Interventions In Rural Communities Research Articles

Prevalence and correlates of diabetes and metabolic syndrome in a rural indigenous community in Baja California, Mexico

BackgroundDiabetes is a leading cause of morbidity and mortality in Mexico and understudied among indigenous populations. This study aimed to determine the prevalence and identify correlates of Type 2 diabetes mellitus (Type 2 DM) and metabolic syndrome (MetS) in a rural, indigenous community in Northwestern Mexico.MethodsA cross-sectional study was conducted in the community of San Quintin, Baja California, Mexico, among a sample of households. A total of 275 participants (≥18 years old) underwent a questionnaire, physical examination, and serologic test. Prevalence and adjusted odds ratio (AOR), using logistic regression modeling, were estimated with 95% confidence intervals (95% CI).ResultsThe prevalence of Type 2 DM and MetS was 21.8 and 53.1%, respectively. Mean ± standard deviation (SD) age and body mass index of study participants was 35.8 ± 13.0 years and 28.7 ± 5.6 kg/m2, respectively. Participants were 75% female and 60.7% self-identified as indigenous. Thirty-seven percent of adults had high blood pressure. After controlling for age, higher educational attainment had a protective effect on Type 2 DM (AOR = 0.39; 95% CI 0.20, 0.77). Additionally, the presence of MetS was associated with being female (AOR = 2.27; 95% CI 1.23, 4.14) and having lower educational attainment (AOR = 0.62; 95% CI 0.37, 0.94).ConclusionsThe prevalence of Type 2 DM and MetS was high in this rural and indigenous population, and education was shown to play a critical role. These findings support the need for community-inclusive health-promoting interventions in rural communities.

Infrastructure is a necessary but insufficient condition to eliminate inequalities in access to water: Research of a rural community intervention in Northeast Brazil

Given the importance of reducing diverse forms of inequality in access to water, highlighted both in the framework of the Human Right to Water (HRW) and in the Sustainable Development Goals (SDG), this work assesses conditions of access to water and related inequalities before and after the construction of a Water Supply System (WSS) in a rural community of Brazil's semi-arid region. A quasi-experimental study was performed to assess the conditions of access to water for study and control groups (amounting to 380 households). The methodology encompassed two phases, one prior and another subsequent to the construction of a WSS in the study community. The analytical framework of the HRW was applied, specifically the normative content regarding quality, accessibility and availability. The case study's findings help to evidence the limitations and challenges of merely infrastructure-related measures to improve access to water. The construction of a new WSS in the studied community was an improvement as it provided water of good quality to the beneficiary households, which entailed a decreased or even a no-longer-existing need to collect water for children and adolescents. However, certain problems persisted, such as the continued practice of collecting water and the use, by certain families, of water that was fecally contaminated. In a different perspective, the WSS made it possible to increase the per capita volume of water consumed by families and to reduce inequalities associated with this aspect. Meanwhile, the research reveals the possible limits of the WSS in ensuring that higher volumes of water will be consumed per capita, especially among households without intra-household water distribution infrastructure.

Resiliency in burn recovery: a qualitative analysis

ABSTRACTThis phenomenological study engaged an availability sample of eight, long-term, adult burn survivors living a primarily rural burn center catchment area of the U.S. in face-to-face interviews focused on their holistic health since their burn injuries occurred. Criteria for the primary study involved females (n = 1) and males (n = 7) with an age range of 18 to 65 years and a minimum of 20% total body surface area (TBSA) injuries that required hospitalization in a specialized burn center. The mean age of participants at the time of interviews was 54.38 years. Burns ranged between 20% and 98% TBSA and one to 22 years since burn injuries occurred. Thematic data analysis revealed resilient protective factors as contributing to participants’ post-burn health and recoveries. Resilient factors included resourcefulness, achievement motivation, optimism, spirituality, and empathy. Increased understanding of resilient protective factors and how they impacted long-term burn recovery in this sample may aid social workers in development and implementation community-based interventions in rural communities that promote resilience, health/mental health and long-term recovery for this population and others who have experienced trauma.

Assessing Heat-Related Mortality Risks among Rural Populations: A Systematic Review and Meta-Analysis of Epidemiological Evidence.

Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

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.

The Chinese Children and Families Cohort Study: The Nutrition, Physical Activity, and Ultraviolet Radiation Data Collection.

This article reports the study design, methodological issues and early results of a pilot study testing methods for collecting nutrition, physical activity, and ultraviolet (UV) radiation exposure data in a groundbreaking study in China. Epidemiological studies suggest that exposures across the entire life course, including in utero, early childhood, and adolescence, may be important in the etiology of adult cancers and other chronic diseases. The Chinese Children and Families Cohort Study intends to follow-up subjects from the 1993 to 1995 Community Intervention Program of folic acid supplementation for the prevention of neural tube defects. This cohort is unique in that only folic acid exposure during pregnancy varies between groups as other supplements were not available, and there were nutrient deficiencies in the populations. Prior to launching a large-scale follow-up effort, a pilot study was conducted to assess the feasibility of recontacting original study participants to collect extensive diet, physical activity, and UV radiation exposure data in this population. The pilot study included 92 mothers and 184 adolescent children aged 14 to 17 years from 1 urban and 1 rural Community Intervention Program site. Subjects completed a Food Frequency Questionnaire, a 3-day food record, a physical activity questionnaire, a 3-day sun exposure diary together with 3 days of personal UV dosimetry, and 7 days of pedometry measurements and provided blood, saliva, and toenail samples. Grip strength and body composition measurements were taken, and ambient solar UV radiation was monitored in both study sites. While most of the assessments were successful, future studies would likely require different dietary intake instruments. The purpose of this report is to describe the study design and methodological issues emerging from this pilot work relevant for the follow-up of this large birth cohort.

Community health needs assessment: a nurses' global health project in Vietnam.

Global health has been directed to providing solutions to various health issues cross-nations, and nurses have received wide recognition as a key health workforce to reduce health disparities globally. Nurses involved in global health research are required to implement evidence-based global nursing practices based on the assessments of local health needs. To assess health needs and to suggest future interventions in rural communities of Vietnam. A multifaceted rapid participatory appraisal with information pyramid was used applying mixed methods from six sources: existing record review, surveys of community residents, surveys of healthcare providers, focus group discussions with community leaders, informal discussions with governmental health administrators and observations of community health station (CHS) facilities. The majority used the CHSs as primary health facilities with high satisfaction for services currently provided. However, there were needs for the stations to provide more comprehensive services including chronic diseases, and for healthcare providers to improve their competences. Community leaders showed high interest in health information for chronic diseases and strong commitment to involvement in the activities for health of their communities. The findings suggest future interventions in the areas of the enhancement of CHS' functions, human resources and the self-care capacity of community residents. The rapid participatory appraisal approach emphasizing community participation and partnership was a useful tool to compile accurate information about the current needs of the community on health, the preparedness of healthcare services to meet community's demands and about community capacity. This process is fundamental to nurses, who initiate global health projects in resource-limited international countries, to generate evidences regarding practice, research and policy for taking responsibilities in promoting the sustainable development goals.

Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study

BackgroundDespite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities.MethodsOne year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015–April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6–59 months and women aged 15–49 years and IPTp uptake (for women aged 15–49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models.ResultsA total of 2046 participants were included from 1328 households; 56.6% were women aged 15–49 years and 43.4% were children aged 6–59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35–0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years.ConclusionTo achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.

Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South.

Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities.

Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial.

BackgroundResearch suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested “Waupaca Eating Smart ” (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods.MethodsWe conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results.ResultsSeven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period.ConclusionThe intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1469-z) contains supplementary material, which is available to authorized users.

A COPD health management program in a community-based primary care setting: a randomized controlled trial.

A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China. A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular follow-up. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits. After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1-21.9%, and awareness scores for COPD by 57.2% (P < .05 for all). The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.

Empowering the community for early detection of cancer: a rural community intervention programme in Kerala, India

Cancer is an emerging health problem in India. Breast, cervical and oral cancers are curable provided they are detected at an early stage. The best way to fight cancer is early diagnosis and appropriate treatment. Community participation is imperative for achieving and sustaining any progress in this direction. This study aims to show a model community intervention programme for cancer control in low resource settings using trained volunteers from the community through screening and creating public awareness. Community survey covered 5126 houses and 19991 individuals. Awareness classes and screening camps were conducted in all the twenty wards of the Panchayath. Prevalence of cancer and precancerous lesions in the Panchayath were 160 and 263 per 100000 populations respectively. Four new cases of cancer were detected during the programme. Early detection of cancer can be made possible by giving proper training and motivation to community volunteers who can educate, motivate, screen and conduct follow up in the community. Panchayats and NGOs can take a lead role and can take this as model for their cancer screening programmes.

Testing to Prevent Colon Cancer: Results From a Rural Community Intervention

Colon cancer is the second leading cause of cancer death in the United States. Despite tests that can detect and enable removal of precancerous polyps, effectively preventing this disease, screening for colon cancer lags behind other cancer screening. The purpose of this study was to develop and test a community-based participatory approach to increase colon cancer screening. Using a community-based participatory research approach, the High Plains Research Network and their Community Advisory Council developed a multicomponent intervention-Testing to Prevent Colon Cancer-to increase colon cancer screening. A controlled trial compared 9 intervention counties in northeast Colorado with 7 control counties in southeast Colorado. We performed a baseline and postintervention random digit-dial telephone survey and conducted both intent-to-treat and on-treatment analyses. In all, 1,050 community members completed a preintervention questionnaire and 1,048 completed a postintervention questionnaire. During the study period, there was a 5% absolute increase in the proportion of respondents who reported ever having had any test in the intervention region (from 76% to 81%) compared with no increase in the control region (77% at both time points) (P = .22). No significant differences between these groups were found in terms of being up to date generally or on specific tests. The extent of exposure to intervention materials was associated with a significant and cumulative increase in screening. This community-based multicomponent intervention engaged hundreds of community members in wide dissemination aimed at increasing colorectal cancer screening. Although we did not find any statistically significant differences, the findings are consistent with an intervention-related increase in screening and provide preliminary evidence on the effectiveness of such interventions to improve colon cancer screening.

Cost Effectiveness Analysis for Nursing Research

With ever-increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives. The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example. This article provides (a) a description of the main concepts and key steps in CEA and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing-led pain and symptom management intervention in rural communities compared with the current usual care. As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is offset by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when U.S. healthcare is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research.

Barriers Related to Delivering Pediatric Weight Management Interventions to Children and Families From Rural Communities

Rates of obesity are higher for children and adults living in rural areas relative to non-rural settings. As a result, there is an immense need for pediatric weight management programs focused on children and families living in rural areas. However, clinicians and families in rural communities experience numerous barriers when participating in these programs. This article reviews challenges faced during the course of providing family-based weight management interventions as part of the Extension Family Lifestyle Intervention Project (E-FLIP) for kids. Effective and innovative suggestions for future programs are provided for consideration when designing weight management programs for rural pediatric populations. A selected review of the pediatric and adult rural service delivery literature and clinicians' experiences are discussed. Challenges to providing pediatric weight management interventions in rural communities include the lower socioeconomic status of many rural families, unique aspects of rural culture, transportation difficulties, limited access and availability of healthy foods, lack of safe places devoted to physical activity, and time constraints. Strategies to overcome barriers related to providing pediatric weight management services and recommendations for future programs targeting children and families from rural areas are provided.

Limits to State‐Led Nation‐Building? An Eritrean Village Responds Selectively to the Plans of the Eritrean Government

AbstractSince independence in the early 1990s, the east African state of Eritrea has been ruled by a self‐consciously nationalist and modernising authoritarian regime, which seeks to build an Eritrean national consciousness among the country's 3.5 million people via top‐down strategies of intervention in rural communities. These are not limited to the use of cultural interventions intended to revise people's identities. They also take the form of state‐led development strategies, including land nationalisation. In a village in highland Eritrea, the residents oppose some of the projects of the state while adopting parts of the national identity proffered to them by the state. The author argues that this case suggests a new way of thinking about the ways in which national identities and nation‐states are constructed – one that reconsiders the relationship between nationalism and resistance, and between nation‐building elites and communities in resistance.

A rural community intervention targeting biomass combustion sources: effects on air quality and reporting of children's respiratory outcomes

ObjectiveImprovements in urban air quality are largely driven by controls on industrial and mobile source emissions, but such factors may have limited influence on many rural environments where biomass combustion...

Characteristics of Rural Crack and Powder Cocaine Use: Gender and Other Correlates

Background: Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. Objectives: Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. Methods: Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. Findings: Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. Conclusions and Scientific Significance: These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.

Community choices on appropriate adolescent reproductive health referral interventions in rural communities in Mwanza, Tanzania

Community choices on appropriate adolescent reproductive health referral interventions in rural communities in Mwanza, Tanzania

The Future For Rural Social Work In China

Rural social work practice and research is receiving great importance in China because of the need for intervention in rural communities due to the huge social changes taking place in rural China. The three key aspects discussed are the possible paths for rural social work intervention, practice and research of rural social work, and education in rural social work.