Appalachia still lags behind the rest of the U.S. on economic and social indicators. Long-term poverty and its associated stresses continue to threaten the health of the people of this region. Residents of Appalachia, though not traditionally thought of as a minority group, experience health disparities equal to those of other minorities. Further, many communities are identified by the US Department of Health and Human Services as “health professional shortage areas” and “medically underserved areas,” designations that illustrate residents’ frequent inability to obtain healthcare in a timely manner.
Diabetes-related problems may be of even greater concern in the Appalachian region than was previously estimated. In 2003, researchers at Ohio University’s Appalachian Rural Health Institute used a random modified Behavioral Risk Factor Surveillance Survey (BRFSS) to identify rates of diabetes and co-morbid conditions in four southeast Appalachian Ohio counties. In this survey, 8.3% of the total sample reported a current diagnosis of diabetes. A similarly designed 2006 follow-up study of seven additional Appalachian Ohio counties found an 11.3% prevalence rate, a rate higher than the 2004 BRFSS national rate of 7.2% and state of Ohio rate of 7.5% rates, rates that are likely under-estimations. This predominately Caucasian Appalachian population has risks and disease incidence similar to other at-risk minority groups, such as African Americans, Native Americans, and Hispanics. Reports from the studies conducted at Ohio University can be viewed at http://www.oucom.ohiou.edu/arhi/research.htm.
Some research says that diabetes rates in the southeast part of the nation and in the Appalachian region are also high. These areas also have higher risks for many chronic diseases, including heart disease and stroke. In the spring of 2008, Dr. Ann Albright, director of the CDC Division of Diabetes Translation, said, “These data are an important step in identifying the places in a state that have the greatest number of people affected by diabetes. If states know which communities or areas have more people with diabetes, they can use that information to target their efforts or tailor them to meet the needs of specific communities.”
An environmental scan of diabetes was completed in the Appalachian region during the winter and spring of 2006 to better understand the problem of diabetes in the region. The main purposes for the scan were to obtain more understanding about the problem of diabetes in the region and adequacy of health care providers and diabetes educators available. Findings indicated that few endocrinologists, diabetologists, or certified diabetes educators are available to meet population needs in the Appalachian region. See the two reports posted on the front page of this website Diabetes Care: Provider Disparities in the Appalachian Region (Denham, Wood, & Remsberg) and Diabetes education in the Appalachian region: Providers’ views (Denham, Remsberg, & Wood).
Additionally, two qualitative studies were completed to learn more about cultural concerns related to diabetes management of families living in Appalachia. One study about 13 Appalachian Ohio families examined the dietary routines, diabetes related family diabetes management routines, and forms of family support (Denham, Manoogian, & Schuster, 2007). A second study examined a different group of 14 Appalachian families living with diabetes to better understand the problems encountered in daily life (Denham & Manoogian, unpublished).
While local physicians are often frustrated by “no shows” or poor consumer adherence, research shows that groups burdened by health disparities are often dissatisfied with physician-consumer communications. Consumers lack opportunities to participate in their care, obtain answers to care management questions, or identify ways outside of the medical establishment to clarify prevention or care management needs. Lack of medical insurance to cover costs and high-out-of-pocket costs often limits access to diabetes education at initial diagnosis and over time.
Diabetes is a disease that requires daily vigilance and regimens for therapeutic self-management. However, research shows that traditional education methods have not significantly improved self-management. Those with low health literacy are more likely to make medication and treatment errors, and less likely to comply with prescribed medical regimens, schedule appointments, or negotiate complex health care systems than those who are health literate. Cultural beliefs and practices impact health practices as well as the prevention and management of disease. Health messages need to appeal to the targeted population. Presently, materials specifically crafted for persons in the Appalachian region related to diabetes are not available.