The Challenges of Constructing a Genogram on an Appalachian Extended Family Health Consciousness

Introduction According to the Centers for Disease Control and Prevention (CDC), Appalachians exhibit high rates of chronic disease-related behaviors such as smoking, unhealthy eating and sedentary lifestyle. Heightened health consciousness, being aware of and valuing one\u27s health, might lead to healthier lifestyles. Knowing that matriarchs are influential in closely-knit Appalachian extended families, a West Virginia family physician identified thirty-six older Appalachian women in his practice. They were each sent 6-page mailings inviting them to participate, along with their extended family, in constructing a genogram. A genogram displays inter-generational patterns of health and disease. It was hypothesized that family members\u27 health consciousness might increase after participation in the project. However, none of the thirty-four women contacted agreed to participate. The reasons for their non-participation were explored. Methods All the potential participants were mailed a survey and follow-up phone interviews were conducted with twenty-five women. The reasons given for non-participation were collated and arranged in order of frequency. Narrative written and verbal comments were examined for recurring themes. Results The primary reasons offered were that the correspondents were uncertain of what was being asked or felt overwhelmed about participating. Also, they cited their families as too sparse, scattered and busy to participate. Nevertheless, in phone conversations, many correspondents indicated willingness to participate in the future. Conclusion The recruitment mailings posed significant obstacles for participants who, when subsequently engaged by phone, were actually favorably disposed. Recruitment of patients from Appalachian practices for similar projects might require personal, oral engagement