Engaging Rural Appalachia in a Community Needs Assessment

Theoretical Background and research questions/hypothesis:  Garrett County Maryland is part of rural Appalachia. Similar to other Appalachian counties, there is higher than average poverty, social and physical isolation, and literacy issues among its citizens. Additionally, it has been designated as a Health Professional Shortage Area (HPSA) and Medically Underserved (MUA) with high levels of uninsured and medically assisted populations.  Distrust toward outsiders and resistance to change further hinders both public health and medical professionals to work with the population.  

Methods:  To facilitate change, the local Health Planning Council sought to understand health problems and develop a comprehensive approach to create a culture of health. The effort, branded “Healthy Mountain Maryland", aimed to engage residents into a mixed methods approach to conduct a county wide health needs assessment. The CDC CHANGE tool was used as it allows for multiple forms of data collection and creates a sense of inclusion amongst participants.  While numerous data collection methods were used, the focus of this presentation is the community survey and focus group portion. The survey and focus group instruments were guided by the CDC CHANGE tool. The web-based survey was developed and piloted with the Health Planning Council and housed on the new community website. Questions centered on two levels: individual and community health within the tool’s five sectors.  The focus groups were designed to ensure sub-populations all had a voice in the process.  These included: low-resource families, first responders, school counselors, the faith community and local community leaders. Both passive and active recruitment methods were used including: social media campaigns, word-of-mouth, active recruiting stations throughout the local community, email blasts and the Healthy Mountain Maryland community website. Building trust and identifying champions helped make the data collection possible. 

Results:  The survey and focus groups reached slightly under 1,000 people in the county. The surveys took approximately 20-25 minutes to complete, while the focus groups averaged one hour and forty-five minutes.  Results indicate the people were most likely concerned about drug abuse, physical activity and nutrition habits.  With physical activity and nutrition, people indicated a desire to engage in healthy behaviors but cited money, time and transportation as the main barriers to action.  For drug and alcohol abuse, most respondents felt that drug activity was fairly common throughout the county.  Reasons cited for not seeking treatment included people not wanting help, fear or shame and lack of resources.   Victim-blaming and a fear of outsiders were often voiced as reasons why drug and alcohol abuse was growing in the County. 

Conclusions:  Based on these findings, we concluded coordinated programs, organizational policies and a systems approach needed to be employed.  These included recommendations for basic skill development classes, existing organizations offer discounted programs for low-income audiences, the creation of a community bus or other transportation and PR campaigns to reduce stigma around addiction issues. 

Implications for research and/or practice: Implications include examining the cultural divide between the haves and have-nots, examination of best-practices for social media campaigns in rural, low-resource communities and strategies to promote healthy behaviors in Appalachian communities.