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Everyday, Dr. Denise Hunter, an internist at Caswell Community Health is visited by patients with chronic conditions such as diabetes, COPD, hypertension, obesity, and more. “Because about eighty percent of chronic medical illnesses are solely lifestyle related…People are just eating poorly, just taking poor care of their bodies”. (Hunter, 39)  Dr. Hunter feels immense frustration of her patients who could be healthy if they changed their lifestyles, preventing and reducing these conditions that are plaguing her patients. However, through her patients she has learned how many of her patients are unaware of how to take the best care of their bodies. “It’s just a lack of knowledge”, reports Dr. Hunter. (Hunter, 39) Andrea Williams-Morales, healthcare administrator at CommWell in Sampson County, North Carolina, guides and helps inform patients to access healthcare. Morales reports many of the patients that visit her struggle with accessing healthcare due to lack of insurance and the lack of knowledge of how often to visit a physician. She recounts her parents were in a similar situation when she was growing up, and sees how many of her patients are unaware of their options for insurance or how to access it. “Unfortunately, didn’t have the education. They were not aware.” (Morales, 15) Though working in two different clinics in rural North Carolina, they both see how the lack of healthcare education impacts their own patients daily. From knowing how to best take care of their bodies, to awareness of accessing medical care and insurance, the lack of health and healthcare education in rural North Carolina has created a large disparity for accessing healthcare.

This lack of healthcare education in these communities stems from lower education rates as well as the difficulty of distributing healthcare education to these areas. Compared to non-rural counties in North Carolina, high school and higher education rates are lower in rural counties. For high school education, 60% of adults in non-rural counties have a high school diploma compared to 58% in rural counties. (Best NC) This gap for higher education is much more significant, 25% of adults in non-rural counties and 14% of adults in rural counties. (Best NC) The lower education rates in rural counties contribute to poor communication between the patient and physician due to a gap of knowledge that may cause a strain between the physician and patient. The poor communication and lack of education can also cause patients to not understand or know how to properly treat conditions they may have, or take care of themselves. This causes patients to either become worse in their conditions or potentially gain new conditions that could have been prevented. This strain could also eventually lead to patients in rural counties to stop visiting physicians altogether. In western North Carolina, self medicating with home remedies is more common in rural counties, and is negatively correlated with education rates; people with lower education tend to self medicate at higher rates than those who have a higher education. (Arcury et al.) It was conducted that of all home remedies people with lower educations tend to use HLVW (honey, lemon, vinegar, whiskey) remedies at significantly higher rates than those who have higher educations. (Arcury et al.) It was recorded in the study that 28.6% of participants with less than a high school degree used HLVW remedies and 30.7% of participants who only have a high school degree use these remedies as well. (Arcury et al.)  However, in contrast to their higher uses of HLVW remedies, participants with a high school diploma or less used multivitamins or minerals at much lower rates, with 3% and 2.1% of participants respectively. (Arcury et al.) This significant difference between the HLVW and vitamin use truly does highlight how a lack of education can alter how one understands to best treat their body, and what is best to medicate themselves with. Health education can help bridge the gap between those with lower education in rural communities to better understand their physicians and the best way to treat themselves.

Healthcare and lifestyle education is the knowledge of how to best take care of one’s body and the understanding of your physician in medical practices. This can be administered or distributed in many methods such as a physician informing patients of healthier lifestyle practices, educational pamphlets, online forums, and health screening centers. Studies are also being conducted to research other methods of how healthcare education can be shared such as community focus groups. Community focus groups are a method to target at-risk individuals to provide information about conditions they may be at risk for, or providing education on how to navigate healthcare and what to ask a physician so they can best understand. (Jennette et al.) This study held seventeen focus groups across five rural counties in North Carolina focusing on kidney disease. These meetings were held in churches and other communal meeting areas. Participants were asked questions regarding their knowledge on kidney disease, the function of kidneys, how they communicate with their physicians, and ways that they see health education being shared. (Jennette et al.) When asked about the health education they see, many participants responded that it was not the most effective. “It needs to be emphasized what will happen and what you’ll have to go through if you don’t take care of yourself”, responds one participant. Another says, “Keep it simple and just make it interesting. If citizens feel intimidated, then they’ll block you out and not learn anything.” (Jennette et al.) The participants did view that the community meeting was an effective method of gaining healthcare education, and many participants preferred it due to feeling comfortable in a familiar setting. (Jennette et al.) Using these targeted community methods is also an effective method to learn from patients on what other methods of distributing health education they preferred such as television or radio ads, and discussing what should be highlighted so the information is learned. (Jennette et al.)

Healthcare education in rural communities can be improved by making accessible, simple and understandable messages,  so patients can have a better understanding of how to care for their body, understand their physician, and how to access healthcare. Due to decreased highschool and higher education rates in rural counties in North Carolina, rural patients are more likely to face healthcare disparities due to their lack of education. This can lead to patients having a straining relationship with their physicians due to difficult communication and some may even choose to no longer visit a physician. This disparity can be lessened to those in rural communities through effective methods of distributing healthcare education, so they can hopefully feel more confident in visiting a physician.


Arcury, Thomas A., et al. “Complementary and alternative medicine use among rural residents in western North Carolina.” Complementary Health Practice Review 9.2 (2004): 93-102

Best NC. 2020 Facts and Figures: Education in North Carolina. 2020.,

Hunter, Denise. Interview with Ina Dixon. 10 April 2019 (Y-0103). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

Jennette, Caroline E., et al. “Community perspectives on kidney disease and health promotion from at-risk populations in rural North Carolina, USA.” Rural and remote health 10.2 (2010): 260-269

Williams-Morales, Andrea.. Interview with Madelaine Katz. 23 July 2019 (Y-0137). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

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