Rural Health Research Articles

Changing Agriculture Patterns and Environment Concerns

Over fifty-percent of India's population depends on agriculture for their living, as it plays a major role in the country's food security. Agriculture has been and is still the foundation of the Indian economy. From Post-Independence subsistence-oriented and feudal systems to modern technologically sophisticated and market-driven agriculture, the sector's history is shaped by government reforms, technological advances, and socio-economic shifts. In this context this paper examines the Post-Independence agrarian structure, the transformative Green Revolution which comes with a number of environment concerns ranging from increased green-house gas emission contributing to global warming and climate change accompanied by land degradation, soil and water pollution. The paper also critically assesses the implications of climate change on crop production, water resources, and rural health and livelihoods and outlines future directions for sustaining agricultural growth and ensuring food security.

Designing state-level policies to support independent pharmacies in providing specialty care services in rural regions

This review paper explores the critical role of independent pharmacies in rural regions, emphasizing their potential to deliver specialty care services despite facing significant challenges. These challenges include financial constraints, regulatory barriers, and limited specialized training and resource access. The paper argues that comprehensive state-level policies are necessary to support these pharmacies, enabling them to overcome these obstacles and enhance healthcare access in rural areas. Key policy recommendations include providing financial incentives such as grants and subsidies, regulatory reforms to streamline licensing processes and expand the scope of practice for pharmacists, and promoting partnerships between pharmacies, healthcare providers, and telehealth services. The paper also highlights the importance of integrating independent pharmacies into state health programs and adopting advanced technologies like telepharmacy and electronic health records. Future research directions are suggested, focusing on the impact of digital health technologies and evolving healthcare payment models on independent pharmacies in rural regions. The paper concludes by underscoring the need for targeted policy interventions to strengthen the role of independent pharmacies in rural healthcare, thereby improving health outcomes and quality of life for rural populations.

Sustaining Current Policies and Introducing New Initiatives: Strategic Five-year Plan for the Government of India

A review of key documents, including political manifestos and reports from NITI Aayog and WHO, outlines healthcare priorities for 2024-2029, aligned with Viksit Bharat 2047 and the UN SDGs. Key actions include expanding Universal Health Coverage through Ayushman Bharat, improving rural healthcare, addressing medical staff shortages, and leveraging digital health, telemedicine, and interoperable records. National missions targeting disease prevention, mental health, and non-communicable diseases aim to promote healthier lifestyles. Strengthening public health preparedness and health information systems, while promoting traditional medicine, is also essential. Expanding maternal and child health programs, increasing access via AB-PMJAY, ensuring quality through NQAS, and driving innovation with R&D funding are vital. Enhanced tobacco control through COTPA, higher taxes, and NTCP campaigns, along with investments in WASH infrastructure through Swachh Bharat and Jal Jeevan Missions, will improve health outcomes. Geriatric care, digitalisation, digital health, mental health, community health workers, and partnerships are critical. Initiatives like healthcare innovation hubs, mobile clinics, and health equity programs will build a resilient, inclusive healthcare system and improve national health.

The requirements of providing health education for rural people through electronic methods: the experiences and perspectives of community health workers.

Reliance solely on traditional approaches in health education is no longer considered sufficient, and electronic/digital education can be a complementary approach. Implementing electronic methods in health education requires identifying the requirements from the perspective of the service providers. Therefore, this study aimed to elucidate the experiences and perspectives of community health workers (Behvarzan) regarding the requirements for providing health education for rural people through electronic/digital means. This descriptive qualitative study was conducted in 2022 at Alborz University of Medical Sciences. Data were collected through semi-structured interviews with 14 Behvarzan from Health Houses (HH) in Karaj City. The data were analyzed using the inductive Elo & Kyngas approach and conventional content analysis facilitated with MAXQDA software. After analyzing the results, we extracted 139 open codes, and by merging them for more precise coding and to facilitate the research process, we formed three main themes and ten subthemes. The themes included Technology (technical infrastructure, content production, content delivery methods, and content delivery channels), Facilities and equipment (communication equipment and electronic content repositories), and Stakeholders (training of providers, motivating providers, persuading learners and target groups, and reference groups). From the perspective of rural healthcare workers, the implementation of electronic education requires necessary technology, equipment, facilities, processes, and content should be pursued and provided through specialized working groups, extending from the Ministry of Health and Medical Education to local HHs. These resources should be available to the healthcare workers and their target populations. Concurrently, educational programs and incentives should be defined and offered at the university level and within health networks for rural healthcare workers and their populations.

Gender differences in factors associated with rural health care practice in Minnesota.

To understand gender differences in factors affecting rural health care workforce to inform the development of effective policies and recruitment strategies to address rural health care workforce shortages. A cross-sectional survey of health care professionals (including Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs)) in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022, during their professional license renewal. The main outcome was whether or not the respondent was practicing in a rural area. The effects of factors associated with rural practice were estimated using binary logistic regression models, and subsequently subgroup analysis was conducted by gender across the four health care professions. Results show that although there were significant gender differences in some factors (growing up in a rural area and family considerations were more likely to influence women's decisions than men's, whereas men were more likely to be influenced by the prospect of having autonomy and broad scope of practice than women), these differences became insignificant when the four health care professionals were analyzed separately suggesting that overall gender differences observed were almost entirely explained by profession differences. Gender differences do not significantly influence the factors impacting rural practice. However, being raised in a rural environment emerges as the most influential predictor of rural practice underscoring the importance of involving rural residents of all genders in health care practice.

Rural Caregiver Perceptions on the Content and Receipt of a Diabetes Management Telehealth Occupation-Based Coaching Intervention.

Type 1 diabetes management for young children requires caregiver involvement to prevent serious health complications. Objectives: Explore the lived experience of rural caregivers' health management routines and perceptions of an occupation-based coaching (OBC) intervention. Following a 12-week, OBC telehealth intervention designed to promote diabetes management and caregiver psychosocial well-being, researchers interviewed eight rural caregivers to explore their perceived quality of life utilizing a phenomenological approach. Three themes emerged related to caregivers' OBC intervention needs: occupational deprivation and decreased well-being; longing for connection with social supports; and desire for knowledgeable, relatable, and accessible providers. Two themes emerged related to their experiences postintervention: satisfaction with diabetes management and psychosocial support and renewed hope for childhood normalcy. Despite drastic shift in family routines after a child's T1D diagnosis, caregivers reported acceptability of OBC for improving health management routines in a rural community following OBC intervention.

Community-based Geriatric Assessments: Is There an Urban/Rural Divide?

Abstract Background There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN. Methods Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts. Results 235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban). Conclusion Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.

A character-strengths based coaching intervention to improve wellbeing of rural community health workers in Madhya Pradesh, India: Protocol for a single-blind randomized controlled trial

BackgroundThere is scarce knowledge on the use of structured positive psychology interventions for reducing work-stress and improving wellbeing of rural community health workers in India, particularly the Accredited Social Health Activists (ASHAs) who are village-level (resident women, incentivised) lay health workers. This trial will test the effectiveness of a ‘character-strengths’ based coaching intervention compared to routine supervision on wellbeing (‘authentic happiness’) of ASHAs. MethodsThis protocol is for a single-blind, parallel group randomized controlled trial comparing the effectiveness of a five-day residential workshop focusing on the use of character-strengths and subsequent 8- to 10-week remote telephonic coaching (weekly) to individually support ASHAs to improve their wellbeing, against routine health system support. The arms are intervention added to routine ASHA supervision (weekly, by the ASHA supervisor), and routine supervision alone (control arm). The target sample comprises 330 rural ASHAs in Madhya Pradesh, India. The primary outcome of mean Authentic Happiness Inventory (AHI) scores will be compared between arms at 3-month follow-up. Secondary outcomes will include an assessment of ASHA's self-reported affect, self-efficacy, flourishing, burnout, motivation, physical health symptoms, quality of life, and routine work performance indicators, and the consequent patient-level outcomes [e.g., service satisfaction and depression remission rates after receiving brief psychological treatment by trained ASHAs]. We will also evaluate the costs of developing and delivering the intervention. DiscussionThis trial will determine whether a character-strengths based coaching intervention is an effective and scalable approach for reducing work-stress and improving wellbeing of rural ASHAs in low-resource settings.

Perspectives of work readiness among Australian health students trained during the COVID-19 pandemic

BackgroundTo explore perspectives of work readiness, including readiness to work rurally, among health students trained in Australia during the COVID-19 pandemic.MethodsParticipants were allied health, medicine, and nursing students in the later years of their degree (third, fourth or final year of an undergraduate entry to practice degree, or second year of postgraduate entry to practice degree), where training is clinically immersive. These students had completed a University Department of Rural Health facilitated rural and remote placement between January 2021 and October 2022. They participated in a cross-sectional online survey (n = 426), comprising Likert-scale questions. Interested survey respondents participated in a semi-structured interview (n = 34). Multiple logistic regression was conducted to examine the predictors of work readiness within the survey, and interview data was analysed via reflexive thematic analysis.ResultsAmong survey respondents, 69.7% felt they would be ready to be a health practitioner when the time came to graduate and 71.8% felt clinically prepared to work in a rural location. Concerns about having developed enough clinical skills on placements to competently practice on graduation and being able to continue studying their course during the pandemic were both predictive of work readiness and feeling clinically prepared to work rurally. Four themes reflecting factors impacting work readiness were developed from interview data: (1) ‘I’d estimate probably a 20–30% reduction in face-to-face handling practice over the course of all of my placements’ encompassed student concerns regarding the collective impact of cancelled placements and lower patient attendance at healthcare facilities on clinical skill development; (2) ‘Two and a half years of sitting behind a computer’ related to student experiences of superficial learning and cohort disconnectedness due to online course delivery and loss of on campus simulations; (3) ‘I’ll still need like a lot of support in my grad year’ related to students recognising the need for support and supervision post-qualifying to bridge the gaps in their learning; and (4) ‘We are the COVID nurses’ encompassed student recognition of skills gained including communication skills, competence with technology and telehealth, knowledge of infection control, and work readiness skills (e.g. adaptability and resilience) as a result of training during the global pandemic.ConclusionsUniversities can support work readiness during pandemic circumstances by fostering clinical skills development through continuation of quality placement experiences and face-to-face curriculum delivery. Although health graduates trained during the pandemic are likely to have a range of additional work ready skills, health services will need to proactively support their transition into the workforce in the coming years.

The Toilet Revolution Empowers Rural Revitalization based on a Health Perspective

Since the reform and opening up, with the rapid development of the Chinese economy, public health problems have become increasingly serious. At the same time, due to the reality of imbalanced urban-rural development in China, improving the living environment in rural areas is the key and difficult point to achieve rural revitalization. Therefore, in 2015, the Chinese government officially began the "Toilet Revolution", a national public health movement aimed at improving urban and rural public health problems, enhancing people's quality of life, promoting rural economic development, and further promoting the implementation of the rural revitalization strategy. Based on a health perspective, this article analyzes the impact of the "toilet revolution" on rural health human capital by reviewing existing data and literature such as the "China Statistical Yearbook" on the level of health service expenditure and the number of sanitary toilet constructions. It further elucidates the mechanism by which the "toilet revolution" empowers rural revitalization, providing a theoretical basis for the government to deepen the "toilet revolution", narrow the urban-rural gap, and promote rural revitalization.

Relationship between Antenatal Care and Pregnancy Outcome among Participants of a Rural Upazilla Health Complex in Bangladesh

Background: Antenatal care (ANC) is crucial for monitoring pregnancy and improving maternal and neonatal health outcomes. This study aimed to examine the relationship between ANC and pregnancy outcomes among participants at rural upazilla health complex, like Sariakandi Upazilla of Bangladesh. Methods: This retrospective study was conducted at the Upazilla Health Complex in Saniakandi, Bangladesh included 45 pregnant women selected through simple random sampling. Data were collected from medical records and structured interviews to gather information on demographics, obstetric history, clinical history, and specifics of ANC. Maternal outcomes of interest included preeclampsia and postpartum hemorrhage, while neonatal outcomes included gestational age at birth, birth weight, Apgar scores, and NICU admissions. Data were analyzed using SPSS version 26, and Pearson correlation coefficients were calculated to explore the relationship between the number of antenatal visits and pregnancy outcomes. Results: Most participants were aged 21-30 (55.6%) with secondary education (80.0%) and were predominantly housewives (97.8%). Preeclampsia was diagnosed in 6.7% of participants, and postpartum hemorrhage occurred in 2.2%. All cases of preeclampsia and postpartum hemorrhage occurred in women with fewer than 4 antenatal visits, indicating a strong negative correlation (Pearson correlation coefficient of 0.82). Neonatal outcomes showed that 2.2% of newborns were preterm, and 17.8% had low birth weight. Higher frequency of ANC visits correlated positively with better Apgar scores at 1 minute (Pearson correlation coefficient of 0.71) and 5 minutes (Pearson correlation coefficient of 0.61). Conclusion: The study highlights the critical role of frequent and timely ANC in improving maternal and neonatal outcomes. Enhanced ANC accessibility and early initiation are essential for reducing the risks of adverse outcomes, particularly in resource-limited settings.

Peecheck 2.0: Design and Improvement of Rapid and Low-Cost Urine Analysis Device for Rural Health Care

Peecheck 2.0: Design and Improvement of Rapid and Low-Cost Urine Analysis Device for Rural Health Care

Smart Devices for Pregnant Women in Healthcare – A Comprehensive Review

Everyone has heard the irony about rural health care in nations with poor or medium incomes because it is so far away and the roads are so bad people can’t get there, but everyone has cell phones, which allow instant communication over hundreds of miles. Over 5 billion people were wireless customers as of 2010. According to a survey by the International Telecommunication Union (ITU), 80% of people living in rural areas and over 90% of people on the planet had access to mobile networks. To control and improve the prenatal care that women receive, and their entire state of health. Out of the 100 pregnant women who used the smartphone mobile terminal app, they delivered a baby. These one hundred were the “experimental group” in the sense that they worked at the hospital and were part of the health assistant app testing process. The control group consisted of hospitalized pregnant women who did not take part in the app’s management.

Rural health in Aotearoa New Zealand: current state and future challenges.

Rural health in Aotearoa New Zealand: current state and future challenges.

Evaluating the impact of pharmacy-led telemedicine services on access to oncology care in rural areas

This review paper explores the impact of pharmacy-led telemedicine services on enhancing access to oncology care in rural areas. With the increasing prevalence of cancer and the challenges associated with delivering specialized oncology services in remote locations, telemedicine has emerged as a vital tool for bridging the healthcare gap. The paper highlights the significant role of pharmacists in managing complex medication regimens, improving patient adherence, and providing essential support through telemedicine platforms. Key findings indicate that telemedicine improves patient access to care and enhances patient and provider satisfaction, leading to better treatment outcomes. The review also discusses the implications for healthcare policy and practice, emphasizing the need for investment in telemedicine infrastructure and pharmacists' integration into this care model. Future research directions are proposed to evaluate the long-term effectiveness of these services and explore advanced telemedicine technologies. The potential of telemedicine to transform rural healthcare access and outcomes is vast, offering a promising solution to address the disparities in oncology care. Keywords: Telemedicine, Oncology Care, Rural Healthcare, Pharmacy-Led Services, Patient Access, Healthcare Disparities.

Nurses' health promotion practices in rural primary health care in Nigeria. A qualitative study.

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

The adaptability of rural healthcare workers' knowledge, skills, and attitudes during public health emergencies: insights from the COVID-19 response in Itilima district, Simiyu, Tanzania

IntroductionCommunity Health Workers (CHWs) are the first contact between the community and health services in multiple rural areas in Tanzania. Therefore, Community Health Workers are set to play a crucial role in emergencies and disasters. This cross-sectional study assessed the readiness of CHWs in Itilima concerning preventing the spread of COVID-19.MethodsA total of 190 CHWs and 30 stakeholders were interviewed using quantitative and qualitative methods, respectively. Multivariate linear regression model was used for quantitative data while thematic analysis was used for qualitative data.ResultsThe study revealed that 140/190 (73%) CHWs had adequate knowledge of COVID-19, with 126/190 (66.32%) after receiving on-job training on COVID-19. There was no association between demographic characteristics and CHWs' knowledge of COVID-19. In-depth interviews (IDIs) highlighted that the majority of the CHWs were equipped with PPEs and other working tools to aid their role in response to COVID-19. Challenges such as incentive inadequacy and insufficient working tools were among the major setbacks highlighted by the CHWs during the IDIs.ConclusionCHWs appear to be adaptable and provide relevant feedback thus can take part in emergencies and disasters when capacity building is done.

Healthcare Concern: The High Rate of Diabetes in Southeastern Nigeria

Diabetes mellitus is an escalating public health crisis globally, and its impact is profoundly felt in Southeastern Nigeria, where the prevalence of diabetes stands at approximately 24%, significantly higher than both national and global averages. This review examines the epidemiology, risk factors, health impacts, and management challenges associated with diabetes in this region. Key contributors to the high diabetes rates in Southeastern Nigeria include genetic predispositions, rapid urbanization, lifestyle changes, and socioeconomic disparities. The health implications of diabetes are severe, encompassing complications such as neuropathy, nephropathy, and cardiovascular disease, which lead to a diminished quality of life and increased mortality. Challenges in managing diabetes are compounded by inadequate healthcare infrastructure, limited access to specialized care, and cultural factors influencing treatment adherence. Effective strategies for diabetes management in Southeastern Nigeria require comprehensive public health interventions, enhanced healthcare infrastructure, and culturally tailored educational programs. Future research should focus on filling gaps in epidemiological data, understanding rural healthcare barriers, and evaluating the effectiveness of targeted interventions. A collaborative approach involving government, healthcare providers, and communities is crucial for mitigating the diabetes burden and improving health outcomes in the region. Keywords: Diabetes mellitus, Southeastern Nigeria, epidemiology, risk factors, healthcare challenges, public health interventions.

Why You Should Attend the Rural Health Conference: A Unique Opportunity for Learning and Collaboration

Abstract Rural health care faces a distinct set of challenges compared to urban areas. Attending a rural health conference can provide invaluable resources and connections to tackle these specific issues and improve the health of rural communities. While limitations exist, the valuable knowledge, connections, and inspiration gained at a rural health conference can significantly benefit your career and the health outcomes of your community. Explore cost-saving strategies, seek support from your employer, and prioritize attending conferences that align with your professional goals.

Innovation of Remote Vital Signs Monitoring and Telemedicine Systems Using Internet of Things for Rural Health Care

Abstract: The emergence of the COVID 19 pandemic called the attention of the public to the challenges that the healthcare system in the Philippines needs to overcome. Rural and remote areas that have geographical disadvantages were also affected due to limited access to healthcare services during the implementation of lockdown in the country. This paper focuses on the developed remote vital sign monitoring and telemedicine system called PaglauM. It is a device that measures a person’s heart and pulse rate, blood oxygen saturation, body temperature, heart rhythm, and heart’s electrical activity and comes with an application that can be used to monitor the user’s vitals and access telemedicine services. This study involved 30 participants for the testing and evaluation of PaglauM compared to available medical devices. The results of the conducted test showed promising output in delivering pre- diagnosis of health. With the use of PaglauM, rural areas that struggle in providing health care because of limited health care facilities and geographical disadvantages can be helped by this cost-effective vital monitoring device that implements the use of telemedicine, providing a way for rural areas to connect to tertiary hospitals regardless of their distance.