Personalized health planning: A roadmap for primary care in rural communities

Given the high poverty rates in rural America, an important issue facing primary care providers in rural communities is how to assist low-income patients in managing their health within the context of limited resources. Personalized health planning (PHP) is a strategic approach to care that engages patients with their providers to develop an individualized wellness and therapeutic plan. The main goals of PHP include: (1) risk assessment and monitoring, (2) patient participation and activation, and (3) prevention and/or minimization of disease. To conceptualize how PHP might be implemented in a low-income rural context, we conducted a secondary qualitative analysis of interview data from Rural Families Speak, a three-year (2000-2002), multi-state study of 413 U.S. rural families earning less than 250% of poverty. Specifically, we asked two questions: (1) What are the types and perceived severity of health issues these families face? and (2) What strategies do these families employ to manage their health issues? Results showed half of participating families had at least one family member who managed a chronic health condition that affected daily living (e.g., depression, arthritis, diabetes) or was classified as “disabled.” Families describing themselves as “healthy” regarded this state as the result of “luck” or “fortune” rather than active prevention efforts. Many described seeking care from low-cost or free clinics to respond to events instead of prevention or minimization of disease effects. Insured and uninsured families reported prioritizing one family member's health needs over another, not seeking care, or delaying care due to financial constraints, especially when unexpected events occurred (e.g., injury or illness of a “usually healthy” family member). Findings suggest rural, low-income patients demonstrate low engagement in their health, do not prioritize prevention, and may exacerbate health conditions by not seeking care when needed. PHP has the potential to address these problems by: (1) raising health awareness through educating patients on their risk; (2) engaging patients in the process of care, including creating a partnership with the primary provider to enact the plan; (3) enhancing knowledge of individual family members' and the family unit's role in promoting health within their financial means; and (4) providing better understanding of tradeoffs when making decisions to access care or follow medical advice. By employing PHP as the vehicle through which primary care is delivered, rural providers can maximize the impact of their engagement with patients and provide a roadmap for health decision-making in low-income families.