Appalachians exhibit high rates of chronic disease-related behaviors which might improve with heightened health consciousness. Knowing one's family history can be an important health maintenance tool. Appalachians' health attitudes are shaped in large, closely knit extended families in which matriarchs play central roles. We sought assistance from West Virginian grandmothers in a family medicine practice in engaging their extended families with their genogram to assess the impact on family members' level of health consciousness.


The family physician identified West Virginian grandmothers in his practice. We sent each of them invitations to participate, along with their extended family, in constructing a genogram,. However, none of the thirty-four women contacted agreed to participate. We explored the reasons for their non-participation. We mailed a follow-up survey to all the potential participants. We made follow-up phone calls after sending a reminder letter. Twenty-seven women responded. We collated and arranged in order of frequency their reasons for non-participation.


The most frequently cited reason for non-participation was that the respondent perceived her extended family to be too busy or to live too far from one another to participate. Her own sense of not feeling up to what was being asked of her was the second most frequently expressed reason, almost as often as the first.


The hypothesis that family physicians might improve health consciousness of Appalachian extended families by engaging them with their genogram remains untested. Testing it will require being mindful of several methodological lessons regarding recruitment of subjects, use of written materials and inclusion criteria. The researcher will be wise to adopt a collaborative, collegial approach such as employed in participatory research.

Conflict(s) of Interest

All authors have no conflicts of interest to disclose.

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