Scholarly Communications Project

Uneasy Tensions in Health Care Delivery in a Rural Appalachian Coal Mining Community: Envisioning Alternative Solutions


Renée Gravois Lee

Dissertation submitted to the Faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of

Doctor of Philosophy


Julie L. Ozanne, Chair
Carol A. Bailey
Ronald Paul Hill
Janet E. Keith
James E. Littlefield

June 28, 1996
Blacksburg, Virginia


Research consistently supports that some segments of society are at considerably higher risk for illness and death than the national average. While the existence and extent of poor health outcomes for these "vulnerable populations" are well documented, less research attempts to explain why such inequities persist and how they might be resolved. Thus, many vulnerable individuals fail to get adequate health care.

How can health care delivery be improved to better serve those consumers most at risk of poor health? Addressing this issue requires an in-depth understanding of the unique health and social needs of vulnerable consumers and how these needs are being met (or not met) by the health care industry. Based on field research using a variety of methods, this study examined health care delivery to one at-risk population, women in a rural Appalachian coal mining community, with the ultimate goal of envisioning service design and distribution strategies that might better serve disadvantaged populations.

Consistent with the change-oriented goal of this research, a feminist approach guided this study. Women's everyday experiences in managing their health needs were explored through an analysis of their health care stories. Health care providers were also interviewed in order to explore both sides of the service encounter dyad. The voices of the women and the providers reveal uneasy tensions in health care delivery and illuminate why the current system does not meet the actual health care needs of the women or their community. A variety of solutions are offered to improve health care delivery.

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The author grants to Virginia Polytechnic Institute and State University or its agents the right to archive and display their thesis or dissertation in whole or in part in the University Libraries in all forms of media, now or hereafter known. The author retains all proprietary rights, such as patent rights. The author also retains the right to use in future works (such as articles or books) all or part of this thesis or dissertation.
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