Investigating emic care in Appalachians of Western North Carolina

People in the Appalachian Mountains have an increased prevalence in poverty, low educational attainment, and low employment opportunities that are associated with poor health outcomes. Also, the Appalachian Mountain people suffer stigmas that have been propagated since the late 1890s. However, much of the research has been an etic focus and the emic focus is limited. A qualitative study of emic care explored the ways people in the Appalachian Mountains of Western North Carolina assured wellbeing. Leininger’s Culture of Care model was used to guide the study and discover emic ways of wellbeing. The sample included 21 persons between the ages of 25 and 70 years old, persons who had lived in Western North Carolina (WNC) for 15 years of more and who had generational roots to Appalachia. Individual interviews were conducted in homes, at workplaces and in community settings after consent was obtained. Audiotapes were transcribed verbatim and analyzed through multiple levels to ensure trustworthiness, credibility and validity of findings. Emic themes were identified and included Communal Caring Relationships, Spirituality, Place Matters, Grandmothers Caring, and Etic Care. Specific actions and situations within each theme were reported. For example, the Place Matters theme included participants relating their ingestion of healthy diet of fresh fruits and vegetables from the garden or locally grown (the land). Enjoying the outdoors was related to physical, emotional, and spiritual wellbeing. Spirituality was found to be a major component in a sense of wellbeing, and was described by participants as going to church, not going to church and the old ways. The use of wild crafted herbs and home remedies occurred by the participants in this study. Leininger’s theory and model were useful in guiding the study, as were Spradley’s ethnographic interview guidelines. The well-being discussed by participants provides the emic sense of wellbeing in the Appalachian culture. However, the model was not fully supported in terms of participants’ discussion of challenges or barriers to wellbeing. Rather, the researcher was able to classify participant responses within the areas of physical, spiritual, and mental well-being. Perhaps this is another indication of how etic perspectives focus much of the perceived Appalachian and non-emic health. The findings provide an understanding of well-being and health that can guide future