Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia

Abstract

Objective:

Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings.

Data Source:

We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia.

Study Inclusion and Exclusion Criteria:

Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings.

Data Extraction:

Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest.

Data Synthesis:

Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework.

Results:

A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels.

Conclusions:

Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.