Mothers’ Perceptions Towards Community Social Pediatrics Services in Rural Settings: A Qualitative Study

Although Quality service in a rural setting is an essential aspect of rural tourism, service quality attributes are less discussed in rural tourism literature. This study investigates tourists' perceptions to identify important factors and existing levels of performance to provide a quality service in rural settings. Accordingly, we use Importance Performance Analysis (IPA) as an analytical frame of reference. Through a rigorous process, 25 service quality attributes were selected to generate tourists' perspectives on the importance and performance of rural tourism in Bangladesh. Data have been collected via a structured questionnaire from 500 respondents. The collected data were analysed using descriptive statistics. The investigation reveals that despite having all-natural resources, Bangladesh failed to flourish in rural tourism due to lacking human-made elements such as infrastructure and tourist facilities. This study will help the tourism stakeholders who provide services in rural settings understand the expectations of tourists. It will also help the policymakers to (re)shape tourism policy to make constructive decisions in developing rural tourism across the country.

Limited access to specialty care in rural settings may result in more expectations of primary care providers and a higher demand for primary care. The authors used survey and administrative data from 1999 from the Veterans Health Administration (VHA) to compare primary care practice management and performance in 19 rural to 103 urban VHA hospitals nationally. Rural VHA hospitals were smaller, less likely to be academically affiliated, and had fewer integrated specialty care services. Primary care providers in rural settings were more likely to manage specialty care services, provide continuity across patient care settings, and have complete responsibility for a broader range of services. However, rural hospitals had more staff per patient allocated to primary care than did urban hospitals. Patients in rural settings received comparable quality care to those in urban settings, and they appeared to be more satisfied with the care they received. Within the VHA system, primary care providers in rural settings provided a broader range of services than those in urban ones. This increased breadth may be attributable to the lack of availability of integrated specialty care services in rural settings. Because of this broader range of responsibilities, the provision of primary care in rural settings may require higher staffing patterns and may be inherently more costly than in urban settings; therefore, researchers should be cautious when comparing primary care expenditures across rural and urban settings.

Background:Despite efforts to achieve universal access to health care by various stakeholders globally, most developing countries continue to face serious health delivery challenges, especially in rural areas.Introduction:These inhibit individuals and communities’ ability to obtain health care services when needed and the freedom to use health care. Although issues of access to health care have been widely researched in South Africa, a detailed account on access to health care in particular communities is necessary for developing interventions that are tailored to the specific needs of that community. Understanding the accounts of stakeholders to the perceived barriers to access to health care services can help comprehend the issues that hinder people from accessing health care. Therefore, this study explored the stakeholders’ perspectives on the barriers to accessing health care services in rural settings in South Africa.Methods:A qualitative approach was used to guide the collection and analysis of the data. Data were collected from a sample of stakeholders selected from three rural areas in South Africa and analysed through thematic analysis. According to the stakeholders interviewed, there are some barriers that exist in the community that impede access to health.Reusults:These are limited or lack of health care facilities and personnel, shortages of medicine, distrust in the health care providers, opening hours of health care facilities and financial constraints, which resulted in the perceived poor health status of the people in those rural areas.Conclusion:This study calls for multifaceted health care reforms and strategies to address infrastructure deficiencies, human resources and medicine shortages to ensure equitable provision of high-quality public services. These strategies or measures must be tailored to the specific needs of rural communities.

Rural practice presents important yet challenging issues for psychology, especially given the North American and international distribution of the population, levels of need for psychological services in rural settings, limited availability of rural services, and migration of rural residents to urban centres. Direct service issues include the need to accommodate a wide variety of mental health difficulties, issues related to client privacy and boundaries, and practical challenges. Indirect service issues include the greater need for diverse professional activities, including collaborative work with professionals having different orientations and beliefs, program development and evaluation, and conducting research with few mentors or peer collaborators. Professional training and development issues include lack of specialized relevant courses and placements, and such personal issues as limited opportunities for recreation and culture, and lack of privacy. Psychology will need to address more fully these complex issues if rural residents are to receive equitable treatment and services. Psychologists who practice in rural settings face many challenges, including geographic issues, unique qualities of rural residents, and considerable need for but lesser availability of services. We document these and other challenges, suggest how psychologists can adapt to rural settings, and identify areas for further research. The paper reviews literature in rural psychology and related areas (e.g., community psychology, rural sociology), and is illustrated by experiences working in rural and northern Manitoba. The issues are also relevant to urban practitioners wishing to adapt services to clients who have migrated from rural settings. Although the world is increasingly urban, many people remain in rural areas (Murray & Keller, 1991). The last Canadian census (Statistics Canada, 1996) classified 22.1% of Canadians as rural, a total of over 6.3 million people. The percentage rural varied from 55.8% for Prince Edward Island to 16.7% for Ontario, but even the latter figure represented 2 million people. In 1990, 24.8% of the U.S. population was rural, representing over 60 million people (Ricketts, Johnson-Webb, & Randolph, 1999). The number and percentage of people in rural areas is even more dramatic globally, which is relevant to international development and training practitioners for non-Western countries. In 1990 (United Nations, 1991), the percent of people in nonurban regions was over 66% for Oceania (excluding Australia and New Zealand), Asia (excluding Japan), and Africa, and was 25-35% for Eastern and Southern Europe, the USSR, Latin America, North America, and Japan. The figures were under 20% only for Western and Northern Europe, and Australia and New Zealand. Even the relatively low percentages still represented large numbers of rural citizens. International statistics also showed a strong association between ruralness and economic development, with the percent nonurban decreasing markedly from least (80%) to most (27%) developed nations. Although distinct definitions of rural are used for such statistics, ruralness varies in degree. Some rural regions are close to urban centres, such as the regions of Manitoba that surround Winnipeg, the provincial capital with 600,000 people. At the other extreme are isolated or frontier regions remote from large centres or psychological services, and perhaps accessible only by plane or seasonal ice roads. Many communities fall between these extremes, such as Thompson, Manitoba, a town 800 kilometres north of Winnipeg with approximately 15,000 people. Whether people live in rural areas close to major centres or in more remote locations, the challenges of rural practice (e.g., isolation, transportation, lack of privacy) remain problematic to some degree. The preceding statistics change constantly as people move between rural and urban settings. …

BackgroundIn British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs’ experience and use of PoCUS in their clinical practice.MethodsThis qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants’ motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken.ResultsThis study used Rogers’ framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner.ConclusionThis study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs.

In a rural Japanese setting, this case report delves into managing a post-partum woman diagnosed with ankylosing spondyloarthritis (AS), showcasing the complexities of balancing effective pain relief with breastfeeding. The study highlights a multifaceted approach that incorporates medical treatment, psychosocial support, and comprehensive patient education, which are essential in rural healthcare where resources may be scarce. Initially managed with diclofenac due to its safer profile for breastfeeding, the patient's treatment was eventually escalated to adalimumab, aligning with improved circumstances regarding breastfeeding. This case emphasizes the critical role of holistic, patient-centered care in family medicine, particularly for managing maternal and child health chronic conditions. It illustrates how integrating mental health support, acknowledging patient fears, and educating families can significantly enhance patient care and outcomes. Through this approach, the report advocates for a broader application of family medicine principles to improve maternal and child health services in rural settings, demonstrating the importance of tailored healthcare strategies that consider patients' medical and emotional needs.

BackgroundCoordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP.MethodsFourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes.ResultsFive key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP.ConclusionsConsumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.

Background: The quality of health services has been known to be grossly deficient in developing countries, but only few studies were carried out to document the deficiencies in a systematic manner. Objective: To assess the quality of reproductive health services in rural settings with emphasis on the structural aspect. Methods: This is a descriptive cross-sectional study conducted in the peripheral health institutions of two administrative zones in South-Central Ethiopia. Data were collected using an interview questionnaire and observation checklist adopted from the WHO Safe Motherhood Need Assessment and the WHO training modules for EPI and STDs. Findings: Multiple structural deficiencies were identified in all components of reproductive health care. Adequate amounts of the absolute minimum equipment required for maternity and neonatal care were not available in many health institutions. Sterilizers were available in 11(15.3%), essential drugs like iron tablets in 14 (19.4%), and ergometrine injection in 48 (66.7%) of the health institution. In the EPI section, refrigerator was available in 57(79.2%) and steam sterilizer in 43(59.7%) of the institutions. Mix of contraceptives was not available widely. Important laboratory tests like syphilis test, were available in only one (1.4%) health institution. Only 8(11.1%) health institutions had adequate IEC materials on all national reproductive health components. (Ethiopian Journal of Health Development, 2000, 14(3): 317-326)

BackgroundDelivering rehabilitation services to meet the requirements of rural inhabitants necessitates more than simply augmenting the quantity of healthcare professionals.ObjectiveThis study delved into the perspectives of rehabilitation professionals regarding the provision of rehabilitation services in rural settings, the challenges encountered, perceived facilitators and barriers to implementation, and their recommendations for delivering effective rehabilitation care.MethodsWe conducted individual semi-structured interviews with a purposefully sampled multi-disciplinary rehabilitation team in the Lucknow district of Uttar Pradesh in this qualitative study. We used interpretive description to examine transcripts inductively through broad-level coding, and consolidated the results into interpretive categories.ResultsThe study involved thirty-two rehabilitation professionals and 27 interviews. We identified three themes: the state of rural rehabilitation, which fosters the social aspects of rehabilitation through either a multi-disciplinary or trans-disciplinary model due to limitations in coverage and capacity; challenges ranging from the lack of rehabilitation guidelines to manpower shortages, as well as policy and administrative issues and ethical dilemmas; and key procedures for effective rural practice, including establishing partnerships, organizing awareness programs for public representatives and physicians, and facilitating access to continuing professional development programs. Barriers and facilitators within themes were affected by the resources and support from local community leaders, as well as the availability or lack of good communication tools with patients, carers, and multidisciplinary team members.ConclusionTo meet the rehabilitation requirements of rural environments, tailored approaches are required, including modifications to education, practice, and policy to address human resource limitations and increased investment in rehabilitation.

The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.

Complicated deliveries, critical care and quality in Emergency Obstetric Care in Northern Tanzania

BackgroundHealth literacy facilitates an individual’s ability to interpret and utilize medical information, thereby influencing their quality of life. Despite the benefits, the current oversaturation of information necessitates the support of healthcare professionals. Help-seeking behavior (HSB) is a term that describes the actions taken to assuage health concerns, and timely medical consultations are critical, especially for older individuals in rural areas who often face barriers to accessing care. These challenges are exacerbated by the perceived psychological distance from medical services in rural settings due to past negative experiences; however, the emergence of social media has helped form a bridge, allowing for direct communication with physicians. While consultations with artificial intelligence (AI) do occur, interaction with human physicians remains the gold standard. Thus, this study sought to understand social media’s role in facilitating health consultations in rural areas and the implications for primary care education among physicians.MethodsThis qualitative study, conducted from September 2022 to June 2023, employed a grounded theory approach to analyze information about a social network-based consulting system that utilized the LINE application. Residents posted anonymous health-related concerns, and comments were extracted. Two researchers coded and assessed the data; another specialist reviewed the findings.ResultsA total of 621 citizens participated, generating 10,432 posts. The grounded theory approach identified five major themes regarding health-related social networking in rural settings: (1) mutual exploration for information sharing highlighted distrust toward primary care physicians; (2) temporary collaboration resulted in superficial health discussions and relationship-building through empathy; (3) conflicts arising from differing health perspectives and misinformation sharing led to intense debates; (4) anxiety was resolved through shared illness experiences and increased empathy, enhancing psychological safety; and (5) a mutual assistance community was created, characterized by improved health dialogues and HSB among participants.ConclusionsThe high engagement with the social network-based consulting system in rural Unnan City highlights technology’s pivotal role in facilitating health dialogue and community engagement, despite challenges related to misinformation and health literacy complexities. As a reflection of the community’s health perceptions and dynamics, future adaptations should incorporate strategies to combat these challenges while preserving collaboration and support.

BackgroundThe literature on interprofessional learning (IPL) has limited empirical evidence on the impact of simulated IPL sessions in promoting collaborative health care services in rural settings. This study aims to explore health care students’ perception of the relevance of simulated IPL for rural health care services.MethodsThree focus group interviews were held with pre-registration medical, pharmacy, and allied health students (n=22). Students worked together to manage complex simulation scenarios in small interprofessional teams. Focus group sessions were held at the end of simulation activities to explore students’ views on the relevance of simulated IPL activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups.ResultsParticipants embraced both the interprofessional and the simulation components enthusiastically and perceived these to be useful for their future as rural health care practitioners. Four major themes emerged from the qualitative analysis: appreciation of the role of other health disciplines, collaborative approach to patient care, competency and skills for future health care practice, and relevance for future rural and remote health care practice. Students acknowledged the simulated IPL sessions for improving their understanding of multidisciplinary practice in rural practice and facilitating the appreciation for collaborative practice and expertise.ConclusionBased on the findings of this study, simulated IPL activities seem to be a potential intervention for developing collaborative practice among pre-registration health profession students. However, further evidence is required to assess if positive responses to simulated IPL activities are sustained in practice and translate into improving patient outcome.

Age-related hearing impairment (ARHI) affects 20-40% of older adults. However, many people with hearing impairment fail to seek professional evaluation and treatment, delay seeking treatment, or abandon treatment. The purpose of this study was to identify barriers and facilitators of access to hearing healthcare resources in a rural setting and to characterize these barriers within the COM-B (capability, motivation, and opportunity) framework. Survey packets were handed out following services at a rural community church; 72 completed surveys were returned. The mean age of participants was 54.4 years. Thirty-one percent of respondents reported moderate to severe hearing impairment; of these individuals, 7 (31%) were currently using a hearing aid. Rates of hearing protection use fell below the Healthy People 2020 target of 53% across occupational and leisure noise exposure. Forty-eight percent (N=34) of participants had never had their hearing tested as an adult. Overall perceived barriers were significantly correlated with age (r= .260, P = .034) and perceived hearing loss (r=-.277, P= .025). Barriers were identified across all domains and subdomains of the COM-B framework. Barriers clustered in the reflective motivation domain, in which participants undervalue the significance of hearing loss. Barriers also clustered within the social and physical opportunity domains, suggesting a lack of access to providers and an undervaluation of hearing loss by others (family and health care providers). These findings provide evidence regarding the accessibility of hearing healthcare services in rural settings and will serve as a foundation for the design of a community-tailored hearing health intervention.

Universal access to health services and universal health coverage are needed to achieve good health for all, yet rural communities face a variety of access barriers. As part of an effort to 'rural proof' health systems, it is therefore imperative to identify and act on the factors limiting access to health services by rural and indigenous communities. This article provides a comprehensive overview of the wide range of access barriers faced by rural and remote communities in two countries where barrier assessments were conducted. It also discusses the potential for barrier assessments to contribute evidence for rural proofing of national health policies, strategies, plans and programs. The study applied a concurrent triangulation design to collect and analyze data obtained from narrative-style literature reviews, in-depth interviews with local health authorities, and secondary analyses of existing household data on Guyana and Peru. These two countries were selected because they have some of the largest rural and indigenous populations in Latin America and the Caribbean, and have national policies in place for providing free, essential health services for these communities. Both quantitative and qualitative data were collected separately, and results were interpreted together. The main objective was to corroborate and cross-validate findings looking for convergence between the separate data analyses. Seven dominant themes were identified across the two countries: use of traditional medicine and practice; decision making, gender, and family power dynamics; ethnicity and trust; knowledge and health literacy; geographic accessibility, health personnel and intercultural skills; and financial accessibility. The findings suggest that the interaction between these barriers may be as important as the singular role played by each factor, thereby highlighting the complex and multifactorial nature of accessing services in rural settings. Issues with limited availability of human resources for health were compounded by inadequate supplies and infrastructure. Financial barriers were often linked to the indirect costs of transport and geographic location, and further exacerbated by reduced socioeconomic status of rural communities, a majority of which are indigenous and have a strong preference for traditional medicines. Importantly, rural and indigenous communities experience considerable non-financial barriers related to issues of acceptability, which requires adaptation of health personnel and health service delivery models to the context-specific needs and realities of each rural community. This study presented an approach for data collection and analysis that is both feasible and effective for evaluating access barriers in rural and remote communities. While this study explored access barriers through general health services in two rural settings, the issues identified reflect the structural deficiencies of many health systems. These challenges and singularities require adaptive organizational models for the provision of health services that respond to the specific characteristics of rural and indigenous communities. This study indicates the potential relevance of conducting assessments of barriers to health services as part of a wider approach to rural proofing and supports the notion that a mixed-methods approach, linking secondary analysis of existing relevant national survey data with focused key-informant interview data, may be an effective and efficient way to transform data into the knowledge policymakers need to rural proof health policies.