Practice In Rural Communities Research Articles

The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities.

The opioid epidemic in the United States continues to disproportionately affect those in rural, compared to urban, areas due to a variety of treatment and recovery barriers. One mechanism to increase capacity of rural-serving providers is through delivery of training and technical assistance (TTA) for evidence-based programs by leveraging the Cooperative Extension System. Guided by the Interactive Systems Framework, the current study evaluates TTA delivered by the Northwest Rural Opioid Technical Assistance Collabroative to opioid prevention, treatment, and recovery providers on short- (satisfaction, anticipated benefit), medium-, (behavioral intention to change current practice), and long-term goals (changes toward adoption of evidence-based practices). We also evaluated differences in short- and medium-term goals by intensity of TTA event and rurality of provider. Surveys of 351 providers who received TTA indicated high levels of satisfaction with TTA events attended, expressed strong agreement that they would benefit from the event, intended to make a professional practice change, and preparation toward implementing changes. Compared to urban-based providers, rural providers reported higher intention to use TTA information to change current practice. We conclude with a review of remaining gaps in the research to practice pipeline and recommendations for moving forward.

For the rural curious: mixed methods evaluation of a rural pharmacy practice elective

BackgroundAs of 2020, 20% of people residing in the United States of America (U.S.) lived in rural communities. Despite rural residents tending to be older, poorer, and having greater disease burden than their urban counterparts, the number of rural primary care providers continues to decline. Nearly 66% of U.S. Primary Care Health Professional Shortage Areas are designated as rural. Pharmacists can help address this shortage of rural primary care providers, often serving as providers of first-contact care; however, only 12% of U.S. pharmacists practice in rural communities. To help address this gap, in 2022 an elective Rural Pharmacy course was created at the University of Minnesota College of Pharmacy by a faculty member who has rural practice experience.MethodsThe course combines formal lectures, guest presentations by rural pharmacists and student interviews with additional rural pharmacists. For the 42 students enrolled in the course in 2022 and 2023, non-parametric statistics were used to compare the percentage of students who were raised in rural communities or who otherwise had extensive exposure to rural, and compare student interest ratings (1 to 7) about practicing/living rural at the beginning and end of the course. Students also wrote end-of-course reflection papers, commenting on the course and their interviews with rural pharmacists.ResultsAcross both years, 45% of the enrolled students had previous experience in rural communities. The net change in Rural Interest scores among students completing both questionnaires was + 5 in 2022 and + 2 in 2023, both non-significant differences. The largest shifts in student interest were from “Not Sure” at the start of the course to “Interested” or “Not Interested” at the end of the course, and from “Interested” to “Very Interested.” In their reflection papers nearly 60% of students reported being most impressed by their interviews with rural pharmacists.ConclusionsA course addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students. Even students who have little interest in living in a rural community can benefit from being introduced to rural culture, enabling them to provide more culturally-responsive care for patients from rural communities.

Abstract PO1-08-04: Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making

Abstract Background: Prior work from our group has shown a high rate of familial breast cancer (BC) among rural BC patients (pts), with 33% reporting > 1 first-degree family members with BC and 55% meeting NCCN germline genetic testing (GGT) criteria (Shelton CH et al. NC Med. J; 2022). In 2018, we increased GGT to include all BC pts and observed: 1) many pts were out-of-criteria per NCCN guidelines but had actionable pathogenic germline variants (PGVs) and 2) knowledge of GGT factored significantly into shared decision making by providers and patients, including for positive and negative results. Beginning in 2019, concurrent with the recommendation from the American Society of Breast Surgeons, we expanded this model of universal GGT to an IRB-approved study to measure the impact of prospective testing on shared decision-making. Herein we report the real-world implementation of universal GGT for patients with BC and genetics-informed treatment decision-making in a rural community practice. Methods: From 2019-2022 all BC pts at a small, rural community hospital were offered GGT. Demographics, clinical features, and GGT results were collected along with clinician-reported clinical recommendations for treatment based on GGT results. Descriptive statistics and two-tailed Fisher’s exact test were employed and significance was set at p< 0.05. Results: 210 BC pts were offered GGT and 192 (91%) underwent testing [97% female, 95% non-Hispanic White, mean age at diagnosis of 62, 75% Stage I], with all but 7 pts completing GGT before primary treatment decisions. 104 (54%) of patients were in-criteria (IC) and 88 (46%) out-of-criteria (OOC) with NCCN GGT guidelines. PGVs were identified in 25 pts (13%) and 15 genes, most commonly BRCA1/2 (5 pts), PALB2 (3), monoallelic MUTYH (3) and ATM, BARD1, CHEK2 (2 pts each). PGV frequencies were 15% in IC and 11% in OOC patients (p=0.495). 46 (24%) pts had only a variant of uncertain significance (VUS) results. 70% of patients had > 1 clinical management change based on their GGT results. Changes in breast surgery, uptake of risk-reducing bilateral salpingo-oophorectomy, surveillance and clinical follow-up were significantly higher in patients with PGV compared to those with VUS/negative results (p < 0.0001). Compared to those with negative results, patients with PGVs in BRCA1 and BRCA2 were significantly more likely to undergo bilateral mastectomy (BLM) while those with PGVs in other genes or with VUS were not significantly more likely to elect for BLM than those with negative results. Clinicians reported that return of GGT reinforced their recommendation for 73/138 (53%) of patients who underwent breast-conserving therapy. GGT results aided in radiation therapy strategy for 54% of pts, most often resulting in dose de-escalation (accelerated fractionation) for negative/VUS pts (Table). Conclusions: Universal GGT for patients with BC was successfully implemented in a rural community practice with >90% uptake. Treatment was enhanced in those with clinically actionable PGVs and de-escalated in those without PGVs. Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making Changes in Radiation Therapy Strategy based on GGT Citation Format: Charles Shelton, Sarah Nielsen, Antonio Ruiz, Lauren Shelton, Karen Freas, Sarah Poll, Brandie Heald, Daniel Pineda-Alvarez, Edward Esplin, Rachel Ellsworth, Hannah Montgomery. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-04.

Knowledge, Attitudes, and Practices of Rural Communities Regarding Antimicrobial Resistance and Climate Change in Adadle District, Somali Region, Ethiopia: A Mixed-Methods Study.

There is an urgent need for interventions in addressing the rapid and disproportionate impact of antimicrobial resistance (AMR) and climate change (CC) on low- and middle-income countries. Within this context, it is important to understand indigenous knowledge in rural communities, which are highly affected. This study examined knowledge, attitude, and practices (KAP) regarding AMR and CC in the Adadle district, Somali region, Ethiopia, utilizing mixed methods, including 362 surveys and 12 focus group discussions among rural communities. Findings showed that 39% and 63% of participants were familiar with AMR and CC, respectively. Of those surveyed, 57% attributed AMR to inappropriate antimicrobial use in animals and humans, while CC was often associated with Allah/God. Multivariable analysis indicated that males exhibited superior knowledge and a positive attitude towards AMR and CC. Additionally, individuals aged 26-35 and 36-45 years showed heightened awareness of AMR and CC, respectively. Moreover, participants who were government employees, pastoralists, and business owners showed better knowledge on CC compared to family caretaker. Religious education and households with more than six members were linked to lower AMR knowledge. This study underlines a greater awareness of CC than AMR and highlights gender-based disparities, recommending integrated educational AMR programs targeting different demographics through a One Health lens, actively involving females, and incorporating local beliefs and practices.

Abstract P302: The Mississippi Rural Community Listening Project

Background: The Appalachia and Mississippi Delta regions have the lowest life expectancy in the United States. In response, Alabama, Mississippi, Kentucky, and Louisiana were selected for The Risks Underlying Rural Areas Longitudinal (RURAL) Study. The RURAL study is an observational population-based study focused on these at-risk communities in the rural south. During the planning phase, investigators identified the need to incorporate insights from the community in the proposal. Therefore, they initiated the “Rural Community Listening Project” in the four states to seek community members’ points of view on outreach research in their communities. The objectives of this research were to hear from members of the communities their concerns and ideas about health research, approaches that would promote their willingness to participate, and their willingness to have blood drawn and x-rays taken as a part of the research process. Method: Mississippi investigators conducted four focus group interviews with 10-12 participants in each focus group. They interviewed a total of 45 men and women between the ages of 35 to 65 in county-specific focus groups. The groups represented four rural Mississippi Counties: LeFlore, Oktibbeha, Panola, and Tishomingo. The investigators digitally recorded the interviews and had them transcribed, then analyzed the transcripts using thematic analysis. Results: Two themes arose: (1) Encouragement to Participate and (2) Barriers to Participation. Encouragement to Participate included (1) having trusted community stakeholders involved, (2) helping the community, (3) promoting one’s health, and (4) receiving feedback on one’s health. Barriers included lack of trust, time, location, and transportation. Overall, the focus group interviewees had not participated in health research but would be willing to do so. Participants had little to no experience in doing health surveys or tracking their health information using mobile or electronic devices but did not raise objections to doing so. Word-of-mouth, social media, newspaper, telephone, cell phone, and mail were recommended as modes of communicating with their communities. “Relevance to the individual” arose as a more prominent encourager than monetary incentives. Focus group interviewees reported trusting doctors, nurses, and health care providers in their respective communities to collect health information. Conclusion: The in-common barriers to participation in research were time, transportation, and location. Across all focus groups, trust emerged as a requisite for research participation. The model of listening to the community’s experiences, concerns, and recommendations can potentially inform future research practices in rural communities and changes to related state and/or local policies.

Oral hygiene practices and associated factors among rural communities in northwest Ethiopia

BackgroundPoor oral hygiene affects the overall health and quality of life. However, the oral hygiene practice in rural communities and contributing factors are not well documented. Accordingly, this study was conducted to assess oral hygiene practices and associated factors among rural communities in northwest Ethiopia.MethodsA cross-sectional study was conducted among 1190 households. Data were collected using a structured and pretested questionnaire, prepared based on a review of relevant literature. The questionnaire comprises socio-demographic information, access to health and hygiene messages, oral hygiene practices, and water quality. We assessed oral hygiene practices with these criteria: mouth wash with clean water in every morning, mouth wash with clean water after eating, brushing teeth regularly, and avoiding gum pricking. Gum pricking in this study is defined as sticking needles or wires into gums to make the gums black for beauty. Multivariable logistic regression was used to identify factors associated with oral hygiene practices. Significant associations were declared on the basis of adjusted odds ratio with 95% confidence interval and p-values < 0.05.ResultsResults showed that all the family members usually washed their mouth with clean water in everyday morning and after eating in 65.2% and 49.6% of the households, respectively. Furthermore, 29.9% of the households reported that all the family members regularly brushed their teeth using toothbrush sticks and one or more of the family members in 14.5% of the households had gum pricking. Overall, 42.9% (95% CI: 39.9, 45.6%) of the households had good oral hygiene practices. Health and/or hygiene education was associated with good oral hygiene practices in the area (AOR: 1.66, 95% CI: 1.26, 2.21).ConclusionMore than half of the households had poor oral hygiene practices in the area and cleaning of teeth with toothpastes is not practiced in the area, where as gum pricking is practiced in more than one-tenth of the households. The local health department needs provide community-level oral health education/interventions, such as washing mouth with clean water at least twice a day, teeth brushing using indigenous methods such as toothbrush sticks or modern methods such as toothpastes, and avoiding gum pricking to promote oral health.

Trypanocide usage in the cattle belt of southwestern Uganda.

Systematic infrastructure and regulatory weaknesses over many decades, in communities struggling with animal African trypanosomiasis (AAT) would be expected to create an environment that would promote drug misuse and risk development of drug resistance. Here, we explore rural community practices of livestock keepers, livestock extension officers and drug shop attendants to determine whether appropriate practice was being followed in administration of trypanocides and other drugs. A questionnaire-based survey was undertaken in southwestern Uganda in 2022 involving 451 farmers who kept cattle, sheep or goats and 79 "professionals" who were either livestock extension officers or drug shop attendants. Respondents reported using one or more type of trypanocidal drug on 80.1% of the 451 farms in the last 30 days. Diminazene aceturate was used on around three-quarters of farms, while isometamidium chloride was used on around one-fifth. Homidium bromide was used on less than 1% of farms. Cattle were significantly more likely to be treated with trypanocides than sheep or goats. On around two-thirds of farms, trypanocides were prepared and injected by farmers, with extension officers administering these drugs on most of the other third, especially on cattle farms. Almost all drugs were obtained from privately-owned drug shops. For treatment of AAT with trypanocides, prescription-only medicines were routinely used by farmers without professional supervision and in the absence of a definitive diagnosis. While a far greater proportion of professionals had a better education and had received training on the use of trypanocides than farmers, there was relatively little difference in their ability to use these drugs correctly. Farmers were more likely than professionals to use only DA to treat trypanosomiasis and were more likely to use antibiotics as well as trypanocidal drugs to treat the animal. Furthermore, they estimated, on average, that twice the recommended dose of either diminazene aceturate or isometamidium chloride was needed to treat a hypothetical 400 kg bovine. A minority of both farmers and professionals reported that they observed the recommended withdrawal times following injection of trypanocidal drugs and very few of either group knew the recommended withdrawal times for milk or meat. Only one in six farmers reported using the sanative pair (alternating use of diminazene aceturate and isometamidium chloride), to reduce the risk of drug resistant trypanosome strains emerging, while this approach was more widely used by professionals. Farmers reported using antibiotics more commonly than the professionals, especially in sheep and goats, raising concerns as to overuse and misuse of this critical class of drugs. In addition to using trypanocides, most farmers also reported using a topical veterinary pesticide for the control of ticks and tsetse. On average, farmers spent 12.2% of their income from livestock sales on trypanocides. This study highlights the complexity of issues involved in the fight against AAT using drug treatment. A multistakeholder campaign to increase awareness among farmers, drug shop attendants, and extension workers of the importance of adherence to recommended drug dosing, using the sanative pair and following recommended drug withdrawal guidance would promote best practice, reduce the risk of emergence of resistant strains of trypanosomes, and support enhanced food safety.

Constraints Inhibiting Farmers’ Adoption of Cattle Feedlots as a Climate-Smart Practice in Rural Communities of the Eastern Cape, South Africa: An In-Depth Examination

The adoption of climate-smart agricultural practices is crucial for enhancing resilience to climate change in rural communities, particularly in developing regions like the Eastern Cape, South Africa. This study provides an in-depth examination of the factors constraining farmers’ adoption of cattle feedlots as a climate-smart practice in the rural communities of the Eastern Cape. The research aims to identify the barriers and challenges that hinder the widespread adoption of cattle feedlots and understand the underlying factors contributing to the farmers’ decision-making processes. The study employed a mixed-methods approach, including surveys and interviews, to gather data from 250 farmers in rural communities of the Eastern Cape. The data were analyzed using regression analysis and thematic analysis to identify the key constraints inhibiting the adoption of cattle feedlots as a climate-smart strategy. The findings revealed several significant constraints that farmers faced in adopting cattle feedlots. Financial limitations, including limited access to credit and lack of financial resources, emerged as critical barriers. Infrastructure and resource constraints, such as inadequate water supply and electricity, hindered adoption. Knowledge and skills gaps, cultural and social factors, market limitations, and environmental considerations further contributed to the constraints experienced by farmers. To address these constraints, the study proposes interventions to promote the adoption of cattle feedlots as a climate-smart practice. These interventions include improving access to affordable financing options, providing capacity-building programs on feedlot management and climate-smart practices, disseminating information on feedlot benefits and best practices, developing the necessary infrastructure, strengthening market linkages, and creating a supportive policy environment. However, it is important to note the study’s limitations, such as the small sample size and the cross-sectional nature of the data, which may limit the generalizability of the findings. Further research is needed to validate and expand upon these findings in a broader context. Overall, this study provides valuable insights into the factors constraining farmers’ adoption of cattle feedlots as a climate-smart practice in the rural communities of the Eastern Cape, South Africa.

A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial.

Māori are the Indigenous people of Aotearoa (New Zealand). Despite global acceptance that cervical cancer is almost entirely preventable through vaccination and screening, wāhine Māori (Māori women) are more likely to have cervical cancer and 2.5 times more likely to die from it than non-Māori women. Rural Māori residents diagnosed with cervical cancer have worse outcomes than urban residents. Living in rural Aotearoa means experiencing barriers to appropriate and timely health care, resulting from distance, the lack of community resourcing, and low prioritization of rural needs by the health system and government. These barriers are compounded by the current screening processes and referral pathways that create delays at each step. Screening for high-risk human papillomavirus (hrHPV) and point-of-care (POC) testing are scientific advances used globally to prevent cervical cancer. This study aims to compare acceptability, feasibility, timeliness, referral to, and attendance for colposcopy following hrHPV detection between a community-controlled pathway and standard care. This is a cluster randomized crossover trial, with 2 primary care practices (study sites) as clusters. Each site was randomized to implement either pathway 1 or 2, with crossover occurring at 15 months. Pathway 1 (community-controlled pathway) comprises HPV self-testing, 1-hour POC results, face-to-face information, support, and immediate referral to colposcopy for women with a positive test result. Pathway 2 (standard care) comprises HPV self-testing, laboratory analysis, usual results giving, information, support, and standard referral pathways for women with a positive test result. The primary outcome is the proportion of women with hrHPV-positive results having a colposcopy within 20 working days of the HPV test (national performance indicator). Qualitative research will analyze successes and challenges of both pathways from the perspectives of governance groups, clinical staff, women, and their family. This information will directly inform the new National Cervical Screening Program. In the first 15-month period, 743 eligible HPV self-tests were performed: 370 in pathway 1 with POC testing and 373 in pathway 2 with laboratory testing. The positivity rate for hrHPV was 7.3% (54/743). Data collection for the second period, qualitative interviews, and analyses are ongoing. This Māori-centered study combines quantitative and qualitative research to compare 2 clinical pathways from detection of hrHPV to colposcopy. This protocol draws on rural community practices strengths, successfully engaging Māori from a whānau ora (family wellness) approach including kanohi ki te kanohi (face-to-face), kaiāwhina (nonclinical community health workers), and multiple venues for interventions. It will inform the theory and practice of rural models of the use of innovative technology, addressing Māori cervical cancer inequities and facilitating Māori wellness. The findings are anticipated to be applicable to other Indigenous and rural people in high-income countries. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000553875; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000553875. DERR1-10.2196/51643.

Determinants of rainwater harvesting practices in rural communities of Limpopo Province, South Africa

ABSTRACT Most rural parts of South Africa’s Limpopo Province are faced with limited water access, provision, and inadequate infrastructure for water reticulation. With over 80% of the provincial population living in rural areas, water availability for domestic and agricultural use has become a source of concern. Rainwater harvesting (RWH) has emerged as an important source of alternative water supply for underserved communities during the summer rainfall season. RWH refers to the collection, storage and conservation of surface runoff for agricultural production and domestic uses. This study assessed the socio-economic characteristics and determinants of RWH practices in rural communities of Limpopo Province. Descriptive statistics were used to describe households’ socio-economic characteristics and logistic regression was used to examine the determinants of RWH practices in rural communities. The analysis was based on a survey of 478 households selected using convenience and purposive sampling techniques. The key findings indicate that a significant number of households (63.8%) practised RWH to augment available water for domestic use, albeit few households used the harvested water for portable use. Further analysis showed that a majority of those who adopted RWH practices were female (64.24%). The results of the empirical models indicate that there is a statistically significant positive relationship between perception, age and level of education in determining the adoption of RWH practices. The findings underline the importance of understanding the adoption of RWH in rural communities and highlight the vital role of education, knowledge, and income in rural communities with limited or no access to a water supply. The study highlights the need for policy to promote the benefits of harvesting rainwater for domestic use.

Territory Identity and Ritual Life of Religious Spaces in Urbanized Communities: A Case Study of Jiangsu

The rapid urbanization in China has had a profound impact on religious practices of rural communities, but few study has explored the relevant dynamics. This study provides an overview of urbanization’s impact on rural religious spaces, and compares the changes of religious spaces before and after urbanization. It aims at improving the understanding of religion in urbanized communities. Phenomenological methods were employed to analyze our transcriptions of 16 interviews which were conducted in the religious spaces of 11 urbanized communities in Jiangsu, China. We also investigated the worship circle mentioned by the participants through field surveys and map analysis. Based on these, four similar themes were sorted out, namely, worship circle and environment, aging and feminizing agents, ritual and secular life, as well as religious well-being. And the results showed that: (1) passive change of worship circles would bring new sense of belonging and identity to elderly residents; (2) the new religious spaces contained a lot of local knowledge and traditional characteristics, which were evolving continuously with sites sacredness maintenance and secularization function expansion; (3) female agents were of great importance to religious spaces preservation.

Nutrition Sensitive Agriculture Practices in Rural Communities of Nalgonda District, India

Nutrition-Sensitive Agriculture (NSA) is important for rural communities as it promotes the production of diverse, nutrient-rich crops and helps to improve food security, reduce malnutrition, and promote better health outcomes. It also helps to increase the incomes of smallholder farmers and enhance their resilience to climate change and other external shocks.&#x0D; The study indicated that the majority of respondents are between the ages of 20 to 40 (59.50%), have a low level of education (51.70% are illiterate), come from joint families (56.10%), and have an annual income between Rs.50,000-1,50,000 (72.78%).&#x0D; The study provides information on the nutrition and agricultural practices of the respondents. It shows that a high proportion of respondents practice kitchen/nutrition gardening (85.56%) and grow vegetables in their garden (85.56%). Leafy vegetables (51.67%) and fruits (57.22%) are the most commonly grown crops. However, practices such as integrated farming systems (4.44%), the Nutri thali concept (0.00%), and organic farming (7.22%) are not widely adopted.&#x0D; The aim of the study was to know the nutrition sensitive agriculture practices followed by small and marginal women in Nalgonda district of Telangana state. In this study a total number of 180 respondents were selected for the study.&#x0D; This study was an attempt to as there is a need to put attention on the educational aspects by stimulating the small and marginal women farmers and the families of rural communities by adopting farming practices that promote the production and consumption of diverse and nutrient-rich crops, rural farmers can also improve their own nutrition as well as that of their communities.

Local‐level water conservation and management practices in rural communities: A case study in Dormaa Municipality, Bono Region, Ghana

AbstractStudies on water conservation strategies and local approaches to water resource management among rural people in Ghana and sub‐Saharan Africa are scarce. This study examined water conservation and management practices among rural communities in Dormaa Municipality. We adopted a concurrent mixed‐method approach using both quantitative and qualitative methods. The quantitative and qualitative data were analysed using SPSS and ATLAS.ti, respectively. Binary logistic regression was used to predict the factors associated with the conservation of improved sources of water and reliability of water management by Ghana Water Company Limited (GWCL). The findings show that 84.4% of the respondents conserve improved sources of water, and 83.6% do not rely on the management of water by the GWCL. Binary logistic regression shows that education, household size and income were significantly associated with the conservation of improved sources of water, while age, marital status and ownership of a house were associated with the reliability of water management by GWCL. Some of the challenges encountered in water management are the unavailability of persons committed to the management of boreholes and the non‐payment of electricity bills. The study recommends policy intervention in technical and material support for effective water conservation and management in rural communities.

Sustainable urban development in Latin America

This paper shows the results of a documentary exploration of sustainable development in Latin America. The Latin American region is characterized by having holistic environmental policies, but it is also integrated and seeks to balance economic growth, social inclusion, and environmental preservation. For this work, different reliable sources have been analyzed to know the Latin American trends around the subject and specify the strategies that must be addressed to achieve the expected results. In this sense, a program is proposed that aims to strengthen environmental awareness and promote sustainable urban planning practices in rural communities in Latin America. The main results show that environmental education empowers local communities to become agents of change and adopt sustainable measures in natural resource management, agriculture, energy, and environmental conservation.

Seeing malaria through the eyes of affected communities: using photovoice to document local knowledge on zoonotic malaria causation and prevention practices among rural communities exposed to Plasmodium knowlesi malaria in Northern Borneo Island

BackgroundMany rural communities in Malaysian Borneo and Southeast Asia are at risk of Plasmodium knowlesi malaria. Multiple factors contribute to infection, however, a deep understanding of illness causation and prevention practices among at-risk communities remains limited. This study aims to document local knowledge on malaria causation and preventive practices of rural communities in Sabah, Malaysia, using photovoice—a participatory research method.MethodsFrom January to June 2022, a photovoice study was conducted with rural communities in Matunggong subdistrict, Malaysia, to explore their experiences with and local knowledge of non-human primate malaria and prevention practices. The study included (1) an introductory phase in which participants were introduced to the photovoice method; (2) a documentation phase in which participants captured and narrated photos from their communities; (3) a discussion phase in which participants discussed photos and relevant topics through a series of three focus group discussions (FGDs) per village; and (4) a dissemination phase where selected photos were shared with key stakeholders through a photo exhibition. A purposively selected sample of 26 participants (adults > 18 years old, male, and female) from four villages participated in all phases of the study. The study activities were conducted in Sabah Malay dialect. Participants and the research team contributed to data review and analyses.ResultsRural communities in Sabah, Malaysia possess local knowledge that attributes non-human primate malaria to natural factors related to the presence of mosquitoes that bite humans and which carry “kuman-malaria” or malaria parasite. Participants revealed various preventive practises ranging from traditional practises, including burning dried leaves and using plants that produce foul odours, to non-traditional approaches such as aerosols and mosquito repellents. By engaging with researchers and policymakers, the participants or termed as co-researchers in this study, showcased their ability to learn and appreciate new knowledge and perspectives and valued the opportunity to share their voices with policymakers. The study successfully fostered a balance of power dynamics between the co-researchers, research team members and policymakers.ConclusionThere were no misconceptions about malaria causation among study participants. The insights from study participants are relevant because of their living experience with the non-human malaria. It is critical to incorporate rural community perspectives in designing locally effective and feasible malaria interventions in rural Sabah, Malaysia. Future research can consider adapting the photovoice methodology for further research with the community toward building locally tailored-malaria strategies.

Socioecological practices and community resilience strategies for sustainable agriculture in lower Sin&amp;uacute;, Colombia

This research examines the socioecological practices of rural communities as an epistemological foundation to configure community resilience strategies and face socio-environmental conflicts due to limited access to water, loss of biodiversity and ancestral knowledge. To meet this objective, a qualitative approach was used with a non-experimental transectional research design of exploratory type with a case study method in the Association of Producers for Community Development of the Cienaga del Bajo Sin&amp;uacute;-ASPROCIG, Colombia. As a main result, it is argued that the rural communities of the lower Sin&amp;uacute; organized in associations carry out self-management models that promote the articulation of social and ecological systems, socio-environmental sustainability and make an adequate management of use and access to ecosystem services.

Severity of illness and risk of mortality in Mayo Clinic’s virtual hybrid advanced care at home program: a retrospective cohort study

BackgroundIn July 2020, Mayo Clinic launched Advanced Care at Home (ACH), a high-acuity virtual hybrid hospital-at-home model (HaH) of care at Mayo Clinic Florida and Northwest Wisconsin, an urban destination medical center and a rural community practice respectively. This study aims to describe demographic characteristics of ACH patients as well as their acuity of illness using severity of illness (SOI) and risk of mortality (ROM), to illustrate the complexity of patients in the program, taking into account the different diagnostic related groups.MethodsMayo Clinic uses All Patient Refined-Diagnosis Related Groups (APR-DRG) to calculate SOI and ROM on hospitalized patients. APR-DRG data, including SOI and ROM, were gathered from individual chart reviews from July 6, 2020, to March 31, 2022.Results Out of 923 patients discharged from ACH, the average APR-DRG SOI was 2.89 (SD 0.81) and ROM was 2.73. (SD 0.92). Mean age was 70.88 (SD 14.46) years, 54.6% were male patients and the average length of stay was 4.10 days. The most frequent diagnosis was COVID-19 infection with 162 patients (17.6%), followed by heart failure exacerbation (12.7%) and septicemia (10.9%). The 30-day readmission rate after discharge from ACH was 11.2% (n = 103) and the 30-day mortality rate was 1.8% (n = 17). There were no in-program patient deaths.ConclusionsSOI and ROM from patients at the ACH program have been shown to be in the range of “moderate/major” according to the APR-DRG classification. The ACH program is capable of accepting and managing highly complex patients that require advanced therapeutic means. Furthermore, the ACH program has an in-program mortality rate of 0 to date. Therefore, ACH is rising as a capable alternative to the brick-and-mortar hospital.

Pneumonitis Following Diesel Oil Siphonage: A Case Series

Abstract&#x0D; Manual siphoning of diesel with mouth from automobiles is common practice in rural communities. Thispractice can be hazardous leading to ingestion and aspiration of diesel leading to chemical pneumonitis. Herewe present two cases of chemical pneumonitis following siphonage of diesel managed with steroids andrecovered completely.

Access to basic drinking water services, safe water storage, and household water treatment practice in rural communities of northwest Ethiopia

Protecting water from cross contamination at source and point of use is an important strategy to improve water quality. However, water safety measures at the source and point of use may not be implemented in the rural communities. This community-based cross-sectional study was, therefore, conducted among 1190 randomly selected households in a rural setting of northwest Ethiopia to assess access to basic drinking water services, safe water storage, and household water treatment practices. Water service level was determined using JMP criteria and practices that prevent cross contamination of water at point of use were used to determine safe water storage. Results showed that 23.0% of the households had access to basic water services; 37.0% practiced safe water storage; and 15.4% practiced one or more household water treatment methods. Public taps (54.5%) and protected spring (25.1%) were the common water sources to rural communities in northwest Ethiopia. Boiling (43.2%), chlorination or water guard (26.8%), and plain sedimentation (23.0%) were among the household water treatment methods commonly practiced in the area. In conclusion, rural households in the studied region has low access to basic water services. Safe water storage practice was also low in the area and household water treatment is not commonly practiced.

A qualitative study on rural residents’ everyday-life information practices and the roles of rural libraries

The purpose of this study is to explore people’s information practices in rural communities and their uses of libraries in everyday life. A qualitative approach with individual interviews was conducted. In the interviews, the researchers worked with participants to draw two information maps to explore their ways of interacting with information. One map was Savolainen’s Information Source Horizons Map, and the other map was the Information Trust Map that the researchers created similar to the horizon map. Preliminary findings revealed themes on sources and attitudes toward information depending on situations, ranging from not caring about information sources in monitoring everyday life information to verifying sources for schoolwork or health-related situations. Findings also showed participants commonly perceived libraries as book repositories, and compared libraries with Google in terms of information providers. Factors influencing people’s trust in information were also identified, for example, whether or not online platforms afforded two-way communications. Additionally, a comparison between the Source Horizon Map and the Information Trust Map showed those sources that were frequently used were often the ones that were least trusted. This study is currently work-in-progress, with the plan of conducting additional interviews. This study will contribute to the gap in the literature on small and rural libraries. The findings of this study will have practical implications for developing public library services and programs in rural communities.