Geographical, economic, social and cultural barriers to accessing services in rural areas are widely reported. Less widely discussed are dilemmas posed by individual and community reluctance to address sensitive health issues. This article, focusing on the highly sensitive area of mental health, and employing a participatory action approach,…

Designed to help bridge the gap between selected Appalachian communities (17 control and 18 experimental Kentucky communities) and the more affluent U.S. society, the Appalachian Community Impact Project (ACIP) used indigenous paraprofessionals, backed by Extension personnel, to work at the community level. It was hypothesized that by using…