Development of the Attitude Scale Towards Rural Health Services: a study with university health students in Türkiye.

BackgroundAccess to rural health services is compromised in many countries including Australia due to workforce shortages. The issues that consequently impact on equity of access and sustainability of rural and remote health services are complex.DiscussionThe purpose of this paper is to describe a number of approaches from the literature that could form the basis of a more integrated approach to health workforce and rural health service enhancement that can be supported by policy. A case study is used to demonstrate how such an approach could work.SummaryDisjointed health services are common in rural areas due to the ‘tyranny of distance.’ Recruitment and retention of health professionals in rural areas and access to and sustainability of rural health services is therefore compromised. Strategies to address these issues tend to have a narrow focus. An integrated approach is needed to enhance rural workforce and health services; one that develops, acknowledges and accounts for social capital and social relations within the rural community.

Objective To measure and analyze the order degree of the internal subsystems and the synergetic degree of the compound system of rural public health service in county areas based on the synergy model of the compound system. Methods According to the distribution of eastern, central and western regions in China, Xiangshan county in Zhejiang province, Wuzhi county in Henan province and Bin county in Shaanxi province were sampled.Based on the index system of synergetic degree measurement including the 52 level-2 evaluation indicators, a questionnaire survey was used to measure the synergetic degree of the compound system of rural public health service in county areas. Results The highest synergetic degrees of the compound system of rural public health service in Xiangshan county, Wuzhi county and Bin county were only 0.181 53, 0.180 68 and 0.213 12 respectively.This indicated the synergy at a low degree.And the synergy of the supply-demand system was an important influential factor for synergy of this compound system, as their development trends were consistent basically. Conclusions The synergy model of the compound system can play a useful role in rural public health service system in county areas.The demand of rural residents deserves more attention and the difference between the service supply and demand should be reduced. Key words: Rural health service; Public health service; Compound system; Synergy degree; Empirical analysis

Rural health services are challenging to manage, a situation perhaps exacerbated by necessity to comply with one-size-fits-all performance frameworks designed for larger services. This raises the questions: do we know what rural health services are doing that is valuable and how should that be evaluated? Twenty-eight qualitative interviews with CEOs and staff of seven Victorian rural health services were conducted, exploring what they value about their 'best practice'. Themes emergent from analysis were compared with 19 government-produced health planning and performance documents. It was found that most dimensions of rural services value aligned with current performance frameworks, but a significant theme about 'community' was missing. Highlighting the relevance of this theme, achieving community-oriented goals accounted for one-third of best practice case studies identified by health services personnel. It is concluded that generating community outcomes is a significant area of value aimed for by rural health services that is missing from current performance measurement frameworks applied to Victorian health services. In this study, a new Evaluative Framework is outlined and further steps needed are suggested.

Solutions for rural Mental Health Services.

This commentary aims to describe a case of how meaningful co-design between rural health service leaders and a health service-embedded research unit can identify emerging research priorities and optimise translation. The challenges facing rural health services are unique, and the important role of health service leaders in the research response is increasingly recognised. Poorly-designed research can contribute to research waste through reduced applicability of results to rural communities, and an opportunity exists to increase research co-designed with rural health services through the involvement of research users during study planning. In early 2020, leaders at a rural Victorian health service approached the embedded health service research unit to request research be conducted on an emerging issue: rural staff well-being in the face of the COVID-19 pandemic. This was based on their concern regarding the lack of available COVID-19-specific evidence to inform organisational policy. In collaboration with the rural health service executive, a translation-focused study of staff well-being with nine rural Victorian health services was developed. Key co-design activities of the project included involving research end-users as study investigators and conducting formal stakeholder engagement regarding study design and outcomes. Meaningful co-design of research with health services is a multifaceted process that can assist researchers and end-users alike in identifying and responding to emerging health issues. In the rural setting where there is a vital need for impactful health research, we recommend that researchers should consider employing co-design processes in order to minimise research waste and optimise the translatability of research findings.

Based on synergetics, system theory and dissipative structure theory, the connotation and composition of the compound system of rural public health service in country area are described in the paper.The authors proposed that the synergy degree model of the compound system for rural public health service in county areas comprises the order degree model and the synergy degree model of the compound system, which are composed of such subsystems as functionality, service network, demand, and economy.They also probed into the evaluation method for synergy degree and built the measuring index system of synergy degree comprising 59 level-2 evaluation indicators. Key words: Rural health service; Public health service; Compound system; Synergy degree; Model

Introduction: Medical students are under immense pressure and competition to advance in their career. 65% of Indian population resides in rural area and their health care needs are to taken care of. Understanding perception and attitude of undergraduate medical students towards rural health service will help in better provision of rural healthcare services. Objectives: 1) To assess the perception and attitude of medical students towards rural health services 2) To understand the factors influencing willingness and unwillingness of medical students towards serving in rural areas Material and methods: A cross-sectional study was conducted among 600 students of first, second and final MBBS studying in a private medical college in Andhra Pradesh. A predesigned semi-structured, self-administered questionnaire was used for data collection and the data was analyzed in Epi Info 7 Results: A total of 467 completed questionnaires were returned with participation rate of 78% out of which 67.9% were females and 32.1% were males. 44.3% of the respondents had a family member working in rural area. 81.4% of respondents believed that rural services should be made compulsory for doctors. 79.9% of respondents expressed willingness to work in rural areas. The commonest reason for willingness to work in rural areas was to gain experience (62.2%) while the commonest reason for unwillingness to work in rural areas was limited infrastructure (57.5%).Conclusions: Rural health services can be improved by employing young medical graduates.

Mental health has been an Australian national priority since 1996 with the health of Australians living in rural and remote regions needing particular attention (AIHW, 2014). Recent government initiatives such as the ‘Mental Health Services in Rural and Remote Areas’ (Commonwealth of Australia, 2015) identify allied health as an essential service and offer strategies to increase access. The needs are immense. Some factors influencing the mental health of rural and remote Australians are at a global level but with local impacts: climate change is proposed to relate to the increased number of natural disasters being experienced in rural areas including enduring droughts, and the increased occurrence of floods and cyclones. Changed international and national economic conditions also affect rural and remote communities. These factors place enormous stress on individuals and communities living outside urban areas and can put mental health at risk. High rates of suicide for young males living in remote Australia (Kolves, Milner, McKay & De Leo, 2012), substance abuse particularly involving alcohol and methamphetamine (Hodges, O'Brien & McGorry, 2007), and higher rates of mental illness for rural indigenous populations (Hunter, 2007) highlight the need for mental health services in these areas. But access to mental health services, particularly specialist services for rural people is extremely difficult – the rural mental health workforce is inadequate or absent and distances to the services that exist create cost and time barriers to care. There is a need to expand the Australian mental health workforce. The Australian occupational therapy profession must make rural mental health a high priority. The time is right. Mental health services in rural areas have been criticised as lacking capacity and vision to ensure high quality care, particularly for people with low prevalence disorders (Harris, 2005). There are also problems in recruitment and retention of allied health staff including occupational therapists to rural and remote areas. But many positive developments are underway and occupational therapists have much to offer rural people with mental health issues. The directive by the Commonwealth Government for mental health services to take a recovery-oriented approach (Australian Health Ministers Advisory Council, 2013), is an opportunity for occupational therapists. Recovery-oriented care compliments occupational therapy philosophy and frameworks. A recovery-oriented approach can transform mental health services as it requires them to be consumer centred (Shepherd, Boardman & Slade, 2008). Occupational therapists working with people with mental illness can instil a sense of hope of recovery and a focus on their strengths rather than the chronic symptoms of mental illness that impede occupational performance and participation. Assisting those with mental illness to return to productive and leisure occupations is an important aspect of recovery-oriented service provision. Apart from the tyranny of distance, and the additional time and cost this implies to access mental health services, people living in rural and remote areas also face additional barriers (Handley et al., 2014). These include: stigma, concerns relating to confidentiality and not wanting to be seen attending a mental health service. Rural community attitudes to coping and stoicism can also prevent people seeking help when services are present, particularly in early or preventative stages. There is a dearth of occupational therapists working in regional and rural mental health services. The role of mental health occupational therapy is not fully understood or appreciated in rural health services and usual rural workforce issues of low recruitment and poor retention are also evident (AIHW, 2014). To overcome workforce shortages, the following strategies are being implemented but could be expanded: Retention of mental health occupational therapists in rural settings also requires consideration. Support for early career occupational therapists through the provision of quality supervision and continuing professional development is often lacking in rural settings. While occupational therapists may take up generic mental health positions, similar to other professions such as psychology and social work, occupational therapists need discipline specific supervision and ongoing education. Occupational therapists should be confident and comfortable enough to request this no matter what their work setting is. The Australian Occupational Therapy Journal is doing its part to raise awareness of mental health as a practice and professional priority by releasing a themed special issue (Volume 62, Issue 5). This issue showcases research relating to mental health practice, and highlights the significant contribution occupational therapists make to the individuals, families and communities experiencing mental health issues. What part will you play?

Purpose: In many rural places, health services struggle to maintain an adequate health workforce to meet their communities’ health care needs. Shortages of allied health professionals are of particular and growing concern. To address this challenge, a two-year Whole-of-Person Retention Improvement Project was developed involving a research partnership with two rural public health services in Victoria, Australia. This project was informed by the author’s Whole-of-Person Retention Improvement Framework (WoP-RIF), aimed to produce new knowledge for rural health services to attract, recruit, and improve the retention of allied health professionals. A set of evidence-informed and contextually relevant recommendations were made in the project’s initial observational phase to strengthen each service’s allied health workforce, 10 of which were shared. The objective of this phase of the project was to explore the challenges and enablers that two rural health services experienced in developing and implementing strategies for allied health workforce improvement. Method: The methodological approaches used for this intervention study were participatory action research and a realist evaluation. The data sources used for the realist evaluation included qualitative (focus group) and observational (project documents and fieldnotes). Results: The results outline the key responses made by the regional and rural health service to implement the 10 shared recommendations and are presented under their relevant WoP-RIF domains: workplace/organisational, role/career, and community/place. The key and shared contexts, drivers, mechanisms, outputs, and outcomes are presented under each recommendation, and where possible, an assessment is made regarding sustainability beyond the project period. Conclusions: The implementation of the recommendations is a complex process requiring whole-of-organisation support by the participating rural public health services. This study identifies five facilitators for successful implementation: 1) the project is considered a strategic human resources initiative and overseen by the executive; 2) it has strong champion(s) in the executive staff; 3) human resources is part of the strategic decision-making arrangements; 4) the change management process is facilitated and led by staff from the target clinical workforce(s); and 5) a partnership approach with local council is adopted for strategies requiring community support and engagement.

Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers’ mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), individual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies.

Introduction: Leadership is considered a necessity for people and institutions by scholars and academicians [1]. This study focuses on understanding traits and characteristics of leaders in a rural and remote health service area of Australia. Methodology: Convenience sampling was used to invite participants, who were identified by their position description. Fourteen healthcare leaders were interviewed. Grounded theory process and thematic analysis were used to analyse the data [2]. Ethical approval was obtained. Results: The results show that adaptation, contentiousness, acting as a role model, agreeableness and ability to take initiative were consistent themes for the existing leaders in rural and remote health service areas. Ownership, passion for work, staff and community involvement and sociability were considered important in rural area. Dominance, self-confidence and extraversion were viewed favourably in rural areas. Resilience, generation trait, adaptability and emotional intelligence were identified as rural specific traits. Conclusion: Rural area leadership is a challenge and leaders require rural specific skills to be successful. Leaders may need to modify and shift emphasis on specific traits and characteristics to work in rural health services. Further study in different rural and remote settings is proposed to test the effectiveness of the described traits and characteristics.

Rural health services have not had the same opporunities for research as metropolitan health services. Despite increasing awareness of the importance of placed-based research led by rural health services, there are few examples in the literature on how this can be done. In this AJRH Practice Insight we aim to provide an update on the establishment and progress of the Colac Area Health (CAH) research unit. This is a health service led research unit that services rural areas classified as MM4-5 by the Modified Monash Model. Practice insight. This experience may assist other small or medium-sized rural health services to undertake the same strategic goal of building locally relevant and place-based research, along with providing hope for those setting out to integrate research into rural health service organisational structures, while minimising the burden on existing resources. This Practice Insight demonstrates that rural health services can integrate research units into their organisational structures, with minimal burden on resources alongside support from partners who understand the value of rural health research. Lessons learned serve as a valuable example for other rural health services who are seeking to drive their own research programs and support their staff to access research career opportunities.

Rural community health service organization is a fundamental system providing basic health care for rural resident. The capacity of the service affects the rural residents' health and spirit, the current rural economic development and social advancement. It also affects the process of establishment of social health care system which covers both the city and rural area. This article discussed the elements that constitute the rural health service organization capability for Hebei province, the establishment of rural community health service capability evaluation index system for the current stage, the quantified analysis and evaluation of the rural community health service capability using the above index to find the problems in rural community health service and provide decision-making guidance for the management and development of rural community health service.

Critical issues in reforming rural mental health service delivery systems under health care reform are outlined. It is argued that the exclusive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural area, which should focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural areas are delineated and three assumptions about the structure of rural communities which are shaping the dialogue on rural health and mental health service delivery are examined. These assumptions include the notion that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and that rural dwellers represent a low risk population which can be effectively served through existing facilities and by extending existing services.

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 demonstrated using a case study to hypothetically model changes in rural PHC workforce supply. What are the implications for practitioners? The Index of Access has significant potential for identifying how rural and remote primary health care access inequities can be addressed. This critically important information can assist health service planners, for example those working in primary health networks, to determine where and how much redistribution of PHC services is needed to correct existing inequities.