Interventions In Rural Communities Research Articles

Facilitators of Multisector Collaboration for Delivering Cancer Control Interventions in Rural Communities: A Descriptive Qualitative Study.

Purpose and ObjectivesMultisector collaboration is a widely promoted strategy to increase equitable availability, access, and use of healthy foods, safe places for physical activity, social supports, and preventive health care services. Yet fewer studies and resources exist for collaboration among governmental and nongovernmental agencies to address public problems in rural areas, despite an excess burden of risk factors for cancer morbidity and mortality. We aimed to learn about cancer prevention activities and collaboration facilitators among rural informal interagency networks.Evaluation MethodsIn 2020, researchers conducted semistructured interviews with staff from rural public health and social services agencies, community health centers, and extension offices. Agency staff were from 5 service areas across 27 rural counties in Missouri and Illinois with high poverty rates and excess cancer risks and mortality. We conducted a thematic analysis to code interview transcripts and identify key themes.ResultsExchanging information, cohosting annual or one-time events, and promoting other agencies’ services and programs were the most commonly described collaborative activities among the 32 participants interviewed. Participants indicated a desire to improve collaborations by writing more grants together to codevelop ongoing prevention programs and further share resources. Participants expressed needs to increase community outreach, improve referral systems, and expand screenings. We identified 5 facilitator themes: commitment to address community needs, mutual willingness to collaborate, long-standing relationships, smaller community structures, and necessity of leveraging limited resources. Challenges included lack of funding and time, long travel distances, competing priorities, difficulty replacing staff in remote communities, and jurisdictional boundaries. Although the COVID-19 pandemic further limited staff availability for collaboration, participants noted benefits of remote collaborative meetings.Implications for Public HealthRural areas need consistent funding and other resources to support health-improving multisector initiatives. Existing strengths found in the rural underresourced areas can facilitate multisector collaborations for cancer prevention, including long-standing relationships, small community structures, and the need to leverage limited resources.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

Feasibility of an Adapted Community-Based Lifestyle Intervention to Prevent Cancer in the Rural South: Healthy Living Partnerships to Prevent Cancer (HELP PC).

Obesity increases risk of cancer onset and promulgates cancer mortality. Healthy Living Partnerships to Prevent Cancer (HELP PC) is an adapted intensive lifestyle intervention that is facilitated by community health workers (CHWs). The primary objective of this one-arm pilot study was to test the feasibility of evaluating HELP PC in a rural community by assessing participant recruitment, retention, and adherence to the intervention. The secondary objectives of this study were to evaluate the feasibility of collecting study measures and analyze intervention effects to inform future studies. Adults of all races and a BMI ≥ 25 kg/m2 who resided in the Dan River Region of Southern Virginia were recruited. Participants received 24 weekly (hour-long) group sessions led by a CHW and two consultations with a registered dietitian (RDN). Seventy-five percent (21/28) of eligible subjects were enrolled (n = 21; mean age = 46 years; 67% African American; 90% female; median BMI = 36.1), and recruitment was completed in 2 weeks. Fifty-two percent (11/21) of participants attended >70% of group sessions (adherence) and 98% of RDN consultations were attended. Eighty-six percent (n=18) of participants completed the 6-month follow-up visit (retention), and showed improvements in moderate physical activity, health literacy, general health, energy, and emotional well-being. Feasibility of HELP PC was established through efficient participant recruitment, modest attendance, high retention, and execution of data collection procedures. Importantly, findings can be applied to advance cancer prevention lifestyle interventions in rural communities.

Health initiativesto reduce the potentially preventable hospitalisation of older people in rural and regional Australia.

Australia's ageing population has growing health care needs, challenging timely health service provision. In rural and regional areas, older Australians have poorer health care outcomes and higher rates of potentially preventable hospital (PPH) admissions. The objective of this study was to identify Australian Governmental initiatives designed to reduce PPH of older adults (65years and over) in rural and regional areas. An internet search, underpinned by an environmental scan methodology, was utilised to systematically search the websites of Australian government health departments for relevant initiatives. Stakeholder interviews were then conducted to enrich the findings of the environmental scan. Thematic analysis was utilised to analyse all data. We identified 13 initiatives currently in existence in Australia that fulfilled the search criteria. Stakeholder interviews revealed a range of other local interventions in rural communities across the country, driven largely by community need and a lack of health service accessibility. The identified small number of Governmental health initiatives designed to reduce the PPH of older people living in rural and regional Australia may indicate gaps in the provision of services designed to enable older adults to remain at home and avoid subsequent hospital admissions. SO WHAT?: A coordinated, systemic approach to health promotion targeting older people in rural and regional areas should be explored, with a focus on collaboration between sectors (including primary care, allied health and prehospital services).

Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review.

BackgroundIn rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health.ObjectiveThe aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States.MethodsA narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes.ResultsAmong 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals.ConclusionsTelehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic.

Sexual Behaviours among Oil and Gas Workers in the Niger-Delta Region of Nigeria: Assessing the Impact of Comprehensive HIV/AIDS Prevention Programs

Introduction: The major means of transmitting sexual-related diseases including HIV is through unprotected sexual activities. This study aimed to assess the impact of comprehensive HIV prevention interventions on the sexual behavior of oil and gas workers in Bonny Island, a rural community of Rivers State, Nigeria. Methods: This is a cross-sectional-quantitative study that employed a structured questionnaire among oil and gas workers aged 15 – 49 years in Bonny Island. The information collected from February to April 2012 (after a three year HIV prevention and control intervention programs) includes the socio-demographics; age, gender, education, occupation, marital status and data related to sexual behaviors. Data were analyzed using IBM-SPSS version 25.0. Results: There were 419 respondents each in baseline and post-intervention surveys. The rate of unprotected sex among respondents at baseline was 82.1% as compared to 20.3% after the intervention, odds ratio-18.02 (95% CI-12.76-25.45; P<0.0001). Sixty-one (14.6%) exchanged sex for gifts in the baseline and 12.4% in the post-intervention. At the baseline, 5.0% used condoms in the last sexual intercourse as compared to 26.0% in the post-intervention; odds ratio - 6.66 (95% CI-4.08-10.88; P<0.0001). Factors associated with condoms use include sex, age, education, duration in the community, marital status, and living with spouses (p<0.01). Conclusion: There was a significant positive impact of a comprehensive intervention programme on the sexual behavior of the workers in the rural community of Rivers State, Nigeria. However, regular interventions in rural communities towards the prevention of spread of STIs and HIV are needed in Nigeria.

Detection of Free-Living Amoebae and Their Intracellular Bacteria in Borehole Water before and after a Ceramic Pot Filter Point-of-Use Intervention in Rural Communities in South Africa.

Free-living amoebae (FLA) are ubiquitous in nature, whereas amoeba-resistant bacteria (ARB) have evolved virulent mechanisms that allow them to resist FLA digestion mechanisms and survive inside the amoeba during hostile environmental conditions. This study assessed the prevalence of FLA and ARB species in borehole water before and after a ceramic point-of-use intervention in rural households. A total of 529 water samples were collected over a five-month period from 82 households. All water samples were subjected to amoebal enrichment, bacterial isolation on selective media, and molecular identification using 16S PCR/sequencing to determine ARB species and 18S rRNA PCR/sequencing to determine FLA species present in the water samples before and after the ceramic pot intervention. Several FLA species including Acanthamoeba spp. and Mycobacterium spp. were isolated. The ceramic pot filter removed many of these microorganisms from the borehole water. However, design flaws could have been responsible for some FLA and ARB detected in the filtered water. FLA and their associated ARB are ubiquitous in borehole water, and some of these species might be potentially harmful and a health risk to vulnerable individuals. There is a need to do more investigations into the health risk of these organisms after point-of-use treatment.

Social Ecology of Hypertension Management Among Latinos Living in the U.S.–Mexico Border Region

While a growing body of research examines individual factors affecting the prevalence and management of hypertension among Latinos, less is known about how socioecological factors operate to determine health and affect implementation of interventions in rural communities. We conducted eight focus groups to assess perceived risks and protective factors associated with managing hypertension among Latino adults and their family members living in two rural/frontier counties in the U.S.-Mexico border region. This analysis is part of a larger study, Corazon por la Vida (Heart for Life), which involved multiple data collection strategies to evaluate the effectiveness of a primary care and a promotora de salud intervention to manage hypertension. Of the 49 focus group participants, 70% were female and 30% were male, 39% were Spanish-only speakers, and 84% had hypertension. Participants' ages ranged between 18 and 75 years, and 63% reported annual incomes below $30,000. Drawing from a social-ecological framework to analyze focus group data, four major themes and subthemes emerged as factors facilitating or inhibiting disease management: (1) individual (emotional burdens, coping mechanisms), (2) social relationships (family as a source of support, family as a source of stress), (3) health system (trust/mistrust, patient-provider communication), and (4) environment (lack of access to safe exercise environment, lack of affordable food). Our findings are relevant to public health practitioners, researchers, and policymakers seeking to shift from individual level or single interventions aimed at improving treatment-modality adherence to multilevel or multiple interventions for rural Latino communities.

Sustainability of a rural volunteer program (Nav-CARE): a case study.

Nav-CARE (Navigation: Connecting, Accessing, Resourcing and Engaging) is an evidence-based program that was implemented over 1 year in a rural community in western Canada. Nav-CARE uses volunteers who are trained in navigation to facilitate access to resources and provide social support to older persons living in the community with serious illness such as cancer, congestive heart failure and chronic obstructive pulmonary disease. Following implementation in which Nav-CARE was found to be feasible, acceptable and have positive outcomes, Nav-CARE was integrated into the local community-based hospice society program. Two years after a successful implementation, it continued to be sustainable in this same rural community. The purpose of this study was to explore the key factors that facilitated the sustainability of Nav-CARE in a rural hospice society. A qualitative single case study design was used with data from several sources collected at different times: (a) pre-implementation, (b) Nav-CARE program implementation (1-year time period), (c) immediately after implementation and (d) 6 months to 2 years after implementation). Data included individual interviews with community stakeholders (n=9), the study volunteer coordinator (n=1), hospice society coordinator (n=1) and Nav-CARE volunteers (n=9). It also included meeting notes of volunteer debriefing sessions and meetings with stakeholders planning for sustainability of Nav-CARE that were held during the 1-year implementation. Data were organized using the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) framework (a well known implementation framework). Data were analyzed using Yin's qualitative case study approach. The findings from this case study suggested that key factors in facilitating sustainability of a rural community intervention (Nav-CARE) were the organizational context (inner context) and facilitation (facilitator and facilitation processes). Additionally, the inner context included the fit of Nav-CARE with the organization's priorities, the absorptive capacity of the organization, and organizational structure and mechanisms to integrate Nav-CARE into current programs. The hospice society was well established and supported by the rural community. The role of the facilitator and the planned facilitation processes (training of volunteer navigators, ongoing support and planning events) were key factors in the sustainability of the Nav-CARE program. The findings found that the formal role of the facilitator in the implementation and sustainability of Nav-CARE in this rural community required skills and knowledge, as well as ongoing mentorship. As well, the facilitation process for Nav-CARE included formal sustainability planning meetings involving stakeholders. Using the i-PARIHS framework and a case study approach, key factors for facilitating sustainability were identified. The role of the facilitator, the facilitation processes and the characteristics of the organizational context were important for the sustainability of Nav-CARE. Future research is needed to understand how to assess and enhance an organization's sustainability capacity and the impact of additional facilitator training and mentoring. This study provides a foundation for future research and adds to the discussion of the issue of sustainability of evidence-based interventions in rural community settings.

Fuentes renovables de energía en comunidades rurales aisladas: una metodología de intervención social.

La presente investigación se propone socializar una metodología de intervención social en comunidades rurales aisladas del sistema eléctrico nacional cubano, para la implementación de soluciones tecnológicas que emplean las fuentes renovables de energía disponibles. La metodología concibe la intervención como una herramienta de gestión para mediar y promover la participación de los diferentes actores y la apropiación social de las tecnologías, en función de la equidad y el autodesarrollo comunitario. También se explicitan los fundamentos teóricos, legales, requerimientos y principios que la sostienen, detallándose los componentes instrumentales que permiten su aplicación, a partir de cuatro etapas de desarrollo, sus objetivos, métodos y procedimientos.

Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review.

Despite widespread promotion of breast and cervical cancer (BCC) screening, uptake remains low in rural communities. Barriers to healthcare, which often result in poorer health outcomes, differentially impact residents of rural communities. Effective interventions addressing the unique needs of rural women may target these barriers and increase BCC screening participation. Our objective is to review and assess the published literature on interventions to increase BCC screening in rural communities. A systematic scoping review of PubMed/Medline was performed to identify BCC screening interventions conducted in rural settings. English language articles from peer-reviewed journals published from January 2006 to October 2019 were included if they reported results for BCC screening interventions in rural communities in the United States. We reviewed 228 articles and identified eight articles consistent with our inclusion criteria. Studies varied in sample population characteristics, geographic location, design, and mode of intervention delivery. Interventions included patient navigation strategies, educational outreach programs, peer counseling, and small media initiatives. Interventions focused on promoting uptake of initial or one-time screening rather than targeted repeat screening, and few studies detailed the cost-effectiveness of the interventions. This review may inform efforts to develop strategies to increase BCC screening among rural women. Additional cancer prevention and control research gaps in rural communities include the examination of the theoretical foundations, design, delivery, and cost-effectiveness of BCC screening interventions for rural communities. Future research might focus on methods to promote repeat BCC screening and effective translation of these interventions for other rural populations.

Tapping into Community Resiliency in Rural Adolescent Pregnancy Prevention: An Implementation Sciences Approach

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resilience-focused adolescent pregnancy prevention intervention in rural communities.

Thinking rural health in Santal community in West Bengal: An interprofessional bottom-up approach to rural health.

An interprofessional and cross-cultural pedagogical project in community health for students in nursing, social work, anthropology and medicine at the end of the bachelor's degree begun in 2014. After a rural context fieldwork in several Santal villages of West Bengal (India), students had to conduct a research project, based on a community-health topic. This paper describes how such a pedagogical project, introducing students to ethnographic research, can initiate new ways of thinking for possible future health interventions in rural communities. An inductive approach based on ethnography was used during the fieldwork, including observations, interviews, focus groups and local documentation. Our observations led to the finding that actions in rural health cannot be initiated without: promoting an interprofessional/interdisciplinary perspective and a culture of complexity and reflectivity; considering local populations in transition and not in a fixed homogenous situation; understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices; considering care itineraries/pathways; and finally being conscious of our apostolic function. Our interprofessional pedagogical project promotes a bottom-up approach in dialogue with a global health vision.

En Nuestra Casa No Hay Chinchorros: A Youth-Oriented, Participatory Approach to Chagas Prevention in Guara, Loja Province, Ecuador

Chagas disease is a neglected tropical disease that disproportionately affects impoverished rural communities. Insecticide-based approaches are inconsistently performed and exorbitantly priced for the communities affected. The present study considers an alternative approach to primary prevention of Chagas disease using entertainment education. As part of an ongoing effort in rural Ecuador, we worked with the children of the community of Guara, national insect control workers, and academicians to co-develop a song to promote behaviors related to preventing Chagas. Through an analysis of the song, we demonstrate opportunities for meaningful intervention in rural communities, as well as challenges to implementing an entertainment education approach when working with national stakeholders.

Collaborating with healthcare providers to understand their perspectives on a hospital-to-home warning signs intervention for rural transitional care: protocol of a multimethod descriptive study

IntroductionThis study builds on our prior research, which identified that older rural patients and families (1) view preparation for detecting and responding to worsening health conditions as their most pressing...

Intersectoral oral health promotion interventions for schoolchildren living in remote rural Andean communities: a realist evaluation.

Intersectoral oral health promotion entails the participation of local communities. IOHP interventions were introduced in Peru in primary schools in 2013 but oral health among schoolchildren living in rural Andean communities remains suboptimal. To understand the contextual elements and the underlying mechanisms associated with intersectoral oral health promotion interventions' current effects on schoolchildren living in remote rural Andean communities. A realist evaluation was carried out in three rural Andean communities where intersectoral oral health promotion interventions aimed at schoolchildren have been implemented. Following an evaluation of the effects among schoolchildren, contextual elements and mechanisms were explored with various stakeholders involved in intersectoral oral health promotion through focus groups and semi-structured interviews. Subsequently, an iterative data analysis and a validation process resulted in the identification of context-mechanism configurations. Previous positive experiences of collaboration, a focus on communication, feelings of being respected and considered, and development of leadership and trust among stakeholders involved in intersectoral oral health promotion were elements of configurations that positively influence intersectoral oral health promotion. On the other hand, unfavorable physical, social and political environments, previous negative health experiences, feelings of not being respected or considered, demotivation, development of mistrust and insufficient leadership were shown to negatively influence outcomes. This research highlights the complexity associated with the deployment of intersectoral oral health promotion interventions in rural communities. Local stakeholders should be further involved to build trust, to facilitate coordination processes among remote rural communities and oral health professionals, and to optimize deployment of intersectoral oral health promotion interventions.

Using Telehealth to Disseminate Primary, Secondary, and Tertiary CVD Interventions to Rural Populations.

This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD). Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages. Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location.

Implementing a Healthcare Provider Education Intervention in Rural Communities to Reduce Asthma Morbidity

Implementing a Healthcare Provider Education Intervention in Rural Communities to Reduce Asthma Morbidity

A Methodological Orientation for Social Learning Based Adaptation Planning: Lessons from Pilot Interventions in Rural Communities of Burkina Faso, Chile and Senegal

Social learning processes have untapped potential to integrate knowledge and experiences across a diverse group of stakeholders, including strengthening a community’s ability to transfer their local knowledge and experiences in dealing with change, to develop locally relevant Climate Change Adaptation (CCA) strategies. This paper evaluates experiences from the application of a CCA planning methodology that leverages social learning as the main approach for local communities to plan and design their CCA strategies in Burkina Faso, Chile and Senegal. In each case, the paper analyses the key features of the emerging social learning processes during the application of the methodology, presents and analyses participants’ feedback and impressions of the process, as well as facilitators’ feedback on the strengths and weaknesses of the methodology. An engaging social learning process was demonstrated through observing varying levels of occurrence of seven features - the pooling of different fields and forms of knowledge amongst the participants; creation of joint language; reshaping of perceptions and preconceptions; transformation of attitudes and patterns of communications; redefining of roles in the learning process; establishment of common values and mutual trust building. The methodology was referred to as being simple, inclusive, helping create ownership and highly interactive, by facilitators who used it. While this research demonstrated the immediate and short-term impacts of social learning to be positive for the CCA planning process, longer term monitoring is needed to fully understand the opportunities and limitations of social learning for CCA planning. In doing so, it is important to recognise the project driven modalities of CCA for rural communities is a limitation in itself in truly benefiting from the long-term benefits of social learning.

Factors associated with syphilis infection: a cross-sectional survey among outpatients in Asikuma Odoben Brakwa District, Ghana

BackgroundSyphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease affects all ages and both sexes but more prevalent among the sexually active age group of 15–49 years. The purpose of the current study was to determine the prevalence and factors associated with syphilis infection among outpatients 15–49 years in the Asikuma Odoben Brakwa District of Ghana where high levels of infection were earlier reported among antenatal women.MethodsA descriptive cross-sectional study was carried out in 13 randomly selected health facilities. Blood samples were collected and tested for syphilis infection and a questionnaire administered to determine factors associated with the disease.ResultsA total 277 patients aged 15–49 years participated in the study. The overall prevalence of syphilis infection was 3.2% (9/277), with 5.7% (6/105) and 1.7% (3/172) among males and females respectively. Significant factors associated with syphilis infection included sub-district of residence, (χ2 (4) = 31.20, p < 0.001) and history of coerced sexual intercourse (χ2 (1) =7.49, p = 0.006).ConclusionsThe prevalence of syphilis infection was high among male patients who lived in rural areas. Having a history of coerced sexual intercourse was a strong predictor for syphilis infection. Access to sexually transmitted infection control interventions in rural communities including health education may help control the disease.