 years with the average age being 40 years. Due to the small size of communities, which ranged in population from 160 to 2,639 people, all viewers knew the story creator or knew of the story creator. Viewers reported digital stories as an acceptable, emotionally engaging way to increase their cancer awareness and begin conversations. These conversations often served as a springboard for reflection, insight, and cancer-prevention and risk-reduction activities.