Question

Literature Review on Health Issues in Rural America

Answer 1

• For more than 25 years, researchers have suggested that rural populations may have a distinct view of health that differs from other non-rural populations. Seminal research in 1987 by Weinert and Long reported that rural people predominantly associated health with “the ability to work”, but were less likely to regard cosmetic, comfort, or life-prolonging aspects of health as important. In subsequent work, Weinert and Burman concluded that the rural “function-based definition of health” may contribute to delays in seeking health care, even in the face of grave illness. In a study of the health beliefs of rural elders, Davis et al. found that subjects described health in terms of autonomy and self-reliance; they feared loss of health primarily because it could lead to “being a burden to others.
• The review process identified 34 articles as having fulfilled the criterion of assessing how rural residents define health.
• In a focus group study by Gessert et al., rural responders were more likely to express greater willingness to accept ill health and even death as natural phenomena.
• Another study found that persons living in the most remote environments were more likely to hold highly stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to actually seek care.
• Thorson et al. found that rural elders were less likely than urban elders to turn to health care providers for issues they considered non-urgent, regardless of how long a particular symptom had been present.
• Hoyt et al. concluded that the agrarian ideology of self-reliance and rugged independence, coupled with a lessened sense of confidentiality and increased pressure to conform due to the smaller, more intimate nature of smaller rural environments, was not conducive to seeking mental health care, particularly for males.
• Another study of rural elderly in New Mexico reported that the common definition of health consisted of remaining autonomous and independent, avoiding contact with the health care system.
• The overarching objective of this review was to better understand rural definitions of health and how they might be applied in health education messaging and patient engagement/ activation strategies related to disease prevention and treatment.
• Rural populations tend to emphasize functional aspects of health, especially the preservation of the ability to work and to fulfill (traditional) social roles. Rural people tend to frame health in terms of independence and self-sufficiency, and to accept ill health with higher degrees of stoicism and seemingly more fatalism.
• Research on rural definitions of health is further complicated by continuously changing rural lifestyles and landscapes as demographics and economic emphases shift. Despite such challenges, however, further research on rural health beliefs and attitudes is critical as American healthcare reform legislation calls for broader, systems-based strategies to improve the public’s health. To better engage and activate rural patients in their own healthcare, a better understanding of the health beliefs of targeted rural populations is needed.