Purpose: To explore, from an emic perspective, the unique socio ecological context in which rural grandparent headed households (GHH) exist, and therefore provide a foundation for the development of culturally-appropriate interventions that might impact their health.
Methods: This qualitative descriptive study was based on the conduct of in-depth, semi-structured interviews with fifteen grandparents, residing in rural Appalachian Kentucky, who were the primary caretakers for their grandchildren. The interviews were conducted using an interview guide that was based on the premises of the Social Ecological Model (SEM). A basic assumption of this model is that intrapersonal, social-cultural, organizational, and policy factors influence individual health and health behaviors, and that these influences are interrelated and reciprocal. Data was analyzed by the research team using line by line coding of the audio recorded transcriptions of the interviews.
Findings: GHH experience both barriers and facilitators to maintaining the health of GHH. Many grandparents viewed the experience of belonging to a GHH as a positive one, believing that having their grandchildren in their home improved their health. They relied on formal and informal networks such as extended family and churches to help with caretaking responsibilities. Grandparents experienced notable barriers to health related to having the primary responsibility of their grandchildren, including lack of resources and family tension related to incarceration and/or opioid drug use by biological parents.
Conclusions: GHH, one of the fastest growing family constellations in rural Appalachia and the US, may be particularly vulnerable to health threats elevating their risk for many chronic diseases. Effective health related interventions to address this risk should be based on the socio-ecological context in which these families exist.
Keywords: Rural, Grandparent headed households, Qualitative, Socio-ecological model
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