0
No votes yet
Article
Open Access Article

The Mountains Hold Things In: The Use of Community Research Review Work Groups to Address Cancer Disparities in Appalachia

Sadie P. Hutson
Kelly A. Dorgan
Amber N. Phillips
Bruce Behringer
ONF 2007, 34(6), 1133-1139 DOI: 10.1188/07.ONF.1133-1139

Purpose/Objectives: To review regional findings about cancer disparities with grass roots community leaders in Appalachia and to identify perspectives about what makes the cancer experience unique in Appalachia.

Research Approach: A community-based participatory approach that includes focus-group methodology.

Setting: Work groups gathered in well-known community locations in northeastern Tennessee and southwestern Virginia.

Participants: 22 lay adult community members (12 in Tennessee and 10 in Virginia), all of whom had a personal and community interest in cancer and were reputed as informal community leaders.

Methodologic Approach: Work groups engaged in a series of five sequential sessions designed to (a) review regional data about cancer disparities and identify perspectives about what makes the cancer experience unique in Appalachia, (b) promote dialogue between the work group members and healthcare providers to identify methods for improved collaboration, and (c) integrate the work group with regional efforts of the states' comprehensive cancer control plans.

Findings: Four major themes emerged from the focus group sessions with each work group: cancer storytelling, cancer collectivism, healthcare challenges, and cancer expectations. The community research review work groups proved to be a successful method to disseminate information about regional cancer disparities.

Conclusions: Study findings provide a unique foundation so that healthcare providers and researchers can begin to address cancer disparities in the Appalachian region.

Interpretation: Nurses are in key positions to partner with trusted community leaders to address disparities across the cancer continuum in Appalachia.

References 

Anderson, C.M. (2004). The delivery of health care in faith-based organizations: Parish nurses as promoters of health. <i>Health Communication</i>, 16, 117-128.

Appalachian Regional Commission. (n.d.). Appalachian region: Economic overview. Retrieved July 13, 2006, from <a target="_blank" href='http://www.arc.gov/index.do?nodeId=26'>http://www.arc.gov/index.do?nodeI...

Appalachian Regional Commission. (2004). Cancer mortality in Appalachia. In <i>An analysis of disparities in health status and access to health care in the Appalachian region: An ARC report</i>. Retrieved February 8, 2005, from <a target="_blank" href='http://www.arc.gov/index.do?nodeId=2343&print=yes'>http://www.arc.gov/in...

Armstrong, L.R., Thompson, T., Hall, H.I., Coughlin, S.S., Steele, B., & Rogers, J.D. (2004). Colorectal carcinoma mortality among Appalachian men and women, 1969-1999. <i>Cancer</i>, 101, 2851-2858.

Behringer, B. (1994). Health care services in Appalachia. In R.A. Couto, N.K. Simpson, & G. Harris (Eds.), <i>Sowing seeds in the mountains: Communitybased coalitions for cancer prevention and control</i> (pp. 62-80). Washington, DC: National Institutes of Health and National Cancer Institute.

Behringer, B., & Friedell, G.H. (2006). Appalachia: Where place matters in health. <i>Preventing Chronic Disease</i>, 3, A113. Retrieved October 3, 2007, from <a target="_blank" href='http://www.cdc.gov/Pcd/issues/2006/oct/06_0067.htm'>http://www.cdc.gov/P...

Billings, D.B. (2006). Welfare and poverty. In R. Ambramson & J. Haskell (Eds.), <i>Encyclopedia of Appalachia</i> (pp. 236-237). Knoxville, TN: University of Tennessee Press.

Bluegrass Coalition for Cancer Screening & Kentucky Medical Association Cancer Committee. (2005). Colorectal cancer facts. <i>Journal of the Kentucky Medical Association</i>, 103, 118.

Brashers, D.E., Neidig, J.L., Haas, S.M., Dobbs, L.K., Cardillo, L.W., & Russell, J.A. (2000). Communication in the management of uncertainty: The case of persons living with HIV or AIDS. <i>Communication Monographs</i>, 67, 63-84.

Brashers, D.E., Neidig, J.L., & Goldsmith, D.J. (2004). Social support and the management of uncertainty for people living with HIV or AIDS. <i>Health Communication</i>, 16, 305-331.

Butterfoss, F.D., Goodman, R.M., & Wandersman, A. (1993). Community coalitions for prevention and health promotion. <i>Health Education Research</i>, 8, 315-330.

Coughlin, S.S., Costanza, M.E., Fernandez, M.E., Glanz, K., Lee, J.W., Smith, S.A., et al. (2006). CDC-funded intervention research aimed at promoting colorectal cancer screening in communities. <i>Cancer</i>, 107, 1196-1204.

Couto, R.A., Simpson, N.K., & Harris, G. (Eds.). (1994). <i>Sowing seeds in the mountains: Community-based coalitions for cancer prevention and control</i>. Rockville, MD: National Cancer Institute.

Cunningham, J.E., & Butler, W.M. (2004). Racial disparities in female breast cancer in South Carolina: Clinical evidence for a biological basis. <i>Breast Cancer Research and Treatment</i>, 86, 161-176.

Denham, S.A., Meyer, M.G., Toborg, M.A., & Mande, M.J. (2004). Providing health education to Appalachia populations. <i>Holistic Nursing Practice</i>, 18, 293-301.

Dorgan, K.A., Hutson, S.P., & Phillips, A. (2007). [In]Credible agents: Cancer communication partners in Appalachia. <i>Business Research Yearbook</i>, 14, 597-602.

Fouad, M.N., Nagy, M.C., Johnson, R.E., Wynn, T.A., Partridge, E.E., & Dignan, M. (2004). The development of a community action plan to reduce breast and cervical cancer disparities between African-American and white women. <i>Ethnicity and Disease</i>, 14(3, Suppl. 1), S53-S60.

Friedell, G.H., Linville, L.H., Rubio, A., Wagner, W.D., & Tucker, T.C. (1997). What providers should know about community cancer control. <i>Cancer Practice</i>, 5, 367-374.

Friedell, G.H., Rubio, A., & Harris, G. (1994). <i>Central Highlands Appalachia Leadership Initiative on Cancer: Sowing seeds in the mountains</i>. Washington, DC: National Institutes of Health and National Cancer Institute.

Friedell, G.H., Rubio, A., Maretzki, A., Garland, B., Brown, P., Crane, M., et al. (2001). Community cancer control in a rural, underserved population: The Appalachian Leadership Initiative on Cancer Project. <i>Journal of Health Care for the Poor and Underserved</i>, 12(1), 5-19.

Green, L.W., & Mercer, S.L. (2001). Can public health researchers and agencies reconcile the push for funding bodies and the pull from communities? <i>Journal of Public Health</i>, 91, 1926-1929.

Halverson, J.A., Barnett, E., & Casper, M. (2002). Geographic disparities in heart disease and stroke mortality among black and white populations in the Appalachian region. <i>Ethnicity and Disease</i>, 12(4, Suppl. 3), 82-91.

Heckler, M.M. (1985). <i>Report of the secretary's task force on black and minority health</i>. Washington, DC: U.S. Government Printing Office.

Henschke, U.K., Leffall, L.D., Mason, C.H., Reinhold, A.W., Schneider, R.L., & White, J.E. (1973). Alarming increase of the cancer mortality in the U.S. black population (1950-1967). <i>Cancer</i>, 31, 763-768.

Hinton, A., Downey, J., Lisovicz, N., Mayfield-Johnson, S., & White-Johnson, F. (2005). The community health advisor program and the deep South network for cancer control: Health promotion programs for volunteer community health advisors. <i>Family Community Health</i>, 28(1), 20-27.

Huang, B. (2002, June). Cancer death rates—Appalachia, 1994-1998. <i>Morbidity and Mortality Weekly Report</i>, 51, 527-529.

Hutson, S.P., & Alter, B.A. (2006). The experiences of siblings of patients with Fanconi's anemia. <i>Pediatric Blood and Cancer</i>, 48, 72-79.

Huttlinger, K., Schaller-Ayers, J., & Lawson, T. (2004). Health care in Appalachia: A population-based approach. <i>Public Health Nursing</i>, 21, 103-110.

Israel, B.A., Eng, E., Schulz, A.J., & Parker, E.A. (2005). <i>Methods in community-based participatory research for health.</i> Jossey-Bass: San Francisco, CA.

Israel, B.A., Schulz, A.J., Parker, E.A., š Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. <i>Annual Review of Public Health</i>, 19, 173-202.

Isserman, A. (1996). <i>Appalachia then and now: An update of "The Realities of Deprivation" reported to the president in 1964</i>. Retrieved June 8, 2007, from <a target="_blank" href='http://www.arc.gov/images/reports/thenandnow/then.pdf'>http://www.arc.go...

Jackson, C.L., Colquitt, J.A., Wesson, M.J., & Zapata-Phelan, C.P. (2006). Psychological collectivism: A measurement validation and linkage to group member performance. <i>Journal of Applied Psychology</i>, 91, 884-899.

Kephart, H. (2000). <i>Our southern highlanders: A narrative of adventure in the southern Appalachians and a study of life among the mountaineers</i>. Knoxville, TN: University of Tennessee Press.

Lengerich, E.J., Tucker, T.C., Powell, R.K., Colsher, P., Lehman, E., Ward, A.J., et al. (2005). Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia. <i>Journal of Rural Health</i>, 21, 39-47.

Mulcahy, R.P. (2006). Health. In R. Ambramson & J. Haskell (Eds.), <i>Encyclopedia of Appalachia</i> (pp. 1631-1677). Knoxville, TN: University of Tennessee Press.

National Institutes of Health. (n.d.). What are health disparities? Retrieved June 14, 2007, from <a target="_blank" href='http://healthdisparities.nih.gov/whatare.html'>http://healthdisparities....

Neuendorf, K.A. (2002). <i>The content analysis guidebook</i>. Thousand Oaks, CA: Sage.

Office of Disease Prevention and Health Promotion. (n.d.). Healthy people 2010. Retrieved February 8, 2007, from <a target="_blank" href='http://www.healthypeople.gov'>http://www.healthypeople.gov</a>

Olson, T. (1998). <i>Blue Ridge folklife</i>. Jackson, MS: University of Mississippi Press.

Orslene, L.E. (2006). New deal communities. In R. Ambramson & J. Haskell (Eds.), <i>Encyclopedia of Appalachia</i> (pp. 186-189). Knoxville, TN: University of Tennessee Press.

Polednak, A.P. (2004). Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer. <i>Ethnicity and Disease</i>, 14, 463-468.

Powe, B.D., & Finnie, R. (2003). Cancer fatalism: The state of the science. <i>Cancer Nursing</i>, 26, 454-465.

Rural Appalachian Cancer Demonstration Program. (n.d.). History of the project. Retrieved June 14, 2007, from <a target="_blank" href='http://www.etsu.edu/kellogg/racdphomw.htm'>http://www.etsu.edu/kellogg/r...

Wallerstein, N.B., & Duran, B. (2006). Using community-based participatory research to address health disparities. <i>Health Promotion Practice</i>, 7, 312-323.

Weller, J. (1993). <i>Yesterday's people: Life in contemporary Appalachia</i>. Lexington, KY: University Press of Kentucky.

Williams, J.A. (2002). <i>Appalachia: A history.</i> Chapel Hill, NC: University of North Carolina Press.

Yabroff, K.R., Lawrence, W.F., King, J.C., Mangan, P., Washington, K.S., Yi, B., et al. (2005). Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment? <i>Journal of Rural Health</i>, 21, 149-157.