Perceived barriers to community health and health promotion amongst African American members of a rural community

Background: An overarching goal of Healthy People 2010 is to eliminate health disparities experienced by African Americans and other minority populations in the United States. The purpose of this study, a collaboration between Georgia Southern University and the Evans County Health Collaborative (ECHC), was to assess perceived barriers to health and health promotion amongst rural African Americans in Evans County, Georgia. Theoretical framework: A social capital perspective (Putnam 2000) was used in conjunction with a multi-level ecological framework, which posits that health is impacted by individual, environmental, economic, political, and social factors (Sweat and Denison 1995). Hypothesis: This inquiry was conducted using an inductive, constructivist approach. Hypotheses are not used in qualitative research of this type (Denzin & Lincoln 1994). Methodology: In-depth qualitative interviews were conducted with a purposeful snowball sample of African American community leaders. Transcripts were analyzed for themes using content analysis (Patton 2002). Results: Themes that emerged included: 1) poor health-seeking and self-care practices (individual), 2) lack of access to quality health care and insurance (environmental), 3) poor high school graduation rates (environmental), 4) lack of job opportunities and high levels of poverty (economic), 5) challenges with race relations and continued segregation (political), and 6) lack of social capital (social). Conclusions: All of these factors have been linked with poor health outcomes in the literature, and reflect the importance of a multi-level view of barriers to community health. Implications for practice: This work highlights the importance of incorporating local voices, especially of marginalized groups, into intervention development.