For many UK researchers who study health in Appalachia, the Center of Excellence in Rural Health (CERH) is an indispensable partner in conducting community-based research. The Center, located in Hazard, connects researchers with the local community and provides necessary infrastructure, from conference rooms to a team of community health workers, called Kentucky Homeplace, who engage participants and gather data.
This week, researchers shared the findings from these community-based studies at the second annual Appalachian Research Day.
“Today is an opportunity for people who do research with the Center to report back about their findings, and see what we can come up with together to better our lives here in Appalachia,” said Fran Feltner, director of the CERH.
Addressing Appalachian health issues
Rural Appalachian communities in Eastern Kentucky experience some of the nation’s most concerning health disparities, including elevated rates of obesity, diabetes, stroke, heart disease, depression, and cancer incidence and death. Residents of Appalachia might also face challenges in accessing health care, such as distance from providers, lack of insurance, or socioeconomic barriers.
Community-based research is essential in addressing disproportionate rates of poor health by collaboratively identifying problems and developing shared solutions that are a good fit for communities. For this type of research to succeed, it must begin at the local level, built upon the foundation of relationships with individuals, neighborhoods and groups who have common questions and concerns. In Eastern Kentucky, the CERH has enabled community-based studies since 1990, when it was founded to improve health through education, service, and research.
In 2015, the CERH launched Appalachian Research Day as an opportunity to share and discuss research findings with the communities that were involved in the studies. Feltner describes the day as an invitation for everyone involved in community health research to “come sit on the porch” of the Center and talk about their work and ongoing needs. More than 100 researchers, coordinators, community health workers, community advisory board members, students, and staff participated this year, with four podium presentations and 13 poster presentations.
“These research findings drive new and exciting health initiatives that are transforming lives across our rural Appalachian region,” Feltner said.
The presentations focused on community research related to healthy lifestyles, depression, lung cancer screening, drug use and risk behaviors in Appalachia.
Mark Dignan, professor in the UK College of Medicine and director of the UK Prevention Research Center, discussed his work with faith-based communities to study energy balance, obesity and cancer in Appalachia. According to the CDC, the national obesity rate in adults is about 29 percent, while in Appalachian states the rate is 31-35 percent. Dignan was particularly interested in how to help people re-engineer their lives to include more physical activity.
“When you do research in the community, hopefully you’ll make change that will be lasting,” he said.
Rates of depression are also higher in Appalachia than the rest of the country. For Appalachian women, the rate of depression is four times higher than the national rate. They are also less likely to receive adequate treatment, according to Claire Snell-Rood, PhD, who shared her research on adapting treatment options for rural settings where the traditional mental health system is both inappropriate and inadequate.
“This research focuses on how to adapt evidence-based programs to address not only limited treatment options in rural areas, but the substantial social and health challenges that impede Appalachian women from obtaining the care they need,” she said.
Snell-Rood worked with Kentucky Homeplace community health workers to conduct interviews with women, and she is currently adopting a collaborative, peer-based practice to support rural individuals in developing their own processes for wellbeing.
Roberto Cardarelli, DO, MPH, professor and chief of community medicine in the UK College of Medicine, also presented his research project, the Terminate Lung Cancer study, which aims to understand the knowledge and attitudes of lung cancer screening among high-risk rural populations. Kentucky’s lung cancer mortality rate dramatically exceeds the national lung cancer mortality rate, with 73.2 deaths per 100,000 in Kentucky versus 49.5 nationally. Cardarelli and his team conducted focus groups in order to develop an effective campaign to promote lung cancer screening in the region.
“We like to focus on research that’s important to communities, and we couldn’t find a more important topic than tobacco cessation and lung cancer screening,” he said.
The final presentation of the day addressed drug use and prescription opioid use in Eastern Kentucky. Michele Staton-Tindall, PhD, associate professor in the UK College of Social Work, conducted research in jails to learn about drug use and health-related risk behaviors among rural women in Appalachia. She said that rates of drug use are “alarmingly high” in this area of Appalachia, with many users injecting.
“Injection is the preferred route of administration, which is coupled with increased public health risks including HCV and HIV,” she said.
Solving problems together
The event was supported in part by the UK Center for Clinical and Translational Science, which aims to accelerate discoveries that improve human health, with particular focus on the Appalachian region.
For Feltner, a nurse who has worked in rural health for 35 years, Appalachian Research Day represents the best qualities of the place she calls home.
“What I love most about Appalachia is the fellowship we have together, as neighbors and friends, working together to solve problems.”