Area Health Service Research Articles

Improving rural and remote health workforce retention amid global workforce shortages: a scoping review of evaluated workforce interventions.

The aim of this study was to conduct a scoping review of a global body of scholarly and industry (grey) literature for evidence of implemented and evaluated interventions to identify best practice workforce retention strategies for organisations providing health services in rural and remote areas. A scoping review was conducted of the scholarly and grey literature by two independent researchers. This comprised a search of four scholarly databases, and a Google and website search for grey literature. Quality checks were conducted, and a total of 15 documents were included in the literature review. Using the World Health Organisation's categories of workforce intervention (regulatory, education, financial incentives, personal and professional support), the documents were analysed to identify effective workforce interventions. The literature review found evidence of regulatory impacts as well as organisation-level evaluated workforce interventions for education-to-employment pathways (education), remuneration programs (financial incentives) and working and living conditions (personal and professional support) but seldom provided insight into how successful interventions were implemented or evaluated at the organisational level. Further, there was an absence of scholarship contributing to the development of empirical evidence to inform organisations about designing, implementing and evaluating workforce strategies to improve health workforce retention in rural and remote communities. Few studies have focused on evidence-based organisation-level interventions to improve rural and remote workforce sustainability. This article offers insights to shape future intervention implementation and evaluation research for rural and remote health workforce sustainability.

Regional Variation in Deescalated Therapy in Older Adults With Early-Stage Breast Cancer

Although trial data support the omission of axillary surgery and radiation therapy (RT) in women aged 70 years or older with T1N0 hormone receptor-positive (HR+) breast cancer, potential overtreatment in older adults with frailty persists. To determine how much geospatial variation in locoregional therapy may be attributed to region vs patient factors. This retrospective cross-sectional study included women aged 70 years or older who were diagnosed with HR+/ERBB2-negative (ERBB2-) breast cancer from January 1, 2013, to December 31, 2017. Data came from Surveillance, Epidemiology, and End Results-Medicare. Hierarchical multivariable modeling was used to evaluate the variance in deescalated care attributable to 4 domains, ie, (1) random, (2) region (health service area [HSA]), (3) patient factors, and (4) unexplained. Patient factors included age, frailty (validated claims-based measure), Charlson Comorbidity Index (CCI), and socioeconomic status (Yost index). Analyses were performed from January to October 2023. HSA. Deescalated care, defined as omission of axillary surgery, RT, or both. Standard therapy was defined as lumpectomy, axillary surgery, and RT or mastectomy with axillary surgery. Multivariable logistic regression was used to identify factors associated with deescalated care receipt. Of 9173 patients (mean [SD] age, 76.5 [5.2] years), 2363 (25.8%) were aged 80 years or older, 705 (7.7%) had frailty, and 419 (4.6%) had a CCI of 2 or greater. While 4499 (49.1%) underwent standard therapy, 4674 (50.9%) underwent deescalated therapy (1193 [13.0%] of the population omitted axillary surgery and 4342 [55.5%] of patients undergoing lumpectomy omitted RT). Of the total variance, random variation explained 27.3%, region/HSA explained 35.3%, patient factors explained 2.8%, and 34.5% was unexplained. In adjusted models, frailty and increased age were associated with a higher likelihood of undergoing deescalated therapy (frailty: odds ratio [OR], 1.70; 95% CI, 1.43-2.02; age, by 1-year increment: OR, 1.10; 95% CI, 1.09-1.11), but CCI was not. Patients in rural areas compared with those in urban areas (OR, 0.82; 95% CI, 0.68-0.99) and Asian and Pacific Islander patients compared with non-Hispanic White patients (OR, 0.68; 95% CI, 0.54-0.85) had a lower likelihood of undergoing deescalated therapy. In this retrospective cross-sectional study of women aged 70 years or older diagnosed with T1N0 HR+/ERBB2- breast cancer, region/HSA contributed more to the variation in deescalated therapy use than patient factors. Unexplained variation may be attributed to unmeasured characteristics, such as multidisciplinary environment and patient preference. Decision support efforts to address overtreatment should target regions with low rates of evidence-based deescalation.

Association between Regional Market Competition and Early Femoropopliteal Interventions for Claudication

ObjectivesRegional market competition is known to impact practice patterns in surgical care. We aimed to investigate the association of regional market competition with the utilization of early peripheral vascular interventions (PVI) for the treatment of claudication, and the subsequent impact on clinical outcomes. MethodsWe conducted a retrospective analysis of 100% Medicare fee-for-service claims data from 01/2019 to 12/2021 to identify patients with a new diagnosis of claudication. We calculated the Herfindahl-Hirschman Index for all sites of service performing PVI according to Health Service Area. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of regional market competition with early (<6 months) PVI for claudication, and progression to chronic limb-threatening ischemia (CLTI), repeat PVI, and major amputation. ResultsWe identified 300,492 patients with a new diagnosis of claudication (mean age 73.8 years, 51.6% male, 11.1% Black), of which 6.1% underwent an early PVI for claudication. Most patients (72.4%) were treated in low-competition markets. After adjusting for patient characteristics, patients treated in moderate-competition markets had the highest odds of receiving an early PVI. Regional market competition was not associated with conversion to CLTI or repeat PVI (P>0.05), but patients treated in high- (aHR 0.70, 95%CI 0.56-0.86) and moderate- (aHR 0.82, 95%CI 0.69-0.92) competition markets had lower hazards of major amputation compared to patients treated in low-competition markets. Early PVI was significantly associated with worse clinical outcomes after adjusting for all factors including market competition (all, P<0.05). ConclusionsThere is a complex interplay between regional market competition, early PVI utilization, and subsequent clinical outcomes for patients with claudication. Early PVI continues to demonstrate a strong association with unfavorable clinical outcomes even when accounting for market competition.

The impact of birth preparedness and complication readiness (BPCR) on maternal outcomes among postpartum mothers

&lt;pre&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Birth preparedness and complications readiness (BPCR) is a strategy to prevent three late causes of maternal death. Previous study results focused on BPCR intermediate outcomes, such as utilizing healthcare facilities during pregnancy and delivery,&lt;/em&gt;&lt;em&gt; rather than maternal outcomes like maternal near miss, morbidity, and mortality.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;&lt;em&gt;Objectives:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; This study examined the correlation between BPCR practices and maternal outcomes among postpartum mothers&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;&lt;em&gt;Methods: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This cross-sectional research was conducted on postpartum mothers in the working area of the Sumberbaru Primary Health Service, Jember Regency, which was carried out from April to June 2023. A total of 78 postpartum mothers were selected using simple random sampling. The interview instrument was adopted from the BPCR JHPIEGO questionnaire, and maternal outcome observations were made using the MCH book. Data were analyzed using the chi-square test to examine the relationship between BPCR and maternal outcome. The level of statistical significance was set to p-value &amp;lt; 0.05&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/pre&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The results of this study indicated that 69.2% of postpartum mothers had less prepared BPCR practices, and for most postpartum women, 55.1% recovered. There was a relationship between BPCR practices and maternal outcomes among postpartum mothers (p-value&amp;lt;0.05). Postpartum mothers with well-prepared BPCR practices had a 3.48 times higher chance of experiencing a complete recovery in maternal outcomes than those with less prepared BPCR practices.&lt;/em&gt;&lt;/p&gt;&lt;pre&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The practice of BPCR in postpartum mothers is in the poor category; most mothers' maternal outcomes are in the fully recovered category. BPCR is an essential factor influencing maternal outcomes, so increasing counseling for mothers and families regarding BPCR is necessary to ensure more optimal maternal outcomes.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/pre&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;

Integrating early child development into an existing health and nutrition program: evidence from a cluster-randomized controlled trial

IntroductionIn low-resource settings, introducing child health programs into community services may compete for caregiver time. We analyzed the impact of a new early childhood development (ECD) program in rural Madagascar on family attendance at other health services and of adding at-home play materials on program attendance.MethodsWe randomized 75 communities where community health workers (CHWs) implement an existing child health and nutrition program (Projet d’Amélioration des Résultats Nutritionnels or PARN), the status quo. We offered two 6-month cycles of 12 ECD sessions to eligible caregiver-child dyads (6–30 months) in 25 sites [T]; we added take-home play materials in Cycle 2 to 25 sites [T+]. We used differences-in-differences with administrative data to analyze the effect of offering ECD sessions on monthly PARN attendance (T+/T vs. C) among age-eligible children and the impact of toy boxes/libraries on monthly ECD session attendance (T + vs. T). We used random intercept models to analyze characteristics associated with program registration.ResultsWe analyzed data for 9,408 dyads; 30% and 32% registered for the program in Cycle 1 and 2 (respectively). On average, CHWs delivered 11.4 sessions (SD: 1.5). Children from wealthier households who already attended PARN sessions were more likely to register, and we found no effect of T or T + on PARN attendance. Adding play materials did not affect monthly ECD session attendance. Children from more populated sites were less likely to participate in both ECD and PARN sessions.ConclusionsIntegrating new services for ECD into the health system was feasible and did not reduce dyad participation in existing services. Investment in health services in more populated areas is needed to provide coverage to all eligible children. Novel strategies should be explored to engage the most vulnerable children in new and existing health services.Trial registrationAEA Social Science Registry (AEARCTR-0004704) on November 15, 2019 (prospective registration) and ClinicalTrials.gov (NCT05129696) on November 22, 2021 (retrospective registration).

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.

Closing the gap? Results-based financing and socio-economic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) programme, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilization of health services. This study leverages the staggered rollout of the programme as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilizing pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section and family planning. Specifically, the RBF programme is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, P < 0.01), first-trimester prenatal care (-0.033, P < 0.01), delivery by caesarean section (-0.028, P < 0.005) and family planning (-0.033, P < 0.005). Additionally, the programme is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, P < 0.01). These effects are more pronounced among lower socio-economic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritizing expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Analisis Hubungan Skill dan Motivasi dengan Penginputan Data Istitha‘Ah Jemaah Haji Wilayah Kerja Dinas Kesehatan Provinsi Sumatera Barat

According to the presentation coverage report, the number of Hajj pilgrims' health data on SISKOHATKES within 2 (two) weeks of departure must be 100% input. However, there has been a decrease in the percentage of target achievement in inputting SISKOHATKES data for 5 years until 2022 (96.98%). This research aims to determine the factors related to inputting health istitha'ah data for Hajj pilgrims by the management of the integrated Hajj computerized health system in the work area of the West Sumatra Provincial Health Service in 2023. This research is a type of observational research with a cross-sectional approach. The research was conducted at the West Sumatra Provincial Health Service from May to August 2023. The sample for this research was all 48 Siskohatkes managers. Data was obtained through a Google Form survey. The analysis uses the Chi-square test, namely connecting two variables, the independent variable and the dependent variable. The significance level is 95% (α= 0.05). Based on the research results, it is known that (P-value = 0.008) there is a relationship between Ability (Skill) and the Performance of SISKOHATKES Managers, (P-value= 0.001) there is a relationship between Work Motivation and Performance of SISKOHATKES Managers. The conclusion of this research is that there is a relationship between skills, work motivation and training and employee performance in the work area of the West Sumatra Provincial Health Service. It is hoped that organizations in improving employee performance will focus more on motivation, training and improving their abilities to achieve performance goals.

Unequal Inaccessibility in Health Services Reason for Rural Migration: An Application of Lee's Push Pull Theory

Rural-to-urban migration has been a growing phenomenon in recent years in Nepal. Federal Democratic Republic Nepal is combating the unequal distribution of resources, power and opportunities induced by a unitary and centralized government in the past. The aim of restructuring the state was to eliminate the uneven distribution of services, power and resources distribution in terms of region. Now, Nepal is implementing three levels of governments- federal, provincial, and local government to eliminate existing inequalities and to make powerful local areas. In this sense, rural-urban migration is not a growing phenomenon but is now a reverse situation. Local governments are developing in the local areas, the local people are migrating to cities. So, the objective of this paper is to apply the push-pull theory of migration and interlink Lee's theory and the distribution of health services in rural areas including Diprung Chuichumma Rural Municipality, Khotang. It is based on the positivistic philosophy and its approach is deductive approach. The causes of rural-to-urban migration are both push-pull factors. Unequal inaccessibility in health services between rural and urban areas is the main reason for migration.

Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial

BackgroundIn the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs.MethodsUsing the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout—emotional exhaustion, depersonalization, and personal accomplishment—among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample.ResultsThe MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach’s definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = − 3.88 − 95% CI 5.69 to − 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = − 2.52, 95% CI − 4.69 to − 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76).ConclusionsThe low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout.Trial registration ClinicalTrials.gov number: NCT01900977.

Unraveling the Factors Influencing Healthcare Accessibility: An In-depth Investigation in Jhenaidah Sadar Upazila

Healthcare plays a significant role in Bangladesh. The key to wealth is health. In the absence of healthcare development, we would not be able to live a quality lifestyle. In order for a nation to develop economically and socially, its health must be in good condition. It is reported that health services in Bangladesh are well funded by the government, but some issues affect the sector. A considerable proportion of Bangladesh's population lacks or has little access to healthcare services. There are several dimensions to the problem of lack of health service participation. This study evaluates, through collecting information from primary data, public health facilities' scarceness and identifies factors that act as barriers to the functioning effectively of public health facilities. The authors conducted qualitative research in order to gain an in-depth understanding of the underlying insights of various components that affect Bangladesh's healthcare sector. A purposive sampling style is followed to specify the respondents. The findings scrutinize the healthcare system in the selected areas of Bangladesh. It has explored what factors affect access to health services in urban areas of Bangladesh. It has also revealed patients’ views towards healthcare services. The findings from the qualitative data have unveiled that there are many key dimensions, in terms of various dimensions, that indicate why people face hurdles when accessing health services. Finally, the paper concludes with a variety of recommendations.

An innovative business model using established Medicare items for delivery of cardiac rehabilitation: A value proposition for primary care.

Approximately 70% of Australians do not attend cardiac rehabilitation (CR). A potential solution is integrating CR into primary care OBJECTIVE: To propose a business model for primary care providers to implement CR using current Medicare items. Using the chronic disease management plan, general practitioners (GPs) complete four clinical assessments at 1-2 weeks, 8-12 weeks, and 6 and 12 months after discharge. The net benefit of applying this model, compared with claiming the most used standard consultation Item 23, in Phase II CR is up to $505 per patient and $543 in Phase III CR. The number of rural GPs providing CR in partnership with the Country Access To Cardiac Health (CATCH) through the GP hybrid model has increased from 28 in 2021 to 32 in 2022. This increase might be attributed to this value proposition. The biggest limitation is access to allied health services in the rural areas.

The implementation of the elective subject "Public Health" in the final year for medical students at Göttingen University Medical Center: results of the UNITE project

International and national frameworks and initiatives call for strengthening the training of health professionals in the public health service (PHS) through cooperation with universities. The German Medical Licensing Regulations of 21st Sep 2021 provides for an integration of PHS into undergraduate medical training in the final year since 1st May 2022. The present study presents the procedure and results of the final year elective Public Health (PH) implementation for medical students at the University Medical Center Göttingen (UMG) in cooperation with the local PHS. In the twelve-month project UNITE (07/21-06/22), the final year elective PH was implemented in seven steps: analysis of the framework conditions, conception of the elective, preparation of a logbook, pilot phase with five students in one-week rotations, public relations for students, introduction of a medical didactic training for staff of the health department and implementation of the elective PHS with students. A cooperation agreement between UMG and the Health Department regulates the training of medical students. Students complete four-week rotations in the areas of public health service and funeral services, paediatric and adolescent medical service, infection control and social psychiatric service. The logbook for students contains learning objectives for individuals specialised in services for self-assessment of the acquired competences. The didactics training was implemented with high learning success of the participating staff. So far three final year students have successfully completed the elective. The implementation of final year elective PHS strengthens the anchoring of public health topics in the education of medical students in Göttingen and makes PHS more visible as a professional perspective. Essential for the successful implementation were the establishment of a continuous cooperation between the university and the health department, student-oriented teaching-learning concept with a logbook suitable for the location, a trained multiprofessional team in the health department, and the evaluation of the elective for quality assurance and further development of the training. The concept presented here can help other locations in establishing the final year elective in PH and can be adapted to specific local conditions.

Behavior of pregnant women to improve oral health knowledge during pregnancy according to Lawrence Green theory in Pakis Public Health Service Area

Background: Pregnancy involves conception, fetal development, and labor. The health of pregnant women needs to pay attention to aspects of oral health because it affects fetal development. The prevalence of periodontal disease in pregnant women reached 35%-100%. Lawrence Green categorizes behavioral influence factors into two, namely behavior and non-behavior, with three main factors: predisposing, reinforcing, and enabling. Purpose: To determine the relationship between the behavior of pregnant women in increasing knowledge about oral health during pregnancy. Methods: This study used qualitative research methods, and information retrieval using in-depth interviews with research samples, who were pregnant women at Pakis public health service area on September 14-30, 2020. Results: There are main findings found such as, there are still pregnant women who do not know how to maintain oral health during pregnancy, pregnant women still do not try to find out information related to oral health during pregnancy, and it was also found that the information provided at services related to oral health during pregnancy was felt to be lacking by some informants. Conclusion: In terms of knowledge and attitudes (predisposing factors), as well as access to services (enabling factors), informants did not experience any obstacles. In terms of support (reinforcing factors), most informants highlighted the importance of support from husbands, family, relatives, and friends for the oral health of pregnant women.

“If it all goes digital, we’ll have to learn”: facilitators and barriers to uptake of digital health in British South Asians with cardiometabolic disease

BackgroundAlthough availability and utilisation of digital health interventions (DHIs) for management of diabetes and cardiovascular disease (“cardiometabolic disease”) have increased, they may exacerbate health inequalities. South Asians have increased cardiometabolic risk, but their experiences of DHIs are poorly investigated and characterised.ObjectiveTo explore facilitators and barriers to DHI uptake and use in South Asian individuals in the UK with cardiometabolic disease.MethodsMixed-methods approach encompassing online/face-to-face/individual interviews (n = 45) and survey (n = 100). After informed consent, transcription and coding, we conducted a thematic analysis informed by a guide for understanding inequalities in DHIs to examine perceptions at the individual, healthcare professional, societal and intervention level.ResultsParticipants described an intersection of factors resulting in varied digital skills and confidence within the community, including individual characteristics, awareness, and support. COVID-19 restrictions acted as both a positive (use of online shopping and social media increasing digital confidence) and negative (lack of access to health services) drivers to DHI uptake. Participants made recommendations for improving DHI uptake in the health service and policy area, such as promotion and upskilling through culturally and language-appropriate avenues such as community organisations and outlets. Participants suggested DHI design improvements should focus on literacy, numeracy, accessibility, and cultural appropriateness.ConclusionsDHIs have the potential to support South Asian populations in the UK to prevent and manage cardiometabolic disease. To improve their uptake, approaches to their implementation should consider community diversity to provide appropriate promotion, education, and support.

Navigating disparities: Insights from a colorectal cancer screening program in federally qualified community healthcare centers.

1537 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in Georgia. Despite evidence for the effectiveness of CRC screening, disparities in access are prevalent in underserved populations. Georgia’s Federally Qualified Health Centers (FQHCs) struggle with low screening rates (42.8%), partly due to Georgia’s lack of Medicaid expansion, poor access to health services in rural areas, and deficiencies in coordinated strategies. The Georgia Colorectal Cancer Control Program (GCRCCP) was funded by the Centers for Disease Control and Prevention to implement evidence-based interventions (EBIs) in qualifying FQHCs across South Georgia. Here, we assess the program's impact on clinic-level screening rates (SR). Methods: Fourteen clinics with 12,159 CRC-eligible patients (ages 50-75) were enrolled from East Georgia Healthcare Center (EGHC) and Albany Area Primary Health Center (AAPHC). FQHC clinics had to have a SR below 60% to participate in the program. In addition to the EBIs (provider assessment and feedback, provider reminders, patient reminders, reducing structural barriers), the GCRCCP integrated provider education using the ECHO Model and navigation through a nationally recognized, evidence-based patient navigation program. We compared baseline (2020 and 2021) and follow-up data (2022) to determine the average change in SR over time, overall, and by demographic sub-groups. Results: The overall change in SR for the 14 clinics was +6.7%, from a baseline average of 45.3% to 52% in 2022. The average change in SR for EGHC clinics (n=9) was +11.5% (from 32.2 to 43.7%). Women had a higher SR (44.9%) than men (41.8%), but both realized an increase in SR, +10.5% and +9.1%. Non-Hispanic Black Americans (NHBA) experienced a higher increase in SR, +13.7% (from 37.2 to 50.9%) than their Non-Hispanic White (NHW) counterparts (+7.5% (from 29.8 to 37.3%)). The uninsured vs. insured followed a similar pattern (+15.3% (from 17.8 to 33.1%)) vs. +2.1 (from 45.9 to 48%). The average change in SR for AAPHC clinics (n=5) was +1.8% (from 58.4 to 60.2%). There was a decline in SR for men, -8.6% (from 64 to 55.4%), and an increase for women, +3.8% (from 58.2 to 62%). NHBA had a decrease in SR, -0.8% (from 61.2 to 61%), while NHW Americans had an increase in SR, +0.2% (from 53.8 to 54.2%). The uninsured and insured groups realized minimal increases of +0.6% (from 46 to 46.6%) and +0.8% (from 62 to 62.8%), respectively. Conclusions: The implementation of EBIs and patient navigation show varied potential to reduce disparities in accessing CRC screening in underserved populations. FQHC clinics that sustain implementation activities and workflow processes can benefit communities long-term and improve health equity.

Urbanization and its Mental Health Implications in the Philippines

The objective of this research is to examine the effectiveness of integrated mental health services in urban settings within the Philippines, with a particular focus on the challenges posed by rapid urbanization. The study aims to develop a comprehensive framework that assesses the availability, accessibility, and efficacy of mental health services in metropolitan areas, thereby contributing to the improvement of public health strategies in urban environments. Utilizing a robust methodological approach, the research evaluates several key components of mental health services, including intervention strategies, community engagement, and policy implementation. The results indicate that while there are numerous services available, significant gaps in service accessibility and effectiveness remain. Factor analysis identified five critical areas for improvement: 1) Community Awareness and Stigma Reduction; 2) Integration of Mental Health into Primary Health Care; 3) Enhanced Training for Mental Health Professionals; 4) Strengthened Support Networks; 5) Policy and Infrastructure Development. The study also highlights the importance of aligning service provision with the specific cultural and socioeconomic contexts of Filipino urban populations. The findings underscore the need for a multi-disciplinary approach to mental health care that includes both governmental and community-level involvement.

Sub-fertility and life style factors which affecting sub-fertility among women in Regional Director of Health Service area, Colombo

Sub-fertility and life style factors which affecting sub-fertility among women in Regional Director of Health Service area, Colombo

Contribution of mobile health technologies to public health in rural areas: Accessibility and education methods

In today's rapidly advancing world, mobile health services have become influential in various aspects of our lives. It is anticipated that mobile applications, especially in rural areas, can play a significant role in the delivery of healthcare services. In this context, it is essential to examine the applications of mobile health services in rural areas and the education methods employed in these applications. The main objective of this study is to explore the contributions of mobile health services applications in rural areas to public health and to examine the education methods used in these services in light of current literature. The focus of this study is on how mobile health applications can be utilized in rural areas, the impact of this usage on public health, and the effectiveness of the education methods employed. The research was conducted through searches using key terms such as "mobile health" and "public health nursing" or "mobile health technologies" and "nursing" or "telehealth" on important academic databases like Google Scholar, PubMed free fulltext, Science Direct, Ebscohost, Sage, Scopus, and CINAHL. The information obtained from literature searches was analyzed to understand the impact of mobile health applications on public health in rural areas and the education methods employed. The study results indicate that the use of mobile health applications in rural areas can contribute significantly to public health. Advantages such as rapid diagnosis and treatment, effective monitoring of chronic diseases, and quick access to emergency services stand out among the potential impacts of mobile health applications. Mobile health applications can contribute significantly to public health in rural areas and increase their usage, particularly in primary healthcare services.

Analytical Study of Providing Additional Food Made from Local Sources: Accelerated Reduction of Stunting in Southeast Sulawesi Province in 2023

Background: Providing additional food made from local food is one strategy for handling nutritional problems in malnourished toddlers and SEZ pregnant women. In order to support improving the quality of Indonesian people, strengthening an economic structure that is productive, independent and competitive, the government has targeted an acceleration in reducing the stunting rate under five. In order to support the implementation of the Acceleration of Stunting Reduction which aims to achieve the quality development target by 2030 and the stunting prevalence target of 14% by 2024.Objective: To produce a comprehensive, up to date and effective analysis of supplementary feeding analysis: Accelerating Stunting ReductionResearch Method: This research uses a qualitative approach and design. Participants in this research were leaders and staff of institutions related to stunting prevention, namely: Provincial Health Services, District Services, Community Health Center Nutrition Officers and Posyandu Cadres. Materials and Tools: Questionnaire form, Camera, Video/handycam equipment, other ATK. This research was carried out in the Southeast Sulawesi Provincial Health Service Area, in June-November 2023. Data analysis method: Reading/studying the data, marking key words and ideas that is in the data. The steps in data analysis are data reduction, data presentation and conclusion drawing as follows: Data reduction, data presentation, conclusion drawingResults. PMT activities made from local food can build family independence in providing quality food for pregnant women and toddlers. Malnutrition among toddlers and pregnant women in KEK in Southeast Sulawesi. This problem must be corrected. One program is providing additional local food. Where Southeast Sulawesi is a coastal and island area that has a lot of food. The success of the local feeding program is demonstrated by improvements in the nutritional status of both targets. In toddlers, success can be seen from the weight gain each month. In this activity, the community health center plays a very important role. At the Puskesmas, all activities carried out by cadres can be monitored by the Puskesmas nutrition staff.Suggestion: Improvements in funding are needed, namely additional funds for food distribution to cadres, adequate transportation is needed. It is necessary to evaluate the process of providing additional food made from local ingredients and evaluate weight gain in children under five and increase in LILA size in pregnant women.