The Disconnect Between Perceptions of Health and Measures of Health in a Rural Appalachian Sample: Implications for Public Health Social Workers

Abstract

This study compared perceived and objective health status among a population with elevated risk of chronic disease in rural, Appalachian Kentucky, in order to inform the practice efforts of public health social workers. Cross-sectional data were collected from a sample of 203 adults recruited through a mailed invitation. The participants ranged in age from 20 to 93 (M = 50.8, SD = 13.5), 115 (56.7%) and nearly all were Caucasian, reflecting the demographic composition of the population of the area. Although 75% of the study population was overweight or obese, over 60% perceived their health status as good, very good, or excellent. Less than half reported engaging in physical exercise, and only 25% reported eating at most one serving of fruits or vegetables in the past week. The results suggest clear discrepancies between perceived health status and objective indicators of health risks in the study sample. Public health social workers who provide health education and advocacy for this population will need to consider these discrepancies when developing practice approaches for individuals residing in this and other similar communities.

Obesity Among Women Living in Appalachia: A Dimensional Analysis

“…These women often mentioned that there were a great many of sick people in the region because of poor diet, lack of physical activity, obesity, and obesity-related illnesses (Coyne et al, 2006;Ely et al, 2011;Pearson et al, 2010). However, there was a mismatch found between Appalachian women's weight status and their self-reported health status.…”

“…It is also well documented that Appalachian women have less education, household income, and access to healthcare than women living outside the Appalachian region (Coyne et al, 2006;Ramsey & Glenn, 2002;Serrano et al, 2007;Tessaro, Rye, Parker, Mangone, & McCrone, 2007). In addition, Appalachian women report eating fewer fruits and vegetables than other types of food, they do not participate in physical activity on a regular basis, and they have less access to preventive screenings to detect diseases (Ely, Miller, & Dignan, 2011;Pearson et al, 2010;Schoenberg et al, 2008;Zizzi et al, 2006). Appalachian women have been found to have low levels of medical and dietary knowledge, and often do not discuss their health concerns outside of the family (Coyne et al, 2006;Tessaro et al, 2007).…”

“…Another weakness is that there is limited literature pertaining solely to obesity in Appalachian women. Finally, multiple studies used telephone surveys to collect data (Ely et al, 2011;Ramsey & Glenn, 2002;Webber & Quintiliani, 2011), and many Appalachian residents may not own or have access to a telephone. Despite these limitations, the information is generalizable to the Appalachian population because the studies were conducted in a variety of Appalachian settings and states.…”

“…However, perceptions of self-rated health and indicators of obesity have been found not to match actual weights and health status indicator in this population. Even though Appalachian women have been found to have high rates of obesity and chronic disease, over 60% report their health status as good, very good, or excellent (Ely et al, 2011).…”

“…Even though these women were obese and many were diagnosed with chronic diseases, they reported that they were in good health. One factor in the mismatch between health and weight status is cultural perceptions being larger or heavier is viewed as the norm by Appalachian women (Ely et al, 2011). Yet, the greatest health threats for communities, according to Appalachian women, are heart disease and cancer due to poor diets and obesity (Schoenberg et al, 2008).…”