Down home: An ethnography about community process and health of older persons in a rural setting

Abstract

<p>The purpose of this study was to understand how rural-dwelling elderly people describe their health and to gain an understanding of rural community processes as they relate to the health of older residents. Although community health nursing practice supports community-level interventions, the influence of communities upon the health of older community members is not well known. Ethnographic design and methods were employed to study the health of older residents in a Western Plains farming community of about 500 people. The sample included 104 people. Interviews, participant observation, examination of artifacts, and photography were used to generate data, which included interview transcripts, field notes, and theoretical memos. Five domains emerged from analysis of categories identified in the data. Five themes crossed the domains and unified data. A metaphor entitled "The Myth of Rural Life" depicted prevailing cultural values and norms. Finally, a theoretical statement developed from the themes and the metaphor. Relationship was a key component for understanding life in Farmington. Reciprocal relationships in which older people and the community were mutual benefactors were crucial to the acceptability of help and support, as well as the acceptance of "outsiders" into the community. The community supported older people to maintain independence and to engage in meaningful activity while older community members supported the community through work and volunteer activities. Stressors in the community were a lack of privacy, and isolation for those who did not conform to prevailing community norms. Implications for the nursing profession include: nurses in rural areas need to foster a sense of relationship and reciprocity within a community since assistance is accepted most easily when older people can reciprocate help. Advocating the use of government supports and programs may not be successful if the programs do not require contributions from recipients. Close relationships can be stressful as well as supportive, and increasing social support and monitoring for an older person may inadvertently decrease privacy and promote stress. Promoting health for the entire community may require finding a common goal that both insiders and outsiders agree is important.</p>