Family Caregivers in Rural Appalachia Caring for Older Relatives with Dementia: Predictors of Service Use

Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the U.S. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, under-resourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally-relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.

Caring Beyond the Challenges: Grit in Dementia Family Caregivers

Scholars and practitioners recognize the importance of family caregivers for persons with dementia (PwD) persevering through difficulties and remaining committed to providing care (i.e., possessing grit). Based on Pearlin’s stress process model, we examined how grit is associated with stressors and strains that interfere with caregiver well-being and jeopardize continued caregiving. The sample included 158 family caregivers of PwD from rural Appalachia. SEM analysis revealed that grit and family and friend affectual solidarity contributed significantly to mastery. Grit and family solidarity were associated indirectly with role overload through their effect on mastery. Results demonstrate the value of acknowledging the role of grit in enhancing caregivers’ confidence about managing difficulties they face and reducing their sense of being overwhelmed by caregiving responsibilities. Thus, strengthening dementia caregivers’ commitment to and perseverance in their role is crucial for sustaining their motivation to provide care, despite the challenges they face.

More Than Just an Internship: One University’s Collaboration with a Rural School District to Attract, Develop, and Retain School Counselors

This promising practice describes an innovative collaboration between West Virginia University, a land grant institution situated in the middle of rural Appalachia, and Kanawha County Schools, located in Charleston, WV. The partnership aimed to assist the rural school district by supporting children in three elementary schools and by providing the university’s school counseling students an immersion experience in rural schools, with the hope of retaining them in the school district following graduation. The collaboration fulfilled the original mission of the program in two ways; first, the school district retained one-third of the school counseling students who participated. Secondly, the collaboration was met with overwhelming support by district leadership, resulting in an increase in school counseling students entering the program in the next academic year.

Resilient Experiments in Rural Housing: Architectural Experiments in Planned Housing

Single family houses contribute substantially to climate change in the US and other parts of the world. In the US specifically, most housing has been designed by builders and developers. The motivation has not been sustainability and a knowledge of how to design net zero energy and net zero water dwelling is not commonly understood. This paper seeks to use a historical model as viewed through the lens of the Living Building Challenge to demonstrate how an architect designed historic example might provide a way of implementing a cutting-edge approach to sustainable housing today. Arthurdale was an early 20th century housing experiment that was conceptualized to provide for sustainable living in rural Appalachia. This paper presents the history of the region, an overview of the houses and the Living Building Challenge and then analyses how this historic prototype might model a sustainable housing development today using the Living Building Challenge system.

Internalizing Symptoms in Children Being Reared by Grandparents in Rural Appalachia: Risk and Protective Factors

The present study investigates factors associated with anxiety, depression, and stress in children being reared by their grandparents in rural Appalachia. Grandparent-headed households, in which grandparents have primary responsibility for care of children, are increasing in number. However, research is needed on child risk for internalizing symptoms in this context. Participants included 35 children aged 5–18 years and one of their custodial grandparents. Interviewers read questionnaires to grandparents and children assessing family functioning and child mental health and participants indicated their answers. Mean scores for child internalizing symptoms and stress were on the higher end of the scale of measurement. Lower grandparent positive parenting, grandparent not having formal custody of children, greater grandparent mental health issues, lower grandparent education, and lower financial status were correlated with greater child anxiety, depression, and stress. Results also indicated that correlates of children’s internalizing symptoms differed based on child sex and age.

‘DIFFERENT THAN A REGULAR WHITE’

Qualitative research can clarify how the racialized social system of Whiteness influences White Americans’ health beliefs in ways that are not easily captured through survey data. This secondary analysis draws upon oral history interviews (n=24) conducted in 2019 with Whites in a rural region of Appalachian western North Carolina. Interviewees discussed personal life history, community culture, health beliefs, and experiences with healthcare systems and services. Thematic analysis conveyed two distinct orientations toward health and healthcare: (1) bootstraps perspective, and (2) structural perspective. Whiteness did not uniformly shape interviewees’ perceptions of health and healthcare, rather, individual experiences throughout their life course and the racialized social system contributed to these Appalachian residents’ assessments of who is responsible for health and healthcare. Dissatisfaction with the Affordable Care Act was salient among interviewees whose life stories reflected meritocratic ideals, regardless of education level, age, or gender identity. They apprised strong work ethic as a core community value, assuming that personal contributions to the social system match the rewards that one receives in return for individual effort. Conversely, interviewees who were primarily socialized outside of rural Appalachia acknowledged some macro-level social determinants of health and expressed support for universal healthcare models. Findings suggest that there is not one uniform type of “rural White” within this region of Appalachia. Interventions designed to increase support for health equity promoting policies and programs should consider how regional and place-based factors shape White Americans’ sense of identity and subsequent health beliefs, attitudes, and voting behaviors. In this Appalachian region, some White residents’ general mistrust of outsiders indicates that efforts to garner more political will for health-promoting social programs should be presented by local, trusted residents who exhibit a structural perspective of health and healthcare.