Restrictions and Countermeasures of Rural Vocational Education in Urban-rural Integration

Institute of Scientific and Technical Information of China (English)

2012-01-01

Developing rural vocational education is of great significance to urban-rural integration: developing rural vocational education is helpful to cultivating new farmers for construction of new socialist countryside,favorable to improving farmers’ ability of finding jobs and starting undertaking, and beneficial to transfer of rural surplus labor and acceleration of urbanization. Restrictions on development rural vocational education mainly include: low value cognition of society and social assessment of rural vocational education; out of balance of cost and expected return of rural vocational education; the quality of supply of rural vocational education failure to satisfy demand of socio-economic development; imperfect rural vocational education system. In view of these,following countermeasures and suggestions are put forward: strengthen propaganda and guidance to build environment of public opinion for rural vocational education; push forward rural vocational compulsory education system to lay social foundation for rural vocational education; reinforce policy support to assist in building rural vocational education system; improve education system to build overall framework of rural vocational education; perfect laws and regulations to establish system and norm for development of rural vocational education.

Mental health academics in rural and remote Australia.

Science.gov (United States)

Pierce, David; Little, Fiona; Bennett-Levy, James; Isaacs, Anton N; Bridgman, Heather; Lutkin, Sarah J; Carey, Timothy A; Schlicht, Kate G; McCabe-Gusta, Zita P; Martin, Elizabeth; Martinez, Lee A

2016-01-01

skills of the existing workforce and (iv) developing innovative approaches to student placements. Strategies to promote awareness of mental health issues included workshops in rural and remote communities, specific suicide prevention initiatives and targeted initiatives to support the mental health needs of Indigenous Australians. The need for collaboration between the widely dispersed MHAs was identified as important to bridge the rural divide, to promote project cohesiveness and ensure new ideas in an emerging setting are readily shared and to provide professional support for one another as mental health academics are often isolated from academic colleagues with similar mental health interests. The MHA project suggests that an integrated approach can be taken to address the common difficulties of community awareness raising of mental health issues, increasing access to mental health services, workforce recruitment and retention (access), and skill development of existing health professionals (access and awareness). To address the specific needs and circumstances of their community, MHAs have customised their activities. As in other rural initiatives, one size was found not to fit all. The triad of flexibility, diversity and connectedness (both to local community and other MHAs) describes the response identified as appropriate by the MHAs. The breadth of the MHA role to provide university sponsored educational activities outside traditional student teaching meant that the broader health workforce benefited from access to mental health training that would not otherwise have occurred. Provision of these additional educational opportunities addressed not only the need for increased education regarding mental health but also reduced the barriers commonly faced by rural health professionals in accessing quality professional development.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

Science.gov (United States)

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

Rural migration and health care

DEFF Research Database (Denmark)

Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn

This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...... up with a more deepgoing review of the relatively small number of studies, which explicitly deal with settlement preferences related to access to health care....

Impact of rural health development programme in the Islamic Republic of Iran on rural-urban disparities in health indicators.

Science.gov (United States)

Aghajanian, A; Mehryar, A H; Ahmadnia, S; Kazemipour, S

2007-01-01

By 1979 50 years of uneven development and modernization by governments prior to the Islamic Revolution had left rural parts of the Islamic Republic of Iran with extremely low economic and health status. This paper reports on the impact of the rural health development programme implemented as an effective and inexpensive way to improve the heath of the rural population, especially mothers and children. It describes the system of rural health centres, health houses and community health workers (behvarz) and demonstrates the effectiveness of the programme through declining measures of rural-urban disparities in health indicators. The implications of inexpensive rural health policies for other countries in the region such as Afghanistan and Central Asian countries with a similar sociocultural structure are discussed.

What Impact Does Behavior of Doctors and Patients on Service Integration of Multi-institutional Readmission cross Township—county Hospitals in Rural China

OpenAIRE

Zhang, Yan; Tang, Wenxi; Zhang, Liang

2017-01-01

Background: With the change of rural residents’ disease spectrum and patients with chronic diseases boom, multi-institutional health service utilization of rural residents and the continuous service demands are growing sharply in rural China.Objective: Evaluate the service integration of multi-institutional readmission cross township—county hospitals (MRCTCH) in rural China, and figure out determines of service integration.Methods: This study featured 7 sample counties in rural China. Based o...

Current State of Child Health in Rural America: How Context Shapes Children's Health.

Science.gov (United States)

Probst, Janice C; Barker, Judith C; Enders, Alexandra; Gardiner, Paula

2018-02-01

Children's health is influenced by the context in which they live. We provide a descriptive essay on the status of children in rural America to highlight features of the rural environment that may affect health. We compiled information concerning components of the rural environment that may contribute to health outcomes. Areas addressed include the economic characteristics, provider availability, uniquely rural health risks, health services use, and health outcomes among rural children. Nearly 12 million children live in the rural United States. Rural counties are economically disadvantaged, leading to higher rates of poverty among rural versus urban children. Rural and urban children are approximately equally likely to be insured, but Medicaid insures a higher proportion of children in rural areas. While generally similar in health, rural children are more likely to be overweight or obese than urban children. Rural parents are less likely to report that their children received preventive medical or oral health visits than urban parents. Rural children are more likely to die than their urban peers, largely due to unintentional injury. Improving rural children's health will require both increased public health surveillance and research that creates solutions appropriate for rural environments, where health care professionals may be in short supply. Most importantly, solutions must be multisectoral, engaging education, economic development, and other community perspectives as well as health care. © 2016 National Rural Health Association.

Rural women's health

National Research Council Canada - National Science Library

Thurston, Wilfreda E; Leach, Belinda; Leipert, Beverly

2012-01-01

... about reduction of government funding and access to health care, and about the shortage of new volunteers to replace them when they burn out. These are a few of the stories told in the chapters of this book. This ground-breaking collection of essays identifies priority issues that must be addressed to ensure rural women's well-being, and offers innovative ideas for improvement and further research. Rural women play a critical role within their families and communities, and the health of these wome...

Impact of the rural health development programme in the Islamic Republic of Iran on rural-urban disparities in health indicators.

Science.gov (United States)

Aghajanian, A; Mehryar, A H; Ahmadnia, S; Kazemipour, S

2008-01-01

By 1979, 50 years of uneven development and modernization by governments prior to the Islamic Revolution had left rural parts of the Islamic Republic of Iran with extremely low economic and health status. This paper reports on the impact of the rural health development programme implemented as an effective and inexpensive way to improve the heath of the rural population, especially mothers and children. It describes the system of rural health centres, health houses and community health workers (behvarz) and demonstrates the effectiveness of the programme through declining measures of rural-urban disparities in health indicators. The implications of inexpensive rural health policies for other countries in the region such as Afghanistan and central Asian countries with a similar sociocultural structure are discussed.

Leadership development for rural health.

Science.gov (United States)

Size, Tim

2006-01-01

Leadership is the capacity to help transform a vision of the future into reality. Individuals who can and will exercise leadership are like a river's current--a part past where we now stand, a part yet to come. We have an ongoing need to remember and to look toward the next "generation." A key responsibility of those here now, is to mentor and to create structures for mentoring, in order to maximize the flow and effectiveness of tomorrow's leaders. When recruiting organizational leaders, the recruitment and interview process must seek individuals who in addition to technical competence, also have demonstrated leadership in their prior work and activities. To exercise effective leadership, we must work to know who we are, how we relate to others, and the environment around us. "Servant leadership" is a perspective held by many throughout the rural health community and offers a key set attributes of leadership useful to rural health. To implement the Institute of Medicine's recommendations in Through Collaboration: the Future of Rural Health, we must develop leaders skilled in collaboration, both internal to their organization and across organizations. The National Advisory Committee on Rural Health and Human Services had it right when they said to the Secretary and to the rest of us, "the best way to honor Jim is to consciously work to help develop the next generation of rural health leaders." There are, of course, a multitude of leadership institutes, programs, and courses throughout America; this is not a call for yet another separate entity. But it is a call to each of us in rural health to assure that we are deliberate in how we identify "emerging leaders from and for rural communities and provide them with the training and resources to play a lead role in ensuring access to quality healthcare in their states and communities." Let's get started.

42 CFR 485.603 - Rural health network.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Rural health network. 485.603 Section 485.603... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an... quality assurance with at least— (1) One hospital that is a member of the network when applicable; (2) One...

Strategies of Integrated Rural Development Adopted by ...

African Journals Online (AJOL)

unique firstlady

organization of self-help and co-operative effort on the part of the community, but ..... which urban and rural areas are considered as an integral part of the ... through these approaches or models, rural development could be attained, but it is ...

Rural Mental Health Ecology: A Framework for Engaging with Mental Health Social Capital in Rural Communities.

Science.gov (United States)

Wilson, Rhonda L; Wilson, G Glenn; Usher, Kim

2015-09-01

The mental health of people in rural communities is influenced by the robustness of the mental health ecosystem within each community. Theoretical approaches such as social ecology and social capital are useful when applied to the practical context of promoting environmental conditions which maximise mental health helping capital to enhance resilience and reduce vulnerably as a buffer for mental illness. This paper explores the ecological conditions that affect the mental health and illness of people in rural communities. It proposes a new mental health social ecology framework that makes full use of the locally available unique social capital that is sufficiently flexible to facilitate mental health helping capital best suited to mental health service delivery for rural people in an Australian context.

Are rural health professionals also social entrepreneurs?

Science.gov (United States)

Farmer, Jane; Kilpatrick, Sue

2009-12-01

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and 'community resilience'. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were 'formally or informally generating community associations or networking that produced social outcomes'. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal 'buzz' and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making 'deals'. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they

Rural Renewal of China in the Context of Rural-Urban Integration: Governance Fit and Performance Differences

Directory of Open Access Journals (Sweden)

Rongyu Wang

2018-02-01

Full Text Available In recent years, rural-urban integrated development has become a vital national strategy in China. In this context, many regions have implemented rural renewal projects to enhance the vitality and development of rural areas. The objective of this study is to reveal the reasons why different rural renewal modes have emerged in contemporary China and assess their ability to facilitate rural-urban integration. An analytical framework, the Institution of Sustainability (IoS and a comparative analysis of two cases are used for the rural renewal evaluation. Our findings indicate that the properties of transactions and the characteristics of the actors involved jointly determine the governance structures of rural renewal. Furthermore, different governance structures contribute to performance differences, particularly differences in the physical outcomes, distribution effects and process efficiency. Finally, we suggest relevant policy recommendations.

Rural mental health: neither romanticism nor despair.

Science.gov (United States)

Wainer, J; Chesters, J

2000-06-01

This paper explores the relationship between rural places and mental health. It begins with a definition of mental health and an outline of the data that have led to the current concern with promoting positive mental health. We then consider aspects of rural life and place that contribute to positive mental health or increase the likelihood of mental health problems. Issues identified include environment, place, gender identity, violence and dispossession and the influence of the effects of structural changes in rural communities. The paper concludes with a discussion of some of the determinants of resilience in rural places, including social connectedness, valuing diversity and economic participation.

Adolescent health: a rural community's approach.

Science.gov (United States)

Groft, Jean N; Hagen, Brad; Miller, Nancy K; Cooper, Natalie; Brown, Sharon

2005-01-01

Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents. A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns. Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as 'a little overweight' or 'definitely overweight', and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal

Assessment of periodontal health among the rural population of Moradabad, India

Directory of Open Access Journals (Sweden)

Manu Batra

2014-01-01

Full Text Available Introduction: Oral health is an integral component of general health and is essential for well-being. India is one of the most populated countries in the world and majority of them resides in rural areas. Moradabad is one of the oldest cities of Uttar Pradesh with diverse culture and beliefs. Aim: The aim was to evaluate the periodontal health status of the rural Moradabad population. Materials and Methods: A representative transversal study on 550 adults aged 20-49 years of rural Moradabad was conducted from February 2011 to June 2011. The survey was carried out using a self-designed questionnaire. Periodontal health was assessed using WHO criteria (1997. Results: Overall the prevalence of periodontal diseases among study subjects was overall 91.6%. Males had a higher prevalence of periodontal disease (93.8% as compared to females (89.5%. Out of total subjects 37.8% had Community Periodontal Index (CPI score 4 and 32.5% had score 3. About 7.3% of subjects had loss of attachment (LOA with 20.2% of them having LOA score 1. Statistically, there was a significant difference (P 35 years, smoking, tobacco chewing (independent risk factors were significantly associated with CPI > 2 (dependent variable (P < 0.05. Conclusion: The current periodontal health status of rural adult population of Moradabad city can be attributed to low literacy along with socio economic status and oral habits. To improve the periodontal health status of the rural population of Moradabad, it is suggested that a community-based approach can be designed.

'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India.

Science.gov (United States)

Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011-2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive 'teamwork' and 'building trust with the community' (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology - which the health workers espouse - is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.

Portrait of a rural health graduate: exploring alternative learning spaces.

Science.gov (United States)

Ross, Andrew; Pillay, Daisy

2015-05-01

Given that the staffing of rural facilities represents an international challenge, the support, training and development of students of rural origin at institutions of higher learning (IHLs) should be an integral dimension of health care provisioning. International studies have shown these students to be more likely than students of urban origin to return to work in rural areas. However, the crisis in formal school education in some countries, such as South Africa, means that rural students with the capacity to pursue careers in health care are least likely to access the necessary training at an IHL. In addition to challenges of access, throughput is relatively low at IHLs and is determined by a range of learning experiences. Insight into the storied educational experiences of health care professionals (HCPs) of rural origin has the potential to inform the training and development of rural-origin students. Six HCPs of rural origin were purposively selected. Using a narrative inquiry approach, data were generated from long interviews and a range of arts-based methods to create and reconstruct the storied narratives of the six participants. Codes, categories and themes were developed from the reconstructed stories. Reid's four-quadrant model of learning theory was used to focus on the learning experiences of one participant. Alternative learning spaces were identified, which were made available through particular social spaces outwith formal lecture rooms. These offered opportunities for collaboration and for the reconfiguring of the participants' agency to be, think and act differently. Through the practices enacted in particular learning spaces, relationships of caring, sharing, motivating and mentoring were formed, which contributed to personal, social, academic and professional development and success. Learning spaces outwith the formal lecture theatre are critical to the acquisition of good clinical skills and knowledge in the development of socially accountable

Mental health literacy in rural Queensland: results of a community survey.

Science.gov (United States)

Bartlett, Helen; Travers, Catherine; Cartwright, Colleen; Smith, Norman

2006-09-01

The aim of this study was to assess the awareness of, and attitudes to, mental health issues in rural dwelling Queensland residents. A secondary objective was to provide baseline data of mental health literacy prior to the implementation of Australian Integrated Mental Health Initiative--a health promotion strategy aimed at improving the health outcomes of people with chronic or recurring mental disorders. In 2004 a random sample of 2% (2132) of the estimated adult population in each of eight towns in rural Queensland was sent a postal survey and invited to participate in the project. A series of questions were asked based on a vignette describing a person suffering major depression. In addition, questions assessed respondents' awareness and perceptions of community mental health agencies. Approximately one-third (36%) of those surveyed completed and returned the questionnaire. While a higher proportion of respondents (81%) correctly identified and labelled the problem in the vignette as depression than previously reported in Australian community surveys, the majority of respondents (66%) underestimated the prevalence of mental health problems in the community. Furthermore, a substantial number of respondents (37%) were unaware of agencies in their community to assist people with mental health issues while a majority of respondents (57.6%) considered that the services offered by those agencies were poor. While mental health literacy in rural Queensland appears to be comparable to other Australian regions, several gaps in knowledge were identified. This is in spite of recent widespread coverage of depression in the media and thus, there is a continuing need for mental health education in rural Queensland.

Expanding rural access to mental health care through online postgraduate nurse practitioner education.

Science.gov (United States)

Kverno, Karan; Kozeniewski, Kate

2016-12-01

Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

Science.gov (United States)

Smith, Tony; Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and

Using the integrated rural mobility and access (IRMA) approach in prospering rural South Africa

CSIR Research Space (South Africa)

Chakwizira, J

2008-11-01

Full Text Available settlements implications of current rural development approaches are outlined. The potential and impact of the integrated rural mobility and access approach (IRMA) in unlocking socio-economic and spatial livelihood opportunities are discussed. In this regard...

Feasibility Analysis and Simulation of Integrated Renewable Energy System for Power Generation: A Hypothetical Study of Rural Health Clinic

Directory of Open Access Journals (Sweden)

Vincent Anayochukwu Ani

2015-01-01

Full Text Available This paper presents the feasibility analysis and study of integrated renewable energy (IRE using solar photovoltaic (PV and wind turbine (WT system in a hypothetical study of rural health clinic in Borno State, Nigeria. Electrical power consumption and metrology data (such as solar radiation and wind speed were used for designing and analyzing the integrated renewable energy system. The health clinic facility energy consumption is 19 kWh/day with a 3.4 kW peak demand load. The metrological data was collected from National Aeronautics and Space Administration (NASA website and used to analyze the performance of electrical generation system using HOMER program. The simulation and optimization results show that the optimal integrated renewable energy system configuration consists of 5 kW PV array, BWC Excel-R 7.5 kW DC wind turbine, 24 unit Surrette 6CS25P battery cycle charging, and a 19 kW AC/DC converter and that the PV power can generate electricity at 9,138 kWh/year while the wind turbine system can generate electricity at 7,490 kWh/year, giving the total electrical generation of the system as 16,628 kWh/year. This would be suitable for deployment of 100% clean energy for uninterruptable power performance in the health clinic. The economics analysis result found that the integrated renewable system has total NPC of 137,139 US Dollar. The results of this research show that, with a low energy health facility, it is possible to meet the entire annual energy demand of a health clinic solely through a stand-alone integrated renewable PV/wind energy supply.

Personalized Health Monitoring System for Managing Well-Being in Rural Areas.

Science.gov (United States)

Nedungadi, Prema; Jayakumar, Akshay; Raman, Raghu

2017-12-14

Rural India lacks easy access to health practitioners and medical centers, depending instead on community health workers. In these areas, common ailments that are easy to manage with medicines, often lead to medical escalations and even fatalities due to lack of awareness and delayed diagnosis. The introduction of wearable health devices has made it easier to monitor health conditions and to connect doctors and patients in urban areas. However, existing initiatives have not succeeded in providing adequate health monitoring to rural and low-literate patients, as current methods are expensive, require consistent connectivity and expect literate users. Our design considerations address these concerns by providing low-cost medical devices connected to a low-cost health platform, along with personalized guidance based on patient physiological parameters in local languages, and alerts to medical practitioners in case of emergencies. This patient-centric integrated healthcare system is designed to manage the overall health of villagers with real-time health monitoring of patients, to offer guidance on preventive care, and to increase health awareness and self-monitoring at an affordable price. This personalized health monitoring system addresses the health-related needs in remote and rural areas by (1) empowering health workers in monitoring of basic health conditions for rural patients in order to prevent escalations, (2) personalized feedback regarding nutrition, exercise, diet, preventive Ayurveda care and yoga postures based on vital parameters and (3) reporting of patient data to the patient's health center with emergency alerts to doctor and patient. The system supports community health workers in the diagnostic procedure, management, and reporting of rural patients, and functions well even with only intermittent access to Internet.

Racism and Health in Rural America.

Science.gov (United States)

Kozhimannil, Katy B; Henning-Smith, Carrie

2018-01-01

This commentary responds to the recent article by Dr. James et al. on racial and ethnic health disparities in rural America, published in the November 16 issue of Morbidity and Mortality Weekly Report. We applaud Dr. James and colleagues for their important contribution uncovering intra-rural racial and ethnic disparities and build on their paper by discussing potential mechanisms, including structural racism. We also discuss several pragmatic steps that can be taken in research, policy, and practice to address racial and ethnic disparities in rural communities and to work toward health equity for all rural residents.

Ruralization of students’ horizons: insights into Australian health professional students’ rural and remote placements

Science.gov (United States)

Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Introduction Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions. Methods Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results The core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions. Conclusions The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study

Utilization of maternal health services in rural primary health centers ...

African Journals Online (AJOL)

Utilization of maternal health services in rural primary health centers in Sub- Saharan Africa. ... their pregnancies were normal during antenatal care visits, hostile attitude of health workers, poverty and mode of payment. Majority of the PHCs provided antenatal, normal delivery, and post natal services. Rural mothers lacked ...

Training child psychiatrists in rural public mental health.

Science.gov (United States)

Petti, T A; Benswanger, E G; Fialkov, M J; Sonis, M

1987-04-01

Lack of appropriate training in both public mental health service and rural mental health service is a major factor in the critical shortage of child psychiatrists in rural settings. The authors describe a residency training program in rural public mental health designed to help alleviate that shortage. The program familiarizes fourth-year residents in child psychiatry with the clinical, political, and social aspects of rural public mental health services through didactic and supervisory sessions as well as an eight-month practicum experience involving provision of inservice training and administrative and case-related consultation to staff of mental health agencies. An assessment of the program indicated that participants felt it was beneficial, but the program was only partly successful in increasing the number of child psychiatrists entering practice in rural areas. The authors urge that residency programs in child psychiatry give priority to training child psychiatrists for work in rural settings.

An evaluation of rural health care research.

Science.gov (United States)

Kane, R; Dean, M; Solomon, M

1979-05-01

Reviews the state of the art of rural health research and evaluation in the U.S. with particular emphasis on the questions of access, health personnel, and financing. The current state of knowledge both in the published and unpublished literature in each area is summarized and a series of unresolved issues is proposed. A strategy for further research to include the various types of rural health care programs is described. Major findings suggest that, although rural populations do have somewhat less access to care than do urban populations, our ability to quantify precisely the extent and importance of this discrepancy is underdeveloped. Despite a substantial investment in a variety of rural health care programs there is inadequate information as to their effectiveness. Programs designed to increase the supply of health personnel to rural areas have met with mixed success. Sites staffed by National Health Service Corps personnel show consistently lower productivity than do sites under other sponsorship. Nonphysician personnel (physician assistants and nurse practitioners) offer a promising source of primary care for rural areas: recent legislation that reimburses such care should increase their utilization. A persistent problem is the expectation (often a mandate) incorporated into many rural health care demonstration efforts that the programs become financially self-sufficient in a finite period of time. Self-sufficiency is a function of utilization, productivity, and the ability to recover charges for services. In many instances stringent enforcement of the self-sufficiency requirement may mean those who need services most will be least likely to receive them.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes.

Science.gov (United States)

Moran, Anna M; Coyle, Julia; Pope, Rod; Boxall, Dianne; Nancarrow, Susan A; Young, Jennifer

2014-02-13

To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

Organizing Rural Health Care

DEFF Research Database (Denmark)

Bunkenborg, Mikkel

2012-01-01

to organize rural health care is more regulatory and distanced in its emphasis on nudging patients and doctors towards the right decisions through economic incentives. This bureaucratic approach to organizing health individually offers a sharp contrast to the religious collectivities that form around health...

Issues in rural adolescent mental health in Australia.

Science.gov (United States)

Boyd, Candice P; Aisbett, Damon L; Francis, Kristy; Kelly, Melinda; Newnham, Krystal; Newnham, Karyn

2006-01-01

The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised--including the nature of mental health issues for rural adolescents and barriers to seeking professional help--are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.

Cultural health beliefs in a rural family practice: a Malaysian perspective.

Science.gov (United States)

Ariff, Kamil M; Beng, Khoo S

2006-02-01

Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service. The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients. Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.

A reproductive health survey of rural women in Hebei.

Science.gov (United States)

Wang, J

1998-12-01

This article presents the findings of a 1995 family planning survey conducted among 657 women aged 18-49 years in rural areas of Tangshan City, Zhoushou City, and Xingtai City in Hebei province, Northern China. 620 were married, 37 were single, and 6 were widowed. 85.8% of married rural women used a contraceptive method (female sterilization or IUD). There were 1219 pregnancies, 230 abortions, 31 miscarriages, and 3 stillbirths. 68.1% received prenatal check-ups at hospitals and health centers. 47.4% received prenatal care during the first trimester of pregnancy. 76.1% received check-ups at township health centers. Women were aware of the need for sound personal hygiene, sanitary napkins, and avoidance of heavy manual work during menstruation. 45.1% had less than 5 years of education; 51.8% had 6-10 years of education; and 3.1% had over 10 years of education. About 54% delivered at home. Home deliveries were due to lack of transportation, high expenses, and other reasons. Deliveries were attended by a doctor or midwife. Postpartum home visits were not assured. 32.4% had routine gynecological check-ups. 48.1% had never received gynecological services. 51.6% of married women had 2 children; 16.9% had more. The author recommended improved socioeconomic and cultural conditions, a women-centered reproductive health security system integrated with education, and legislative change. Reproductive health education should be integrated into family planning programs and include health awareness and more education. Men should participate in programs and share more responsibility for reproduction. Services should improve in quality.

Creating a new rural pharmacy workforce: Development and implementation of the Rural Pharmacy Health Initiative.

Science.gov (United States)

Scott, Mollie Ashe; Kiser, Stephanie; Park, Irene; Grandy, Rebecca; Joyner, Pamela U

2017-12-01

An innovative certificate program aimed at expanding the rural pharmacy workforce, increasing the number of pharmacists with expertise in rural practice, and improving healthcare outcomes in rural North Carolina is described. Predicted shortages of primary care physicians and closures of critical access hospitals are expected to worsen existing health disparities. Experiential education in schools and colleges of pharmacy primarily takes place in academic medical centers and, unlike experiential education in medical schools, rarely emphasizes the provision of patient care in rural U.S. communities, where chronic diseases are prevalent and many residents struggle with poverty and poor access to healthcare. To help address these issues, UNC Eshelman School of Pharmacy developed the 3-year Rural Pharmacy Health Certificate program. The program curriculum includes 4 seminar courses, interprofessional education and interaction with medical students, embedding of each pharmacy student into a specific rural community for the duration of training, longitudinal ambulatory care practice experiences, community engagement initiatives, leadership training, development and implementation of a population health project, and 5 pharmacy practice experiences in rural settings. The Rural Pharmacy Health Certificate program at UNC Eshelman School of Pharmacy seeks to transform rural pharmacy practice by creating a pipeline of rural pharmacy leaders and teaching a unique skillset that will be beneficial to healthcare systems, communities, and patients. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness

Science.gov (United States)

Gold, Paul B; Meisler, Neil; Santos, Alberto B; Carnemolla, Mark A; Williams, Olivia H; Keleher, Jennie

2006-01-01

Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = $549, interquartile range [IQR] = $0–$5,145, versus Mdn = $0, IQR = $0–$40; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills. PMID:16177278

Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

Science.gov (United States)

Ogunbodede, E O; Kida, I A; Madjapa, H S; Amedari, M; Ehizele, A; Mutave, R; Sodipo, B; Temilola, S; Okoye, L

2015-07-01

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations. © International & American Associations for Dental Research 2015.

Rural adolescents' access to adolescent friendly health services.

Science.gov (United States)

Secor-Turner, Molly A; Randall, Brandy A; Brennan, Alison L; Anderson, Melinda K; Gross, Dean A

2014-01-01

The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

The old age health security in rural China: where to go?

Science.gov (United States)

Dai, Baozhen

2015-11-04

The huge number of rural elders and the deepening health problems (e.g. growing threats of infectious diseases and chronic diseases etc.) place enormous pressure on old age health security in rural China. This study aims to provide information for policy-makers to develop effective measures for promoting rural elders' health care service access by examining the current developments and challenges confronted by the old age health security in rural China. Search resources are electronic databases, web pages of the National Bureau of Statistics of China and the National Health and Family Planning Commission of China on the internet, China Population and Employment Statistics Yearbook, China Civil Affairs' Statistical Yearbook and China Health Statistics Yearbooks etc. Articles were identified from Elsevier, Wiley, EBSCO, EMBASE, PubMed, SCI Expanded, ProQuest, and National Knowledge Infrastructure of China (CNKI) which is the most informative database in Chinese. Search terms were "rural", "China", "health security", "cooperative medical scheme", "social medical assistance", "medical insurance" or "community based medical insurance", "old", or "elder", "elderly", or "aged", "aging". Google scholar was searched with the same combination of keywords. The results showed that old age health security in rural China had expanded to all rural elders and substantially improved health care service utilization among rural elders. Increasing chronic disease prevalence rates, pressing public health issues, inefficient rural health care service provision system and lack of sufficient financing challenged the old age health security in rural China. Increasing funds from the central and regional governments for old age health security in rural China will contribute to reducing urban-rural disparities in provision of old age health security and increasing health equity among rural elders between different regions. Meanwhile, initiating provider payment reform may contribute to

‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

Science.gov (United States)

Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. PMID:25025872

'Poorly defined': unknown unknowns in New Zealand Rural Health.

Science.gov (United States)

Fearnley, David; Lawrenson, Ross; Nixon, Garry

2016-08-05

There is a considerable mismatch between the population that accesses rural healthcare in New Zealand and the population defined as 'rural' using the current statistics New Zealand rural and urban categorisations. Statistics New Zealand definitions (based on population size or density) do not accurately identify the population of New Zealanders who actually access rural health services. In fact, around 40% of people who access rural health services are classified as 'urban' under the Statistics New Zealand definition, while a further 20% of people who are currently classified as 'rural' actually have ready access to urban health services. Although there is some recognition that current definitions are suboptimal, the extent of the uncertainty arising from these definitions is not widely appreciated. This mismatch is sufficient to potentially undermine the validity of both nationally-collated statistics and also any research undertaken using Statistics New Zealand data. Under these circumstances it is not surprising that the differences between rural and urban health care found in other countries with similar health services have been difficult to demonstrate in New Zealand. This article explains the extent of this mismatch and suggests how definitions of rural might be improved to allow a better understanding of New Zealand rural health.

Mental healthcare delivery in rural Greece: A 10-year account of a mobile mental health unit

Directory of Open Access Journals (Sweden)

Vaios Peritogiannis

2017-01-01

Full Text Available Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs. Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60% were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults, and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28% receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes

Science.gov (United States)

2014-01-01

Objective To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. Design This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. Results This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Conclusion Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts. PMID:24521004

Feasibility of a multifaceted educational strategy for strengthening rural primary health care

Directory of Open Access Journals (Sweden)

Hortensia Reyes-Morales

2017-05-01

Full Text Available Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strat­egy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams; Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observa­tion, questionnaires and in-depth interviews with key players. Results. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. Conclusion. The educational strategy proved to be acceptable; its feasibil­ity for usual care conditions will depend on the improvement of organizational processes at rural facilities.

Rural Health Disparities

Science.gov (United States)

... in the Delta Region for specific data. U.S. – Mexico Border While life expectancy in many counties of ... documents the successes, challenges, and relevant information for planning. ... on rural/urban disparities see What sources cover health behaviors and ...

Rural School Math and Science Teachers' Technology Integration Familiarization

Science.gov (United States)

Kalonde, Gilbert

2017-01-01

This study explored the significance of technology integration familiarization and the subsequent PD provided to rural middle school teachers with several opportunities to gain technological skills for technology use in rural middle school math and science classrooms. In order to explore the use of technology in rural schools, this study surveyed…

Exploring the Influence of Social Determinants, Social Capital, and Health Expertise on Health and the Rural Church.

Science.gov (United States)

Plunkett, Robyn; Leipert, Beverly; Olson, Joanne

2016-09-01

In rural communities, religious places can significantly shape health for individuals, families, and communities. Rural churches are prominent community centers in rural communities and are deeply woven into rural culture. Thus, health influences arising from the rural church likely have health implications for the greater community. This article explores health influences emerging from rural churches using social determinants of health, social capital, and health expertise. Although nurses are important health resources for all populations, their value in rural areas may be exceedingly significant. The contribution of nurses to church-based health capital in rural communities may be quite significant and underestimated, although it remains poorly understood. © The Author(s) 2015.

Social Integration and Health Behavioral Change in San Luis, Honduras

Science.gov (United States)

McQuestion, Michael J.; Calle, Ana Quijano; Drasbek, Christopher; Harkins, Thomas; Sagastume, Lourdes J.

2010-01-01

This study explores the effects of social integration on behavioral change in the course of an intensive, community-based public health intervention. The intervention trained volunteers and mobilized local organizations to promote 16 key family health practices in rural San Luis, Honduras, during 2004 to 2006. A mixed methods approach is used.…

Countermeasures for Intensive Use of Land from the Perspective of Urban-Rural Integration

OpenAIRE

Jia, Li-bin

2012-01-01

This paper analyzes problems of excessive emphasis on expansion of urban land, improper village and town construction, and low land utilization efficiency in urban-rural integration construction. In line with characteristics and principle of intensive land use of urban-rural integration, it puts forward integration of urban-rural land layout, practically exploring connotation, and improving land intensification in many ways. Based on these, it presents countermeasures for intensive use of lan...

Exposing some important barriers to health care access in the rural USA.

Science.gov (United States)

Douthit, N; Kiv, S; Dwolatzky, T; Biswas, S

2015-06-01

To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA. This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA. Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) 'Rural Health Services' and 'Rural Health.' MeSH subtitle headings used were 'USA,' 'utilization,' 'trends' and 'supply and distribution.' Keywords added to the search parameters were 'access,' 'rural' and 'health care.' Searches in Google Scholar employed the phrases 'health care disparities in the USA,' inequalities in 'health care in the USA,' 'health care in rural USA' and 'access to health care in rural USA.' After eliminating non-relevant articles, 34 articles were included. Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts. Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis.

Science.gov (United States)

Mberu, Blessing U; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C

2016-01-01

It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately

Improving reproductive health in rural China through participatory planning.

Science.gov (United States)

Kaufman, Joan; Liu, Yunguo; Fang, Jing

2012-01-01

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia.

Science.gov (United States)

Whelan, Jessica J; Willis, Karen

2007-01-01

Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey.

Science.gov (United States)

Smith, Tony; Sutton, Keith; Pit, Sabrina; Muyambi, Kuda; Terry, Daniel; Farthing, Annie; Courtney, Claire; Cross, Merylin

2018-02-01

The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Cross-sectional survey comprising 21 core questions used by all UDRHs. Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post-placement rural practice intention. The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention. © 2017 National Rural Health Alliance Inc.

Integrated farm sustainability assessment for the environmental management of rural activities

International Nuclear Information System (INIS)

Stachetii Rodrigues, Geraldo; Aparecida Rodrigues, Izilda; Almeida Buschinelli, Claudio Cesar de; Barros, Inacio de

2010-01-01

Farmers have been increasingly called upon to respond to an ongoing redefinition in consumers' demands, having as a converging theme the search for sustainable production practices. In order to satisfy this objective, instruments for the environmental management of agricultural activities have been sought out. Environmental impact assessment methods are appropriate tools to address the choice of technologies and management practices to minimize negative effects of agricultural development, while maximizing productive efficiency, sound usage of natural resources, conservation of ecological assets and equitable access to wealth generation means. The 'system for weighted environmental impact assessment of rural activities' (APOIA-NovoRural) presented in this paper is organized to provide integrated farm sustainability assessment according to quantitative environmental standards and defined socio-economic benchmarks. The system integrates sixty-two objective indicators in five sustainability dimensions - (i) Landscape ecology, (ii) Environmental quality (atmosphere, water and soil), (iii) Sociocultural values, (iv) Economic values, and (v) Management and administration. Impact indices are expressed in three integration levels: (i) specific indicators, that offer a diagnostic and managerial tool for farmers and rural administrators, by pointing out particular attributes of the rural activities that may be failing to comply with defined environmental performance objectives; (ii) integrated sustainability dimensions, that show decision-makers the major contributions of the rural activities toward local sustainable development, facilitating the definition of control actions and promotion measures; and (iii) aggregated sustainability index, that can be considered a yardstick for eco-certification purposes. Nine fully documented case studies carried out with the APOIA-NovoRural system, focusing on different scales, diverse rural activities/farming systems, and contrasting

Genital Ulcers and Sexual Transmitted Disease in Rural Nigeria ...

African Journals Online (AJOL)

Casual sex was a dominant behavioural pattern. The phenomenon of denial was encountered in females. STDs are not uncommon in rural Nigeria. Integration of Sexual health in rural health, family health, and school health is urgently needed. Key Words: Genital ulcers, STDs, Rural Nigeria Jnl of Medical Investigation and ...

Rural and remote health research: Does the investment match the need?

Science.gov (United States)

Barclay, Lesley; Phillips, Andrew; Lyle, David

2018-04-01

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000-2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005-2014. This is a retrospective analysis of publicly available datasets. National Health and Medical Research Council Rural and Remote Health Research 2000-2014. 'Australian Rural Health Research' was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005-2014. Of the 16 651 National Health and Medical Research Council-funded projects, 185 (1.1%) that commenced funding during the period 2000-2014 were defined as 'Australian Rural Health Research'. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented. Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia. © 2018 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National

Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care.

Science.gov (United States)

Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

2013-10-01

The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems. Considering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N0 which controls N1, N2, and N3 proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network. Among 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network. The registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N0 to the relay peers which connected to the N1, N2, and N3 nodes, controlled by the cloud controller through a JXTA network.

A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons.

Science.gov (United States)

Horvath, Keith J; Iantaffi, Alex; Swinburne-Romine, Rebecca; Bockting, Walter

2014-01-01

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.

Medical student attitudes before and after participation in rural health fairs

Directory of Open Access Journals (Sweden)

David C Landy

2012-01-01

Full Text Available Background: Despite an increased need, residents of rural communities have decreased access to healthcare and oftenpresentuniquehealthcare challenges associated with their rurality. Ensuring medical students receive adequate exposure to these issues is complicated by the urban location of most medical schools. Health fairs (fairs conducted in rural communities can provide students exposure to ruralhealth;however, it is unknown how participation affects attitudes regarding these issues. Materials and Methods: During the 2010-2011 academic year, first-year medical students were surveyed before and after participating in a rural fair regarding the importance of rural health issues, the need for exposure to rural healthcare, their plans to practice in a rural community,andthe educational impact of fairs. Results : Of the 121participating students, 77% and 61% completed pre- and post-fair surveys, respectively. Few had lived in a rural area or planned to practice primary care. Participants strongly agreed that the delivery of healthcare in rural areas was important, and that all physicians should receive rural health training (4.8 and 3.7 out of 5, respectively despite less than halfplanning to practice in a rural community.After participating in a rural fair, student attitudes were unchanged, although 87% of participants strongly agreed their involvement had contributed to improving patient health and 70% that the fairs provided rural medicine experience. Conclusions : Among urban medical school students with varied interests in primary care, there was strong interest in volunteering at rural fairs and appreciation for the importance of rural health. Fairs provided interested students with rural medicine experience that reinforced student attitudes regarding rural health. Further, students felt their participation improved patient health.

Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

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Buykx Penny

2011-03-01

Full Text Available Abstract Background Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. Methods/Design The evaluation framework aims to examine the health service over a six-year period in terms of: (a Structural domains (health service performance; sustainability; and quality of care; (b Process domains (health service utilisation and satisfaction; and (c Outcome domains (health behaviours, health outcomes and community viability. Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. Discussion This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how

Role of AYUSH Doctors in Filling the Gap of Health Workforce Inequality in Rural India with Special Reference to National Rural Health Mission: A Situational Analysis

OpenAIRE

Janmejaya Samal

2013-01-01

Paucity of health workforce in rural India has always been a problem. Lack of interest of modern allopathic graduates in serving the rural poor has worsened the situation little more. The National Rural Health Mission brought an innovative concept of mainstreaming of AYUSH and revitalization of local health tradition by collocating AYUSH doctors at various rural health facilities such as community health centers and primary health centers. In this context a study was aimed, based on secondary...

Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

African Journals Online (AJOL)

Rural-Urban Disparities in Health and Health Care in Africa: Cultural Competence, Lay-beliefs in Narratives of Diabetes among the Rural Poor in the Eastern Cape ... to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pains, treatment of diabetes (e.g. gym exercise).

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

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Mberu, Blessing U.; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C.

2016-01-01

Background It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

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Blessing U. Mberu

2016-12-01

Full Text Available Background: It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective: The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design: We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results: In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to

Locating of Rural Health Centers Equipped with Telehealth using GIS: A Case Study on Khorramabad City, Iran

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Safdari Reza

2016-10-01

Full Text Available Residents of the rural and remote area always having limitations on accessing properly required service providers. In such condition, the establishment of rural health centers equipped with telehealth, and also the use of GIS for optimal site selection to the centers, would play an important role in facilitating the achievement of quality health services in desired time factor. This study intended to find the optimal sites for building the Rural Health Centers Equipped with remote health facilities in, Khorramabad City, using GIS. During the pilot study, we identified few effective locating criteria and sub-criteria for rural health centers equipped with telehealth, the priorities was also determined in that descriptive study. Further, we prepared a special layer for each criterion on the site selection, and by integrating such layers based on specified rules and patterns, about the spatial analysis , (like distance and density analysis were done. For such methods, we used Arc Map, Arc Catalog and Arc toolbox environments of Arc GIS (version 9.3. Finally, a map was prepared that indicated the possibility of appropriateness for establishing the centers in the study area. Considering a large number of areas, the research team selected the areas which were the appropriate location for build rural health centers which could be equipped with Telehealth.

Defining the medical imaging requirements for a rural health center

CERN Document Server

2017-01-01

This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study.

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Coghill, Cara-Lee; Valaitis, Ruta K; Eyles, John D

2015-05-03

Few studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs. This descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis. Themes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited. Public health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.

China's rural public health system performance: a cross-sectional study.

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Tian, Miaomiao; Feng, Da; Chen, Xi; Chen, Yingchun; Sun, Xi; Xiang, Yuanxi; Yuan, Fang; Feng, Zhanchun

2013-01-01

In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance. The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region. China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%. The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.

Rural Health Information Hub

Science.gov (United States)

... U.S. (2011-2015): Individual-level & Placed-based Disparities Source: Southwest Rural Health Research Center Online Library » Resource and Referral Service Need help finding information? RHIhub can provide free assistance customized to your ...

Effect of medicare payment on rural health care systems.

Science.gov (United States)

McBride, Timothy D; Mueller, Keith J

2002-01-01

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.

Science.gov (United States)

Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans

2016-01-01

Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost

Approaching integrated urban-rural development in China: The changing institutional roles

OpenAIRE

Li, Yuheng; Hu, Zhichao; Liu, Yansui

2014-01-01

Ever since the twenty-first century, the Chinese government has been undertaking a series of rural-favored policies and measures to promote comprehensive development in rural China. The fundamental purpose is to accomplish integrated urban-rural development (IURD) given the ever enlarging urban-rural inequalities during the post-reform era. Considering the long time biased policies against the countryside, the paper aims to examine the institutional roles in approaching the IURD. IURD at prov...

Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns.

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Sypek, Scott; Clugston, Gregory; Phillips, Christine

2008-12-01

To explore the reported impact of regional resettlement of refugees on rural health services, and identify critical health infrastructure for refugee resettlement. Comparative case study, using interviews and situational analysis. Four rural communities in New South Wales, which had been the focus of regional resettlement of refugees since 1999. Refugees, general practitioners, practice managers and volunteer support workers in each town (n = 24). The capacity of health care workers to provide comprehensive care is threatened by low numbers of practitioners, and high levels of turnover of health care staff, which results in attrition of specialised knowledge among health care workers treating refugees. Critical health infrastructure includes general practices with interest and surge capacity, subsidised dental services, mental health support services; clinical support services for rural practitioners; care coordination in the early settlement period; and a supported volunteer network. The need for intensive medical support is greatest in the early resettlement period for 'catch-up' primary health care. The difficulties experienced by rural Australia in securing equitable access to health services are amplified for refugees. While there are economic arguments about resettlement of refugees in regional Australia, the fragility of health services in regional Australia should also be factored into considerations about which towns are best suited to regional resettlement.

Transforming rural health systems through clinical academic leadership: lessons from South Africa.

Science.gov (United States)

Doherty, J E; Couper, I D; Campbell, D; Walker, J

2013-01-01

Under-resourced and poorly managed rural health systems challenge the achievement of universal health coverage, and require innovative strategies worldwide to attract healthcare staff to rural areas. One such strategy is rural health training programs for health professionals. In addition, clinical leadership (for all categories of health professional) is a recognised prerequisite for substantial improvements in the quality of care in rural settings. Rural health training programs have been slow to develop in low- and middle-income countries (LMICs); and the impact of clinical leadership is under-researched in such settings. A 2012 conference in South Africa, with expert input from South Africa, Canada and Australia, discussed these issues and produced recommendations for change that will also be relevant in other LMICs. The two underpinning principles were that: rural clinical leadership (both academic and non-academic) is essential to developing and expanding rural training programs and improving care in LMICs; and leadership can be learned and should be taught. The three main sets of recommendations focused on supporting local rural clinical academic leaders; training health professionals for leadership roles in rural settings; and advancing the clinical academic leadership agenda through advocacy and research. By adopting the detailed recommendations, South Africa and other LMICs could energise management strategies, improve quality of care in rural settings and impact positively on rural health outcomes.

Generational attitudes of rural mental health nurses.

Science.gov (United States)

Crowther, Andrew; Kemp, Michael

2009-04-01

To determine how attitudes of rural mental health nurses differ across generations. Survey. Mental health services in rural New South Wales. Practising mental health nurses. Survey responses. Survey response rate 44%. A total of 89 mental health nurses, clustered in inpatient units and community health centres, responded. Of these nurses, 4 were veterans, 52 baby boomers, 17 Generation X and 5 Generation Y. There are significant differences in how mental health nurses from different generations view their work, and in what is expected from managers. Managers need to modify traditional working styles, allowing greater flexibility of employment. They must also accept lower staff retention rates, and facilitate the development of younger staff.

76 FR 30244 - Veterans' Rural Health Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-05-24

... on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines... Rural Health Strategic Plan discussion and work session and the other is the Committee's annual report... DEPARTMENT OF VETERANS AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The...

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

Directory of Open Access Journals (Sweden)

Wenxi Tang

2015-03-01

Full Text Available Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system.Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences.Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1 improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2 improvement on quality of care through continuous care and coordinated supplier behaviours; (3 improvement on the system efficiency through active interaction between suppliers and patients

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China.

Science.gov (United States)

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. The integrated care system needs collaborative work from different levels

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

Directory of Open Access Journals (Sweden)

Wenxi Tang

2015-03-01

Full Text Available Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1 improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2 improvement on quality of care through continuous care and coordinated supplier behaviours; (3 improvement on the system efficiency through active interaction between suppliers and patients. Conclusion

Rural Health in the People's Republic of China; Report of a Visit by the Rural Health Systems Delegation, June 1978.

Science.gov (United States)

Public Health Service (DHHS), Rockville, MD.

A 28-day visit to the People's Republic of China during June and July 1978 by the Rural Health Systems Delegation from the United States, sponsored by the Committee on Scholarly Communication with the People's Republic of China, resulted in an exchange of information about rural health policy and planning. Specific areas of emphasis included:…

Integration of Rural Community Pharmacies into a Rural Family Medicine Practice-Based Research Network: A Descriptive Analysis

Directory of Open Access Journals (Sweden)

Nicholas E. Hagemeier

2015-01-01

Full Text Available Purpose: Practice-based research networks (PBRN seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1 evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2 explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3 explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88% were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%, improved relationships with providers in the community (75.9%, and professional development opportunities (69.0% were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63% and workflow disruptions (20% as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas.   Type: Original Research

Integrated rural development programs: a skeptical perspective.

Science.gov (United States)

Ruttan, V W

1975-11-01

In examining integrated rural development programs the question that arises is why is it possible to identify several relatively successful small-scale or pilot rural development projects yet so difficult to find examples of successful rural development programs. 3 bodies of literature offer some insight into the morphology of rural development projects, programs, and processes: the urban-industrial impact hypothesis; the theory of induced technical change; and the new models of institutional change that deal with institution building and the economics of bureaucratic behavior. The urban-industrial impact hypothesis helps in the clarification of the relationships between the development of rural areas and the development of the total society of which rural areas are a part. It is useful in understanding the spatial dimensions of rural development where rural development efforts are likely to be most successful. Formulation of the hypothesis generated a series of empirical studies designed to test its validity. The effect of these studies has been the development of a rural development model in which the rural community is linked to the urban-industrial economy through a series of market relationships. Both the urban economy's rate of growth and the efficiency of the intersector product and factor markets place significant constraints on the possibilities of rural area development. It is not possible to isolate development processes in the contemporary rural community in a developing society from development processes in the larger society. The induced technical change theory provides a guide as to what must be done to gain access to efficient sources of economic growth, the new resources and incomes that are necessary to sustain rural development. Design of a successful rural development strategy involves a combination of technical and institutional change. The ability of rural areas to respond to the opportunities for economic growth generated by local urban

Perceived needs of health tutors in rural and urban health training institutions in Ghana: Implications for health sector staff internal migration control.

Science.gov (United States)

Alhassan, Robert Kaba; Beyere, Christopher B; Nketiah-Amponsah, Edward; Mwini-Nyaledzigbor, Prudence P

2017-01-01

The population of Ghana is increasingly becoming urbanized with about 70% of the estimated 27 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32% of the national health sector workforce works. Moreover, the rural-urban disparities in the density of health tutors (staff responsible for pre-service training of health professionals) are enormous. This paper explores perceived needs of health tutors in rural and urban health training institutions in Ghana. This is a descriptive qualitative study conducted in the Greater Accra and Northern regions of Ghana. The Study used the deductive thematic and sub-thematic analysis approaches. Five health training institutions were randomly sampled, and 72 tutors engaged in separate focus group discussions with an average size of 14 participants per group in each training institution. Perceived rural-urban disparities among health tutors were found in the payment of extra duty allowances; school infrastructure including libraries and internet connectivity; staff accommodation; and opportunities for scholarships and higher education. Health tutors in rural areas generally expressed more frustration with these work conditions than those in urban areas. There is the need to initiate and sustain work incentives that promote motivation of rural health tutors to control ongoing rural-urban migration of qualified staff. It is recommended the following incentives be prioritized to promote retention of qualified health tutors in rural health training schools: payment of research, book and rural allowances; early promotion of rural staff; prioritizing rural tutors for scholarships, and introduction of national best health tutor awards.

The Impact of Tobacco Consumption on Rural Household Expenditure and Self-rated Health Among Rural Household Members in China.

Science.gov (United States)

Li, Changle; Supakankunti, Siripen

2018-03-26

To estimate how tobacco consumption affects household expenditure on other goods and services in rural China and to assess the tobacco consumption affects self-rated health among rural household members in China. A Seemingly Unrelated Regression was used to assess the impact of tobacco consumption on rural household expenditure. To detect tobacco consumption causing heterogeneity in self-rated health among adults in rural China, this study employed a random effects generalized ordered probit model. 2010-2014 China Family Panel Studies was used for the analysis. The data set included 3,611 households and 10,610 adults in each wave. Tobacco consumption households assign significantly lower budget shares to food, health care, dress, and education in rural China. Moreover, self-rated health factor has a significantly positive coefficient with respect to non-smokers and ex-smokers, that is, when the individuals is a non-smoker or ex-smoker, he/ she will be more likely to report his/her health status as positive. The first analysis showed that tobacco consumption crowds out expenditures on food, dress, health care, and education for rural households in China, and the second analysis indicated that non-smokers and ex-smokers are more likely to report their health status as better compared with last year. The results of the present study revealed that Chinese policymakers might consider controlling tobacco consumption since tobacco control can improve not only rural household welfare but also rural household members' health status. Therefore, the tobacco tax policy and brief clinical interventions by the doctor should be implemented in rural China.

Modern energy access to all in rural India: An integrated implementation strategy

International Nuclear Information System (INIS)

Balachandra, P.

2011-01-01

Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. - Highlights: ► Expanding rural energy access in India is critical with majority lacking access to modern energy. ► Innovative and integrated implementation strategy for achieving universal rural energy access. ► Design of an integrated rural energy policy and proposal for new institutional mechanism. ► Establishing rural energy access authorities and energy access funds as supporting mechanisms. ► Bioenergy-based micro-enterprises for delivering energy services at an affordable cost.

Mobile phone-based clinical guidance for rural health providers in India.

Science.gov (United States)

Gautham, Meenakshi; Iyengar, M Sriram; Johnson, Craig W

2015-12-01

There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance. © The Author(s) 2014.

What Aspects of Rural Life Contribute to Rural-Urban Health Disparities in Older Adults? Evidence From a National Survey.

Science.gov (United States)

Cohen, Steven A; Cook, Sarah K; Sando, Trisha A; Sabik, Natalie J

2017-11-29

Rural-urban health disparities are well-documented and particularly problematic for older adults. However, determining which specific aspects of rural or urban living initiate these disparities remains unclear. The purpose of this study was to assess associations between place-based characteristics of rural-urban status and health among adults age 65+. Data from the 2012 Behavioral Risk Factor Surveillance System were geographically linked to place-based characteristics from the American Community Survey. Self-reported health (SRH), obesity, and health checkup within the last year were modeled against rural-urban status (distance to nearest metropolitan area, population size, population density, percent urban, Urban Influence Codes [UIC], Rural-Urban Continuum Codes [RUCC], and Rural-Urban Commuting Area [RUCA]) using generalized linear models, accounting for covariates and complex sampling, overall, and stratified by area-level income. In general, increasing urbanicity was associated with a reduction in negative SRH for all 7 measures of rural-urban status. For low-income counties, this association held for all measures and characteristics of rural-urban status except population density. However, for high-income counties, the association was reversed-respondents living in areas of increasing urbanicity were more likely to report negative SRH for 4 of the 7 measures (RUCC, UIC, RUCA, and percent urban). Findings were mixed for the outcome of obesity, where rural areas had higher levels, except in low-income counties, where the association between rurality and obesity was reversed (OR 1.033, 95%CI: 1.002-1.064). These results suggest that rural-urban status is both a continuum and multidimensional. Distinct elements of rural-urban status may influence health in nuanced ways that require additional exploration in future studies. © 2017 National Rural Health Association.

The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices.

Science.gov (United States)

Thomas, Tami; Blumling, Amy; Delaney, Augustina

2015-01-01

General health implications of religiosity and spirituality on health have been associated with health promotion, so the purpose of this study was to examine the influence of religiosity and spirituality on rural parents' decision making to vaccinate their children against human papillomavirus (HPV). The associations of religiosity and spirituality with parental HPV vaccine decisions were examined in a sample of parents residing in small rural communities (N = 37). Parents of children aged 9 to 13 years participated in focus groups held in rural community contexts. Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing HPV vaccination. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which parents perceived their control over and coping with health issues potentially related to HPV vaccination. Together, religiosity and spirituality were found to play integral roles in these parents' lives and influenced their attitudes toward HPV vaccination uptake for their children.

Food Insecurity and Rural Adolescent Personal Health, Home, and Academic Environments

Science.gov (United States)

Shanafelt, Amy; Hearst, Mary O.; Wang, Qi; Nanney, Marilyn S.

2016-01-01

Background: Food-insecure (FIS) adolescents struggle in school and with health and mental health more often than food-secure (FS) adolescents. Rural communities experience important disparities in health, but little is known about rural FIS adolescents. This study aims to describe select characteristics of rural adolescents by food-security…

78 FR 17418 - Rural Health Information Technology Network Development Grant

Science.gov (United States)

2013-03-21

... Information Technology Network Development Grant AGENCY: Health Resources and Services Administration (HRSA...-competitive replacement award under the Rural Health Information Technology Network Development Grant (RHITND... relinquishing its fiduciary responsibilities for the Rural Health Information Technology Network Development...

Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Directory of Open Access Journals (Sweden)

Kevin R. Tarlow

2014-01-01

Full Text Available Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n=94 had low health-related quality of life (HRQOL, often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n=40 was associated with an improvement in mental health-related quality of life (d = 0.70,  P<.001. These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

A comparison of health inequalities in urban and rural Scotland.

Science.gov (United States)

Levin, Kate A; Leyland, Alastair H

2006-03-01

Previous research suggests that there are significant differences in health between urban and rural areas. Health inequalities between the deprived and affluent in Scotland have been rising over time. The aim of this study was to examine health inequalities between deprived and affluent areas of Scotland for differing ruralities and look at how these have changed over time. Postcode sectors in Scotland were ranked by deprivation and the 20% most affluent and 20% most deprived areas were found using the Carstairs indicator and male unemployment. Scotland was then split into 4 rurality types. Ratios of health status between the most deprived and most affluent areas were investigated using all cause mortality for the Scottish population, 1979-2001. These were calculated over time for 1979-1983, 1989-1993, 1998-2001. Multilevel Poisson modelling was carried out for all of Scotland excluding Grampian to assess inequalities in the population. There was an increase in inequalities between 1981 and 2001, which was greatest in remote rural Scotland for both males and females; however, male health inequalities remained higher in urban areas throughout this period. In 2001 female health inequalities were higher in remote rural areas than urban areas. Health inequalities amongst the elderly (age 65+) in 2001 were greater in remote rural Scotland than urban areas for both males and females.

The quality of integrated reproductive health services: perspectives of clients in KwaZulu-Natal, South Africa

Directory of Open Access Journals (Sweden)

P Maharaj

2005-09-01

Full Text Available The focus of family planning programmes has shifted away from an emphasis on controlling fertility towards helping individuals achieve their reproductive goals. This article seeks to expand knowledge about the quality of integrated services from the perspective of clients at health facilities in KwaZulu-Natal. The results from 300 structured interviews with clients visiting health facilities found that overall quality of services was relatively high. However, the quality of services varied somewhat between rural and urban areas. Clients visiting urban health facilities reported greater satisfaction with services than clients visiting rural health facilities. The interviews with clients suggests that existing efforts to integrate services has had limited success. Clients were rarely offered an expanded range of services during their visit. In most cases, clients only received services for which they presented at the health facility.

Health behaviours of young, rural residents: a case study.

Science.gov (United States)

Bourke, Lisa; Humphreys, John; Lukaitis, Fiona

2009-04-01

To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours. Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours. Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences. The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required.

42 CFR 440.20 - Outpatient hospital services and rural health clinic services.

Science.gov (United States)

2010-10-01

... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... services that are not generally furnished by most hospitals in the State. (b) Rural health clinic services... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural health...

Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

Science.gov (United States)

T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

2014-01-01

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

The impact of husbands' gender equity awareness on wives' reproductive health in rural areas of China.

Science.gov (United States)

Ying, Cui; Li, Yang; Hui, Han

2011-02-01

The aim of this study was to investigate the effect of husbands' gender equity awareness on wives' reproductive health in rural areas of China. A qualitative study of 1919 wives aged from 18 to 69 years and their husbands was conducted in rural China. Data were collected through 3838 structured interviews. We quantified "belief in gender equity" based on responses to 7 specific statements and graded the responses according to a system scoring the strength of the overall belief (a total score 19 or higher, strong; 15-18, moderate; and 14 or less, weak). Data were recorded by bi-input with EpiData 3.1 after being carefully checked. χ(2) tests and logistic regression were performed in this study. Only 20.0% of the husbands demonstrated strong convictions about gender equity. Husbands' gender equity awareness is related to wives' receiving any prenatal care, the number of prenatal visits to a healthcare provider, having a hospital delivery of a newborn, and having gynecological examination one time per year. Raising husbands' gender awareness on wives' reproductive health and reducing female illiteracy were very necessary. The whole community should participate actively in the progress of reproductive health promotion. China's Health System requires an integration of its various sectors, including family planning, maternal and child care in resource sharing, and service delivery. Obstetricians & gynecologists. After completing this CME activity, physicians should be better able to evaluate the impact of husbands' gender equity awareness on wives' reproductive health in rural areas of China; assess how raising husbands' gender awareness on wives' reproductive health and reducing female illiteracy will improve wives' reproductive health; and analyze how China's Health System can integrate its various sectors, including family planning, maternal, and childcare in resource sharing, and service delivery, to improve wives' reproductive health.

The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China.

Science.gov (United States)

Wang, Xin; Birch, Stephen; Ma, Huifen; Zhu, Weiming; Meng, Qingyue

2016-08-12

Facing the challenges of aging populations, increasing chronic diseases prevalence and health system fragmentation, there have been several pilots of integrated health systems in China. But little is known about their structure, mechanism and effectiveness. The aim of this paper is to analyze health system integration and develop recommendations for achieving integration. Huangzhong and Hualong counties in Qinghai province were studied as study sites, with only Huangzhong having implemented health system integration. Questionnaires, interviews, and health insurance records were sources of data. Social network analysis was employed to analyze integration, through structure measurement and effectiveness evaluation. Health system integration in Huangzhong is higher than in Hualong, so is system effectiveness. The patient referral network in Hualong has more "leapfrog" referrals. The information sharing networks in both counties are larger than the other types of networks. The average distance in the joint training network of Huangzhong is less than in Hualong. Meanwhile, there are deficiencies common to both systems. Both county health systems have strengths and limitations regarding system integration. The use of medical consortia in Huangzhong has contributed to system effectiveness. Future research might consider alternative more context specific models of health system integration.

Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering.

Science.gov (United States)

le Roux, K W D P; Couper, I

2015-06-01

The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

Substance abuse in outpatients attending rural and urban health ...

African Journals Online (AJOL)

Substance abuse in outpatients attending rural and urban health centres in Kenya. ... Objectives: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya. Design: A ... Socio-cultural factors might be responsible for the differences noted.

Integrated Water Resources Simulation Model for Rural Community

Science.gov (United States)

Li, Y.-H.; Liao, W.-T.; Tung, C.-P.

2012-04-01

The purpose of this study is to develop several water resources simulation models for residence houses, constructed wetlands and farms and then integrate these models for a rural community. Domestic and irrigation water uses are the major water demand in rural community. To build up a model estimating domestic water demand for residence houses, the average water use per person per day should be accounted first, including water uses of kitchen, bathroom, toilet and laundry. On the other hand, rice is the major crop in the study region, and its productive efficiency sometimes depends on the quantity of irrigation water. The water demand can be estimated by crop water use, field leakage and water distribution loss. Irrigation water comes from rainfall, water supply system and reclaimed water which treated by constructed wetland. In recent years, constructed wetlands play an important role in water resources recycle. They can purify domestic wastewater for water recycling and reuse. After treating from constructed wetlands, the reclaimed water can be reused in washing toilets, watering gardens and irrigating farms. Constructed wetland is one of highly economic benefits for treating wastewater through imitating the processing mechanism of natural wetlands. In general, the treatment efficiency of constructed wetlands is determined by evapotranspiration, inflow, and water temperature. This study uses system dynamics modeling to develop models for different water resource components in a rural community. Furthermore, these models are integrated into a whole system. The model not only is utilized to simulate how water moves through different components, including residence houses, constructed wetlands and farms, but also evaluates the efficiency of water use. By analyzing the flow of water, the water resource simulation model can optimizes water resource distribution under different scenarios, and the result can provide suggestions for designing water resource system of a

Different perspectives on the key challenges facing rural health: The challenges of power and knowledge.

Science.gov (United States)

Malatzky, Christina; Bourke, Lisa

2018-05-25

To examine the effects of dominant knowledge in rural health, including how they shape issues central to rural health. In particular, this article examines the roles of: (i) deficit knowledge of rural health workforce; (ii) dominant portrayals of generalism; and (iii) perceptions of inferiority about rural communities in maintaining health disparities between rural- and metropolitan-based Australians. A Foucauldian framework is applied to literature, evidence, case studies and key messages in rural health. Three scenarios are used to provide practical examples of specific knowledge that is prioritised or marginalised. The analysis of three areas in rural health identifies how deficit knowledge is privileged despite it undermining the purpose of rural health. First, deficit knowledge highlights the workforce shortage rather than the type of work in rural practice or the oversupply of workforce in metropolitan areas. Second, the construction of generalist practice as less skilled and more monotonous undermines other knowledge that it is diverse and challenging. Third, dominant negative stereotypes of rural communities discourage rural careers and highlight undesirable aspects of rural practice. The privileging of deficit knowledge pertaining to rural health workforce, broader dominant discourses of generalism and the nature of rural Australian communities reproduces many of the key challenges in rural health today, including persisting health disparities between rural- and metropolitan-based Australians. To disrupt the operations of power that highlight deficit knowledge and undermine other knowledge, we need to change the way in which rural health is currently constructed and understood. © 2018 National Rural Health Alliance Ltd.

Psychological health among Chinese college students: a rural/urban comparison.

Science.gov (United States)

Zhang, Jie; Qi, Qing; Delprino, Robert P

2017-09-01

The literature on suicide among the Chinese indicates that younger individuals from rural areas are at higher risk of suicide than their urban counterparts. While earlier studies have investigated the relationship between psychological health and major demographic variables, the relationship of psychological health as it relates to suicide by those from urban and rural areas have been rare. Studying the psychological health of college students from rural China in comparison with students who originate from urban areas may shed light on the mental health disparities of the two populations. This study examined the relationship of psychological health and rural/urban origins of college students in China. Data was obtained from 2 400 college students who completed a survey questionnaire while in attendance at a key university in Beijing China in 2013. Four standardised psychological health scales were administered to obtain measures of participants' self-esteem, depression, social support, and suicide ideation. Findings indicated that urban students had significantly higher scores than their rural counterparts on self-esteem and social support. However, there was no statistically significant difference between the groups on measures of depression and suicide ideation.

Oral health and access to dental care: a qualitative exploration in rural Quebec.

Science.gov (United States)

Emami, Elham; Wootton, John; Galarneau, Chantal; Bedos, Christophe

2014-01-01

We sought to explore how rural residents perceive their oral health and their access to dental care. We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation. Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities. Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.

Information needs of rural health professionals: a review of the literature

OpenAIRE

Dorsch, Josephine L.

2000-01-01

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal...

Indoor Air Pollution and Health Risks among Rural Dwellers in ...

African Journals Online (AJOL)

`123456789jkl''''#

Ethiopian Journal of Environmental Studies and Management Vol.3 No.2 2010 ... occurrence of air pollution related health problems among the rural dwellers, one ... Key words: Indoor environment, air quality, rural health, fuel-wood.

The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China

Directory of Open Access Journals (Sweden)

Xin Wang

2016-08-01

Full Text Available Introduction: Facing the challenges of aging populations, increasing chronic diseases prevalence and health system fragmentation, there have been several pilots of integrated health systems in China. But little is known about their structure, mechanism and effectiveness. The aim of this paper is to analyze health system integration and develop recommendations for achieving integration. Method: Huangzhong and Hualong counties in Qinghai province were studied as study sites, with only Huangzhong having implemented health system integration. Questionnaires, interviews, and health ­insurance records were sources of data. Social network analysis was employed to analyze integration, through structure measurement and effectiveness evaluation. Results: Health system integration in Huangzhong is higher than in Hualong, so is system ­effectiveness. The patient referral network in Hualong has more “leapfrog” referrals. The information sharing ­networks in both counties are larger than the other types of networks. The average distance in the joint ­training network of Huangzhong is less than in Hualong. Meanwhile, there are deficiencies common to both systems. Conclusion: Both county health systems have strengths and limitations regarding system integration. The use of medical consortia in Huangzhong has contributed to system effectiveness. Future research might consider alternative more context specific models of health system integration.

Rurality and mental health: an Australian primary care study.

Science.gov (United States)

Campbell, A; Manoff, T; Caffery, J

2006-01-01

Until recently, there has been a significant gap in the literature exploring the issues of the mental health needs for rural communities in Australia. In this study we investigated the prevalence of diagnosable psychological disorders in both a rural and a non-rural primary care sample in far north Queensland, Australia. In a previous study we had screened some 300 GP attendees, on a number of sociodemographic variables and measures of psychological wellbeing, from four rural GP practices and one regional GP practice. Of these, 130 participants agreed to further follow up. In this study, 118 of the participants were selected and contacted by phone to complete the Composite International Diagnostic Interview-Short Form (CIDI-SF). The CIDI-SF diagnosis was then analysed in relation to the sociodemographic indicators that had previously been collected. The prevalence of diagnosable mental health disorders in the rural sample was found to be higher in comparison with the regional urban sample. The sociodemographic factors of rural residence, gender, and length of residence were associated with having a CIDI-SF diagnosis. Although there were a number of methodological limitations to this study, there did appear to be a significant relationship between rural location and the likelihood of receiving a CIDI-SF diagnosis. Why this might be the case is not clear, and we consider a number of explanations, but our finding suggests that further research in mental health should consider the issue of rurality as a key feature to be explored.

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

Science.gov (United States)

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

Inequities in visual health and health services use in a rural region in Spain.

Science.gov (United States)

Latorre-Arteaga, Sergio; Fernández-Sáez, José; Gil-González, Diana

2017-06-06

To analyse perceived visual health and health services use in a rural population in relation to socioeconomic characteristics and compared with the general population in Spain. Cross-sectional study in a rural population using a structured questionnaire including questions comparable to the Spanish National Health Survey (2012). A descriptive analysis was carried out through the calculation of frequencies and prevalence, the χ 2 test for independent variables, contrasts of proportions and logistic regression to obtain associations between the rural and general populations and socioeconomic variables. For the rural population studied, the prevalence of poor perceptions of visual health is 40.8% in men and 39.4% in women, and is strongly associated with age, employment situation, income and presence of chronic diseases (p ˂0.001). Compared with the general population, the rural population has a higher risk of presenting with serious difficulties related to farsightedness (OR: 2.56; 95% CI: 1.32-4.95) and make less use of optical correction (OR: 0.57; 95%CI: 0.44-0.74). The use of health services is not sufficient for adequate prevention, particularly in diabetics. For those affected by poor vision, the distance to travel to receive an eye exam, the belief that eyesight problems come with age and the cost of glasses are the principal reasons used to explain why eyesight problems are not resolved. The rural population presents worse visual health that is influenced by social and economic factors. Improving accessibility and reducing barriers is essential to tackle avoidable visual disability and reduce health inequities. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Rural interdisciplinary mental health team building via satellite: a demonstration project.

Science.gov (United States)

Cornish, Peter A; Church, Elizabeth; Callanan, Terrence; Bethune, Cheri; Robbins, Carl; Miller, Robert

2003-01-01

This paper reports on the results of a demonstration project that examined the role of telehealth/telemedicine (hereafter referred to as telehealth) in providing interdisciplinary mental health training and support to health professionals in a rural region of Atlantic Canada. Special emphasis was placed on addressing the question of how training might affect interdisciplinary collaboration among the rural health professionals. Five urban mental health professionals from three disciplines provided training and support via video-satellite and internet, print and video resources to 34 rural health and community professionals. In order to assess the rural community's needs and the impact of the interventions, questionnaires were administered and on-site interviews were conducted before and after the project. Throughout the project, field notes were recorded and satisfaction ratings were obtained. Satisfaction with the video-satellite presentations was high and stable, with the exception of one session when signal quality was very poor. Rural participants were most satisfied with opportunities for interaction and least satisfied with the variable quality of the video transmission signal. High staff turnover among rural professionals resulted in insufficient power to permit statistical analysis. Positive reports of the project impact included expanded knowledge and heightened sensitivity to mental health issues, increased cross-disciplinary connections, and greater cohesion among professionals. The results suggest that, with some refinements, telehealth technology can be used to facilitate mental health training and promote interdisciplinary collaboration among professionals in a rural setting.

Rural Health Networks: How Network Analysis Can Inform Patient Care and Organizational Collaboration in a Rural Breast Cancer Screening Network.

Science.gov (United States)

Prusaczyk, Beth; Maki, Julia; Luke, Douglas A; Lobb, Rebecca

2018-04-15

Rural health networks have the potential to improve health care quality and access. Despite this, the use of network analysis to study rural health networks is limited. The purpose of this study was to use network analysis to understand how a network of rural breast cancer care providers deliver services and to demonstrate the value of this methodology in this research area. Leaders at 47 Federally Qualified Health Centers and Rural Health Clinics across 10 adjacent rural counties were asked where they refer patients for mammograms or breast biopsies. These clinics and the 22 referral providers that respondents named comprised the network. The network was analyzed graphically and statistically with exponential random graph modeling. Most (96%, n = 45) of the clinics and referral sites (95%, n = 21) are connected to each other. Two clinics of the same type were 62% less likely to refer patients to the same providers as 2 clinics of different types (OR = 0.38, 95% CI = 0.29-0.50). Clinics in the same county have approximately 8 times higher odds of referring patients to the same providers compared to clinics in different counties (OR = 7.80, CI = 4.57-13.31). This study found that geographic location of resources is an important factor in rural health care providers' referral decisions and demonstrated the usefulness of network analysis for understanding rural health networks. These results can be used to guide delivery of patient care and strengthen the network by building resources that take location into account. © 2018 National Rural Health Association.

The Rural Alabama Pregnancy and Infant Health (RAPIH) Program.

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Leeper, J. D.; And Others

The impact of the Rural Alabama Pregnancy and Infant Health (RAPIH) Program was evaluated in relation to prenatal care, birth outcome measures, and several child health and home environment outcomes. Begun in 1983, RAPIH targets poor rural blacks in three of west-central Alabama's poorest counties, where economic conditions and infant mortality…

Information needs of rural health professionals: a review of the literature.

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Dorsch, J L

2000-10-01

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

Lay Meanings of Health among Rural Older Adults in Appalachia

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Goins, R. Turner; Spencer, S. Melinda; Williams, Kimberly

2011-01-01

Purpose: Self-perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define…

Charting the future course of rural health and remote health in Australia: Why we need theory.

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Bourke, Lisa; Humphreys, John S; Wakerman, John; Taylor, Judy

2010-04-01

This paper argues that rural and remote health is in need of theoretical development. Based on the authors' discussions, reflections and critical analyses of literature, this paper proposes key reasons why rural and remote health warrants the development of theoretical frameworks. The paper cites five reasons why theory is needed: (i) theory provides an approach for how a topic is studied; (ii) theory articulates key assumptions in knowledge development; (iii) theory systematises knowledge, enabling it to be transferable; (iv) theory provides predictability; and (v) theory enables comprehensive understanding. This paper concludes with a call for theoretical development in both rural and remote health to expand its knowledge and be more relevant to improving health care for rural Australians.

Marginalization and health service coverage among indigenous, rural, and urban populations: a public health problem in Mexico.

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Roldán, José; Álvarez, Marsela; Carrasco, María; Guarneros, Noé; Ledesma, José; Cuchillo-Hilario, Mario; Chávez, Adolfo

2017-12-01

  Marginalization is a significant issue in Mexico, involving a lack of access to health services with differential impacts on Indigenous, rural and urban populations. The objective of this study was to understand Mexico’s public health problem across three population areas, Indigenous, rural and urban, in relation to degree of marginalization and health service coverage.   The sampling universe of the study consisted of 107 458 geographic locations in the country. The study was retrospective, comparative and confirmatory. The study applied analysis of variance, parametric and non-parametric, correlation and correspondence analyses.   Significant differences were identified between the Indigenous, rural and urban populations with respect to their level of marginalization and access to health services. The most affected area was Indigenous, followed by rural areas. The sector that was least affected was urban.   Although health coverage is highly concentrated in urban areas in Mexico, shortages are mostly concentrated in rural areas where Indigenous groups represent the extreme end of marginalization and access to medical coverage. Inadequate access to health services in the Indigenous and rural populations throws the gravity of the public health problem into relief.

Developing Integrated Rural Tourism: Actor Practices in the English/Welsh Border

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Saxena, Gunjan; Ilbery, Brian

2010-01-01

This paper examines community attitudes and distinctive practices that shape local responses to integrated rural tourism (IRT) development in the lagging rural region of the English/Welsh border area. The focus is on how actors acquire attributes as a result of their relations with others and how these assumed identities are performed in, by and…

The Role of Hopelessness in the Health of Low-Class Rural Chinese Residents.

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Zhang, Huiping; Wu, Lei; Cheng, Mingming

2018-03-12

It is well known that health inequality has been happening between rural and urban Chinese populations, however, the health differences among rural Chinese residents remain unclear. This study aims to assess the physical and mental health of rural Chinese residents in different social classes, and then to examine the mediating role of hopelessness between social class and health-related quality of life (HRQOL). A stratified multi-stage sampling was used to recruit 2003 rural residents responding to the 12-item Short Form Health Survey (SF-12). The results showed that lower-class rural Chinese residents reported lower physical and mental health as well as a higher level of hopelessness. Furthermore, hopelessness could fully mediate the association between social class and physical and mental health. These findings will generate significant implications for identifying those at particular risk for lower quality of life and designing social work intervention programs in rural China's context.

Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

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Gullapalli N Rao

2012-01-01

Full Text Available Blindness is a major global public health problem and recent estimates from World Health Organization (WHO showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP. It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

Reproductive health issues in rural Western Kenya

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Ouma Peter

2008-03-01

Full Text Available Abstract Background We describe reproductive health issues among pregnant women in a rural area of Kenya with a high coverage of insecticide treated nets (ITNs and high prevalence of HIV (15%. Methods We conducted a community-based cross-sectional survey among rural pregnant women in western Kenya. A medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were measured. Results Of 673 participants, 87% were multigravidae and 50% were in their third trimester; 41% had started antenatal clinic visits at the time of interview and 69% reported ITN-use. Malaria parasitemia and anaemia (haemoglobin Conclusion In this rural area with a high HIV prevalence, the reported use of condoms before pregnancy was extremely low. Pregnancy health was not optimal with a high prevalence of malaria, geohelminth infections, anaemia and underweight. Chances of losing a child after birth were high. Multiple interventions are needed to improve reproductive health in this area.

Urban versus rural populations' views of health care in Scotland.

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Farmer, Jane; Hinds, Kerstin; Richards, Helen; Godden, David

2005-10-01

To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.

Identifying Factors for Worker Motivation in Zambia's Rural Health Facilities.

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Cross, Samuel S; Baernholdt, Dr Marianne

2017-01-01

Within Zambia there is a shortage of health workers in rural areas. This study aims to identify motivating factors for retaining rural health workers. Sixty rural health workers completed surveys and 46 were interviewed. They rated the importance of six motivating factors and discussed these and other factors in interviews. An interview was conducted with a Government Human Resources Manager (HR Manager) to elicit contextual information. All six factors were identified as being very important motivators, as were two additional factors. Additional career training was identified by many as the most important factor. Comparison of results and the HR Manager interview revealed that workers lacked knowledge about opportunities and that the HR manager was aware of barriers to career development. The Zambian government might better motivate and retain rural health workers by offering them any combination of identified factors, and by addressing the barriers to career development.

Rural Public Libraries as Community Change Agents: Opportunities for Health Promotion

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Flaherty, Mary Grace; Miller, David

2016-01-01

Rural residents are at a disadvantage with regard to health status and access to health promotion activities. In many rural communities, public libraries offer support through health information provision; there are also opportunities for engagement in broader community health efforts. In a collaborative effort between an academic researcher and a…

Coaching mental health peer advocates for rural LGBTQ people.

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Willging, Cathleen E; Israel, Tania; Ley, David; Trott, Elise M; DeMaria, Catherine; Joplin, Aaron; Smiley, Verida

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured interviews and written logs from coaches and advocates. The six major themes comprising the results centered on (1) coaching support, (2) peer advocate skills and preparation, (3) working with help seekers, (4) negotiating diversity, (5) logistical challenges in rural contexts, and (6) systemic challenges. We concluded that peer advocacy for LGBTQ people with mental distress offers an affirmative, community-based strategy to assist the underserved. To be successful, however, peer advocates will likely require ongoing training, coaching, and infrastructural support to negotiate contextual factors that can influence provision of community resources and support to LGBTQ people within rural communities.

Utilization of Mental Health Services by Veterans Living in Rural Areas.

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Teich, Judith; Ali, Mir M; Lynch, Sean; Mutter, Ryan

2017-06-01

There is concern that veterans living in rural areas may not be receiving the mental health (MH) treatment they need. This study uses recent national survey data to examine the utilization of MH treatment among military veterans with a MH condition living in rural areas, providing comparisons with estimates of veterans living in urban areas. Multivariable logistic regression is utilized to examine differences in MH service use by urban/rural residence, controlling for other factors. Rates of utilization of inpatient and outpatient treatment, psychotropic medication, any MH treatment, and perceived unmet need for MH care are examined. There were significant differences in MH treatment utilization among veterans by rural/urban residence. Multivariate estimates indicate that compared to veterans with a MH condition living in urban areas, veterans in rural areas had 70% lower odds of receiving any MH treatment. Veterans with a MH condition in rural areas have approximately 52% and 64% lower odds of receiving outpatient treatment and prescription medications, respectively, compared to those living in urban areas. Differences in perceived unmet need for mental health treatment were not statistically significant. While research indicates that recent efforts to improve MH service delivery have resulted in improved access to services, this study found that veterans' rates of MH treatment are lower in rural areas, compared to urban areas. Continued efforts to support the provision of behavioral health services to rural veterans are needed. Telemedicine, using rural providers to their maximum potential, and engagement with community stakeholder groups are promising approaches. © 2016 National Rural Health Association.

Community participation in rural health: a scoping review

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Kenny Amanda

2013-02-01

Full Text Available Abstract Background Major health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein’s definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare. Methods A scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies. Results We identified six articles that most closely demonstrated higher level community participation; Arnstein’s notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured. Conclusions In an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for

Residential rurality and oral health disparities: influences of contextual and individual factors.

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Ahn, SangNam; Burdine, James N; Smith, Matthew Lee; Ory, Marcia G; Phillips, Charles D

2011-02-01

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.

Listening to the rural health workers in Papua New Guinea - the social factors that influence their motivation to work.

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Razee, Husna; Whittaker, Maxine; Jayasuriya, Rohan; Yap, Lorraine; Brentnall, Lee

2012-09-01

Despite rural health services being situated and integrated within communities in which people work and live, the complex interaction of the social environment on health worker motivation and performance in Low Middle Income Countries has been neglected in research. In this article we investigate how social factors impact on health worker motivation and performance in rural health services in Papua New Guinea (PNG). Face-to-face in-depth interviews were conducted with 33 health workers from three provinces (Central, Madang, and Milne Bay) in PNG between August and November 2009. They included health extension officers, community health workers and nursing officers, some of whom were in charge of the health centres. The health centres were a selection across church based, government and private enterprise health facilities. Qualitative analysis identified the key social factors impacting on health worker motivation and performance to be the local community context, gender roles and family related issues, safety and security and health beliefs and attitudes of patients and community members. Our study identified the importance of strong supportive communities on health worker motivation. These findings have implications for developing sustainable strategies for motivation and performance enhancement of rural health workers in resource poor settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Occupational Health Services Integrated in Primary Health Care in Iran.

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Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

2015-01-01

A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

Impact of rural residence and health system structure on quality of liver care.

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Catherine Rongey

Full Text Available Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75 and rural (HR 0.96, CI 0.94-0.97 residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50 and rural residents (HR 1.06, CI 1.02-1.10 were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.

Utilising a collective case study system theory mixed methods approach: a rural health example.

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Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2014-07-28

Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services

Self-recognition of mental health problems in a rural Australian sample.

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Handley, Tonelle E; Lewin, Terry J; Perkins, David; Kelly, Brian

2018-04-19

Although mental health literacy has increased in recent years, mental illness is often under-recognised. There has been little research conducted on mental illness in rural areas; however, this can be most prominent in rural areas due to factors such as greater stigma and stoicism. The aim of this study is to create a profile of those who are most and least likely to self-identify mental health problems among rural residents with moderate- to-high psychological distress. Secondary analysis of a longitudinal postal survey. Rural and remote New South Wales, Australia. Four-hundred-and-seventy-two community residents. Participants completed the K10 Psychological Distress Scale, as well as the question 'In the past 12 months have you experienced any mental health problems?' The characteristics of those who reported moderate/high distress scores were explored by comparing those who did and did not experience mental health problems recently. Of the 472 participants, 319 (68%) with moderate/high distress reported a mental health problem. Reporting a mental health problem was higher among those with recent adverse life events or who perceived more stress from life events while lower among those who attributed their symptoms to a physical cause. Among a rural sample with moderate/high distress, one-third did not report a mental health problem. Results suggest a threshold effect, whereby mental health problems are more likely to be acknowledged in the context of additional life events. Ongoing public health campaigns are necessary to ensure that symptoms of mental illness are recognised in the multiple forms that they take. © 2018 National Rural Health Alliance Ltd.

Rural-urban disparity in oral health-related quality of life.

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Gaber, Amal; Galarneau, Chantal; Feine, Jocelyne S; Emami, Elham

2018-04-01

The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population. A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001). The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes

Health information technology workforce needs of rural primary care practices.

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Skillman, Susan M; Andrilla, C Holly A; Patterson, Davis G; Fenton, Susan H; Ostergard, Stefanie J

2015-01-01

This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT. Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires. EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas. Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations. © 2014 National Rural Health Association.

Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia.

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Page-Carruth, Althea; Windsor, Carol; Clark, Michele

2014-01-01

The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where there is good primary care, there develops a number of downstream

Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia

Directory of Open Access Journals (Sweden)

Althea Page-Carruth

2014-06-01

Full Text Available Objective: The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. Methods: The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results: The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. Conclusions: The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where

76 FR 44091 - Veterans' Rural Health Advisory Committee; Notice of Meeting

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2011-07-22

... Rural Health, 1722 I Street, NW., Washington, DC. The toll- free number for the meeting is 1-800-767... contact Judy Bowie, Designated Federal Officer, at rural.health.inquiry@va.gov or (202) 461-7100. Dated...

Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains.

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Durey, Angela; Hill, Peter; Arkles, Rachelle; Gilles, Marisa; Peterson, Katia; Wearne, Susan; Canuto, Condy; Pulver, Lisa Jackson

2008-12-01

To examine how OTDs and staff in rural and remote Indigenous health contexts communicate and negotiate identity and relationships, and consider how this may influence OTDs' transition, integration and retention. Ten case studies were conducted in rural and remote settings across Australia, each of an OTD providing primary care in a substantially Indigenous practice population, his/her partner, co-workers and Indigenous board members associated with the health service. Cases were purposefully sampled to ensure diversity in gender, location and country of origin. Identity as 'fluid' emerged as a key theme in effective communication and building good relationships between OTDs and Indigenous staff. OTDs enter a social space where their own cultural and professional beliefs and practices intersect with the expectations of culturally safe practice shaped by the Australian Indigenous context. These are negotiated through differences in language, role expectation, practice, status and identification with locus with uncertain outcomes. Limited professional and cultural support often impeded this process. The reconstruction of OTDs' identities and mediating beyond predictable barriers to cultural engagement contributes significantly not only to OTDs' integration and, to a lesser extent, their retention, but also to maximising effective communication across cultural domains. Retention of OTDs working in Indigenous health contexts rests on a combination of OTDs' capacity to adapt culturally and professionally to this complex environment, and of effective strategies to support them.

Family planning and fertility decline in rural Iran: the impact of rural health clinics.

Science.gov (United States)

Salehi-Isfahani, Djavad; Abbasi-Shavazi, M Jalal; Hosseini-Chavoshi, Meimanat

2010-09-01

During the first few years of the Islamic Revolution of 1979, and aided by pro-natal government policies, Iranian fertility was on the rise. In a reversal of its population policy, in 1989, the government launched an ambitious and innovative family planning program aimed at rural families. By 2005, the program had covered more than 90% of the rural population and the average number of births per rural woman had declined to replacement level from about 8 births in the mid 1980s. In this paper, we evaluate the impact of a particular feature of the program - health houses - on rural fertility, taking advantage of the variation in the timing of their construction across the country. We use three different methods to obtain a range of estimates for the impact of health houses on village-level fertility: difference-in-differences (DID), matching DID, and length of exposure. We find estimates of impact ranging from 4 to 20% of the decline in fertility during 1986-1996. (c) 2010 John Wiley & Sons, Ltd.

How decentralisation influences the retention of primary health care workers in rural Nigeria.

Science.gov (United States)

Abimbola, Seye; Olanipekun, Titilope; Igbokwe, Uchenna; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra; Ihebuzor, Nnenna; Aina, Muyi

2015-01-01

In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC - usually the only form of formal health service available in rural communities - is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular - in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co

77 FR 77185 - Veterans' Rural Health Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-12-31

... Rural Health (ORH), 1722 I Street, NW., Washington, DC. The toll-free number for the meeting is 1- 800... Affairs, 810 Vermont Avenue NW, Washington, DC 20420, or email at rural.health.inquiry@va.gov . Any member...

Rural bioenergy: innovative integrated biosystem design for fuel and food from agrowastes

Energy Technology Data Exchange (ETDEWEB)

Selvam, Pagandai V. Pannir; Santiago, Brunno Henrique de S. [Universidade Federal de Alagoas (UFAL), Maceio, AL (Brazil)], email: pannirbr@gmail.com; Almeida, Louizy Minora C.A. de; Israel, Samy B.S. [Universidade Federal do Rio Grande do Norte (DEQ/CT/UFRN), Natal, RN (Brazil). Centro de Tecnologia. Dept. de Engenharia Quimica

2008-07-01

Brazil is the leader known for its ethanol biofuel development, but also for biomass charcoal, yet lacks in clean rural biofuel production. This paper deals with the system design for sustainable rural projects developments based on the the bioenergy production from biomass wastes using Innovative process equipment design and the process optimization. With the economic objective towards sustainable clean small scale rural energy production, and also the co-production of hot, cold thermal energy, at first, several preliminary projects had been developed and analysed. Then, a detailed project engineering and the results on economical viability were obtained. The dynamic material, energy and cash flow models of the complex integrated food processing and small scale energy productions, were at first constructed using excel electronic spread sheet for Windows. Computer aided system for process modeling and simulation using SUPERPRO, Intelligent Inc. Economic feasibilities studies using genetics algorithms are under developments. The preliminary analysis of cost and investments of the the integrated biomass utilisation projects which are included for this study are: biological aerobic treatment process, methane gas production using anaerobic digestion process, aerobic composting, drying of tropical fruits, effluent treatments, biogas and syngas production as well as cogeneration of energy production for drying and cooling using biogas. These models allowed us the identification of tech economical and scale up problems. The results obtained with several preliminary project development with few case studies are reported for integrated project developments for fuel and food using process and cost simulation models. Several economic problems related with implementation of the small scale rural energy system for sustained local developments based on tropical fruit producing rural areas are analysed and a concept of the integrated bio system for micro enterprise has been

Barefoot Doctors and the "Health Care Revolution" in Rural China: A Study Centered on Shandong Province.

Science.gov (United States)

Xu, Sanchun; Hu, Danian

2017-09-01

Barefoot doctors were rural medical personnel trained en masse, whose emergence and development had a particular political, economic, social, and cultural background. Like the rural cooperative medical care system, the barefoot doctor was a well-known phenomenon in the Cultural Revolution. Complicated regional differences and a lack of reliable sources create much difficulty for the study of barefoot doctors and result in differing opinions of their status and importance. Some scholars greatly admire barefoot doctors, whereas others harshly criticize them. This paper explores the rise and development of barefoot doctors based on a case study of Shandong province. I argue that the promotion of barefoot doctors was a consequence of the medical education revolution and an implementation of the Cultural Revolution in rural public health care, which significantly influenced medical services and development in rural areas. First, barefoot doctors played a significant role in accomplishing the first rural health care revolution by providing primary health care to peasants and eliminating endemic and infectious illnesses. Second, barefoot doctors were the agents who integrated Western and Chinese medicines under the direction of the state. As an essential part of the rural cooperative medical system, barefoot doctor personnel grew in number with the system's implementation. After the Cultural Revolution ended, the cooperative medical system began to disintegrate-a process that accelerated in the 1980s until the system's collapse in the wake of the de-collectivization. As a result, the number of barefoot doctors also ran down steadily. In 1985, "barefoot doctor" as a job title was officially removed from Chinese medical profession, demonstrating that its practice was non-universal and unsustainable. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China

OpenAIRE

Wang, Xin; Birch, Stephen; Ma, Huifen; Zhu, Weiming; Meng, Qingyue

2016-01-01

Introduction: Facing the challenges of aging populations, increasing chronic diseases prevalence and health system fragmentation, there have been several pilots of integrated health systems in China. But little is known about their structure, mechanism and effectiveness. The aim of this paper is to analyze health system integration and develop recommendations for achieving integration. Method: Huangzhong and Hualong counties in Qinghai province were studied as study sites, with only Huangzhon...

Home on the Range--Health Literacy, Rural Elderly, Well-Being

Science.gov (United States)

Young, David; Weinert, Clarann; Spring, Amber

2012-01-01

The demographic and socioeconomic impacts of the baby boomer generation turning 65 in 2011 will be magnified in rural areas where elderly are already disproportionately represented. The overall goal of a collaborative, community-based project was to improve the health literacy, health outcomes, and overall well-being of rural elderly in four…

Variations in Influenza and Pneumonia Immunizations for Medicare Beneficiaries Served by Rural Health Clinics.

Science.gov (United States)

Wan, Thomas T H; Lin, Yi-Ling; Ortiz, Judith

2017-08-01

The availability of a rural health clinic (RHC) database over the period of 6 years (2008-2013) offers a unique opportunity to examine the trends and patterns of disparities in immunization for influenza and pneumonia among Medicare beneficiaries in the southeastern states. The purpose of this exploratory study was twofold. First, it examined the rural trends and patterns of immunization rates before (2008-2009) and after (2010-2013) the Affordable Care Act (ACA) enactment by state and year. Second, it investigated how contextual, organizational, and aggregate patient characteristics may influence the variations in immunization for influenza and pneumonia of Medicare beneficiaries served by RHCs. Four data sources from federal agencies were merged to perform a longitudinal analysis of the influences of contextual, organizational, and aggregate patient characteristics on the disparities in immunization rates of rural Medicare beneficiaries for influenza and pneumonia. We included both time-varying and time-constant predictors in a multivariate analysis using Generalized Estimating Equation. This study revealed the increased immunization rates for both influenza and pneumonia over a period of 6 years. The ACA had a positive effect on increased immunization rates for pneumonia, but not for influenza, in rural Medicare beneficiaries in the eight states. The RHCs that served more dually-eligible patients had higher immunization rates. For influenza immunization, provider-based RHCs had a higher rate than the independent RHCs. For pneumonia immunization, no organizational variables were relevant in the explanation of the variability. The results also showed that no single dominant factor influenced health care disparities. This investigation suggested further improvements in preventive care are needed to target poor and isolated rural beneficiaries. Furthermore, the integration of immunization data from multiple sources is critically needed for understanding health

Mental Health in Rural Caregivers of Persons With Dementia

Directory of Open Access Journals (Sweden)

Alexandra J. Werntz

2015-12-01

Full Text Available Informal caregiving for dementia is common and often affects caregiver mental health. In addition to typical stressors faced by caregivers of persons with dementia (PWDs, rural caregivers often face additional stressors associated with living in more remote locations; unfortunately, this group is largely understudied. Ninety-three caregiver–PWD dyads completed measures of social support, perceived control, self-efficacy, burden, and cognitive functioning. Measures of PWD activities of daily living and mental functioning were also collected. These variables were hypothesized to predict caregiver self-reported symptoms of depression, anxiety, and stress. Contrary to predictions, only caregiving-related self-efficacy and caregiver burden predicted the caregiver’s mental health. Future interventions for improving rural caregiver self-reported mental health should target cognitions associated with caregiving self-efficacy and caregiver burden. Health care providers for rural families should focus on ways to reduce feelings of caregiver burden and provide caregivers with useful skills and tools for caregiving.

Community-based mental health intervention for underprivileged women in rural India: an experiential report.

Science.gov (United States)

Rao, Kiran; Vanguri, Prameela; Premchander, Smita

2011-01-01

Objective. To share experiences from a project that integrates a mental health intervention within a developmental framework of microcredit activity for economically underprivileged women in rural India. Method. The mental health intervention had two components: group counseling and stress management. The former comprised of ventilation and reassurance and the latter strengthening of coping skills and a relaxation technique. Focus group discussions were used to understand women's perception of how microcredit economic activity and the mental health intervention had affected their lives. Results. Women in the mental health intervention group reported reduction in psychological distress and bodily aches and pains. Majority (86%) reported that the quality of their sleep had improved with regular practice of relaxation and that sharing their problems in the group had helped them to unburden. The social support extended by the members to each other, made them feel that they were not alone and could face any life situation. Conclusion. The study provided qualitative evidence that adding the mental health intervention to the ongoing economic activity had made a positive difference in the lives of the women. Addressing mental health concerns along with livelihood initiatives can help to enhance both economic and social capital in rural poor women.

Health care in rural areas.

Science.gov (United States)

Nath, L M

1994-02-01

In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

Improvement of Emergency Management Mechanism of Public Health Crisis in Rural China: A Review Article.

Science.gov (United States)

Hu, Jiaxiang; Chen, Chao; Kuai, Tingting

2018-02-01

With the rapid development of social economy in China, various public health emergencies frequently occur. Such emergencies cause a serious threat to human health and public safety, especially in rural China. Owing to flaws in emergency management mechanism and policy, the government is not capable to effectively deal with public health emergencies. Therefore, this study aimed to discuss the path to improve the emergency management mechanism for public health emergency in rural China. This study was conducted in 2017 to detect the emergency management mechanism of public health crisis (EMMPHC) in Rural China. Data were collected using the following keywords: Rural China, public health emergency, emergency management mechanism, organization mechanism, operation mechanism in the databases of PubMed, Scopus, Web of Science, and CNKI. EMMPHC in rural China can be enhanced from the following three aspects. First, a permanent institution for rural emergency management with public health management function is established. Second, the entire process of emergency management mechanism, including the stages of pre-disaster, disaster, and post-disaster, is improved. Finally, investment in rural public health is increased, and an adequate reserve system for emergency resources is formed. The new path of EMMPHC in rural China can effectively help the local government accomplish the dispatch capability in public health emergency, and it has important research significance for the protection of public health and social stability of residents in rural China.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

Science.gov (United States)

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Health concerns associated with unconventional gas mining in rural Australia.

Science.gov (United States)

Haswell, Melissa R; Bethmont, Anna

2016-01-01

Many governments globally are investigating the benefits and risks associated with unconventional gas mining for shale, tight and coal seam gas (coalbed methane) to determine whether the industry should proceed in their jurisdiction. Most locations likely to be developed are in rural areas, with potential impact on farmers and small communities. Despite significant health concerns, public health knowledge and growing evidence are often overlooked in decision-making. It is difficult to gain a broad but accurate understanding of the health concerns for rural communities because the evidence has grown very recently and rapidly, is complex and largely based in the USA, where the industry is advanced. In 2016, a concerned South Australian beef and lamb farmer in an area targeted for potential unconventional gas development organised visits to homes in developed unconventional gas areas of Pennsylvania and forums with leading researchers and lawyers in Pennsylvania and New York. Guided by priorities identified during this trip, this communication concisely distils the research evidence on these key concerns, highlighting the Australian situation where evidence exists. It summarises key information of particular concern to rural regions, using Australia as an example, to assist rural health professionals to be better prepared to engage in decision-making and address the challenges associated with this new industry. Discussions with communities and experts, supported by the expanding research from the USA and Australia, revealed increasing health concerns in six key areas. These are absence of a safe solution to the toxic wastewater management problems, air pollution, land and water competition, mental health and psychosocial wellbeing risks, fugitive methane emissions and lack of proven regulatory regimes. Emerging epidemiological studies suggesting interference with foetal development and birth outcomes, and exacerbation of asthma conditions, are particularly concerning

Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis.

Science.gov (United States)

Brundisini, F; Giacomini, M; DeJean, D; Vanstone, M; Winsor, S; Smith, A

2013-01-01

Rurality can contribute to the vulnerability of people with chronic diseases. Qualitative research can identify a wide range of health care access issues faced by patients living in a remote or rural setting. To systematically review and synthesize qualitative research on the advantages and disadvantages rural patients with chronic diseases face when accessing both rural and distant care. This report synthesizes 12 primary qualitative studies on the topic of access to health care for rural patients with chronic disease. Included studies were published between 2002 and 2012 and followed adult patients in North America, Europe, Australia, and New Zealand. Qualitative meta-synthesis was used to integrate findings across primary research studies. Three major themes were identified: geography, availability of health care professionals, and rural culture. First, geographic distance from services poses access barriers, worsened by transportation problems or weather conditions. Community supports and rurally located services can help overcome these challenges. Second, the limited availability of health care professionals (coupled with low education or lack of peer support) increases the feeling of vulnerability. When care is available locally, patients appreciate long-term relationships with individual clinicians and care personalized by familiarity with the patient as a person. Finally, patients may feel culturally marginalized in the urban health care context, especially if health literacy is low. A culture of self-reliance and community belonging in rural areas may incline patients to do without distant care and may mitigate feelings of vulnerability. Qualitative research findings are not intended to generalize directly to populations, although meta-synthesis across a number of qualitative studies builds an increasingly robust understanding that is more likely to be transferable. Selected studies focused on the vulnerability experiences of rural dwellers with chronic

Public health preparedness of health providers: meeting the needs of diverse, rural communities.

Science.gov (United States)

Hsu, Chiehwen Ed; Mas, Francisco Soto; Jacobson, Holly E; Harris, Ann Marie; Hunt, Victoria I; Nkhoma, Ella T

2006-11-01

Meeting the needs of public health emergency and response presents a unique challenge for health practitioners with primary responsibilities for rural communities that are often very diverse. The present study assessed the language capabilities, confidence and training needs of Texas rural physicians in responding to public health emergencies. In the first half of year 2004, a cross-sectional, semistructured survey questionnaire was administered in northern, rural Texas. The study population consisted of 841 practicing or retired physicians in the targeted area. One-hundred-sixty-six physicians (30%) responded to the survey. The responses were geographically referenced in maps. Respondents reported seeing patients with diverse cultural backgrounds. They communicated in 16 different languages other than English in clinical practice or at home, with 40% speaking Spanish at work. Most were not confident in the diagnosis or treatment of public health emergency cases. Geographic information systems were found useful in identifying those jurisdictions with expressed training and cultural needs. Additional efforts should be extended to involve African-American/Hispanic physicians in preparedness plans for providing culturally and linguistically appropriate care in emergencies.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

Directory of Open Access Journals (Sweden)

Marije Versteeg

2013-01-01

Full Text Available Background: South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods: The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results: Response rates ranged from 83% in the first round (n=44 to 64% in the final round (n=34. The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH, governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion: Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Reforming Victoria's primary health and community service sector: rural implications.

Science.gov (United States)

Alford, K

2000-01-01

In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

Rural mental health workforce difficulties: a management perspective.

Science.gov (United States)

Moore, T; Sutton, K; Maybery, D

2010-01-01

The recruitment, retention and training of mental health workers is of major concern in rural Australia, and the Gippsland region of Victoria is no exception. Previous studies have identified a number of common factors in these workforce difficulties, including rurality, difficulties of access to professional development and training, and professional and personal isolation. However, those previous studies have often focused on medicine and been based on the perspectives of practitioners, and have almost ignored the perspectives of managers of rural mental health services. The study reported in this article sought to contribute to the development of a more sustainable and effective regional mental health workforce by complementing earlier insights with those of leading administrators, managers and senior clinicians in the field. The study took a qualitative approach. It conducted semi-structured in-person interviews with 24 managers of health/mental-health services and senior administrators and clinicians working in organisations of varying sizes in the public and private sectors. Thematic content analysis of the transcribed interviews identified core difficulties these managers experienced in the recruitment, retention and training of employees. The study found that some of the issues commonly resulting in difficulties in recruiting, retaining and developing a trained workforce in rural areas, such as rurality (implying personal and professional isolation, distances to deliver service and small organisations) and a general shortage of trained personnel, are significant in Gippsland. Through its focus on the perspectives of leaders in the management of rural mental health services, however, the study found other key issues that contribute to workforce difficulties. Many, including the unattractive nature of mental health work, the fragmented administration of the mental health system, short-term and tied funding, and shortcomings in training are external to

Differences in health care seeking behaviour between rural and urban communities in South Africa

Science.gov (United States)

2012-01-01

Objective The aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population. Design A cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. Results The results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988). Conclusion Recommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour. PMID:22691443

Health problems and the health care provider choices: A comparative study of urban and rural households in Egypt

Directory of Open Access Journals (Sweden)

Salma B. Galal

2014-06-01

Conclusion: Urban families have less health complaints than rural; however, rural families recover sooner. Families bypass often public primary health care services. Urban families overuse outpatient clinics in public hospitals.

Gender and rural-urban differences in reported health status by older people in Bangladesh.

Science.gov (United States)

Kabir, Zarina Nahar; Tishelman, Carol; Agüero-Torres, Hedda; Chowdhury, A M R; Winblad, Bengt; Höjer, Bengt

2003-01-01

The study aims to (i) describe regional variation and gender differences in health status of older people (60 years and older) in Bangladesh, indicated by self-reported health problems and functional ability; (ii) explore influence of socio-economic factors on health status of older people. In a cross-sectional study in rural and urban Bangladesh, 696 older persons were asked about their health problems and ability to manage activities of daily living (ADL). More than 95% of older people reported health problems. Approximately 80% of elderly women in both the regions reported having four or more health problems compared with 42% and 63% elderly men in the urban and rural regions, respectively. More women (urban: 55%; rural: 36%) than men (urban: 32%; rural: 22%) also reported difficulties with ADL. Irrespective of age, sex and area of residence, those reporting greater number of health problems were more likely to report difficulty with at least one ADL task. Reporting pattern of specific health problems varied between urban and rural regions. Socio-economic indicators were found to have little influence on reporting of health problems, particularly in the rural region. Observed regional difference may be related to the influence of social and environmental factors, and level of awareness concerning certain health conditions.

Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

Directory of Open Access Journals (Sweden)

Avi Kenny

2015-12-01

Full Text Available This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa.

Integrating indigenous knowledge systems (IKS) in improving rural accessibility and mobility (in support of the comprehensive rural development programme in South Africa)

CSIR Research Space (South Africa)

Nhemachena, C

2011-07-01

Full Text Available INDIGENOUS KNOWLEDGE SYSTEMS (IKS) IN IMPROVING RURAL ACCESSIBILITY AND MOBILITY (IN SUPPORT OF THE COMPREHENSIVE RURAL DEVELOPMENT PROGRAMME IN SOUTH AFRICA) CHARLES NHEMACHENA1, JAMES CHAKWIZIRA2, SIPHO DUBE1, GOODHOPE MAPONYA1, REMINA RASHOPOLA3... of Environmental Sciences, Private Bag X5050, Thohoyandou, 0950 3 Department of Rural Development and Land Reform, PO Box X833, Pretoria 0001 ABSTRACT This study discusses opportunities and challenges for integrating local knowledge in improving...

Integrated satellite imaging and syndromic surveillance reveal health effects of smoke from wildfires in rural eastern North Carolina counties in the summer of 2008

Science.gov (United States)

Rationale: Wildfire smoke often impacts rural areas without air quality monitors, limiting assessment of health impacts. A 2008 wildfire in Pocosin Lakes National Wildlife Refuge produced massive quantities of smoke affecting eastern NC, a rural area with limited air quality moni...

Strengthening rural Latinos' civic engagement for health: The Voceros de Salud project.

Science.gov (United States)

López-Cevallos, Daniel; Dierwechter, Tatiana; Volkmann, Kelly; Patton-López, Megan

2013-11-01

This article describes the Latino Health Ambassadors Network (Voceros de Salud ) project created to support and mobilize Latino community leaders to address health inequalities in a rural Oregon county. Voceros de Salud is discussed as a model that other rural communities may implement towards strengthening Latino civic engagement for health.

US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions.

Science.gov (United States)

Benitez, Joseph A; Seiber, Eric E

2018-03-01

Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations. Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach. Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents. © 2017 National Rural Health Association.

Rural vs urban hospital performance in a 'competitive' public health service.

Science.gov (United States)

Garcia-Lacalle, Javier; Martin, Emilio

2010-09-01

In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals. Copyright 2010 Elsevier Ltd. All rights reserved.

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

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Kumar, Koshila; Jones, Debra; Naden, Kathryn; Roberts, Chris

2015-01-01

One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. This study provided theoretical insight into the broader range of interrelating and

EMPOWERMENT OF RURAL MASSES IN HEALTH SECTOR

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J S Mathur

1995-09-01

Full Text Available The health status of 80% population residing in rural areas has not improved to desired goals from the basic health services provided to them. Local people have remained indifferent to them. They should be equal partners in the management of health services operating in their areas, therefore, a process needs to be designed to create conditions to know of economic, social and health problems for the whole community with their active participation and fullest possible relience upon the communities initiative to solve them.A community development programme was launched on 2nd Oct. 1952 in first five year plan and was hailed as a programme "of the people, for the people, by the people" to exterminate the triple enemies - poverty illness and ignorance. The community development programmes were envisaged as a multipurpose programme cordinated for agriculture, social welfare, education and health.      .It is currently recognized that despite of expansion of the primary health care infra structure upto village level, a comprehensive and effective approach to community health has not been yet achieved. Local community is not sufficiently involved in its own health care, consequently the impact in terms of community health remains small. A comprehensive and integrated approach to community health for population control and response to family welfare planning depends more than any other factor but on an assurance of survival of the children and by creating the right environment for small family norms. All this and change in attitude for the desire of a male child and improvement in low status of women is possible by community itself. Low rate of literacy in women, early marriage of girls are seriously impending the

Empowerment of rural masses in health sector

Directory of Open Access Journals (Sweden)

J S Mathur

1995-09-01

Full Text Available The health status of 80% population residing in rural areas has not improved to desired goals from the basic health services provided to them. Local people have remained indifferent to them. They should be equal partners in the management of health services operating in their areas, therefore, a process needs to be designed to create conditions to know of economic, social and health problems for the whole community with their active participation and fullest possible relience upon the communities initiative to solve them. A community development programme was launched on 2nd Oct. 1952 in first five year plan and was hailed as a programme "of the people, for the people, by the people" to exterminate the triple enemies - poverty illness and ignorance. The community development programmes were envisaged as a multipurpose programme cordinated for agriculture, social welfare, education and health.      . It is currently recognized that despite of expansion of the primary health care infra structure upto village level, a comprehensive and effective approach to community health has not been yet achieved. Local community is not sufficiently involved in its own health care, consequently the impact in terms of community health remains small. A comprehensive and integrated approach to community health for population control and response to family welfare planning depends more than any other factor but on an assurance of survival of the children and by creating the right environment for small family norms. All this and change in attitude for the desire of a male child and improvement in low status of women is possible by community itself. Low rate of literacy in women, early marriage of girls are seriously impending the

The Successful Implementation of Electronic Health Records at Small Rural Hospitals

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Richardson, Daniel

2016-01-01

Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement…

Meaningful Use of Health Information Technology by Rural Hospitals

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McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele

2011-01-01

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

Understanding Australian rural women's ways of achieving health and wellbeing - a metasynthesis of the literature.

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Harvey, Desley J

2007-01-01

Although Australian rural women appear to be coping well despite a lack of services, harsh environmental conditions and overall rural health disadvantage, there is little research into the factors which promote good health among them. The aim of this article is to document and analyse current understandings about how rural Australian women maintain health and wellbeing, by conducting a metasynthesis of peer reviewed empirical qualitative research. Searches were conducted of CINAHL, MEDLINE, Proquest, Blackwell Synergy, Informit, Infotrac, National Rural Health Alliance and Indigenous Health Infonet data bases. A definition of health and wellbeing as a positive concept emphasising social and personal resources as well as physical capacities, provided a framework for the review. Six studies published in rural health, nursing and sociology journals between 2001 and 2006 were selected. Common and recurring themes from the original studies were identified. Reciprocal translation was used to synthesise the findings among the studies, leading to interpretations beyond those identified in the original studies. Four themes emerged from the metasynthesis: isolation, belonging, coping with adversity, and rural identity. The findings of this study exhibit a tension between a sense of belonging and the experience of social and geographical isolation. The study findings also reveal tension between adherence to a strong gendered rural identity which fosters a culture of stoicism and self reliance and feelings of resistance to societal expectations of coping with adversity. Metasynthesis enabled a deeper understanding of the health and wellbeing of rural women in Australia. The social experiences of rural women influence the way they construe their health and wellbeing. Understanding how women maintain health and wellbeing is critical in ensuring that policies and services meet the needs of rural women and do not entrench existing inequalities.

Rural maternity care.

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Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

2012-10-01

rural settings. Remuneration models should facilitate interprofessional collaboration. 9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care. 10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported. 11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery. 12. All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met. 13. Quality improvement and outcome monitoring should be integral to all maternity care systems. 14. Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.

What keeps health professionals working in rural district hospitals in South Africa?

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Louis S. Jenkins

2015-06-01

Full Text Available Background: The theme of the 2014 Southern African Rural Health Conference was ‘Building resilience in facing rural realities’. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. Conference workshop: The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, ‘What is it that keeps you going to work every day?’ Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Results: Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Conclusion: Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported.

Influences on the choice of health professionals to practise in rural ...

African Journals Online (AJOL)

Background. Training health care professionals (HCPs) to work in rural areas is a challenge for educationalists. This study aimed to understand how HCPs choose to work in rural areas and how education influences this. Methods. Qualitative individual interviews were conducted with 15 HCPs working in rural areas in SA.

Food Insecurity and Rural Adolescent Personal Health, Home, and Academic Environments.

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Shanafelt, Amy; Hearst, Mary O; Wang, Qi; Nanney, Marilyn S

2016-06-01

Food-insecure (FIS) adolescents struggle in school and with health and mental health more often than food-secure (FS) adolescents. Rural communities experience important disparities in health, but little is known about rural FIS adolescents. This study aims to describe select characteristics of rural adolescents by food-security status. Baseline analysis using data from a randomized trial to increase school breakfast participation (SBP) in rural Minnesota high schools. Students completed a survey regarding food security, characteristics, and home and school environments. Schools provided academic data and staff measured height and weight. Food security was dichotomized as FS vs FIS. Bivariate analysis, multivariate linear/logistic regression, and testing for interaction of food security and sex were performed. Food-insecure adolescents reported poorer health, less exercise, had lower grades, and higher SBP (p breakfast (p = .05). All associations except reported benefits remained significant after adjustment. Interactions were identified with girls' grade point average and with boys' caloric and added sugar intake. Negative associations among food insecurity and positive youth development are identified in our sample. Policy and environmental strategies should address the complexities of these associations, including exploration of the role of school meals. © 2016, American School Health Association.

Changing the Care Process: A New Concept in Iranian Rural Health Care

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Abbas Abbaszadeh, RN, BSCN, PhD

2013-03-01

Conclusion: The findings of this study indicate that the process of health care in Iranian rural society is changing rapidly with community health workers encountering new challenges. There is diminished efficiency in responding to the changing care process in Iran's rural society. Considering this change in process of care, therefore, the health care system should respond to these new challenges by establishing new health care models.

A telecommunications journey rural health network.

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Moore, Joe

2012-01-01

Utilizing a multi-gigabit statewide fiber healthcare network, Radiology Consultants of Iowa (RCI) set out to provide instantaneous service to their rural, critical access, hospital partners. RCIs idea was to assemble a collection of technologies and services that would even out workflow, reduce time on the road, and provide superior service. These technologies included PACS, voice recognition enabled dictation, HL7 interface technology, an imaging system for digitizing paper and prior films, and modern communication networks. The Iowa Rural Health Telecommunication Project was undertaken to form a system that all critical access hospitals would participate in, allowing RCI radiologists the efficiency of "any image, anywhere, anytime".

Rural health clinics infrastructure

Energy Technology Data Exchange (ETDEWEB)

Olson, K.

1997-12-01

The author discusses programs which were directed at the installation of photovoltaic power systems in rural health clinics. The objectives included: vaccine refrigeration; ice pack freezing; lighting; communications; medical appliances; sterilization; water purification; and income generation. The paper discusses two case histories, one in the Dominican Republic and one in Colombia. The author summarizes the results of the programs, both successes and failures, and offers an array of conclusions with regard to the implementation of future programs of this general nature.

Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda.

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Serneels, Pieter; Montalvo, Jose G; Pettersson, Gunilla; Lievens, Tomas; Butera, Jean Damascene; Kidanu, Aklilu

2010-05-01

To understand the factors influencing health workers' choice to work in rural areas as a basis for designing policies to redress geographic imbalances in health worker distribution. A cohort survey of 412 nursing and medical students in Rwanda provided unique contingent valuation data. Using these data, we performed a regression analysis to examine the determinants of future health workers' willingness to work in rural areas as measured by rural reservation wages. These data were also combined with those from an identical survey in Ethiopia to enable a two-country analysis. Health workers with higher intrinsic motivation - measured as the importance attached to helping the poor - as well as those who had grown up in a rural area and Adventists who had participated in a local bonding scheme were all significantly more willing to work in a rural area. The main result for intrinsic motivation in Rwanda was strikingly similar to the result obtained for Ethiopia and Rwanda combined. Intrinsic motivation and rural origin play an important role in health workers' decisions to work in a rural area, in addition to economic incentives, while faith-based institutions can also influence the decision.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

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Whitehead, J; Shaver, John; Stephenson, Rob

2016-01-01

Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

Directory of Open Access Journals (Sweden)

J Whitehead

Full Text Available Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

Outpatient prescription practices in rural township health centers in Sichuan Province, China

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Jiang Qian

2012-09-01

Full Text Available Abstract Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59. About 60% of the prescriptions contained Chinese patent medicine (CPM, and almost all prescriptions (98.07% contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the

Integration of academic learning and service development through guided projects for rural practitioners in India.

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Vyas, Rashmi; Zachariah, Anand; Swamidasan, Isobel; Doris, Priya; Harris, Ilene

2011-01-01

Christian Medical College Vellore (CMC) aspired through its Fellowship in Secondary Hospital Medicine (FSHM), a 1-year distance-learning program, to integrate academic learning and service development through guided projects for junior doctors working in small rural hospitals. The purpose of this article is to report the evaluation of the effectiveness of the project work in the FSHM program. Mixed method evaluation was done using focus group discussion with students, written surveys for students and faculty, and telephone interviews with students and medical superintendents. Evidence for validity was gathered for the written survey. Criteria for trustworthiness were applied for the qualitative data analysis. The major strengths of the project work identified were that students became aware of local health problems and how to deal with them, learned to work as a team, and had a sense of doing something useful. Recommendations for improvement were to have more interactions between guides and students. The benefits of projects to the hospital were providing improved clinical care, improved health systems, cost effective care management and benefits to the community. Service learning through guided project work should be incorporated into distance-learning educational programs for junior doctors working in rural hospitals.

Impact of new information technologies on training and continuing education for rural health professionals.

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Crandall, L A; Coggan, J M

1994-01-01

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy-makers must direct resources to its priority development in rural communities.

Work motivation and job satisfaction of health workers in urban and rural areas.

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Grujičić, Maja; Jovičić-Bata, Jelena; Rađen, Slavica; Novaković, Budimka; Šipetić-Grujičić, Sandra

2016-08-01

Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

What Explains Divorced Women's Poorer Health? The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample

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Lavelle, Bridget; Lorenz, Frederick O.; Wickrama, K. A. S.

2012-01-01

Economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the…

Recruiting and retaining mental health professionals to rural communities: an interdisciplinary course in Appalachia.

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Meyer, Deborah; Hamel-Lambert, Jane; Tice, Carolyn; Safran, Steven; Bolon, Douglas; Rose-Grippa, Kathleen

2005-01-01

Faculty from 5 disciplines (health administration, nursing, psychology, social work, and special education) collaborated to develop and teach a distance-learning course designed to encourage undergraduate and graduate students to seek mental health services employment in rural areas and to provide the skills, experience, and knowledge necessary for successful rural practice. The primary objectives of the course, developed after thorough review of the rural retention and recruitment literature, were to (1) enhance interdisciplinary team skills, (2) employ technology as a tool for mental health practitioners, and (3) enhance student understanding of Appalachian culture and rural mental health. Didactic instruction emphasized Appalachian culture, rural mental health, teamwork and communication, professional ethics, and technology. Students were introduced to videoconferencing, asynchronous and synchronous communication, and Internet search tools. Working in teams of 3 or 4, students grappled with professional and cultural issues plus team process as they worked through a hypothetical case of a sexually abused youngster. The course required participants to engage in a nontraditional manner by immersing students in Web-based teams. Student evaluations suggested that teaching facts or "content" about rural mental health and Appalachian culture was much easier than the "process" of using new technologies or working in teams. Given that the delivery of mental health care demands collaboration and teamwork and that rural practice relies increasingly more on the use of technology, our experience suggests that more team-based, technology-driven courses are needed to better prepare students for clinical practice.

Rural and urban married Asian immigrants in Taiwan: determinants of their physical and mental health.

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Chen, Walter; Shiao, Wen-Been; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh

2013-12-01

Different geographical areas with unique social cultures or societies might influence immigrant health. This study examines whether health inequities and different social factors exist regarding the health of rural and urban married Asian immigrants. A survey was conducted on 419 rural and 582 urban married Asian immigrants in Taiwan in 2009. Whereas the descriptive results indicate a worse mental health status between rural and urban married Asian immigrants, rural married immigrants were as mentally healthy as urban ones when considering different social variables. An analysis of regional stratification found different social-determinant patterns on rural and urban married immigrants. Whereas social support is key for rural immigrant physical and mental health, acculturation (i.e., language proficiency), socioeconomics (i.e., working status), and family structure (the number of family members and children living in the family) are key to the mental health of urban married immigrants in addition to social support. This study verifies the key roles of social determinants on the subjective health of married Asian immigrants. Area-differential patterns on immigrant health might act as a reference for national authorities to (re)focus their attention toward more area-specific approaches for married Asian immigrants.

Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi.

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Lindgren, T G; Deutsch, K; Schell, E; Bvumbwe, A; Hart, K B; Laviwa, J; Rankin, S H

2011-01-01

existing health centers, the data suggest that the mobile clinics provided services for people who otherwise may not have attended a health center. The GAIA mobile clinics were integrated into a catchment area through a community participation model, allowing point-of-care primary health services to be provided to thousands of people in remote rural villagers. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programs.

The role of health system governance in strengthening the rural health insurance system in China.

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Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

2017-05-23

Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

Does More Education Always Lead to Better Health? Evidence from Rural Malaysia

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2015-01-01

Background. Education is usually associated with improvement in health; there is evidence that this may not be the case if education is not fully utilised at work. This study examines the relationship between education level, occupation, and health outcomes of individuals in rural Malaysia. Results. The study finds that the incidence of chronic diseases and high blood pressure are higher for tertiary educated individuals in agriculture and construction occupations. This brings these individuals into more frequent contact with the health system. These occupations are marked with generally lower levels of education and contain fewer individuals with higher levels of education. Conclusions. Education is not always associated with better health outcomes. In certain occupations, greater education seems related to increased chronic disease and contact with the health system, which is the case for workers in agriculture in rural Malaysia. Agriculture is the largest sector of employment in rural Malaysia but with relatively few educated individuals. For the maintenance and sustainability of productivity in this key rural industry, health monitoring and job enrichment policies should be encouraged by government agencies to be part of the agenda for employers in these sectors. PMID:25685796

Does More Education Always Lead to Better Health? Evidence from Rural Malaysia

Directory of Open Access Journals (Sweden)

Gareth Leeves

2015-01-01

Full Text Available Background. Education is usually associated with improvement in health; there is evidence that this may not be the case if education is not fully utilised at work. This study examines the relationship between education level, occupation, and health outcomes of individuals in rural Malaysia. Results. The study finds that the incidence of chronic diseases and high blood pressure are higher for tertiary educated individuals in agriculture and construction occupations. This brings these individuals into more frequent contact with the health system. These occupations are marked with generally lower levels of education and contain fewer individuals with higher levels of education. Conclusions. Education is not always associated with better health outcomes. In certain occupations, greater education seems related to increased chronic disease and contact with the health system, which is the case for workers in agriculture in rural Malaysia. Agriculture is the largest sector of employment in rural Malaysia but with relatively few educated individuals. For the maintenance and sustainability of productivity in this key rural industry, health monitoring and job enrichment policies should be encouraged by government agencies to be part of the agenda for employers in these sectors.

Does more education always lead to better health? Evidence from rural malaysia.

Science.gov (United States)

Leeves, Gareth; Soyiri, Ireneous

2015-01-01

Background. Education is usually associated with improvement in health; there is evidence that this may not be the case if education is not fully utilised at work. This study examines the relationship between education level, occupation, and health outcomes of individuals in rural Malaysia. Results. The study finds that the incidence of chronic diseases and high blood pressure are higher for tertiary educated individuals in agriculture and construction occupations. This brings these individuals into more frequent contact with the health system. These occupations are marked with generally lower levels of education and contain fewer individuals with higher levels of education. Conclusions. Education is not always associated with better health outcomes. In certain occupations, greater education seems related to increased chronic disease and contact with the health system, which is the case for workers in agriculture in rural Malaysia. Agriculture is the largest sector of employment in rural Malaysia but with relatively few educated individuals. For the maintenance and sustainability of productivity in this key rural industry, health monitoring and job enrichment policies should be encouraged by government agencies to be part of the agenda for employers in these sectors.

Oral health: perceptions of need in a rural Iowa county.

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Ettinger, Ronald L; Warren, John J; Levy, Steven M; Hand, Jed S; Merchant, James A; Stromquist, Ann M

2004-01-01

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa. The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non-farm households and town households. The sample was subsequently post-stratified by gender and age group into young elderly, 65-74 years old, and old elderly, 75 years and older. Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.

Improving mental health awareness among rural Aboriginal men: perspectives from Gippsland.

Science.gov (United States)

Isaacs, Anton; Maybery, Darryl

2012-04-01

To identify views of Aboriginal people in rural areas about improving mental health awareness among Aboriginal men. Semi-structured interviews were conducted with 17 Aboriginal people, including men, carers and health workers. Participants highlighted the need for mental health awareness programs in the community. They described the type of programs to be conducted as well as their method, content and frequency. This study demonstrates that mental health awareness programs designed specifically for rural Aboriginal men need to involve local Elders and other significant individuals from the community, be de-stigmatised by including mental health under Men's Health and by embedding the messages within a cultural framework.

Stigma-related mental health knowledge and attitudes among primary health workers and community health volunteers in rural Kenya

NARCIS (Netherlands)

Mutiso, Victoria N.; Musyimi, Christine W.; Nayak, Sameera S.; Musau, Abednego M.; Rebello, Tahilia; Nandoya, Erick; Tele, Albert K.; Pike, Kathleen; Ndetei, David M.

2017-01-01

Background: The study was conducted in rural Kenya and assessed stigma in health workers from primary health facilities. Aims: This study compared variations in stigma-related mental health knowledge and attitudes between primary health workers (HWs) and community health volunteers (CHVs). Methods:

Transportation Matters: A Health Impact Assessment in Rural New Mexico.

Science.gov (United States)

Del Rio, Michelle; Hargrove, William L; Tomaka, Joe; Korc, Marcelo

2017-06-13

This Health Impact Assessment (HIA) informed the decision of expanding public transportation services to rural, low income communities of southern Doña Ana County, New Mexico on the U.S./Mexico border. The HIA focused on impacts of access to health care services, education, and economic development opportunities. Qualitative and quantitative data were collected from surveys of community members, key informant interviews, a focus group with community health workers, and passenger surveys during an initial introduction of the transit system. Results from the survey showed that a high percentage of respondents would use the bus system to access the following: (1) 84% for health services; (2) 83% for formal and informal education opportunities; and (3) 81% for economic opportunities. Results from interviews and the focus group supported the benefits of access to services but many were concerned with the high costs of providing bus service in a rural area. We conclude that implementing the bus system would have major impacts on resident's health through improved access to: (1) health services, and fresh foods, especially for older adults; (2) education opportunities, such as community colleges, universities, and adult learning, especially for young adults; and (3) economic opportunities, especially jobs, job training, and consumer goods and services. We highlight the challenges associated with public transportation in rural areas where there are: (1) long distances to travel; (2) difficulties in scheduling to meet all needs; and (3) poor road and walking conditions for bus stops. The results are applicable to low income and fairly disconnected rural areas, where access to health, education, and economic opportunities are limited.

Transportation Matters: A Health Impact Assessment in Rural New Mexico

Directory of Open Access Journals (Sweden)

Michelle Del Rio

2017-06-01

Full Text Available This Health Impact Assessment (HIA informed the decision of expanding public transportation services to rural, low income communities of southern Doña Ana County, New Mexico on the U.S./Mexico border. The HIA focused on impacts of access to health care services, education, and economic development opportunities. Qualitative and quantitative data were collected from surveys of community members, key informant interviews, a focus group with community health workers, and passenger surveys during an initial introduction of the transit system. Results from the survey showed that a high percentage of respondents would use the bus system to access the following: (1 84% for health services; (2 83% for formal and informal education opportunities; and (3 81% for economic opportunities. Results from interviews and the focus group supported the benefits of access to services but many were concerned with the high costs of providing bus service in a rural area. We conclude that implementing the bus system would have major impacts on resident’s health through improved access to: (1 health services, and fresh foods, especially for older adults; (2 education opportunities, such as community colleges, universities, and adult learning, especially for young adults; and (3 economic opportunities, especially jobs, job training, and consumer goods and services. We highlight the challenges associated with public transportation in rural areas where there are: (1 long distances to travel; (2 difficulties in scheduling to meet all needs; and (3 poor road and walking conditions for bus stops. The results are applicable to low income and fairly disconnected rural areas, where access to health, education, and economic opportunities are limited.

The Changing Context of Rural America: A Call to Examine the Impact of Social Change on Mental Health and Mental Health Care.

Science.gov (United States)

Carpenter-Song, Elizabeth; Snell-Rood, Claire

2017-05-01

Recent social changes and rising social inequality in the rural United States have affected the experience and meaning of mental illness and treatment seeking within rural communities. Rural Americans face serious mental health disparities, including higher rates of suicide and depression compared with residents of urban areas, and substance abuse rates in rural areas now equal those in urban areas. Despite these increased risks, people living in rural areas are less likely than their urban counterparts to seek or receive mental health services. This Open Forum calls for a research agenda supported by anthropological theory and methods to investigate the significance of this changed rural social context for mental health.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

Science.gov (United States)

Whitehead, J.; Shaver, John; Stephenson, Rob

2016-01-01

Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405

Qualitative exploration of the career aspirations of rural origin health science students in South Africa.

Science.gov (United States)

Diab, Paula N; Flack, Penny S; Mabuza, Langalibalele H; Reid, Stephen J Y

2012-01-01

There is evidence in the literature that rural background significantly encourages eventual rural practice. Given the shortage of healthcare providers in rural areas, we need to explore ways of ensuring throughput and success of rural-origin students in health sciences. It is therefore important to understand who these students are, what motivates them and the factors involved in the formation of their career choices. The aim of this study is to understand the aspirations of undergraduate health science students of rural origin with regard to their future career plans. The objectives of the study include to explore and identify the key issues facing rural-origin students with regard to their future career plans. Individual interviews were conducted with 15 health science students from two South African universities. Transcriptions were analyzed with the aid of Nvivo v8 (www.qsrinternational.com). The findings suggest health science students of rural origin studying at universities in the South African context face specific challenges related to the nature of the contrast between rural and urban life, in addition to the more generic adaptations that confront all students on entering tertiary education. In order to support rural students in their studies, academic, financial, emotional and social stressors need to be addressed. Universities should strengthen existing support structures as well as aid the development of further support that may be required.Key words: career plan, health science, rural background, South Africa.

Work motivation and job satisfaction of health workers in urban and rural areas

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Grujičić Maja

2016-01-01

Full Text Available Background/Aim. Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. Methods. The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Results. Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. Conclusion. In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

OpenAIRE

Abayneh, Sisay; Lempp, Heidi; Alem, Atalay; Alemayehu, Daniel; Eshetu, Tigist; Lund, Crick; Semrau, Maya; Thornicroft, Graham; Hanlon, Charlotte

2017-01-01

Background It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods Thirty nine semi-structured interviews were carried out with pur...

Trialing the Community-Based Collaborative Action Research Framework: Supporting Rural Health Through a Community Health Needs Assessment.

Science.gov (United States)

Van Gelderen, Stacey A; Krumwiede, Kelly A; Krumwiede, Norma K; Fenske, Candace

2018-01-01

To describe the application of the Community-Based Collaborative Action Research (CBCAR) framework to uplift rural community voices while conducting a community health needs assessment (CHNA) by formulating a partnership between a critical access hospital, public health agency, school of nursing, and community members to improve societal health of this rural community. This prospective explorative study used the CBCAR framework in the design, collection, and analysis of the data. The framework phases include: Partnership, dialogue, pattern recognition, dialogue on meaning of pattern, insight into action, and reflecting on evolving pattern. Hospital and public health agency leaders learned how to use the CBCAR framework when conducting a CHNA to meet Affordable Care Act federal requirements. Closing the community engagement gap helped ensure all voices were heard, maximized intellectual capital, synergized efforts, improved communication by establishing trust, aligned resources with initiatives, and diminished power struggles regarding rural health. The CBCAR framework facilitated community engagement and promoted critical dialogue where community voices were heard. A sustainable community-based collaborative was formed. The project increased the critical access hospital's capacity to conduct a CHNA. The collaborative's decision-making capacity was challenged and ultimately strengthened as efforts continue to be made to address rural health.

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

Science.gov (United States)

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

Facilitating the formation of accountable care organizations in rural areas.

Science.gov (United States)

Baloh, Jure; Zhu, Xi; Vaughn, Tom; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Nattinger, Matthew

2014-07-01

This Policy Brief presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries. Doing so provides considerations for provider organizations contemplating creating rural-based ACOs. Key Findings. (1) Previous organizational integration and risk-sharing experience facilitated ACO formation. (2) Use of an electronic health record system fostered core ACO capabilities, including care coordination and population health management. (3) Partnerships across the care continuum supported utilization of local health care resources.

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China.

Science.gov (United States)

Wang, Hong; Zhang, Licheng; Yip, Winnie; Hsiao, William

2006-09-01

This study examines adverse selection in a subsidized voluntary health insurance scheme, the Rural Mutual Health Care (RMHC) scheme, in a poor rural area of China. The study was made possible by a unique longitudinal data set: the total sample includes 3492 rural residents from 1020 households. Logistic regression was employed for the data analysis. The results show that although this subsidized scheme achieved a considerable high enrollment rate of 71% of rural residents, adverse selection still exists. In general, individuals with worse health status are more likely to enroll in RMHC than individuals with better health status. Although the household is set as the enrollment unit for the RMHC for the purpose of reducing adverse selection, nearly 1/3 of enrolled households are actually only partially enrolled. Furthermore, we found that adverse selection mainly occurs in partially enrolled households. The non-enrolled individuals in partially enrolled households have the best health status, while the enrolled individuals in partially enrolled households have the worst health status. Pre-RMHC, medical expenditure for enrolled individuals in partially enrolled households was 206.6 yuan per capita per year, which is 1.7 times as much as the pre-RMHC medical expenditure for non-enrolled individuals in partially enrolled households. The study also reveals that the pre-enrolled medical expenditure per capita per year of enrolled individuals was 9.6% higher than the pre-enrolled medical expenditure of all residents, including both enrolled and non-enrolled individuals. In conclusion, although the subsidized RMHC scheme reached a very high enrollment rate and the household is set as the enrollment unit for the purpose of reducing adverse selection, adverse selection still exists, especially within partially enrolled households. Voluntary RMHC will not be financially sustainable if the adverse selection is not fully taken into account.

Social Environmental Eeterminants and Health: Rural Brazil versus Brazil Urban.

Directory of Open Access Journals (Sweden)

Rackynelly Alves SARMENTO

2015-10-01

Full Text Available The rural population lives in socioeconomic inequality conditions motivated by several problems, including an insufficient sewage systems and water supply, these, sometimes, most responsibles by the appearance of waterborne diseases that contribute to the rise of child mortality and other problems. Rural areas in Brazil are defined by opposition and exclusion in urban areas. This definition is arbitrary and physical-geographic, not considering the social and economic processes involving the territories. This study purposed to verify, by means of sociodemographic aspects, environmental sanitation and main grievances/diseases importance for public health of the population from forest field and water, if the most rural municipalities (MMR are more precarious than the more urban (MMU. To this end, was carried out a descriptive study based on secondary sources (Atlas of Human Development in Brazil, IBGE census, PNAD and Sinan. Among the results, it follows that the rural population identified by IBGE boils down to 15.6% of Brazil’s population. In 29% of the municipalities, the population living in rural areas exceeds the city. The higher frequencies from IDMH very low are for MMR, while the higher frequency from IDMH very high and high are for MMU. In health, the MMR also exhibit deficiency. It was observed high incidence rates of diseases related to poor conditions of sanitation. From these results, it was identified a more precarious health profile in MMR when compared to MMU.

Health disparities among the western, central and eastern rural regions of China after a decade of health promotion and disease prevention programming.

Science.gov (United States)

Zhang, Xi-Fan; Tian, Xiang-Yang; Cheng, Yu-Lan; Feng, Zhan-Chun; Wang, Liang; Southerland, Jodi

2015-08-01

Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate (IMR), maternal mortality rate (MMR) and under 5 mortality rate (U5MR) had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR (65.05%); whereas, western rural China had the greatest reduction in MMR (72.99%) but smallest reduction in U5MR (57.36%). Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators (odds ratios): IMR (central: 2.13; western: 5.31), U5MR (central: 2.25; western: 5.69), MMR (central: 1.94; western: 3.31), and prevalence of infectious diseases (central: 1.62; western: 3.58). The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health disparities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Retention of health workers in rural Sierra Leone: findings from life histories.

Science.gov (United States)

Wurie, Haja R; Samai, Mohamed; Witter, Sophie

2016-02-01

Sierra Leone has faced a shortage and maldistribution of staff in its post-conflict period. This long-standing challenge is now exacerbated by the systemic shock and damage wrought by Ebola. This study aimed to investigate the importance of different motivation factors in rural areas in Sierra Leone and thus to contribute to better decisions on financial and non-financial incentive packages, here and in similar contexts. This article is based on participatory life histories, conducted in 2013 with 23 health workers (doctors, nurses, midwives and Community Health Officers) in four regions of Sierra Leone who had worked in the sector since 2000. Although the interviews covered a wide range of themes, here we present findings on motivating and demotivating factors for staff, especially those in rural areas, based on thematic analysis of transcripts. Rural health workers face particular challenges, some of which stem from the difficult terrain, which add to common disadvantages of rural living (poor social amenities, etc.). Poor working conditions, emotional and financial costs of separation from families, limited access to training, longer working hours (due to staff shortages) and the inability to earn from other sources make working in rural areas less attractive. Moreover, rules on rotation which should protect staff from being left too long in rural areas are not reported to be respected. By contrast, poor management had more resonance in urban areas, with reports of poor delegation, favouritism and a lack of autonomy for staff. Tensions within the team over unclear roles and absenteeism are also significant demotivating factors in general. This study provides important policy-focused insights into motivation of health workers and can contribute towards building a resilient and responsive health system, incorporating the priorities and needs of health workers. Their voices and experiences should be taken into account as the post-Ebola landscape is shaped.

Social capital and maternal health care use in rural Ethiopia

NARCIS (Netherlands)

Sheabo Dessalegn, S.

2017-01-01

This thesis analyzes the effect of social capital on maternal health care use in rural Ethiopia. Reports show that in Ethiopia, despite the huge investment in health infrastructure and the deployment of health professionals to provide maternal health services free of charge, utilization remains low.

Body Mass Index and Rural Status on Self-Reported Health in Older Adults: 2004-2013 Medicare Expenditure Panel Survey.

Science.gov (United States)

Batsis, John A; Whiteman, Karen L; Lohman, Matthew C; Scherer, Emily A; Bartels, Stephen J

2018-02-01

To ascertain whether rural status impacts self-reported health and whether the effect of rural status on self-reported health differs by obesity status. We identified 22,307 subjects aged ≥60 from the Medical Expenditure Panel Survey 2004-2013. Body mass index (BMI) was categorized as underweight, normal, overweight, or obese. Physical and mental component scores of the Short Form-12 assessed self-reported health status. Rural/urban status was defined using metropolitan statistical area. Weighted regression models ascertained the relative contribution of predictors (including rural and BMI) on each subscale. Mean age was 70.7 years. Rural settings had higher proportions classified as obese (30.7 vs 27.6%; P rural residents had lower physical health status (41.7 ± 0.3) than urban (43.4 ± 0.1; P rural/urban by BMI. Individuals classified as underweight or obese had lower physical health compared to normal, while the differences were less pronounced for mental health. No differences in mental health existed between rural/urban status. A BMI * rural interaction was significant for physical but not mental health. Rural residents report lower self-reported physical health status compared to urban residents, particularly older adults who are obese or underweight. No interaction was observed between BMI and rural status. © 2017 National Rural Health Association.

Strengthening training in rural practice in Germany: new approach for undergraduate medical curriculum towards sustaining rural health care.

Science.gov (United States)

Holst, Jens; Normann, Oliver; Herrmann, Markus

2015-01-01

After decades of providing a dense network of quality medical care, Germany is facing an increasing shortage of medical doctors in rural areas. Current graduation rates of generalists do not counterbalance the loss due to retirement. Informed by international evidence, different strategies to ensure rural medical care are under debate, including innovative teaching approaches during undergraduate training. The University of Magdeburg in Saxony-Anhalt was the first medical school in Germany to offer a rural elective for graduate students. During the 2014 summer semester, 14 medical students attended a two-weekend program in a small village in Northern Saxony-Anhalt that allowed them to become more familiar with a rural community and rural health issues. The elective course raised a series of relevant topics for setting up rural practice and provided students with helpful insight into living and working conditions in rural practice. Preliminary evaluations indicate that the rural medicine course allowed medical students to reduce pre-existing concerns and had positive impact on their willingness to set up a rural medical office after graduation. Even short-term courses in rural practice can help reduce training-related barriers that prevent young physicians from working in rural areas. Undergraduate medical training is promising to attenuate the emerging undersupply in rural areas.

Integration and Optimization of Renewables and Storages for Rural Electrification

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Morris Brenna

2016-09-01

Full Text Available The electricity access in Sub-Saharan African countries is below 10%; thus, introducing a microgrid for rural electrification can overcome the endemic lack of modern electricity access that hampers the provision of basic services such as education, healthcare, safety, economic and social growth for rural communities. This work studies different possible comparison methods considering variations such as land area required, location for the storage, efficiency, availability and reliability of energy resources, and technology cost variability (investment cost and levelized cost of electricity, which are among the major key parameters used to assess the best possible utilization of renewables and storage system, either using them in the form of integrated, hybrid or independent systems. The study is carried out largely with the help of the Micropower optimization modeling simulator called HOMER for Ethiopia. As a result, the study proposes the use of Photovoltaic (PV–Wind–Hydro–Battery hybrid system model that concludes the optimal configuration of power systems at affordable price for underserved rural communities.

Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales)

Energy Technology Data Exchange (ETDEWEB)

Jimenez, A. C.; Olson, K.

1998-09-01

This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/.

Utilisation of maternal health care in western rural China under a new rural health insurance system (New Co-operative Medical System).

Science.gov (United States)

Long, Qian; Zhang, Tuohong; Xu, Ling; Tang, Shenglan; Hemminki, Elina

2010-10-01

To investigate factors influencing maternal health care utilisation in western rural China and its relation to income before (2002) and after (2007) introducing a new rural health insurance system (NCMS). Data from cross-sectional household-based health surveys carried out in ten western rural provinces of China in 2003 and 2008 were used in the study. The study population comprised women giving birth in 2002 or 2007, with 917 and 809 births, respectively. Correlations between outcomes and explanatory variables were studied by logistic regression models and a log-linear model. Between 2002 and 2007, having no any pre-natal visit decreased from 25% to 12% (difference 13%, 95% CI 10-17%); facility-based delivery increased from 45% to 80% (difference 35%, 95% CI 29-37%); and differences in using pre-natal and delivery care between the income groups narrowed. In a logistic regression analysis, women with lower education, from minority groups, or high parity were less likely to use pre-natal and delivery care in 2007. The expenditure for facility-based delivery increased over the period, but the out-of-pocket expenditure for delivery as a percentage of the annual household income decreased. In 2007, it was 14% in the low-income group. NCMS participation was found positively correlated with lower out-of-pocket expenditure for facility-based delivery (coefficient -1.14 P < 0.05) in 2007. Facility-based delivery greatly increased between 2002 and 2007, coinciding with the introduction of the NCMS. The rural poor were still facing substantial payment for facility-based delivery, although NCMS participation reduced the out-of-pocket expenditure on average. © 2010 Blackwell Publishing Ltd.

Social Health Insurance in Nigeria: Policy Implications in A Rural ...

African Journals Online (AJOL)

Social health insurance was introduced in Nigeria in 1999 and had since been restricted to workers in the formal public sector. There are plans for scaling up to include rural populations in a foreseeable future. Information on willingness to participate and pay a premium in the programme by rural populations is dearth.

Innovations on a shoestring: a study of a collaborative community-based Aboriginal mental health service model in rural Canada

Directory of Open Access Journals (Sweden)

Graham Douglas

2009-12-01

Full Text Available Abstract Background Collaborative, culturally safe services that integrate clinical approaches with traditional Aboriginal healing have been hailed as promising approaches to ameliorate the high rates of mental health problems in Aboriginal communities in Canada. Overcoming significant financial and human resources barriers, a mental health team in northern Ontario is beginning to realize this ideal. We studied the strategies, strengths and challenges related to collaborative Aboriginal mental health care. Methods A participatory action research approach was employed to evaluate the Knaw Chi Ge Win services and their place in the broader mental health system. Qualitative methods were used as the primary source of data collection and included document review, ethnographic interviews with 15 providers and 23 clients; and 3 focus groups with community workers and managers. Results The Knaw Chi Ge Win model is an innovative, community-based Aboriginal mental health care model that has led to various improvements in care in a challenging rural, high needs environment. Formal opportunities to share information, shared protocols and ongoing education support this model of collaborative care. Positive outcomes associated with this model include improved quality of care, cultural safety, and integration of traditional Aboriginal healing with clinical approaches. Ongoing challenges include chronic lack of resources, health information and the still cursory understanding of Aboriginal healing and outcomes. Conclusions This model can serve to inform collaborative care in other rural and Indigenous mental health systems. Further research into traditional Aboriginal approaches to mental health is needed to continue advances in collaborative practice in a clinical setting.

Backward Integration: A Panacea for Rural Development in Nigeria

Directory of Open Access Journals (Sweden)

Rasaq Alabi Olanrewaju

2016-12-01

Full Text Available Business is like a marathon race. It involves both mental and psychical alertness, exploring opportunities and taking chances is the strength, risk is the rule of the game and control is the price for the race. To this end, the aim of every business entity is to operate profitably in the industry it belongs, grow and possibly gain the largest share of the industry market. Among the strategies used in gaining control in the business industry is Integration which is the ability to influence or control either or both raw material input (backward integration or the distribution chain (forward integration or better still grow towards possible monopoly (conglomerate. While effort will be made to discuss other types of integration, this paper will focus more on the backward integration programme, its effect on the survival and growth of business entities, advantages and disadvantages to business operation and its role in rural development in Nigeria.

Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers.

Science.gov (United States)

Beatty, Kate E; Erwin, Paul Campbell; Brownson, Ross C; Meit, Michael; Fey, James

Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). United States. LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. LHDs decision to seek PHAB accreditation. Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation

Oral Health in Rural Communities

Science.gov (United States)

... people with partial edentulism when compared to urban (Urban, 38.4%, High Poverty Rural 51.3%, Other Rural, 45%). Counties with high rates of full edentulism are also rural (Urban, 4.3%, High-Poverty Rural 10.5%, Other Rural, 8.2%). ( Mitchell, ...

The Rural Recreation Integration Project: Reaching Out with Interactive Video Technology.

Science.gov (United States)

Anderson, Lynn; And Others

1996-01-01

North Dakota's Rural Recreation Integration Project disseminates innovative training and technical assistance from therapeutic recreation specialists to recreation and human service providers. The information helps facilitate the inclusion of people with disabilities into recreation/leisure activities. To make the training accessible, they use the…

Integration and transformation of rural service delivery: The role of management information and decision support systems

CSIR Research Space (South Africa)

Mashiri, M

2005-01-01

Full Text Available The paper deals with two main themes: 1) the integration and transformation of rural service delivery; and 2) role of management information and decision support systems in this process. Referring specifically to the types of rural areas, conditions...

Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

African Journals Online (AJOL)

medical health care system, rural-urban disparities would seem obvious. .... have led to the development and onset of the illness and cure/controllability, what the ..... and then went back for the result but the nurse that I saw said that I should ...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

Science.gov (United States)

Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

2016-07-22

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

A rural CT scanner: evaluating the effect on local health care

International Nuclear Information System (INIS)

Merkens, B.J.; Mowbray, R.D.; Creeden, L.; Engels, P.T.; Rothwell, D.M.; Chan, B.T.B.; Tu, K.

2006-01-01

The first small rural hospital in Ontario to propose a computed tomography (CT) scanner was in Walkerton, a town 160 km north of London. The Ontario Ministry of Health approved the proposal as a pilot project to evaluate the effect on local health care of a rural scanner. This evaluation study had 3 parts: a survey of physicians, a survey of patients, and an analysis of population CT scanning rates. The physicians in the area served by the scanner were asked about its impact on their care of their patients in a mailed questionnaire and in semistructured interviews. Scanner outpatients were given a questionnaire in which they rated the importance of its advantages. The analysis of scanning rates--the ratio of number of scans to estimated population--compared rates in the area with other Ontario rates before and after the scanner was introduced. The physicians reported that local CT allowed them to diagnose and treat patients sooner, closer to home, and with greater confidence. On average, 75% of the patients ranked faster and closer access as very important. Scanning rates in the area rose, although they did not match urban rates. The study confirms that the rural scanner changed the area's health care in significant ways and that it helped to narrow the gap between rural and urban service levels. We recommend that CT be expanded to other rural regions. (author)

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

Science.gov (United States)

Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

2018-01-11

The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

Mental health in remote rural developing areas: concepts and cases

National Research Council Canada - National Science Library

1995-01-01

"In this book, we illustrate some of the social and environmental incluences that shape health and mental health care, using examples from rural villages in Alaska as well as other developing areas of the world...

Oral Health Promotion Intervention In Rural Contexts: Impact assessment. Córdoba, Argentina.

Directory of Open Access Journals (Sweden)

Lila Cornejo

2014-03-01

Full Text Available Introduction: The study was carried out in Cruz del Eje Department, Cordoba Province, Argentina. It was based on diagnosis of conceptions of health, concentration of fluoride in drinking water and accessibility to dental coverage in 71 rural schools. Additionally, parents and teachers’ conceptions of general and oral health, dental clinical status and sialochemistry of students from eight schools were considered. Objective: To evaluate a community intervention strategy for promoting oral health in rural contexts. Through the participation of the teacher as a mediator of healthy pattern, this strategy was developed. Methods: In order to elaborate oral health promoting strategies, educational workshops, epistolary communication and on site tutorials meetings were implemented. Specific health projects to be added to the Educational Institutional Programs, as a contextualized mediating strategy for promoting oral health were designed by teachers. The strategy was evaluated comparing dental caries increase (CI detected the previous year and the one following the implementation of the educational plans. Mac Nemar's test was applied, and p<0.05 was set to indicate statistical differences between both periods. Results: A 30.43% CI (p<0.0001 was observed the year before implementing the educational programs as well as a CI reduction to 17.39% (p=0.0002 a year after their application. Conclusion: The drop off in 57.14% of the CI in rural areas, confirms the intervention strategy of designed for this particular context.Keywords: community intervention, oral health promotion, rural communities.

Social Work Practice in a Rural Health Care Setting: Farm Families.

Science.gov (United States)

Durham, Judith A.; Miah, M. Mizanur Rahman

1993-01-01

Literature review addresses the status of farm families; farm stresses and their effects; dysfunctional family relationships; and the unique attitudes, behaviors, and perceptions of rural culture toward social service intervention. By implementing coordinated service programs and initiating new legislation that addresses rural health care issues,…

Rural Health Care Information Access and the Use of the Internet: Opportunity for University Extension

Science.gov (United States)

Das, Biswa R.; Leatherman, John C.; Bressers, Bonnie M.

2015-01-01

The Internet has potential for improving health information delivery and strengthening connections between rural populations and local health service providers. An exploratory case study six rural health care markets in Kansas showed that about 70% of adults use the Internet, with substantial use for accessing health information. While there are…

Factors associated with motivation of health workers in Moshi rural ...

African Journals Online (AJOL)

Vihar

Motivation of health workers and availability of working equipments in Moshi rural is highest in religious health facilities, moderate in .... reasons accounting for the observed staffing ... money after office hours(85.7%) and lastly, inadequate ...

Development of an integrated and sustainable rural service for people with diabetes in the Scottish Highlands.

Science.gov (United States)

Cramp, Geoffrey J

2006-01-01

were identified: a reduction in waiting times for secondary care out patients; an improvement in communication between health-care professionals; further education for both health-care professionals and patients; and the use and role of allied health professionals. Seventeen solutions were recommended, including the introduction of a managed clinical network, use of an integrated IT system, use of a remote access consultation clinic, and web-based peer education and group sessions for allied health professionals. A new service configuration was proposed with the patient at the centre of a non-hierarchical system using standardised referral letters with a seamless flow of information. Local processes for the implementation of government directives are imposing pressures on relatively smaller organisations. These pressures develop as a result of attempts to ensure local ownership and in overcoming the difficulties unique to the remote and rural setting. Further evaluation of the implementation of initiatives to solve the issues of service planning in remote areas is needed to clarify their level of effectiveness.

Rural Women Veterans' Use and Perception of Mental Health Services.

Science.gov (United States)

Ingelse, Kathy; Messecar, Deborah

2016-04-01

While the total number of veterans in the U.S. is decreasing overall, the number of women veterans is significantly increasing. There are numerous barriers which keep women veterans from accessing mental health care. One barrier which can impact receiving care is living in a rural area. Veterans in rural areas have access to fewer mental health services than do urban residing veterans, and women veterans in general have less access to mental health care than do their male colleagues. Little is known about rural women veterans and their mental health service needs. Women, who have served in the military, have unique problems related to their service compared to their male colleagues including higher rates of post-traumatic stress disorder (PTSD) and military sexual trauma (MST). This qualitative study investigated use of and barriers to receiving mental health care for rural women veterans. In-depth interviews were conducted with ten women veterans who have reported experiencing problems with either MST, PTSD, or combat trauma. All ten women had utilized mental health services during active-duty military service, and post service, in Veterans Administration (VA) community based-outpatient clinics. Several recurring themes in the women's experience were identified. For all of the women interviewed, a sentinel precipitating event led to seeking mental health services. These precipitating events included episodes of chronic sexual harassment and ridicule, traumatic sexual assaults, and difficult combat experiences. Efforts to report mistreatment were unsuccessful or met with punishment. All the women interviewed reported that they would not have sought services without the help of a supportive peer who encouraged seeking care. Barriers to seeking care included feeling like they were not really a combat veteran (in spite of serving in a combat unit in Iraq); feeling stigmatized by providers and other military personnel, being treated as crazy; and a lack of interest

For more than love or money: attitudes of student and in-service health workers towards rural service in India.

Science.gov (United States)

Ramani, Sudha; Rao, Krishna D; Ryan, Mandy; Vujicic, Marko; Berman, Peter

2013-11-21

While international literature on rural retention is expanding, there is a lack of research on relevant strategies from pluralistic healthcare environments such as India, where alternate medicine is an integral component of primary care. In such contexts, there is a constant tug of war in national policy on "Which health worker is needed in rural areas?" and "Who can, realistically, be got there?" In this article, we try to inform this debate by juxtaposing perspectives of three cadres involved in primary care in India-allopathic, ayurvedic and nursing-on rural service. We also identify key incentives for improved rural retention of these cadres. We present qualitative evidence from two states, Uttarakhand and Andhra Pradesh. Eighty-eight in-depth interviews with students and in-service personnel were conducted between January and July 2010. Generic thematic analysis techniques were employed, and the data were organized in a framework that clustered factors linked to rural service as organizational (salary, infrastructure, career) and contextual (housing, children's development, safety). Similar to other studies, we found that both pecuniary and non-pecuniary factors (salary, working conditions, children's education, living conditions and safety) affect career preferences of health workers. For the allopathic cadre, rural primary care jobs commanded little respect; respondents from this cadre aimed to specialize and preferred private sector jobs. Offering preferential admission to specialist courses in exchange for a rural stint appears to be a powerful incentive for this cadre. In contrast, respondents from the Ayurvedic and nursing cadres favored public sector jobs even if this meant rural postings. For these two cadres, better salary, working and rural living conditions can increase recruitment. Rural retention strategies in India have predominantly concentrated on the allopathic cadre. Our study suggests incentivizing rural service for the nursing and Ayurvedic

Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales); TOPICAL

International Nuclear Information System (INIS)

Jimenez, A. C.; Olson, K.

1998-01-01

This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

Directory of Open Access Journals (Sweden)

Liu Xiaoyun

2012-02-01

Full Text Available Abstract Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

Science.gov (United States)

2012-01-01

Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

A cross-sectional study of health-related behaviors in rural eastern China.

Science.gov (United States)

Sun, Ye-Huan; Yu, Tak-Sun Ignatius; Tong, Shi-Lu; Zhang, Yan; Shi, Xiao-Ming; Li, Wei

2002-12-01

This study examined the status of health-related behaviors among rural residents and the factors influencing the practice of such behaviors. One thousand and ninety subjects aged 15 years or over in a rural community, Anhui Province, China were surveyed. A questionnaire was used to collect information on the health knowledge, attitude and behavior of the subjects. Information on health behavior included smoking, drinking, dietary habits, regular exercises, sleeping pattern and oral health behavior. The prevalence of smoking and drinking in the male subjects was 46.5% and 46.9%, respectively. There was a positive significant association between smoking and drinking. Only 8.3% of all subjects ate three regular meals a day regularly. Among subjects who ate two meals a day, 89.7% did not have breakfast. Only 1.7% of subjects took part in regular exercise. About 85% of subjects slept 6 to 8 h per day. Only 38.4% of the respondents had the habit of hand washing before eating and after using the lavatory. 79.3% of the subjects brushed their teeth every day, and among them, only 10.6 percent brushed their teeth twice a day. Further analyses showed that 64.8% of subjects had 3-5 items of positive health behaviors out of 8 items and only 16.9% had six or more items. Logistical regression analyses suggested that better health behavior was affected by sex, age, years of education, income and health knowledge. The status of health behaviors among rural residents was generally poor. It is thus urgent to reinforce health education in rural communities in China.

Meeting Recommended Levels of Physical Activity and Health-Related Quality of Life in Rural Adults.

Science.gov (United States)

Hart, Peter D

2016-03-01

Little is known about physical activity (PA) and health-related quality of life (HRQOL) among rural adults. The purpose of this study was to investigate the relationship between meeting recommended levels of PA and HRQOL in a rural adult population. This study analyzed data from 6,103 rural adults 18 years of age and older participating in a 2013 survey. Respondents reporting at least 150 minutes a week of moderate-intensity (or moderate-vigorous combination) PA during the past month were categorized as meeting PA guidelines. Five health variables were used to assess HRQOL. A continuous HRQOL ability score was also created using item response theory (IRT). Rural adults who met recommended levels of PA were significantly more likely to report good HRQOL in adjusted models of physical health (OR: 1.99; 95% CI: 1.54-2.56), mental health (OR: 1.96; 95% CI: 1.46-2.64), inactivity health (OR: 2.14; 95% CI: 1.54-2.97), general health (OR: 1.69; 95% CI: 1.35-2.13), and healthy days (OR: 1.98; 95% CI: 1.58-2.47), compared to those who did not meet recommended levels. Furthermore, rural adults meeting recommended levels of PA also had a significantly greater HRQOL ability score (51.7 ± 0.23, Mean ± SE), compared to those not meeting recommended levels (48.4 ± 0.33, p meeting recommended levels of PA increases the likelihood of reporting good HRQOL in rural adults. These results should be used to promote the current PA guidelines for improved HRQOL in rural populations.

Reinforcing marginality? Maternal health interventions in rural Nicaragua.

Science.gov (United States)

Kvernflaten, Birgit

2017-06-23

To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.

The Cumbria Rural Health Forum: initiating change and moving forward with technology.

Science.gov (United States)

Ditchburn, Jae-Llane; Marshall, Alison

2016-01-01

The Cumbria Rural Health Forum was formed by a number of public, private and voluntary sector organisations to collaboratively work on rural health and social care in the county of Cumbria, England. The aim of the forum is to improve health and social care delivery for rural communities, and share practical ideas and evidence-based best practice that can be implemented in Cumbria. The forum currently consists of approximately 50 organisations interested in and responsible for delivery of health and social care in Cumbria. An exploration of digital technologies for health and care was recognised as an initial priority. This article describes a hands-on approach undertaken within the forum, including its current progress and development. The forum used a modified Delphi technique to facilitate its work on discussing ideas and reaching consensus to formulate the Cumbria Strategy for Digital Technologies in Health and Social Care. The group communication process took place over meetings and workshops held at various locations in the county. A roadmap for the implementation of digital technologies into health and social care was developed. The roadmap recommends the following: (i) to improve the health outcomes for targeted groups, within a unit, department or care pathway; (ii) to explain, clarify, share good (and bad) practice, assess impact and value through information sharing through conferences and events, influencing and advocacy for Cumbria; and (iii) to develop a digital-health-ready workforce where health and social care professionals can be supported to use digital technologies, and enhance recruitment and retention of staff. The forum experienced issues consistent with those in other Delphi studies, such as the repetition of ideas. Attendance was variable due to the unavailability of key people at times. Although the forum facilitated collective effort to address rural health issues, its power is limited to influencing and supporting implementation of change

Oral health status of rural-urban migrant children in South China.

Science.gov (United States)

Gao, Xiao-Li; McGrath, Colman; Lin, Huan-Cai

2011-01-01

In China, there is a massive rural-urban migration and the children of migrants are often unregistered residents (a 'floating population'). This pilot study aimed to profile the oral health of migrant children in South China's principal city of migration and identify its socio-demographic/behavioural determinants. An epidemiological survey was conducted in an area of Guangzhou among 5-year-old migrant children (n = 138) who received oral examinations according to the World Health Organization criteria. Parents' oral health knowledge/attitude, child practices, and impact of children's oral health on their quality-of-life (QoL) were assessed. The caries rate and mean (SD) dmft were 86% and 5.17 (4.16), respectively, higher than those national statistics for both rural and urban areas (P Oral hygiene was satisfactory (DI-S Oral health impacts on QoL were considerable; 60% reported one or more impacts. 58% variance in 'dmft' was explained by 'non-local-born', 'low-educated parents', 'bedtime feeding', 'parental unawareness of fluoride's effect and importance of teeth', and 'poor oral hygiene' (all P oral health-related QoL (both P Oral health is poor among rural-urban migrant children and requires effective interventions in targeted sub-groups. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.

County-level poverty is equally associated with unmet health care needs in rural and urban settings.

Science.gov (United States)

Peterson, Lars E; Litaker, David G

2010-01-01

Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care. © 2010 National Rural Health Association.

The impact of innovation funding on a rural health nursing service: the Reporoa experience.

Science.gov (United States)

Connor, Margaret; Nelson, Katherine; Maisey, Jane

2009-07-01

Health Reporoa Inc. offers a first contact rural nursing service to the village of Reporoa and surrounding districts. From 2003 to 2006 it became a project site through selection for the Ministry of Health (MoH) primary health care nursing innovation funding. Health Reporoa Inc. successfully achieved its project goals and gained an ongoing contract from Lakes District Health Board to consolidate and further expand its services at the close of the funding period. This paper examines the impact of the innovation funding during the project period and in the two years that followed. The major impact came through an expansion of the accessible free health service to the local population; advancing nursing practice; increased connection to the nursing profession and wider health community, and enhanced affirmation of the nursing contribution. The rural nursing service model developed at Health Reporoa, through the benefit of innovation funding, can now act as a blueprint for other rural health services, particularly those in high deprivation areas.

The Effects of Housing on Health and Health Risks in an Aging Population: A Qualitative Study in Rural Thailand

Directory of Open Access Journals (Sweden)

Ratana Somrongthong

2014-01-01

Full Text Available Background. Over the last decade, Thailand has experienced an aging population, especially in rural areas. Research finds a strong, positive relationship between good quality housing and health, and this paper assesses the impact and living experience of housing of older people in rural Thailand. Methods. This was a mixed-method study, using data from observations of the physical adequacy of housing, semistructured interviews with key informants, and archival information from health records for 13 households in rural Thailand. Results. There were four main themes, each of which led to health risks for the older people: “lighting and unsafe wires,” “house design and composition,” “maintenance of the house,” and “health care equipment.” The housing was not appropriately designed to accommodate health care equipment or to fully support individual daily activities of older people. Numerous accidents occurred as a direct result of inadequate housing and the majority of houses had insufficient and unsafe lighting, floor surfaces and furniture that created health risks, and toilets or beds that were at an unsuitable height for older people. Conclusion. This paper provides an improved and an important understanding of the housing situation among older people living in rural areas in Thailand.

Integrated water resources management for sustainable development of in western rural China

Institute of Scientific and Technical Information of China (English)

CHEN Gui-bao; HUANG Gao-bao

2010-01-01

Management in water resources development of Jinghe watershed of western rural China is examined with Participatory Rural Appraisal method--a rare applied method in China and questionnaire survey of stakeholders.Combination of these two survey methods derives good results as it could avoid personal bias in identifying and ranking the issues on a concrete basis in following up households'survey.Statistic Package for Social Sciences(SPSS)was used for data analysis.Results indicate that since the early 1980s.issues of water scarcity,river pollution,soil erosion,insufficient participation of stakeholders in water resources use and management,as well as centrahzed water planning and management system have created difficulties for sustainable development of the watershed.The stakeholders and local governments are fully aware of the challenges and are committed to achieving a solution through integrated water resource management(IWRD).The concept and the application of IWRD for rural China are reviewed and analyzed,and a framework for implementation of IWRD in China is developed.It is conchided that the keys to successful implementation of the approach will depend on optimal arrangement of institutions,policy reforms,community involvement and capacity building in water sector,which need to fully integrate various management functions within the watershed.

Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?

Science.gov (United States)

Alston, Margaret

2007-05-01

The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.

Service providers' experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service.

Science.gov (United States)

Newman, Lareen; Bidargaddi, Niranjan; Schrader, Geoffrey

2016-10-01

Complexity"; (4) "Technical Compatibility" with two sub-themes: technical-clinical and technical-administrative; and (5) "Broader Organisational Culture", with two sub-themes: organizational policy support and 'digital telehealth' culture. The digitised telehealth network was generally well received by providers and adopted into clinical practice. Compared with the previous analog system, staff found advantages in better visual and audio quality, more technical stability with less "drop-out", less time delay to conversations and less confusion for clients. Despite these advantages, providers identified a range of challenges to starting or continuing use and they recommended improvements to increase uptake among mental health service providers and other providers (including GPs), and to clinical uses other than mental health. To further increase uptake and impact of telehealth-mediated mental health care in rural and remote areas, even with a high quality digital system, future research must design innovative care models, consider time and cost incentives for providers to use telehealth, and must focus not only on technical training but also how to best integrate technology with clinical practice and must develop an organization-wide digital telehealth culture. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care

OpenAIRE

Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

2013-01-01

Objectives The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventati...

Rural Indonesian health care workers' constructs of infection prevention and control knowledge.

Science.gov (United States)

Marjadi, Brahmaputra; McLaws, Mary-Louise

2010-06-01

Understanding the constructs of knowledge behind clinical practices in low-resource rural health care settings with limited laboratory facilities and surveillance programs may help in designing resource-appropriate infection prevention and control education. Multiple qualitative methods of direct observations, individual and group focus discussions, and document analysis were used to examine health care workers' knowledge of infection prevention and control practices in intravenous therapy, antibiotic therapy, instrument reprocessing, and hand hygiene in 10 rural Indonesian health care facilities. Awareness of health care-associated infections was low. Protocols were in the main based on verbal instructions handed down through the ranks of health care workers. The evidence-based knowledge gained across professional training was overridden by empiricism, nonscientific modifications, and organizational and societal cultures when resources were restricted or patients demanded inappropriate therapies. This phenomenon remained undetected by accreditation systems and clinical educators. Rural Indonesian health care workers would benefit from a formal introduction to evidence-based practice that would deconstruct individual protocols that include nonscientific knowledge. To achieve levels of acceptable patient safety, protocols would have to be both evidence-based and resource-appropriate. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Beyond the biomedical: community resources for mental health care in rural Ethiopia.

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Selamu, Medhin; Asher, Laura; Hanlon, Charlotte; Medhin, Girmay; Hailemariam, Maji; Patel, Vikram; Thornicroft, Graham; Fekadu, Abebaw

2015-01-01

The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources. We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered. The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities. The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support

Beyond the biomedical: community resources for mental health care in rural Ethiopia.

Directory of Open Access Journals (Sweden)

Medhin Selamu

Full Text Available The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources.We employed resource mapping within the Programme for Improving Mental Health Care (PRIME, to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered.The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs represented all the biomedical health services in the district. In addition the Health Development Army (HDA are community volunteers who support health promotion and prevention activities.The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be

Responding to rural health disparities in the United States

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Ian Jones

2013-04-01

Full Text Available The paper focuses on the need to address territorial inequalities in American healthcare services. It shows how much the situation has become critical in the United States. It discusses to what extent telemedicine is a sustainable option to reduce the negative consequences of the economic, professional and physical barriers to care in rural areas. As far as healthcare is concerned, rural and urban environments in the United States do not have to face the same barriers and challenges. The article first details what specific health issues have to be dealt with in rural areas. The case of emergency care in Vermont is then developed to illustrate what could be the benefits of using ICTs to improve access to care.

Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria.

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Campbell, P C; Ebuehi, O M

2011-01-01

Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one' efforts. Several factors affect job satisfaction. To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. A cross sectional comparative study recruited qualified health workers selected by multi stage sampling technique from rural and urban health facilities in four local government areas (LGAs) of Ogun State in Southwestern Nigeria. Data were collected and analysed using Epi info V 3.5.1 RESULTS: The response rates were 88(88%) and 91(91%) respectively in the rural and urban areas. While urban workers derived satisfaction from availability of career development opportunities, materials and equipment, in their current job, rural workers derived satisfaction from community recognition of their work and improved staff relationship. Major de-motivating factors common to both groups were lack of supportive supervision, client-provider relationship and lack of in-service training. However more rural 74(84.1%) than urban 62(68.1%) health workers would prefer to continue working in their present health facilities (p=0.04). There was a statistically significant difference between the two groups in job satisfaction with respect to tools availability and career development opportunities (pfactors influencing job satisfaction between rural and urban healthcare workers. There is need for human resource policy to be responsive to the diverse needs of health workers particularly at the primary level.

Integrated rural industrialization through biogas

International Nuclear Information System (INIS)

Anon.

1992-01-01

Role of biogas in rural industrialization in India is explained. The Khadi and Village Industries Commission has installed over 2 lakhs (0.2 million) biogas plants during the last 30 years. A 15 cu.m. capacity plant costs Rs. 35,000/-. It produces 65 tons bio-manure worth Rs. 13,000/- in a year and fuel gas equivalent to 3,285 litres of kerosene worth Rs. 9855/-. It provides employment to 300 man days. In addition to serving as a source of energy and manure, it reduces deforestation, solves rural sanitation problem and maintain environmental equilibrium. Industrial activities suitable for rural areas and which can use biogas as a source of power are indicated. (M.G.B.)

Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

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Mohamed, Somaia

2013-03-01

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

Transportation constraints to rural health accessibility in Ogun ...

African Journals Online (AJOL)

Transportation constraints to rural health accessibility in Ogun Waterside Local Government Area of Ogun State Nigeria. ... Of the 200 questionnaires administered, 182 questionnaires were received for analysis using the Statistical Package for Social Sciences (SPSS). Secondary data was also sourced to serve as ...

Assessment of primary health care in a rural health centre in Enugu South east Nigeria.

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M Chinawa, Josephat; T Chinawa, Awoere

2015-01-01

Primary health care (PHC) is a vital in any community. Any health centre with a well implemented PHC program can stand the test of time in curbing under five mortality and morbidity. This study was therefore aimed at assessing the activities in a health centre located in a rural area in Enugu state and to determine the pattern and presentation of various diseases in the health centre. This is retrospective study undertaken in a primary health care centre in Abakpa Nike in Enugu east LGA of Enugu State of Nigeria from December 2011 to December 31(st) 2013. Data retrieved were collected with the aid of a structured study proforma and analyzed using SPSS Version 18. Total number of children that attended immunization program in the health centre over 20 months period was 25,438 (12,348 males and 13090 females), however only 17745 children (7998 males and 9747 females) were actually registered in the hospital records. None of the children was immunized for DPT2 and OPV(0) and HBV(1) in the course of this study. The dropout rate using DPT1, 2 and 3 (DPT1-DPT2/DPT3) was very high (494%). The mean immunization coverage rate was 8.3%. Family planning activities, integrated management of childhood illnesses program were also carried out in the health centre but at very low level. The major fulcrum of events in the health centre which include immunization coverage, IMCI, and management of common illnesses were simply non operational. However the health centre had a well knitted referral system.

Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach.

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Cai, Jiaoli; Coyte, Peter C; Zhao, Hongzhong

2017-07-18

In recent decades, China has experienced tremendous economic growth and also witnessed growing socioeconomic-related health inequality. The study aims to explore the potential causes of socioeconomic-related health inequality in urban and rural areas of China over the past two decades. This study used six waves of the China Health and Nutrition Survey (CHNS) from 1991 to 2006. The recentered influence function (RIF) regression decomposition method was employed to decompose socioeconomic-related health inequality in China. Health status was derived from self-rated health (SRH) scores. The analyses were conducted on urban and rural samples separately. We found that the average level of health status declined from 1989 to 2006 for both urban and rural populations. Average health scores were greater for the rural population compared with those for the urban population. We also found that there exists pro-rich health inequality in China. While income and secondary education were the main factors to reduce health inequality, older people, unhealthy lifestyles and a poor home environment increased inequality. Health insurance had the opposite effects on health inequality for urban and rural populations, resulting in lower inequality for urban populations and higher inequality for their rural counterparts. These findings suggest that an effective way to reduce socioeconomic-related health inequality is not only to increase income and improve access to health care services, but also to focus on improvements in the lifestyles and the home environment. Specifically, for rural populations, it is particularly important to improve the design of health insurance and implement a more comprehensive insurance package that can effectively target the rural poor. Moreover, it is necessary to comprehensively promote the flush toilets and tap water in rural areas. For urban populations, in addition to promoting universal secondary education, healthy lifestyles should be promoted

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

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Chen Chi-Liang

2008-03-01

Full Text Available Abstract Background Taiwan's National Health Insurance (NHI, implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

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Elder, W G; Amundson, B A

1991-01-01

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

Psychological health among Chinese college students: a rural/urban ...

African Journals Online (AJOL)

Journal of Child and Adolescent Mental Health ... higher scores than their rural counterparts on self-esteem and social support. However, there was no statistically significant difference between the groups on ... AJOL African Journals Online.

78 FR 73926 - Veterans' Rural Health Advisory Committee; Notice of Meeting

Science.gov (United States)

2013-12-09

... Administration (VHA) Office of Rural Health (ORH). The Committee will hear a presentation on the Women's Health... Manager, Regulation Policy and Management, Office of the General Counsel. [FR Doc. 2013-29301 Filed 12-6...

Large-scale mHealth professional support for health workers in rural Maharashtra, India.

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Hegde, Shailendra Kumar B; Saride, Sriranga Prasad; Kuruganty, Sudha; Banker, Niraja; Patil, Chetan; Phanse, Vishal

2018-04-01

Expanding mobile telephony in India has prompted interest in the potential of mobile-telephone health (mHealth) in linking health workers in rural areas with specialist medical advice and other professional services. In 2012, a toll-free helpline offering specialist medical advice to community-based health workers throughout Maharashtra was launched. Calls are handled via a 24 h centre in Pune, staffed by health advisory officers and medical specialists. Health advisory officers handle general queries, which include medical advice via validated algorithms; blood on-call services; grievance issues; and mental health support - the latter calls are transferred to a qualified counsellor. Calls requiring more specialist advice are transferred to the appropriate medical specialist. This paper describes the experience of the first 4 years of this helpline, in terms of the services used, callers, nature of calls, types of queries serviced and lessons learnt. In the first 4 years of the helpline, 669 265 calls were serviced. Of these calls, 453 373 (67.74%) needed medical advice and were handled by health advisory officers. Specialist services were required to address 199 226 (29.77%) calls. Blood-bank-related services accounted for 7919 (1.18%) calls, while 2462 (0.37%) were grievance calls. Counselling for mental health issues accounted for 6285 (0.94%) calls. The large-scale mHealth professional support provided by this helpline in Maharashtra has reached many health workers serving rural communities. Future work is required to explore ways to expand the reach of the helpline further and to measure its effectiveness in improving health outcomes.

Discrimination, perceived social inequity, and mental health among rural-to-urban migrants in China.

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Lin, Danhua; Li, Xiaoming; Wang, Bo; Hong, Yan; Fang, Xiaoyi; Qin, Xiong; Stanton, Bonita

2011-04-01

Status-based discrimination and inequity have been associated with the process of migration, especially with economics-driven internal migration. However, their association with mental health among economy-driven internal migrants in developing countries is rarely assessed. This study examines discriminatory experiences and perceived social inequity in relation to mental health status among rural-to-urban migrants in China. Cross-sectional data were collected from 1,006 rural-to-urban migrants in 2004-2005 in Beijing, China. Participants reported their perceptions and experiences of being discriminated in daily life in urban destination and perceived social inequity. Mental health was measured using the symptom checklist-90 (SCL-90). Multivariate analyses using general linear model were performed to test the effect of discriminatory experience and perceived social inequity on mental health. Experience of discrimination was positively associated with male gender, being married at least once, poorer health status, shorter duration of migration, and middle range of personal income. Likewise, perceived social inequity was associated with poorer health status, higher education attainment, and lower personal income. Multivariate analyses indicate that both experience of discrimination and perceived social inequity were strongly associated with mental health problems of rural-to-urban migrants. Experience of discrimination in daily life and perceived social inequity have a significant influence on mental health among rural-to-urban migrants. The findings underscore the needs to reduce public or societal discrimination against rural-to-urban migrants, to eliminate structural barriers (i.e., dual household registrations) for migrants to fully benefit from the urban economic development, and to create a positive atmosphere to improve migrant's psychological well-being.

78 FR 54967 - Rural Health Care Support Mechanism

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2013-09-09

... effective date. SUMMARY: In this document, the Commission announces that the Office of Management and Budget... Commission established the Healthcare Connect Fund, which reforms, expands, and modernizes the Rural Health... determine if entities are complying with the Commission's rules, and to prevent waste, fraud, and abuse. The...

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions.

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Keane, Sheila; Lincoln, Michelle; Smith, Tony

2012-06-22

Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology. Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors. Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. 'Pull factors' favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. 'Push factors' discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants. While personal factors affecting recruitment and

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions

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Keane Sheila

2012-06-01

Full Text Available Abstract Background Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology. Methods Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors. Results Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD; the impact of management; and career progression. ‘Pull factors’ favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. ‘Push factors’ discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel; limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by

Building the Foundation for a Health Education Program for Rural Older Adults

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Jung, Seung Eun; Parker, Stephany; Hermann, Janice; Phelps, Joshua; Shin, Yeon Ho

2018-01-01

We explored rural older adults perceptions of health to inform health promotion program development, using social marketing as our framework. Participants in seven focus groups viewed independence and holistic health as indicators of health and identified healthful eating and physical activity as actions to promote health. Barriers to these…

NRHM - the panacea for rural health in India: a critique

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Vikas Bajpai

2012-01-01

Full Text Available There has been news of the Central Government’s flag ship rural health care scheme - National Rural Health Mission (NRHM being given an extension till 2015; albeit there is little talk of what we have learned from the experiences of NRHM till now so as to remove the bottle necks in its implementation. After seven years of implementation NRHM has failed to achieve its stated objectives. This calls for a scrutiny of this failure. This article analyzes fundamental conceptual dilemmas inherent to the Mission to draw lessons for future. The most important lesson that ought to be learnt is that ‘the health of the people is not a standalone phenomenon that can be improved through healthcare alone. It requires a comprehensive action plan encompassing food security, employment and poverty alleviation as well

An examination of the health information seeking experiences of women in rural Ontario, Canada

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C.N. Wathen

2006-01-01

Full Text Available Introduction. Women are active information seekers, particularly in the context of managing health for themselves and their families. Rural living may present particular challenges and opportunities for women in their health information seeking. Method. Forty women living in a rural part of Ontario, Canada were interviewed using a semi-structured interview guide. They were asked about their health information seeking for both chronic and acute concerns. Analysis. Interview transcripts were organized using NVivo software (version 6 and analysed using a coding scheme iteratively developed by both authors. Results. Emerging themes included: the context of rural living, information and health literacy, the role of unanticipated information intermediaries in the search process, and the mis-match between assumptions made by 'the system' about sources of information, and women's lived realities. Conclusion. . There are unique challenges and enablers to health information seeking for women living in rural areas, including the role of formal, informal and ICT-based information intermediaries, the availability to women of required literacies for health information seeking and uptake. Research findings such as those presented in this paper can assist in better understanding both the contexts of information seeking, as well as the preferences and behaviour of those with information needs.

Impact and management of dual relationships in metropolitan, regional and rural mental health practice.

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Endacott, Ruth; Wood, Anita; Judd, Fiona; Hulbert, Carol; Thomas, Ben; Grigg, Margaret

2006-01-01

To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.

Health-seeking behaviour of human brucellosis cases in rural Tanzania

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MacMillan Alastair

2007-11-01

Full Text Available Abstract Background Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it. Methods This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA test at the Veterinary Laboratory Agencies (VLA in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases. Results The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. Conclusion More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in

Psidium guajava: A Single Plant for Multiple Health Problems of Rural Indian Population.

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Daswani, Poonam G; Gholkar, Manasi S; Birdi, Tannaz J

2017-01-01

The rural population in India faces a number of health problems and often has to rely on local remedies. Psidium guajava Linn. (guava), a tropical plant which is used as food and medicine can be used by rural communities due to its several medicinal properties. A literature search was undertaken to gauge the rural health scenario in India and compile the available literature on guava so as to reflect its usage in the treatment of multiple health conditions prevalent in rural communities. Towards this, electronic databases such as Pubmed, Science Direct, google scholar were scanned. Information on clinical trials on guava was obtained from Cochrane Central Register of Controlled Trials and Clinicaltrial.gov. The literature survey revealed that guava possesses various medicinal properties which have been reported from across the globe in the form of ethnobotanical/ethnopharmacological surveys, laboratory investigations and clinical trials. Besides documenting the safety of guava, the available literature shows that guava is efficacious against the following conditions which rural communities would encounter. (a) Gastrointestinal infections; (b) Malaria; (c)Respiratory infections; (d) Oral/dental infections; (e) Skin infections; (f) Diabetes; (g) Cardiovascular/hypertension; (h) Cancer; (i) Malnutrition; (j) Women problems; (k) Pain; (l) Fever; (m) Liver problems; (n) Kidney problems. In addition, guava can also be useful for treatment of animals and explored for its commercial applications. In conclusion, popularization of guava, can have multiple applications for rural communities.

Index of Access: a new innovative and dynamic tool for rural health service and workforce planning.

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McGrail, Matthew R; Russell, Deborah J; Humphreys, John S

2017-10-01

Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning. Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations. Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions. Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities. What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making. What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is

Building a sustainable workforce in a rural and remote health service: A comprehensive and innovative Rural Generalist training approach.

Science.gov (United States)

Orda, Ulrich; Orda, Sabine; Sen Gupta, Tarun; Knight, Sabina

2017-04-01

Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, CONCLUSIONS: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU. © 2016 National Rural Health Alliance Inc.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

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Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

2018-03-23

The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

Health workers' knowledge of and attitudes towards computer applications in rural African health facilities.

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Sukums, Felix; Mensah, Nathan; Mpembeni, Rose; Kaltschmidt, Jens; Haefeli, Walter E; Blank, Antje

2014-01-01

The QUALMAT (Quality of Maternal and Prenatal Care: Bridging the Know-do Gap) project has introduced an electronic clinical decision support system (CDSS) for pre-natal and maternal care services in rural primary health facilities in Burkina Faso, Ghana, and Tanzania. To report an assessment of health providers' computer knowledge, experience, and attitudes prior to the implementation of the QUALMAT electronic CDSS. A cross-sectional study was conducted with providers in 24 QUALMAT project sites. Information was collected using structured questionnaires. Chi-squared tests and one-way ANOVA describe the association between computer knowledge, attitudes, and other factors. Semi-structured interviews and focus groups were conducted to gain further insights. A total of 108 providers responded, 63% were from Tanzania and 37% from Ghana. The mean age was 37.6 years, and 79% were female. Only 40% had ever used computers, and 29% had prior computer training. About 80% were computer illiterate or beginners. Educational level, age, and years of work experience were significantly associated with computer knowledge (pworkplace. Given the low levels of computer knowledge among rural health workers in Africa, it is important to provide adequate training and support to ensure the successful uptake of electronic CDSSs in these settings. The positive attitudes to computers found in this study underscore that also rural care providers are ready to use such technology.

Medicare and Rural Health

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... community has a significant impact on the local economy. In rural areas, Medicare reimbursement is a critical source of that healthcare spending, particularly since the higher percentage of elderly population in rural areas mean that Medicare accounts for ...

Self-reported morbidity and health service utilization in rural Tamil Nadu, India.

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Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate

2016-07-01

In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability. Copyright © 2016 Elsevier Ltd. All rights

Urban-rural disparities in child nutrition-related health outcomes in China: The role of hukou policy.

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Liu, Hong; Rizzo, John A; Fang, Hai

2015-11-23

Hukou is the household registration system in China that determines eligibility for various welfare benefits, such as health care, education, housing, and employment. The hukou system may lead to nutritional and health disparities in China. We aim at examining the role of the hukou system in affecting urban-rural disparities in child nutrition, and disentangling the institutional effect of hukou from the effect of urban/rural residence on child nutrition-related health outcomes. This study uses data from the China Health and Nutrition Survey 1993-2009 with a sample of 9616 children under the age of 18. We compute height-for-age z-score and weight-for-age z-score for children. We use both descriptive statistics and multiple regression techniques to study the levels and significance of the association between child nutrition-related health outcomes and hukou type. Children with urban hukou have 0.25 (P system exacerbates urban-rural disparities in child nutrition-related health outcomes independent of the well-known disparity stemming from urban-rural residence. Fortunately, however, child health disparities due to hukou have been declining since 2000.

Rural recruitment and retention of health workers across cadres and types of contract in north-east India: A qualitative study.

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Rajbangshi, Preety R; Nambiar, Devaki; Choudhury, Nandini; Rao, Krishna D

2017-09-01

Background Like many other low- and middle-income countries, India faces challenges of recruiting and retaining health workers in rural areas. Efforts have been made to address this through contractual appointment of health workers in rural areas. While this has helped to temporarily bridge the gaps in human resources, the overall impact on the experience of rural services across cadres has yet to be understood. This study sought to identify motivations for, and the challenges of, rural recruitment and retention of nurses, doctors and specialists across types of contract in rural and remote areas in India's largely rural north-eastern states of Meghalaya and Nagaland. Methods A qualitative study was undertaken, in which 71 semi-structured interviews were carried out with doctors (n = 32), nurses (n = 28) and specialists (n = 11). In addition, unstructured key informant interviews (n = 11) were undertaken, along with observations at health facilities and review of state policies. Data were analysed using Ritchie and Spencer's framework method and the World Health Organization's 2010 framework of factors affecting decisions to relocate to, stay in or leave rural areas. Results It was found that rural background and community attachment were strongly associated with health workers' decision to join rural service, regardless of cadre or contract. However, this aspiration was challenged by health-systems factors of poor working and living conditions; low salary and incentives; and lack of professional growth and recognition. Contractual health workers faced unique challenges (lack of pay parity, job insecurity), as did those with permanent positions (irrational postings and political interference). Conclusion This study establishes that the crisis in recruiting and retaining health workers in rural areas will persist until and unless health systems address the core basic requirements of health workers in rural areas, which are related to health-sector policies

Making basic health care accessible to rural communities: a case study of Kiang West district in rural Gambia.

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Sanneh, Edward Saja; Hu, Allen H; Njai, Modou; Ceesay, Omar Malleh; Manjang, Buba

2014-01-01

This study focuses on lack of access to basic health care, which is one of the hindrances to the development of the poor, and subjects them to the poverty penalty. It also focuses on contributing to the Bottom of the Pyramid in a general sense, in addition to meeting the health needs of communities where people live on less than $1 a day. Strengthened multistakeholder responses and better-targeted, low-cost prevention, and care strategies within health systems are suggested to address the health burdens of poverty-stricken communities. In this study, a multistakeholder model which includes the government, World Health Organization, United Nations Children Emergency Fund, and the Medical Research Council was created to highlight the collaborative approach in rural Gambia. The result shows infant immunization and antenatal care coverage were greatly improved which contributes to the reduction in mortality. This case study also finds that strategies addressing health problems in rural communities are required to achieve 'Millennium Development Goals'. In particular, actual community visits to satellite villages within a district (area of study) are extremely vital to making health care accessible. © 2013 Wiley Periodicals, Inc.

Is the health of people living in rural areas different from those in cities? Evidence from routine data linked with the Scottish Health Survey.

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Teckle, P; Hannaford, P; Sutton, M

2012-02-17

To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics. Mortality and hospital record data linked to two cross sectional health surveys. Respondents in the community-based 1995 and 1998 Scottish Health Survey who consented to record-linkage follow-up. Hypertension, all-cause premature mortality, total hospital stays and admissions due to coronary heart disease (CHD). Older age and lower social class were strongly associated with an increased risk of each of the four health outcomes measured. After adjustment for individual and practice characteristics, no consistent pattern of better or poorer health in people living in rural areas was found, compared to primary cities. However, individuals living in remote small towns had a lower risk of a hospital admission for CHD and those in very remote rural had lower mortality, both compared with those living in primary cities. This study has shown how linked data can be used to explore the possible influence of area of residence on health. We were unable to find a consistent pattern that people living in rural areas have materially different health to that of those living in primary cities. Instead, we found stronger relationships between compositional determinants (age, gender and socio-economic status) and health than contextual factors (including rurality).

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

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Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

2014-12-01

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

Directory of Open Access Journals (Sweden)

Hage Eveline

2013-01-01

Full Text Available Abstract Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the

Comic books carry health messages to rural children in Honduras.

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Vigano, O

1983-12-01

This article reports on the use of children as message carriers in a rural water and sanitation project in western Honduras. The Honduran Water and Sanitation Project represents the 1st such effort to have a specific health education component. It was decided to direct the education component toward children because of their important role in providing and handling drinking water and caring for younger members of the family. Rural primary schools surfaced as a potential channel of communication. The comic book format was selected because it is simple enough to be used in the schools without much training, economical to produce (US$0.30/copy), effective and attractive to children, and consistent with the Project's philosophy that dialogue and participation are essential components of health education. Each comic book contains a single-concept message, e.g., 1 cause of water contamination or a method of water purification. The 1st module was pretested in 3 rural schools. Following classroom study of the comic book, correct answers on 5 questions related to the comic book story increased from 59% to 80%. 95% of the children indicated that they liked the characters, and teachers expressed satisfaction with the materials. 1200 copies of the 1st module have been distributed to 30 rural schools, and production plans include 11 additional modules on topics such as prevention of water-related sickness and personal hygiene.

Physical and mental health perspectives of first year undergraduate rural university students.

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Hussain, Rafat; Guppy, Michelle; Robertson, Suzanne; Temple, Elizabeth

2013-09-15

University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services. Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses. The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling. The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the

A platform to integrate climate information and rural telemedicine in Malawi

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Lowe, R.; Chadza, T.; Chirombo, J.; Fonda, C.; Muyepa, A.; Nkoloma, M.; Pietrosemoli, E.; Radicella, S. M.; Tompkins, A. M.; Zennaro, M.

2012-04-01

It is commonly accepted that climate plays a role in the transmission of many infectious diseases, particularly those transmitted by mosquitoes such as malaria, which is one of the most important causes of mortality and morbidity in developing countries. Due to time lags involved in the climate-disease transmission system, lagged observed climate variables could provide some predictive lead for forecasting disease epidemics. This lead time could be extended by using forecasts of the climate in disease prediction models. This project aims to implement a platform for the dissemination of climate-driven disease risk forecasts, using a telemedicine approach. A pilot project has been established in Malawi, where a 162 km wireless link has been installed, spanning from Blantyre City to remote health facilities in the district of Mangochi in the Southern region, bordering Lake Malawi. This long Wi-Fi technology allows rural health facilities to upload real-time disease cases as they occur to an online health information system (DHIS2); a national medical database repository administered by the Ministry of Health. This technology provides a real-time data logging system for disease incidence monitoring and facilitates the flow of information between local and national levels. This platform allows statistical and dynamical disease prediction models to be rapidly updated with real-time climate and epidemiological information. This permits health authorities to target timely interventions ahead of an imminent increase in malaria incidence. By integrating meteorological and health information systems in a statistical-dynamical prediction model, we show that a long-distance Wi-Fi link is a practical and inexpensive means to enable the rapid analysis of real-time information in order to target disease prevention and control measures and mobilise resources at the local level.

Integration of PV modules in existing Romanian buildings from rural areas

Energy Technology Data Exchange (ETDEWEB)

Fara, S.; Finta, D. [IPA SA Research Development, Engineering and Manufacturing for Automation Equipment and Systems, Bucharest (Romania); Fara, L.; Comaneci, D. [Polytechnic Univ. of Bucharest (Romania); Dabija, A.M. [Univ. of Architecture and Urbanism Ion Mincu, Bucharest (Romania); Tulcan-Paulescu, E. [West Univ. of Timisoara, Timisoara (Romania)

2010-07-01

Romania has launched a national research project to promote the use of distributed solar architecture and the use of BIPV systems. These systems include solar tunnels and active solar photovoltaic (PV) systems installed on the roofs and facades of buildings in rural areas. In contrast to other EU states, Romania does not have a photovoltaic building construction branch. The number of isolated cases are insufficient to identify a starting point regarding the PV market in the building industry. The main objective of the project is to demonstrate the efficiency of integrating various PV elements in buildings from rural areas, to test them and to make them known so that they can be used on a large scale. This will be accomplished by installing new products on 2 buildings in Bucharest and in 1 building in Timisoara. The PV modules will be integrated with the architecture. One of the buildings will be a historical building while the other 2 will be new buildings with different typologies. The installed power for each building will be of about 1.000 Wp, including some technologies with PV modules.

Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada.

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Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea

2015-01-01

Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.

Rural health prepayment schemes in China: towards a more active role for government.

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Bloom, G; Shenglan, T

1999-04-01

A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.

Modelo para la valoración integral de tecnologías de electrificación rural;Model for Integral valuation of technologies for rural electrification.

Directory of Open Access Journals (Sweden)

Ciaddy Gina Rodríguez Borges

2015-06-01

Full Text Available En el presente trabajo se desarrolla un modelo para la valoración integral de distintas tecnología de electrificación rural, basado fundamentalmente en el comportamiento de los sistemas híbridos que emplean fuentes renovables de energía, considerando múltiples criterios, tales como: el porcentaje de generación diesel requerido, costo de la energía equivalente, valor presente neto, costo de operación y mantenimiento, riesgos de la instalación y facilidad de gestión del sistema. Se estudian ocho sistemas energéticos, dimensionados para ofrecer una calidad similar a la extensión de red, que pueden satisfacer distintos escenarios de recursos energéticos y consumos de energía desde 20 hasta 320 kWh/día, y se emplea el modelo matemático desarrollado en un caso práctico, a través del cual se demuestra la facilidad que presenta para valorar tecnologías de electrificación rural, ameritando solo tres datos característicos de la comunidad: la irradiación solar promedio, la velocidad de vientos y el consumo de energía estimada.In this work it is developed a model for the integral valuation of different technology of rural electrification, the study of the behavior of the hybrid systems was emphasized with the use of renewable energy sources and it was considered multiple approaches for the valuation, such as: the percentage of required generation diesel, cost of the equivalent energy, net present value, operation cost and maintenance, risks of the installation and easiness of administration of the system. A group of eight sized energy systems was studied to offer a similar quality to the one given by the net extension net, with which it can satisfy energy consumptions from 20 up to 320 kWh/day, estimating the behavior of the proposed systems for different scenarios of energy resources readiness. The developed mathematical pattern allows valuing technologies for rural electrification using three characteristic data of the community

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980).

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Feng, Xing Lin; Martinez-Alvarez, Melisa; Zhong, Jun; Xu, Jin; Yuan, Beibei; Meng, Qingyue; Balabanova, Dina

2017-05-23

China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population. We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources. The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China's three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a "health-for-all" policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An

Voices from the Gila: health care issues for rural elders in south-western New Mexico.

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Averill, Jennifer B

2002-12-01

A goal of the Healthy People 2010 initiative is to reduce or eliminate health disparities in vulnerable populations, including populations from rural and minority ethnic backgrounds. Rural communities, including elderly populations, experience lower rates of personal income, educational attainment, health-insurance coverage, access to emergency and specialty care services, and reported health status than do urban communities. A need exists to address identified research priorities, such as the perceptions of rural elders, their family members, and health care providers. The purposes of this study were to explore the health care perceptions, needs, and definitions of health for multicultural rural elders in one county of south-western New Mexico, and to consider practice implications. Informed consent procedures followed the University of New Mexico Health Sciences Center Human Research Review Committee guidelines. Research methods. This critical ethnography incorporated ethnographic interviews, ethnographic participant observation, photography, review of pertinent documents, and analysis of contextual factors. The sample consisted of 22 participants. Definitions of health varied with socioeconomic status, encompassing avoidance of contact with the health care system, obtaining needed medications, remaining independent, a sense of spiritual belonging, eating wisely, and exercising moderately. Three major concerns emerged from the analysis: the escalating cost of prescription drugs, access-to-care issues, and social isolation. The primary limitation was the small sample size. Although the researcher's position as an outsider to local communities may also have affected the outcome, it provided fresh insight to regional problems. The study addressed national research priorities for a vulnerable group of rural elders. Nursing implications include the need for expanded knowledge and educational preparation regarding elder issues and community-level services, inclusion of

Towards an integrated analysis of rural systems: the case study of the Alento basin

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Quaranta, Giovanni; Salvia, Rosanna

2014-05-01

The role and the functions of rural areas are undergoing considerable change due to economic, social and environmental drivers. The outcome of the transformation is the production of highly heterogeneous landscapes, rural mosaics, which are home to varying degrees of intensity of land-use and processes of deactivation, abandonment and land degradation. The identification of rural mosaics has implications both for determining the impacts on the stock of connected natural resources and for defining measures and policies able to support the resilience of rural territories and the identification of sustainable strategies for development. The study proposes a methodology for the integrated analysis of the rural territory which combines the analysis of land cover dynamics, using GIS, with an assessment of socio-economic dynamics, reconstructed through the combined use of indicators and local history, and which is aware that the differences and peculiarities within rural territories are the result of actions taken over time and of the different adaptive strategies undertaken by communities operating in different fields, under the influence of specific ecologic and environmental conditions. The methodology, applied to a socio-ecological system which is representative of the Mediterranean basin, is proposed as a tool to support the territorialisation of polices, opening the process up to perspectives able to better comprehend the dynamic evolution of rural territories, internalising that evolution in the definition of the instruments and measures to adopt.

Mobile instant messaging for rural community health workers: a case from Malawi.

Science.gov (United States)

Pimmer, Christoph; Mhango, Susan; Mzumara, Alfred; Mbvundula, Francis

2017-01-01

Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources. The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.

Building relationships with physicians. Internal marketing efforts help strengthen organizational bonds at a rural health care clinic.

Science.gov (United States)

Peltier, J W; Boyt, T; Westfall, J E

1997-01-01

Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians.

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

Science.gov (United States)

Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

2015-05-01

To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

Mental health in primary health care in a rural district of Cambodia: a situational analysis.

Science.gov (United States)

Olofsson, Sofia; Sebastian, Miguel San; Jegannathan, Bhoomikumar

2018-01-01

While mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries. Primary health care is considered to be the most important way for people to get mental health care. Cambodia is a country with a long history of war and has poor mental health and limited resources for care. The aim of this study was to conduct a situational analysis of the mental health services in the rural district of Lvea Em, Kandal Province, Cambodia. A cross-sectional situational analysis was done to understand the mental health situation in Lvea Em District comparing it with the national one. The Programme for improving mental health care (PRIME) tool was used to collect systematic information about mental health care from 14 key informants in Cambodia. In addition, a separate questionnaire based on the PRIME tool was developed for the district health care centres (12 respondents). Ethical approval was obtained from the National Ethics Committee for Health Research in Cambodia. Mental health care is limited both in Lvea Em District and the country. Though national documents containing guidelines for mental health care exist, the resources available and health care infrastructure are below what is recommended. There is no budget allocated for mental health in the district; there are no mental health specialists and the mental health training of health care workers is insufficient. Based on the limited knowledge from the respondents in the district, mental health disorders do exist but no documentation of these patients is available. Respondents discussed how community aspects such as culture, history and religion were related to mental health. Though there have been improvements in understanding mental health, discrimination and abuse against people with mental health disorders seems still to be present. There are very limited mental health care services with hardly any budget allocated to them in Lvea Em District and Cambodia

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership.

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Drobac, Peter C; Basinga, Paulin; Condo, Jeanine; Farmer, Paul E; Finnegan, Karen E; Hamon, Jessie K; Amoroso, Cheryl; Hirschhorn, Lisa R; Kakoma, Jean Baptise; Lu, Chunling; Murangwa, Yusuf; Murray, Megan; Ngabo, Fidele; Rich, Michael; Thomson, Dana; Binagwaho, Agnes

2013-01-01

Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women's Hospital. The PHIT Partnership's health systems support aligns with the World Health Organization's six health systems building blocks. HSS activities focus across all levels of the health system - community, health center, hospital, and district leadership - to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers. The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

Science.gov (United States)

Scott, David M; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan