Non-metropolitan Locations Research Articles

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

IntroductionHealth workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions.MethodsResponses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software.ResultsThe core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions.ConclusionsThe study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

QuickStats: Percentage* of Adults Aged ≥18 Years Who Walked ≥10 Minutes as a Method of Transportation,† by Location of Residence§ - National Health Interview Survey, United States, 2005, 2010, and 2015¶.

Overall, the percentage of adults aged ≥18 years that walked as a method of transportation increased from 29.4% in 2005 to 32.5% in 2015. A similar pattern was observed for adults residing in metropolitan locations (31.2% to 34.1%) but there was no change for those residing in nonmetropolitan locations (22.4% to 22.2%). Regardless of year, adults residing in metropolitan locations were more likely to have walked as a method of transportation than were adults residing in nonmetropolitan locations.

Between Ooru, Area, and Pettai: The Terms of the Local in Tamil Cinema of the Twenty-First Century

This article focuses on films that star the young Tamil cinema actor Dhanush and that are set in Madurai and surrounding nonmetropolitan locations in the state of Tamil Nadu. Through these films, the article examines the construct of the area or the pettai as a production of the local in the age of so-called globalization, and what implications this formation has for an understanding of the relationship between cinema and space in the context of Tamil films produced in the first decade of the twenty-first century. This construct of the pettai is viewed through questions on regionality, globalization, mobility, and gender, in an effort to understand the contemporariness of these films.

Urban/Rural disparities in Oregon pediatric traumatic brain injury.

BackgroundTraumatic brain injury (TBI) greatly contributes to morbidity and mortality in the pediatric population. We examined potential urban/rural disparities in mortality amongst Oregon pediatric patients with TBI treated in trauma hospitals.MethodsWe conducted a retrospective study of children ages 0–19 using the Oregon Trauma Registry for years 2009–2012. Geographic location of injury was classified using the National Center for Health Statistics Urban/Rural Classification Scheme. Incidence rates were calculated using Census data for denominators. Associations between urban/rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.ResultsOf 2794 pediatric patients with TBI, 46.6 % were injured in large metropolitan locations, 24.8 % in medium/small metropolitan locations, and 28.6 % in non-metropolitan (rural) locations. Children with rural locations of injury had a greater annualized TBI incidence rate, at 107/100,000 children per year, than those from large metropolitan areas (71/100,000 per year). Compared to children injured in urban locations, those in rural locations had more than twice the crude odds of mortality (odds ratio [OR], 2.5; 95 % CI, 1.6–4.0). This association remained significant (OR, 1.8; 95 % CI, 1.04–3.3) while adjusting for age, gender, race, insurance status, injury severity, and type of TBI (blunt vs. penetrating).ConclusionWe observed higher rates of TBI and greater proportions of severe injury in rural compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for demographic and injury factors associated with urban/rural residence. Further research is needed to examine treatment disparities by urban/rural location. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0063-2) contains supplementary material, which is available to authorized users.

Where are the overseas graduates staying on? Overseas graduate migration and rural attachment in Australia

In order to tackle persistent labour and skill shortages, a number of developed countries have implemented visa programmes and development plans to enhance the attraction and retention of domestically educated overseas graduates. While prior work has principally focused on exploring their migratory flows between countries, few studies have empirically examined the career and migration trajectories of overseas graduates within the country of study. This paper redresses this gap by investigating the spatial choices of overseas graduates from Australian Higher Education Institutions for employment after graduation. Drawing on a nationally representative survey of graduates, our analysis focuses on examining the individual characteristics that lead to the settlement of overseas graduates in non-metropolitan locations across Australia given the pronounced labour and skill shortages experienced outside the country's urban centres. Results highlight the importance of possessing education or health qualifications and having previously studied and lived in non-metropolitan areas as the key factors underlying the selection of such locales as post-graduation employment destinations. Age, gender, salary, and an English-speaking background were not found to be significant factors in the decision to locate outside of metropolitan areas. These findings are of significant value for future policy development aimed at attracting and retaining overseas graduates to locales with the greatest labour needs.

Positive impacts on rural and regional workforce from the first seven cohorts of James Cook University medical graduates

The regionally-based James Cook University (JCU) School of Medicine aims to meet its mission to address the health needs of the region by combining selection and curriculum strategies shown to increase rural career recruitment outcomes. The School has graduated 536 students in its first seven cohorts from 2005 to 2011. This paper presents the early career practice locations and the specialty training undertaken by these cohorts, and describes the association between later practice location with both hometown at application and internship location. Hometown at application' data for JCU Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates was retrieved from administrative databases held by the university, while postgraduate location and career data were obtained either from personal contact via email, telephone, Facebook or electronically from the Australian Health Practitioner Regulation Authority website. Practice location was described across Australian Standard Geographical Classification Remoteness Area (RA) categories. Data for the primary practice location of 536 JCU MBBS graduates across postgraduate years (PGY) 1 to 7 is 99% complete. A total of 65% of JCU graduates undertook their internship in non-metropolitan locations including 20% in RA 2 and 44% in RA 3-5, a pattern of practice different to that of other Australian clinicians. For the internship year, 'non-metropolitan-origin' JCU MBBS graduates predominantly worked in RA 2-5 locations, while 'metropolitan origin' graduates were more likely to work in major cities. However, by PGY 7, the distribution of 'rural' and 'metropolitan' origin JCU graduates across RA categories was similar. The RA category of internship location - either 'metropolitan (RA 1) or 'non-metropolitan' (RA 2-5) - was associated with the location of subsequent practice across PGY 2-7. This comprehensive data set provides the first real evidence from one of Australia's new medical schools on actual postgraduate practice location, as compared to 'intent to practice'. The geographic profile by RA of JCU graduates' hometown and patterns of postgraduate practice is different to that of other Australian medical students and doctors. This early evidence supports the JCU model of distributed non-metropolitan medical education, and suggests more regionally-located internship and specialty training places would further increase the medical workforce in northern and/or rural Australia. The workforce impact of the seven cohorts of graduates in this study is starting to be felt in rural and regional Australia, and, if these trends continue, will result in significant workforce improvements over the next decade. These results support further investment in regional and rural medical education.

Rural and Remote Area Service Provision for People Aging With Intellectual Disability

AbstractIn recent years, a combination of factors has seen life expectancies for people with intellectual disabilities increase dramatically. The majority of research so far has focused upon metropolitan areas, but little information is available regarding the impact of this relatively new phenomenon within rural localities. The authors examine the issues surrounding aging with an intellectual disability within rural areas and identify possible areas of change to policy and practice that may better support the individual living in nonmetropolitan locations. A three‐round Delphi research model was utilized over a period of 12 months to examine the views of disability support workers from rural organizations regarding issues associated with aging. This study detailed a large number of items rated as important by direct care staff. A thematic analysis identified specific areas of concern including funding, training challenges and options, and access to relevant generic and specialist services. The findings of this study have implications for the delivery of rural services and training of staff. The results point to the need for changes to initial training and professional development options to support staff to work successfully with people with intellectual disabilities who are aging in rural areas.

Improving numeracy education in rural schools: a professional development approach

In Australia, concerns about the quality of mathematics education that students experience are particularly salient in rural schools. These schools typically report great difficulty in attracting and retaining qualified teachers of mathematics. Teachers in non-metropolitan locations may also experience professional isolation if they have limited access to professional development opportunities. This article reports on a year-long research and development project that provided such opportunities to teachers in ten rural and metropolitan schools in South Australia. Its purpose was to help the teachers plan and implement numeracy strategies across the school curriculum. The project was informed by a new model of numeracy whose elements comprise mathematical knowledge, dispositions, tools, contexts, and a critical orientation to the use of mathematics. To investigate the effectiveness of the numeracy model and the professional development approach, data were collected via lesson observations, teacher and student interviews, and written tasks that tracked changes over time in teachers’ understanding of numeracy. Most teachers began the project with a concern for improving students’ mathematical knowledge or dispositions, but then gradually incorporated other elements of the model into their planning and practice. A case study of an early career teacher in a rural school illustrates one developmental trajectory through the elements of the model. Teachers identified time, openness, collegiality, and accountability as features of the professional development approach that contributed to its effectiveness. Implications for sustainability and scaling up are discussed, especially with reference to supporting teachers in rural schools.

Professional supervision for allied health practitioners working in non-metropolitan health care settings: A comprehensive systematic review.

Review objective/question The review objectives are to synthesize the best available evidence on the experiences and effects of professional supervision on allied health clinician practice and client outcomes across rural and remote health settings. Specifically, the review questions are: 1. What are the experiences of professional supervision for allied health professionals working in non-metropolitan settings? 2. What are the effects of professional supervision on allied health practitioner practice and clients outcomes in non-metropolitan locations? Types of participants Both qualitative and quantitative components of this review will consider all research studies that include allied health professionals including Audiology, Clinical Measurement Sciences, Dietetics and Nutrition, Exercise Physiology, Medical Radiations Professions, Occupational Therapy, Orthoptics, Pharmacy, Physiotherapy, Podiatry, Prosthetics and Orthotics, Physiotherapy, Podiatry, Psychology, Social Work and Speech Pathology in all health care settings (private practice, community health and hospital settings) working in regional, rural or remote locations. Defining what constitutes regional, rural and remote (non-metropolitan) within a world wide context is difficult, hence for this review regional, rural and remote practice will be defined as working in geographical or professional isolation. This may include any studies undertaken outside metropolitan areas or where participants are identified as working professionally isolated, for example being the only physiotherapist in a specific location. Exclusion criteria - Students who are not employed as an allied health professional (e.g. allied health, medical and nursing students on clinical placements will be excluded) - Medical clinicians - Nursing clinicians - Health workers (other than allied health) - Allied Health Assistants Phenomena of interest/Types of intervention(s) The focus of both qualitative and quantitative components of the review is professional supervision. For this review professional supervision is defined as “a working alliance between two or more professional members in which the aim is to achieve a range of goals that can be broadly categorised into themes relating to (a) organisational/administrative functions, (b) clinical practice, and (c) provision of personal support to the employee”. This review will include all styles of professionals supervision such as face-to-face, telephone, videoconference or online to both individuals and groups. TRUNCATED AT 350 WORDS

More than ‘making do’: Rethinking cinema attendance in regional and rural Australia

ABSTRACTCinema is one of the most popular forms of cultural entertainment in contemporary rural Australia, yet very little is understood about film circulation, presentation and consumption in non-metropolitan locations. Despite a growing interest in the situation of rural cinema by film historians, scholars have been slow to engage with the detail and meaning of its more recent past. The preoccupation with the connections between cinema and contemporary modernity have tended to over-estimate the significance of the metropolitan and to obscure the diversity and richness of cinema-going practice in Australia. Drawing on analysis of national box office data and material from a microstudy conducted in the rural town of Merimbula on the far south coast of New South Wales, this article seeks to contribute to addressing this gap. It considers three key questions—Who is watching films at the cinema in rural Australia? Why are they watching? And what do these acts of consumption mean?

Innovations in a pre-service teacher education programme

Recent graduates of pre-service education completed a written questionnaire on teaching practices in mathematics, Information and Communications Technology (ICT) and science; professional development needs; and teaching locations. The graduates were implementing innovations in teaching, including integration of ICT into student learning. Surprising findings that emerged for teachers in metropolitan compared to non-metropolitan locations were the influence of the school on practices, lack of time in non-metropolitan locations for professional development and the degree of diversity in student ages and grade levels being taught. Teacher education, while fostering the development of innovative practices, therefore needs to address broader educational factors involving student diversity and school culture.

Pulling the coat: postcolonial performativity in Black British women's drama

This paper analyzes black British women's drama produced during the 1980s and 1990s to understand the transformations in black lesbian politics through these decades. It explores the intersections between queer cultures and postcolonialism as a political theory and ideology that thinks of colonialism as an encounter with specific material, linguistic and cultural effects on the colonizing and colonized populations. Using Audre Lorde's idea of the ‘progress’ and ‘future’ of black women's politics, I outline a critical model described in this paper as ‘postcolonial performativity’. This model, I argue, allows us to look at representations of black sexualities in literature, culture and society in relation to concerns of class, vocabularies of sexualities, place of origin and belonging. A close reading of works by black British women playwrights, Jackie Kay, Jacqueline Rudet and Valerie-Mason John, indicates that the plays serve as instances of public pedagogy, thereby transforming the cultural project into an activist one of ensuring racial and sexual justice. The paper concludes by suggesting black British women's drama draws upon the intersection of sexuality, race, and class based justice and it can serve as a model not only for the assertion of black sexualities in Britain as a postcolonial metropolis but also non-metropolitan postcolonial locations in Africa, Asia and the Caribbean, the metaphorical ‘homes’ of black diasporic populations.

Functional specialization across space: a case study of the Canadian Electricity Industry, 1971–2001

This article examines the location of functions within the electricity sector in Canada from 1971 to 2001, using a centre‐periphery model. Power generation, distribution and retailing are generally carried out by multiestablishment crown corporations. Location patterns of different functions—management, scientific, production, etc.—are analyzed via the use of occupational groups. The spatial distribution of functions is found to be generally consistent with centre‐periphery relationships, with evidence of a growing functional specialization between large metropolitan and nonmetropolitan locations. However, differences emerge depending on power generation sources: fossil fuels, hydro, nuclear, solar or biomass. The choice of a power generation source has consequences for local economies.

Local amenities and life-cycle migration: Do people move for jobs or fun?

Do households move for jobs or fun, and where do they go when they move? We address these questions using the 1970–2000 US Census. Based on a panel of quality of life and business environment measures, households prefer MSAs in warm coastal areas and non-metropolitan locations, while firms prefer large, growing cities. In addition, cities with improving business environments acquire increasing shares of workers, especially workers with high levels of human capital; cities with improving consumer amenities become relatively more populated by retirees. Further analysis of individual level migration decisions indicates that regardless of marital status, young, highly educated households tend to move towards places with higher quality business environments. This tendency is especially pronounced among highly educated couples who are more subject to job market co-location problems. In contrast, regardless of education, couples near retirement tend to move away from places with favorable business environments and towards places with highly valued consumer amenities. These patterns help explain why areas unattractive to both households and business have struggled, as with upstate New York, while the sun-belt and other regions are thriving.

Benefits and challenges of providing transitional rehabilitation services to people with spinal cord injury from regional, rural and remote locations

To identify the factors influencing participation and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations. Grounded Theory analysis of service records and policy documents. One transitional rehabilitation service for people with SCI. Service records of 40 individuals with SCI from non-metropolitan locations who participated in transitional rehabilitation and 29 individuals with SCI who declined transitional rehabilitation over a two-year period. Home-based transitional rehabilitation programs offered by a multidisciplinary team including physiotherapy, occupational therapy, nursing and social work. Participation was measured using the percentage of people from non-metropolitan locations who decline transitional rehabilitation. The benefits and challenges of transitional rehabilitation were identified using open, axial and selective coding of service records. People with SCI from non-metropolitan areas were underrepresented among transitional rehabilitation participants, with 69% of those declining transitional rehabilitation coming from regional or rural areas. The study identified five functions of transitional rehabilitation that presented both benefits and challenges of this model in assisting people from non-metropolitan locations. These included: (1) the identification, education, coordination and funding of local care providers; (2) family involvement in rehabilitation; (3) contact with social and community supports; (4) specialist support to problem-solve discharge needs; and (5) skill acquisition and transfer in a community environment. The transitional rehabilitation model offers many advantages over traditional hospital-based rehabilitation but still faces challenges in offering an equitable model for people with SCI from non-metropolitan locations.

Differences in Beneficiary Assessments of Health Care between TRICARE Prime and TRICARE Prime Remote

We examined differences in health care ratings and reported health care experiences for active duty uniform services personnel using health care plans other than military treatment facilities. We used a cross-sectional mail survey of a stratified sample of 3,871 beneficiaries enrolled in TRICARE Prime (TP) and TRICARE Prime Remote (TPR). The adjusted plan mean composite and global ratings were compared between TP and TPR participants. There were few significant differences between the two groups. Patient satisfaction was higher when patients chose their providers (TPR), and use of some preventive services was higher in managed-care plans (TP). Respondents in metropolitan locations differed significantly from those in nonmetropolitan locations in ratings of plans, quality of health care received, and access to services. The military health system is achieving some success in delivering uniform benefits but faces challenges in delivering high-quality uniform benefits in rural communities.

The First Graduate Cohort at Charles Sturt University: What Impact on the Rural Pharmacist Shortage?

Objective: This paper reports a descriptive study of the first cohort of graduates from a non‐metropolitan university. The objective was to elucidate students' future practice intentions.Methods: A questionnaire was developed and administered to students in their second and third year of study in the Bachelor of Pharmacy course offered at Charles Sturt University. An abridged version of the questionnaire was administered to final year students the following year as part of an ongoing research activity.Results: Whilst still in the early years of their course, students indicated a strong preference for a rural, community site for their pre‐registration year. By the end of 2000, 62% of all graduates, and 88% of female graduates, had accepted preregistration training placements in non‐metropolitan locations. The pre‐registration practice location for one in six of this first cohort was a hospital pharmacy, an increase from the 10% who declared in the 1999 survey that they were intending to do their pre‐registration year in a hospital.Conclusion: The vast majority of students who complete their undergraduate training at a non‐metropolitan university express the desire to practise in non‐metropolitan sites during their studies. After graduation, this intention is confirmed by choice of practice location.

City-Suburban, Metro-Nonmetro, and Regional Differences in the Housing Quality of U.S. Elderly Households

This article uses data from the 1987 American Housing Survey (AHS) to assess in what U.S. locations elderly (age 60 and over) households are more at risk of occupying physically deficient housing. Metropolitan and nonmetropolitan locations are distinguished by their settlement type (city, suburban, and rural) and regional contexts. The AHS data consisted of a sample of 12,859 age 60 and older householders representing a statistical population of 26,318,348 American households. Within metropolitan areas, central cities had the highest rate of physical deficiencies whereas the urban suburbs suffered from the lowest prevalence rates. Elderly households living in nonmetropolitan rural areas, and in the rural parts of metropolitan areas, had the highest housing deficiency rates in the country. These national comparisons were misleading, however, to the extent that they primarily reflected the poor housing conditions found in only one or two regions of the country, particularly the South.

Rural Women in a Restructuring Economy: Work and Commuting in Eastern Iowa

Rural women's labor-force participation rates have increased rapidly over the past decade and a half, simultaneous with economic restructuring in both metropolitan and nonmetropolitan areas. This article examines women's labor-force participation and returns to employment within four nonmetropolitan counties in eastern Iowa, contiguous with three metropolitan areas. The job structures and job rewards of women employed in four industry groups in metropolitan and nonmetropolitan job locations are compared in the context of the constraints posed by commuting costs. Also examined are findings about the nature and extent of nonmetropolitan women's labor-force participation in the context of the employment restructuring trends in the metropolitan and nonmetropolitan portions of the study area.

Paths to Ownership of Small Businesses Among Immigrants in Israeli Cities and Towns

This paper examines the role of location and ethnicity in paths to entrepreneurship among immigrants in Israel. focusing on differences between immigrants of Eastern (Middle Eastern and North African) and Western (European and American) origin, and between metropolitan and nonmetropolitan locations. Analysis is based on census data for cohorts of immigrants defined by age and year of immigration and on a survey of blue-collar and distribution small businesses. The combination of a population of Eastern origin and peripheral location created the most restricted paths to entrepreneurship. These paths were characterized by a high dependency on kinship and social networks for advancement through blue-collar and distribution self-employment opportunities in locations where such opportunities and supportive networks were least available.