Individuals In Rural Communities Research Articles

Magrabi ICO Cameroon Eye Institute, Yaoundé, Cameroon: Ophthalmology Subspecialty Patient Care and Training Center in Central Africa

To report establishment of the Magrabi ICO Cameroon Eye Institute at Yaoundé, Cameroon, as an ophthalmology subspecialty patient care and training center in Central Africa. Perspective. Assessment of unpublished and published material. To improve, preserve and restore eye health and vision in a region with world-high prevalence of functional vision impairment and blindness, the Africa Eye Foundation established the Magrabi ICO Cameroon Eye Institute as an ophthalmology subspecialty patient care center for all in need and a training center for ophthalmologists, ophthalmology subspecialists, and allied personnel. In 2017, the year of its inauguration and the first year of operation, the Magrabi ICO Cameroon Eye Institute provided ophthalmology subspecialty care to more than 25 000 patients and surgery for pediatric and adult cataract, glaucoma, retinal disease, oculoplastic disorders, and other vision-threatening conditions. Outreach programs extended care to an additional 2500 individuals in rural communities and 7 training courses were conducted for ophthalmologists and allied personnel. Through ophthalmology subspecialty patient care and the training of ophthalmologists and allied personnel, Magrabi ICO Cameroon Eye Institute is acting to enhance vision and the quality of life for individuals and families in all segments of society.

Abstract C38: Increasing colorectal cancer screening in rural populations: A systematic literature review

Abstract Background: Research demonstrates that early detection through recommended screening for colorectal cancer (CRC) yields favorable treatment outcomes; however, screening rates remain low, particularly in rural communities. Residents of rural communities have unique barriers to health care that often result in poorer health outcomes. Targeted interventions to increase CRC screening are needed to tackle barriers to preventive health behaviors among individuals in rural communities. Methods: A systematic literature search of PubMed/Medline was performed to identify CRC screening interventions conducted in rural communities. English language articles from peer-reviewed journals published from January 2006 to December 2016 were included if they reported results for CRC screening interventions in rural communities in the United States. Results: Of the 358 articles abstracted, 29 met the inclusion criteria. The studies detailed interventions in rural settings, particularly among populations with low CRC screening rates including American Indians/Alaska Natives, African Americans, and uninsured individuals. Studies varied in design and mode of intervention delivery; however, interventions emphasizing community-based participatory research principles yielded improved CRC screening adherence. Interventions to increase CRC screening included communication campaigns, home-based screening, and patient navigation. Few interventions included a theoretical foundation or information on cost-effectiveness. Conclusions: More research is needed to examine the theoretical framework, design, delivery, and cost-effectiveness of CRC screening interventions for rural populations. Additional assessment is needed to determine how effectively these interventions can be translated to different types of rural settings. Synthesis of this literature may inform efforts to develop targeted interventions to increase CRC screening in rural populations. Citation Format: Joelle Atere-Roberts, Ingrid J. Hall, Judith Lee Smith. Increasing colorectal cancer screening in rural populations: A systematic literature review [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C38.

Management of Cold Water-induced Hypothermia: A Simulation Scenario for Layperson Training Delivered via a Mobile Tele-simulation Unit.

Newfoundland and Labrador (NL) has one of the highest provincial drowning rates in Canada, largely due to the many rural communities located near bodies of water. Factor in the province’s cold climate (average NL’s freshwater temperature is below 5.4°C)and the prevalence of winter recreational activities among the population, there exists an inherent risk of ice-related injuries and subsequent hypothermia. Oftentimes, these injuries occur in remote/rural settings where immediate support from Emergency Medical Services (EMS) may not be available. During this critical period, it frequently falls on individuals without formal healthcare training to provide lifesaving measures until help arrives.Training individuals in rural communities plays an important role in ensuring public safety. In recent years, simulation-based education has become an essential tool in medical, marine and first aid training. It provides learners with a safe environment to hone their skills and has been shown to be superior to traditional clinical teaching methods. The following case aims to train laypeople from rural settings in the immediate management of an individual who becomes hypothermic following immersion into cold water.However, reaching these individuals to provide training can be a challenge in a province with such a vast geography. To assist with overcoming this, the development of a simulation center that is portable between communities (or Mobile Tele-Simulation Unit) has occurred. By utilizing modern technology, this paper also proposes an innovative method of connecting with learners in more difficult to reach regions.

Feasibility of Assessing Suicide Ideation and History of Suicidal Behavior in Rural Communities.

Suicide in rural areas has not received significant attention in the research literature to this point, although suicide rates are higher among adults and older adults in rural areas than in urban areas. The aims of the study were as follows: (1) establish the feasibility of assessing suicide ideation and history of suicidal behavior; (2) determine preliminary estimates of the prevalence of suicide ideation, and history of suicide attempts; and (3) examine the effectiveness and acceptability of safety and referral plans for individuals whose responses indicated elevated suicide risk, in rural communities with limited access to referral care. Participants were 96 adults aged 40 to 85years old (M=57.34, SD=11.47) residing in West Texas. Our results indicate that 26% of participants endorsed a lifetime history of suicide ideation and/or suicide attempt(s) and 12.5% reported suicide ideation in the past year. In addition, 93.4% of participants reported that participation in our suicide-focused study was an excellent or good experience. Results suggest that individuals in rural communities are willing to talk about suicide, found the experience helpful, and were satisfied with the referral process.

Program note: Expanding healthy housing and environmental awareness in rural communities through local and national partnerships

ABSTRACTHealthy homes are an important contributor to individual and family health. Sharing healthy home information with individuals in rural communities can be challenging because of limited resources and transportation challenges. One effective way to increase consumer awareness of healthy homes, especially in rural areas, is through collaboration. The national Healthy Homes Partnership (HHP) is a 15-year-old public outreach education program that addresses housing deficiencies and risks associated with poor indoor air quality. Between September 2014 and November 2015, HHP had 9,617 direct and 2,000,838 indirect educational contacts. State partners created advisory coalitions to bring together organizations with the common goals of reducing housing hazards and improving health. This paper highlights the efforts of the Healthy Homes Partnership, including examples of effective outreach from multiple states. Healthy housing efforts have demonstrated that local outreach along with online information can be an effective strategy to reach rural residents. In this program note, the authors explore the benefits and challenges associated with a holistic approach to bridging health and housing knowledge gaps in rural communities.

GERIATRIC HEALTH SCREENING: AN INTERPROFESSIONAL EDUCATION OPPORTUNITY

AbstractThe Institute of Medicine, among other organizations, has established interprofessional education (IPE) as a goal for all health professions. Most academic accrediting agencies are now requiring activity in this area. Programs located in largely rural areas without an academic medical center may have more difficulty in achieving IPE for their students.The Montana Geriatric Workforce Enhancement Program at the University of Montana provides interdisciplinary student training through geriatric health screening. Pharmacy, nursing, medicine, physical therapy, social work, and speech pathology students from four Montana academic institutions participate. In a typical year, approximately 65 pharmacy students, 40 physical therapy students, 20 nursing students, 30 social work students, and varying numbers of students from other disciplines are involved in over 50 screening events held throughout the state.Under faculty supervision, teams of students provide screenings for older individuals in rural communities, including counseling on the results and follow up of abnormal values. Screenings for lipids, hemoglobin A1c, bone density, blood pressure, hepatitis C, balance testing and fall risk assessment, caregiver stress, cognition and depression are provided. Barriers to participation include varying formats and schedules for clinical training, requirements for appropriate supervision of students and identification of community referral resources. Approaches utilized by pharmacy, two different nursing programs, physical therapy, social work, speech pathology, and medicine will be described and compared. Evaluation results from surveys of faculty and students will be included.

A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China

ObjectivesThis study was designed to examine the effect of health literacy on diabetes prevention and control and risk factors for low diabetes health literacy among elderly individuals with prediabetes in...

Integrated Resources and Training Facilitation: A Strategic Priority when Promoting ICT in Developing Countries

In a rural context in a developing country purchasing a computer and connecting it to the Internet is in itself difficult, even when the lack of money is a minor issue. These issues prevent individuals in rural communities from familiarizing themselves with educational technology and ICT in general. The present study investigates the specific barriers to buying and utilizing ICT and ways in which these barriers can be overcome in a case study involving stakeholders from an educational institution in rural Bangladesh. Through a transformative methodology and a phenomenographic approach to the analysis (Larsson & Holmstrom, 2007), interview data on the decision-making experience of computer purchases, and the after-purchase experience of learning computer-related skills, the integration of the technology and the skills in interviewees’ (students and teachers) learning environments is analyzed. The barriers to purchasing a computer fall in four major categories: Cultural, financial, infrastructural, and knowledge barriers; with knowledge transcending the other barriers. When addressing the barriers to facilitate purchase of a computer locally situated knowledge is crucial. The study concludes that more research is needed to fully understand the diffusion and development of knowledge and inclination to purchase a computer.

Informal talk: shaping understandings of sexually transmitted infections (STIs) in rural Australia

Although there have been great strides in the prevention, care and treatment of sexually transmitted infections (STIs, including HIV) in Australia, the increasing trend towards higher rates of some STIs is of concern, especially reports of higher rates of chlamydia in inner regional areas. Reasons for these changes are unclear but suggest there is an inconsistent use of prevention measures and ambivalence towards acting responsibly around sexual behaviours. Understanding an individual's response to the circumstances or contexts in which knowledge about STIs are operationalised in rural communities becomes central to recognising how individuals experience health and illness, especially for developing interventions to prevent the transmission of STIs. The aim of this research is to understand how individuals in rural communities make sense of their experiences in relation to STIs and how rurality influences discussion about STIs and health-seeking behaviours. In-depth interviews with 24 participants, 18 females and 6 males, aged between 19 and 65 years provide the data for the study. Methodological principles of 'grounded theory' underpin the analysis. An eclectic approach to grounded theory was used in the current study that was derived from a number of authors. The findings revealed that a number of contexts shape the actions and reactions of rural individuals towards STIs. These include 'public and private world of individuals', 'forms of talking in rural communities' and 'managing information and use of health services'. Factors that shape social life in rural communities such as the social bonds that are present, the relationships developed, and the way in which people behave influence the public and private aspects of rural life. Different forms of talk were identified that indicate that sexual issues are discussed in a number of informal ways and encompass distinct experiences of conveying information with regard to sex and STIs. Managing information and use of health services occurs when individuals assess and identify the need to access services for STIs. The strength of this research lies in the identification of a number of contexts such as the private-public divide and types of talk where informal mechanisms encourage individuals to conform and comply with community rules and values. Using informal talk as a health promotion and or prevention strategy in rural locations can provide an alternative approach to potentially changing social norms. It would be possible to extend the idea of positive informal talk to include symbols and imagery that encourage individuals to seek treatment and provide a more positive view of 'reputation'. Engaging rural individuals in positive talk about sexual risk, access to treatment for STIs, and provision of accurate knowledge can help to build new 'social norms' that encourage new interpretations.

Perceptions of the role of ICT on quality of life in rural communities in Uganda

The role of information and communication technology (ICT) in enabling various development goals including the millennium development goals and ultimately human development is no longer disputed. Emphasis is now being placed on optimizing ICT benefits on the quality of life (QoL) of people, especially in developing countries. To address this need, this paper reports a study that applied Sen's capability approach to explore how individuals in rural communities in Uganda perceived the importance of ICT toward their QoL and how this perception influenced ICT adoption. It was established that while perception was inclined to social benefits, ICT uptake and use toward improved QoL is still limited. One reasonable conclusion is therefore that state and policymakers should adopt a pluralistic approach to ICT provision: one that does not only focus on availability and affordability, but also considers expanding people's awareness and agency for development benefit. ICT investments otherwise have a high risk of being severely underutilized.

Rural livelihood diversity to manage economic shocks: Evidence from south-east Zimbabwe

Livelihood strategies used by households and individuals in rural communities are shaped by human, natural, financial, social and physical capital resources that can be accessed. The ability to diversify livelihoods depends on asset portfolios and the economic shocks that rural households face. The main objective of this paper is to improve understanding of rural livelihood challenges in south-east Zimbabwe and how households in this area diversify livelihoods to cope with these challenges. A cluster analysis of 200 households surveyed in 2008 in the Chiredzi district identified five distinct livelihood strategies: (1) subsistence smallholders/ unskilled workers; (2) subsistence smallholders/nontimber forestry products (NTFPs) harvesters; (3) crop production and NTFPs extraction integrators; (4) commercial smallholders with regular off-farm employment; and (5) specialised commercial livestock producers. Multinomial logit model results showed that the level of education of the household head, value of physical assets, cattle numbers and income, remittances, NTFP income and economic shocks were the main determinants of these livelihood choices. There is also some evidence that those households that were statistically significantly affected by HIV/AIDS shock practised distresspush diversification by harvesting NTFPs. These results suggest that policymakers need to advise rural households on how to improve their risk management capacities, and move from geographically untargeted investments in livelihood assets to a more integrated approach adapted to the asset bases of individual households.

Social-ecological Resilience of a Nuosu Community-linked Watershed, Southwest Sichuan, China

Farmers of the Nuosu Yi ethnic group in the Upper Baiwu watershed report reductions in the availability of local forest resources. A team of interdisciplinary scientists worked in partnership with this community to assess the type and extent of social-ecological change in the watershed and to identify key drivers of those changes. Here, we combine a framework for institutional analysis with resilience concepts to assess system dynamics and interactions among resource users, resources, and institutions over the past century. The current state of this system reflects a legacy of past responses to institutional disturbances initiated at the larger, national system scale. Beginning with the Communist Revolution in 1957 and continuing through the next two decades, centralized forest regulations imposed a mismatch between the scale of management and the scale of the ecological processes being managed. A newly implemented forest property rights policy is shifting greater control over the management of forest resources to individuals in rural communities. Collective forest users will be allowed to manage commodity forests for profit through the transfer of long-term leases to private contractors. Villagers are seeking guidance on how to develop sustainable and resilient forest management practices under the new policy, a responsibility returned to them after half a century and with less abundant and fewer natural resources, a larger and aggregated population, and greater influence from external forces. We assess the watershed’s current state in light of the past and identify future opportunities to strengthen local institutions for governance of forest resources.

A new PCR-based approach indicates the range of Clonorchis sinensis now extends to Central Thailand.

Differentiation of the fish-borne trematodes belonging to the Opisthorchiidae, Heterophyidae and Lecithodendriidae is important from a clinical and epidemiological perspective, yet it is impossible to do using conventional coprological techniques, as the eggs are morphologically similar. Epidemiological investigation therefore currently relies on morphological examination of adult worms following expulsion chemotherapy. A PCR test capable of amplifying a segment of the internal transcribed spacer region of ribosomal DNA for the opisthorchiid and heterophyid flukes eggs taken directly from faeces was developed and evaluated in a rural community in central Thailand. The lowest quantity of DNA that could be amplified from individual adults of Opisthorchis viverrini, Clonorchis sinensis and Haplorchis taichui was estimated at 0.6 pg, 0.8 pg and 3 pg, respectively. The PCR was capable of detecting mixed infection with the aforementioned species of flukes under experimental conditions. A total of 11.6% of individuals in rural communities in Sanamchaikaet district, central Thailand, were positive for ‘Opisthorchis-like’ eggs in their faeces using conventional parasitological detection techniques. In comparison to microscopy, the PCR yielded a sensitivity and specificity of 71.0% and 76.7%, respectively. Analysis of the microscopy-positive PCR products revealed 64% and 23% of individuals to be infected with O. viverrini and C. sinensis, respectively. The remaining 13% (three individuals) were identified as eggs of Didymozoidae, presumably being passed mechanically in the faeces following the ingestion of infected fishes. An immediate finding of this study is the identification and first report of a C. sinensis–endemic community in central Thailand. This extends the known range of this liver fluke in Southeast Asia. The PCR developed herein provides an important tool for the specific identification of liver and intestinal fluke species for future epidemiological surveys.

Population health needs beyond ratifying the Kyoto Protocol: a look at occupational deprivation

The dramatic impact of climate change is physically and economically affecting the world, a consequence of neglecting scientific information known since the 1960s and 1970s. International discussion has focused on the needs of the physical environment and general health concerns (such addressing greenhouse gas production and population health issues); however, little acknowledgement has yet been made of local human issues, such as the effect of climate change on the mental health of those in rural communities. This commentary takes an occupational science perspective to describe new ways of classifying potential mental health problems associated with climate change and its impact on the rural environment. It challenges policy makers to take a proactive approach to addressing the current impacts of climate change on the future mental health of individuals in rural communities.

Improving the Quality of Rural Nursing Care

The purpose of this chapter is to review the literature on quality of care in rural areas. Keywords related to rural quality of care were used to search CINAHL and MEDLINE databases for articles published between 2005 and 2007 (limited to studies occurring in the United States). The review consisted of a total of 46 articles. Limitations include inconsistent definitions of rural, the use of only articles available to the reviewers, an unclear understanding of the context of many of the studies, and lack of a clear operational definition of quality. The studies were grouped and discussed according to quality of workforce, practice, treatment, interventions, and technology in rural areas. Each study's contribution to the understanding of quality health care in rural areas and to determining what was effective in improving staff, patient, or organizational outcomes in rural areas was considered. This chapter also offers a discussion of ethical issues and data quality in rural research. Issues for future research include a focus on patient safety, mental health issues, and the use of technology to improve quality of care in rural areas. Future research should also focus on demonstration studies of model applications. The nursing profession has a unique opportunity to conduct research that will contribute to the development of knowledge that will ultimately improve the quality of health and health care for individuals in rural communities.

A Comparison of Patient Satisfaction with Telehealth and On‐Site Consultations: A Pilot Study for Prenatal Genetic Counseling

Many different fields of medicine are now utilizing video conferencing as a means to offer consultations to individuals in rural communities. However, there is a lack of published literature regarding the use of telehealth in clinical genetics and, specifically, in genetic counseling. Those experiences that have been reported mostly centered on cancer genetic counseling, sickle cell anemia consultation and care, or pediatric/adult genetic assessment. In these studies, the patients reported an overall satisfaction with telehealth, signifying that this type of communication may play an important role in the future of medicine. This pilot study compared patient satisfaction with prenatal genetic counseling performed via video conferencing versus that performed on-site. The results show that there was a high level of patient satisfaction when video conferencing was used to conduct prenatal genetic counseling consultations, suggesting that telehealth can be utilized as a means to offer this service to underserved populations.

What we have learnt from post-1994 innovations in pro-poor service delivery in South Africa: a case study-based analysis

Service delivery is vital for alleviating poverty in South Africa. This paper contributes to the dialogue on how to maximise the impact of pro-poor service delivery by considering evidence from a wide selection of case studies to distinguish the successes and failures of post-1994 pro-poor service delivery. Case evidence brings to light four important points: that decentralisation and participation can reinforce historical distributions of privilege; that community ownership is neither a necessary nor a sufficient condition for effective service delivery to individuals in rural communities; that when managed well private outsourcing can benefit the poor; and that the abolition of user fees is often not the best way to ensure access to basic services. The paper cautions against overly ambitious and idealistic policy making. When a policy fails because of its lack of flexibility or its disregard for the constraints of the implementation context, this failure should be attributed to short-sighted policy making and not to implementation failure. This paper is based partly on consultation work done under Servaas van der Berg on the effectiveness of alternative social delivery mechanisms – as commissioned by the World Bank for its World Development Report 2004.