By Mikaela Canterbury, RN, OCN®

Found along the expansive Appalachian mountain range in the Eastern United States, Appalachia is legally recognized as an economically disadvantaged area that’s home to a unique population of patients requiring special considerations.

As the United States has gradually become a more connected country, expanded access to information has increased many patients’ knowledge, acceptance, and tolerance of different medical conditions and treatments. However, what some physicians and nurses may not understand is that technology and information often come to an abrupt halt in the foothills of Appalachia. 

Historically, the Appalachian terrain has physically inhibited the spread of many modern technologies and advancements, fostering the unique culture of its residents. The physical isolation often thought responsible for the mountain people’s resilience may also explain its citizens’ distrustful attitudes. Isolation often requires the need for close-knit, independent family units as well as a strong local community.

Isolated attitudes, paired with a general suspicion for outsiders such as healthcare providers, has directly affected patient care—as well as patient outcomes—for many residents. But connecting them to experts and information through increased internet access can change that. Thanks to a U.S. Department of Agriculture (USDA) grant, improvements to internet access in Appalachia are underway. “High-speed internet e-connectivity is a necessity, not an amenity, vital for quality of life and economic opportunity,” USDA Secretary Sonny Perdue said in a statement.

The ReConnect Program provides millions of dollars to help bridge the gap for many rural communities. By addressing technologic access in Appalachia, residents as well as providers will gain access to the necessities of modern medicine already available to most other areas of the country. 

According to Lengerich et al., “The rates of unstaged cancer, of every examined site, were elevated in rural Appalachia, suggesting a lack of access to cancer health care.”  The needs of rural Appalachian patients with cancer make it clear that telehealth could be a lifesaving service for the disparate community. The ReConnect program can improve patient outcomes by providing them with quick access to physicians and nurses all over the country with the most up-to-date, evidence-based treatment information.

Nurses Can Make a Difference

While we wait for the gap in technology to close, the nursing community should consider how rural Appalachian culture affects patient behavior. Noncompliance, missed appointments, and omitted medications are often exasperated by rural isolation and the transportation burden to appointments and pharmacies. Trusting home remedies and herbal medicine over traditional treatments could be attributed to a lack of education about modern medicines and distrust of healthcare professional outsiders.

Nurses must assess for transportation issues, understand patients’ education levels, and monitor the benefits and limitations of their home support system. Nurses can educate patients about the importance of coming to appointments and help to coordinate their care to limit multiple trips. Nurses should emphasize the importance of taking medications as prescribed and maintaining good communication with providers when possible.

Once the nursing community understands that patients in rural Appalachia don’t have the same access to resources and information as many others across the United States, nurses can adjust their own care strategies accordingly. When modernization finally opens new doors for Appalachians—and when services like telehealth become available—health disparities in those rural communities can end. But until the gap in technology and access is closed, it’s up to nurses to lead the way and ensure the best possible outcomes for their patients.