This case study examines the process whereby a community based self-care health education program was developed and implemented in a poverty-struck coal mining region of southern Appalachia. One of the principle dynamics explored here in depth is the tension between “insiders” (persons who know the area but may not be well versed in program planning, implementation or evaluation) and “outsiders”; persons who may be professionally prepared for mounting programs but are hampered in their ability to adjust to or handle the vicissitudes of an unfamiliar social or cultural situation. Suggestions are advanced as to how this tension might be better managed.
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