People of Appalachian Heritage

The Appalachian region in the United States consists of 13 states extending from New York to Alabama. The vast region includes several large cities and many people live in small settlements and in limited-accessible hollows or “hollers.” This isolation and rough topography have contributed to the development of secluded communities where people, over time, have developed a strong sense of independence and family and community cohesiveness. This chapter follows the dominant values and beliefs according to the 12 domains of the Purnell Model for Cultural Competence: overview/heritage, communication, family roles and organization, workforce issues, biocultural ecology, high-risk behaviors, nutrition, pregnancy, death rituals, spirituality, health-care practices, and health-care practitioners.