An Overview of the Appalachian Culture 1

An Overview of the Appalachian Culture

Ihssan Tahir

Transcultural Nursing NU542

May 18th, 2020

An Overview of the Appalachian Culture 2

Abstract

Appalachian land is an area of the United States that stretches from the
southern most part of New York State to northern Alabama. These states
include all of West Virgina, Alabama, Georgia, Kentucky, Maryland,
Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina,
Tennessee, and Virginia. Forty-two percent of the Region's population is rural,
compared with 20 percent of the national population (ARC, 2015).

In the 2010 census, roughly 25.2 million people lived in the federally defined
Appalachian region (Giger, Haddad 2021). Much of what is now considered
Appalachian land was once home to American Indians. Thomas Walker was
known to be the first European American to travel throughout the
Appalachian territory (Giger, Haddad 2021). Several years later more people
would come to settle on this land. Many of the current day Appalachians have
roots in Northern Europe though in recent years the racial and ethnic
demographics have shifted. According to the last decadal census, there was a
50% percent spike in the minority population. Minority population growth
surpassed that of White for all Appalachian states and was particularly high
for children and persons of younger working ages.

Like most unknown cultures and subcultures many myths and stereotypes
have developed about Appalachians and their way of life. Lack of healthcare
resources, communication barriers, and isolation continue to be barriers that
affect health outcomes in these communities. This paper will delve into the
cultural habits, familial ties, spirituality, barriers and communication
behaviors of the Appalachian people in relation to the Kapp Family case
study.
An Overview of the Appalachian Culture 3

Introduction to Appalachian Culture

Brewer (2017) states, “The term “Appalachia” has many definitions and may

include cultural, geographical, or political concepts to define a very large, very diverse

region.” For this reason it is difficult to come up with a set core of cultural beliefs and

values. For means of clarification the Appalachian Regional Commission (ARC) classified

Appalachia into clear and distinct regions. These include the Central and South Central

subregions contain Western North Carolina, Eastern Tennessee, Southwestern West

Virginia, Western Virginia, and Eastern Kentucky and other areas. To understand the

geographic location is to understand the culture.

The most common view of Appalachians is poor, isolated and shoeless mountain

people (Elam, 2002). Though some of this is true, such as poverty, many have stereotypes

have been ingrained into the perception of this culture.

There are several core beliefs that are important to the Appalachians. Four cultural habits

that are important include independence, the ethic of neutrality, family and personalism

(Giger, Haddad 2021). According to Swank (2011), Appalachian culture maintains a

patriarchal hierarchy. This means that men, mainly the father, make family decision. You

can witness this in the family circle by Mr. Kapp treating his wife, Mrs. Kapp, with home

remedies. In the case study the Kapp Family brings the matriarch, Mrs. Kapp, to the

hospital once she is visibly ill and this bears witness to the fact they truly value

independence.
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Throughout the years education has improved greatly in many Appalachian communities.

According to Appalachian Regional Commission (ARC, 2018), 11.4% of persons age 25 or

older have less than an eighth grade graduation, 35.4% have some high school education

but no diploma, 84.6 hold a high school degree or GED and 21.7% hold a 4-year college

degree of higher. The generational differences can be witnessed through the Kapp family.

Mr. Kapp finished elementary school only while both his son in law, Roy, and daughter

Rebecca have some form of high school training. Access to education has improved greatly

throughout the years allowing more Appalachians to attend school. Organizations, such as

the Appalachian Higher Education Network (AHE), are relatively new and prompted post

secondary education among many Appalachian communities.

In 2015, the per capita income of those living in Appalachian region was $30,308.00

compared to $46, 049.00 in other part of the United States (Giger, Haddad 2021). This is

line with the annual income of Roy working at the local machine shop. A majority of

Appalachians work in professions where a manual skill is required such as woodwork,

plumbing and auto mechanic work. Along with that, a majority of Appalachians live in

rural areas where poverty is rampant. According to Giger and Haddad (2021), rural resident

tend to have poorer health outcomes due to limited access to health serviced.

Health and High-Risk Behaviors

There are certain high-risk behaviors that exist in the Appalachian regions due to

extreme poverty. According to Giger and Haddad (2021), these include lifestyle factors
An Overview of the Appalachian Culture 5

such as tobacco use and poor diets high in fats and carbohydrates. Along with that poor oral

health and low levels of exercise all add to the chronic health issues many Appalachians

face.

According to Behringer (2006) families in the mountains remember tobacco as the

"Christmas crop". Cultivation of tobacco has played a very integral part of Appalachian

culture. Local studies have found that even in more urban areas of Appalachia, 50% of

primary care patients have some personal relationship with tobacco production, sales, or

use of it,

Disease prevention is not a common finding in many of these communities. Many

Appalachians often participate less often in preventative health screening programs (Giger,

Haddad 2021). This results in poor health outcomes once diseases such as hypertension,

diabetes cancer or renal issues arise. Some of these behavior patterns are the result of lack

of availability and the mistrust of health practioners.

It is very important for the nurse to act in conjunction with the Kapp family in order

for them to seek follow up care.

Familial Ties

Since many Appalachian families live in rural and isolated settings relatives play an

integral part in day to day life. The Appalachian family is typically patriarchal (Behringer,

2006). Typically healthcare choices are left to the matriachs of the families. According to

Giger and Haddad (2021) extended family also play a vital role as compared to other
An Overview of the Appalachian Culture 6

middle class American families. Family members are often sought on for advice, validation

and support. Additionally, family members don’t move to far from one another.

The Kapp’s represent a typical Appalachian family as far as family roles. Mr. Kapp

seems to make the final choices and even treats his wife at home, but one can witness that

the extended family is important as the son in law, Roy, is involved with illness of Mrs.

Kapp. Women also play an integral part in healthcare choices. According to Giger and

Haddad (2021), mothers often are the first health care teachers of their children. This is

why it is very important to give Ruth solid information on how to care for her child.

Children are a very important component of Appalachian culture and grandparents

typically aid in taking care of young ones (Giger, Haddad 2021).

Appalachian Spirituality

When many arrived to the United States many followed different forms of

Christianity and were Presbyterian or partook in another organization demonization (Giger,

Haddad 2021). The Kapp’s are “very spiritual” and undemonational church. Many

communities made this shift due to no access to properly trained clergy. It is quite common

for many Appalachian families to adhere to undemonational practices.

There is a very strong correlation between spirituality and health. This can be seen

in the fact that the Kapp’s are leaving Mrs. Kapps health at God’s will. Many According to

Behringer (2006), many families directly tie their spiritual beliefs to health outcomes.

Prayer requests, anointing and testimony are not uncommon practices when suffering from

health ailments (Giger, Haddad 2021).

Health Barriers
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There are several important barriers that many Appalachians face when it comes to

seeking out healthcare. These include inaccess to services, lack of culturally component

providers, financial costs and transportation. Many clinics that do exist in federally

assigned Appalachian areas have limited staff or staff that does not have a good grasp on

the culture (Giger, Haddad 2021).

Many of these facts can be witnessed in the Kapp family. There is only one vehicle

available and the family is surviving on a meager income. These two factors can greatly

hinder the family from seeking initial care and follow up care as well.

Communication

There are several communication differences specific to the Appalachian culture.

English is spoken in all regions but there are several differences in specific meanings of

words (Giger, Haddad 2021). This can often result in the misinterpretations. When

communicating with the Kapp family it is important not to use direct eye contact as it is

seen as impolite. Nonverbal communication is just as important as verbal communication

in this culture.

Space is also very important to many Appalachians. Many people in this

community value their land with a huge sense of pride and willingly choose to live far in

the wilderness. Since many live in poverty and harsh living conditions they are considered

to be present oriented. Essentially, this means that they do not focus on the future, as they

believe it is not promised. This relates directly to the spiritual component that many

Appalachians possess by leaving everything in “God’s Hands” (Elam, 2002).

An Overview of the Appalachian Culture 8

Appalachian Folk Remedies

There are several health and high-risk behaviors many Appalachians related to their

cultural habits. According to Giger, Haddad (2021), “Appalachia is one of the areas in the

Unites States with excess mortality, morbidity and disability.” Due to living in

mountainous and isolated regions many have become independent and self-sufficient

relying on natural remedies to cure acute and chronic illnesses.

According to Brewer (2017), depictions of nursing care in Appalachia came from a

focus on the “granny midwife” central to women’s health or herbalists and lay healers

common in the early 20th century. This can be witnessed in the fact that Ruth gave birth at

home with the help of a neighbor. There is a strong interdependence on surrounding family

and neighbors when it comes to disease. Many of these individuals are not properly trained

to treat chronic problems and at times can even worsen them.

The Kapp family is seen relying on many natural and unnatural remedies to treat

Mrs. Kapp’s pulmonary tuberculosis. Remedies used by the family include whiskey, rock

candy and honey. Such remedies are not only limited to adults but children as well.

Rebecca, Ruth’s daughter, is also taking red bark and ginseng tea for loose stools. It is

common in most Appalachian communities for care to be sought when individuals are

visibly ill and treatments at home have not worked.

At times folk remedies can be beneficial while at other times the are can a deterrent.

In the case of the Kapp’s it is important to encourage remedies that do not counter modern

medicine.
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Disparities in Appalachia

There are certain biological disparities that are specific to the Appalachian culture.

Traumatic injuries, respiratory tract diseases, heart diseases and cancers are all common

issues in many of these communities. Men have a greater risk of death in these

communities and children are often victims of child abuse and burns. Many of these deaths

are the result of limited hospitals in rural areas (Giger, Haddad 2021).

Mrs. Kapp suffers from respiratory issues along with many Appalachians. This is

due to the fact that high-risk jobs such as textile, timber and mining greatly increase the

risk of lung diseases. Additionally, many in these communities begin smoking at a very

young age. Diet also plays a very vital role in the health outcomes of many individuals.

Fats and carbohydrates are consumed often along with breads and as a result obesity is a

big problem among many age groups (Giger, Haddad 2021).

Kapp Family Follow-up Plans

 Mrs. Kapp:

o Ensure medication compliancy, proper education and understanding when

mixing folk medicines and prescription medication.

 Ruth:

o Proper prenatal care, follow up with social services for access to food

stamps (if not already receiving), signing up for a newborn class.

 Rebecca
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o Ensuring that Ruth understands the importance of following up. Making

sure she can spot signs of dehydration in the child and when to seek

appropriate care. Perhaps a social service consult and education is key here

in order not to mix natural remedies and prescription drugs.

 Mr. Kapp

o As a decision maker of the house I would ensure that he have a solid

understanding of Mrs. Kapps illness process. I would also make sure that he

also have a solid understanding how to administer her prescription

medications and the dangers in mixing them with folks remedies.

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References

Brewer, E. P. (2017). Perceptions of Nursing in Appalachia: A State of the Science

Paper. Journal of Transcultural Nursing, 29(1), 6–13. doi: 10.1177/1043659617704046

The Appalachian Region. (n.d.). Retrieved May 18, 2020, from

https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp

The Appalachian Region. (n.d.). Retrieved May 23, 2020, from

https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp

Giger, J. N., & Haddad, L. G. (2021). Transcultural Nursing Assessment and

Intervention (8th ed.). St. Louis, Missouri: Elsevier Inc