Practice In Rural Communities Research Articles

English

BACKGROUND: Poor infant feeding practices and their consequences are one of the world's major problems and a serious obstacle to social and economic development. Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding practices vary among different regions and communities.AIMS AND OBJECTIVES: To assess the knowledge, attitude and practices of infant feeding and, to assess the prevalence of exclusive breastfeeding practices among women in rural area of West Bengal, India.MATERIALS AND METHODS: This cross-sectional study was conducted on mothers of children less than two year of age attending the outpatient department of Malda Medical College and Hospital, a rural medical college in Eastern India. A total of 200 mothers were interviewed who were randomly selected. A structured, pretested and predesigned questionnaire was used to collect information on the socio-demographic profile and infant feeding practice.RESULTS: Mothers of male children were 65% and female children were 35%. 44% were literate upto middle school and 28% with primary education. 14% mothers were illiterate. 52% of mothers had the knowledge about initiation of breast feeding within 1 hour of birth whereas only 28% practiced it. 80% mothers had the knowledge of exclusive breast feeding but only 60% practiced it. 24% of infants had received prelacteal feeds and only 2% breast fed upto 24 months.CONCLUSIONS: Despite higher rates of early initiation of breastfeeding and exclusive breastfeeding, awareness of the benefits of exclusive breastfeeding was low. Creating an awareness of the advantages of breastfeeding will strengthen and support this common practice in rural communities and avoid early introduction of complementary foods for socio-cultural reasons.

One program, multiple training sites: does site of family medicine training influence professional practice location?

Numerous strategies have been suggested to increase recruitment of family physicians to rural communities and smaller regional centers. One approach has been to implement distributed postgraduate education programs where trainees spend substantial time in such communities. The purpose of the current study was to compare the eventual practice location of family physicians who undertook their postgraduate training through a single university but who were based in either metropolitan or distributed, non-metropolitan communities. Since 1998, the Department of Family Practice at the University of British Columbia in Canada has conducted an annual survey of its residents at 2, 5, and 10 years after completion of training. The authors received Ethics Board approval to use this anonymized data to identify personal and educational factors that predict future practice location. The overall response rate was 45%. At 2 years (N=222), residents trained in distributed sites were 15 times more likely to enter practice in rural communities, small towns and regional centers than those who trained in metropolitan teaching centers. This was even more predictive for retention in non-urban practice sites. Among the subgroup of physicians who remained in a single practice location for more than a year preceding the survey, those who trained in smaller sites were 36 times more likely to choose a rural or regional practice setting. While the vast majority of those trained in metropolitan sites chose an urban practice location, a subgroup of those with some rural upbringing were more likely to practice in rural or regional settings. Trainees from distributed sites considered themselves more prepared for practice regardless of ultimate practice location. Participation in a distributed postgraduate family medicine training site is an important predictor of a non-urban practice location. This effect persists for 10 years after completion of training and is independent of other predictors of non-urban practice including gender, rural upbringing, and rural undergraduate training. It is hypothesized that this is due not only to a curriculum that supports preparedness for this type of practice but also to opportunities to develop personal and professional roots in these communities.

Poultry Slaughtering Practices in Rural Communities of Bangladesh and Risk of Avian Influenza Transmission: A Qualitative Study

Slaughtering sick poultry is a risk factor for human infection with highly pathogenic avian influenza and is a common practice in Bangladesh. This paper describes human exposures to poultry during slaughtering process and the customs and rituals influencing these practices in two Bangladeshi rural communities. In 2009, we conducted 30 observations to observe slaughtering practices and 110 in-depth and short interviews and 36 group discussions to explore reasons behind those practices. The villagers reported slaughtering 103 poultry, including 20 sick poultry during 2months. During different stages of slaughtering, humans, the environment, healthy poultry, and other animals were exposed to poultry blood and body parts. Women performed most of the slaughtering tasks, including evisceration. Defeathering required the most time and involved several persons. During festivals, ceremonies, and rituals, many people gathered and participated in the slaughtering of poultry. Exposure to poultry slaughtering created numerous opportunities for potential avian influenza transmission. Strategies that can be further tested to determine if they reduce the risk of transmission include skinning the carcasses of sick poultry, using hot water for defeathering and cleaning, using a bucket to contain slaughtering blood and carcass, burying the offal and encouraging handwashing.

Recruiting Doctors From and for Underserved Groups: Does New Brunswick’s Initiative to Recruit Doctors for Its Linguistic Minority Help Rural Communities?

Within health care, there are underserved groups. New Brunswick's French-speaking minority, which also mostly lives in rural communities, is one such group. A physician shortage potentially prevents this population from accessing health promotion and clinical prevention services. This study analyzes whether New Brunswick Francophone doctors with rural backgrounds are more likely than doctors from urban regions to set up practice in rural communities of the province. A questionnaire was sent to 390 New Brunswick Francophone physicians admitted in medicine between 1973 and 2000. It collected information on geographic origin and history of medical practice. Multivariate logistic regressions were used to identify whether a rural background is associated with the likelihood of ever and currently practicing in rural communities. We used the General Practice Rurality Index-simplified to quantify the rurality level of communities. In total, 264 (67%) physicians participated. A rural background was positively associated with the establishment of a first medical practice in a rural community. This relationship was only significant among family physicians. There was no statistically significant relationship between rurality of community of origin and rurality of current community of practice among either family or specialty physicians. Although Francophone doctors with a rural background were more likely than their urban counterparts to set up their first practice in a rural community, this effect was not sustained. This raises questions as to why they leave rural communities and highlights the importance of measures to retain doctors as a way to promote public health for underserved rural groups.

Family Planning Practices in Rural Community

This study focuses on the various factors that encourage the practice of family planning for rural communities in Malaysia. Family planning program is a modern alternative for married couples in determining the desired number of children in a family in addition to helping women obtain optimal health with birth intervals exist. It is associated in the field of demography which saw control of the birth rate of a family. Key reference data for this study are based on various population and housing census report Malaysia since the 1980s to 2010. This Followed by a field study based on the questionnaire on targeted population. Multivariate Analysis is used to cluster variables to key factors and then evaluated based on the significance of regression analysis as appropriate. The study found that the level of education, understanding husband, and type of work is the most significant factor influencing the practice of family planning. The study found that rural communities have begun to realize its importance but still not be able to receive a variety of modern methods of family planning practice to practice except oral contraceptives. Thus the results of the study provide some suggestions for improving the knowledge society towards good health and fertility potential trend towards the policy proposed by Malaysia's 70 million populations.

Breastfeeding patterns and factors associated with exposure to Sub-optimal breastfeeding practices in rural communities of Arba Minch Zuria, Ethiopia

Breastfeeding patterns and factors associated with exposure to Sub-optimal breastfeeding practices in rural communities of Arba Minch Zuria, Ethiopia

Community’s knowledge, attitudes and practices about tuberculosis in Itang Special District, Gambella Region, South Western Ethiopia

BackgroundTuberculosis (TB) is one of the primary public health problems in developing countries. HIV/AIDS, poverty, undernutrition, over-crowded living conditions and lack of knowledge about the disease have been known to increase the risk of spreading the bacteria and the risk of developing the disease. The objective of this study was to assess the level of TB knowledge, attitudes and practices of rural communities of Itang Special District of the Gambella Regional State of Ethiopia.MethodsBetween November 2011 and January 2012, a community-based cross sectional study was carried out in a randomly selected rural kebeles (i.e. the smallest administrative units) of Itang communities. The study participants were interviewed using pre-tested questionnaire. The overall knowledge, attitudes and practices of the study participants were assessed using the mean score of each outcome as a cut-off value. Having a score above the mean on each of the three target outcomes was equated with having a good level of knowledge, or having favorable attitude and good practices towards TB.ResultsOut of 422 study participants (58.5% males and 41.5% females) only 3.3% mentioned bacteria/germ as a cause of pulmonary TB (PTB) and 9.9% mentioned cough for at least two weeks as the sign of TB. Taking the mean knowledge score as the cut-off value, 57.6% (95% CI: 52.7% to 62.3%) of the study participants had good level of knowledge about TB, 40.8% (95% CI: 36.0% to 45.6%) had favorable attitude towards TB and 45.9% (95% CI: 41.1% to 50.9%) had good practices. Female participants were less likely to have good level of knowledge [adjusted odds ratio (AOR) = 0.33, 95% CI, 0.21 to 0.51, p < 0.001], less likely to have favorable attitude (AOR = 0.23, 95% CI, 0.14 to 0.37) and less likely to have good practices (AOR = 0.37, 95% CI, 0.24 to 0.57, p < 0.001) compared to male participants.ConclusionMajority of the study participants had no correct information about the causative agent of TB and the main symptom of PTB. Moreover, low level of overall knowledge, attitudes and practices about TB was associated with female participants. Hence, TB control strategy in the present study area should include community awareness raising component.

Counseling Professionals in Community Outreach: An Anxiety Support Group for Vietnamese Immigrant Women in Taiwan

Vietnamese immigrant women in Taiwan are at increased risk of anxiety, and community-based group interventions can provide them an accessible form of assistance. Understanding and serving the counseling needs of Vietnamese immigrant women is a new challenge for Taiwan counseling professionals. This study presents the results of outreach efforts by the university counseling staff member offering counseling services for immigrant women in a rural community. A support group is used to address the anxiety among Vietnamese immigrant women. A sample of ten Vietnamese immigrant women participated in the intervention group, and their participation was subjected to quantitative study and analysis using the subscales of the State-Trait Anxiety Inventory (STAI) and the Social Interaction Anxiety Scale (SIAS). Results indicated no significant changes for the STAI-State and the STAI-Trait, but a significant change for the SIAS, suggesting that the social interaction anxiety measures may be the more relevant outcome indicators than the measures of state and trait anxiety in supporting group intervention. Implications are considered for current group intervention practices in rural communities with the aim to help the counseling professionals better understand the practice of group intervention in the context of immigrant women suffering from anxiety.

An Interprofessional Rural Health Education Program

To develop, implement, and assess an interprofessional rural health professions program for pharmacy and medical students. A recruitment and admissions process was developed that targeted students likely to practice in rural areas. Pharmacy students participated alongside medical students in completing the Rural Health Professions program curriculum, which included monthly lecture sessions and assignments, and a capstone clinical requirement in the final year.Assessment. Fourteen pharmacy students and 33 medical students were accepted into the program during the first 2 years of the Rural Health Professions program. Approximately 90% of the rural health professions students were originally from rural areas. The rural health professions program is an interprofessional approach to preparing healthcare providers to practice in rural communities.

Attracting small-town docs a challenge

The federal government of Canada’s plan to forgive student debt for family doctors intending to practise in rural communities will help increase the pool of rural physicians but a larger suite of solutions is required, say educators and rural doctors. Doctors will qualify for up to $8000 per year

Rural dentists: Does growing up in a small community matter?

The aging of the dental work-force has implications for both patients and dentists, especially those in rural and underserved areas. Anecdotal information regarding dental workforce trends indicates that students from rural communities are more likely to practice in rural communities than are students from urban areas. Although the medical literature supports this premise relative to physicians, there are no data to verify this statement relative to dentistry. Therefore, the authors decided to study whether this premise applies to dentistry. The authors conducted a retrospective analysis of dental student records from a Midwestern dental school for the years 1980 through 2010 to determine if there was a statistical correlation between the size of a dental student's town of origin and the size of the community where he or she practiced after graduation. They also examined what role, if any, the student's sex played. Dentists from rural areas were approximately six times more likely to practice in a rural area than were dentists from urban areas. Female dentists were only slightly less likely to practice in a rural community than were male dentists. Dentists from rural communities were more likely to practice in rural communities than were dental students from urban areas. To ensure future access to care in rural communities, rural dentists may want to recruit actively or work closely with dental students from rural areas when hiring associates or seeking purchasers for their dental practices.

Effects of an Interprofessional Rural Rotation on Nursing Student Interest, Perceptions, and Intent

Purpose Rural areas are in critical need of nurses to meet the health needs of their residents. The problem under investigation in this study was whether a semester-long interdisciplinary rural rotation changed nursing students’ interest in rural health, perceptions of their performance of selected nursing skills, and their intention to practice in a rural community. Sample Two hundred forty eight (248) senior level baccalaureate students completed pre- and post-rotation surveys. 53.6% of students reported an increased interest in rural health. Findings Significant differences were found in students’ confidence in aspects of their performance including recognizing cultural differences, community assessment, community participation, meeting the unique needs of rural patients, identifying barriers to care, and identifying the impact of socioeconomic status on health. Students who attended high school in a rural community, expressed increased interest in rural health, and evaluated the rotation favorably were more likely to practice in a rural state after graduation (p < .05). Conclusions The findings have implications for changes in nursing education. A more comprehensive approach to rural health may be needed to attract students to nursing practice in rural communities. Key Words : Rural, Nursing education, Nursing practice, Intention

Infant feeding practices in the rural population of north India.

Background:Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding practices vary among different regions and communities.Objectives:To assess the pattern of infant feeding and its relation to certain practices of maternity and newborn care, and to assess the knowledge of mothers on the advantages of exclusive breastfeeding.Materials and Methods:The cross-sectional study was carried out in randomly selected villages of the Bhojipura Block of Bareilly district, Uttar Pradesh. A total of 123 women who had delivered within the last year were interviewed in a house-to-house survey. A study instrument was used to collect data. Chi- square test and regression analysis were used to analyze the data.Results:Most of the mothers were aged less than 30 years (78.04%) and were Hindus (73.9%). Most were illiterate (69.9%) and belonged to the lower socioeconomic class (97.5%). The majority were housewives (99.1%) and multiparous (68.2%). Most had initiated breastfeeding (78.8%) within 24 hours of delivery. About 15.4% of the infants did not receive colostrum and 22.8% of the infants were not exclusively breastfed. Ghutti (water mixed with honey and herbs), boiled water, tea, and animal milk were commonly used pre-lacteal feeds. About 47.2% of the respondents were not aware of the benefits of exclusive breastfeeding. About one quarter of the mothers started complementary feeding before the child was six months old. About half the deliveries had taken place at home and only a quarter of the females had had three or more antenatal visits during pregnancy. The birth weight of the majority (78%) of newborns was not measured. A majority (69.9%) of the mothers did not receive advice on child feeding. Multivariate logistic regression analysis showed that maternity and newborn care variables had no significant association with exclusive breastfeeding.Conclusions:Despite higher rates of early initiation of breastfeeding and exclusive breastfeeding, awareness of the benefits of exclusive breastfeeding was low. This indicates the need to promote awareness of the correct method of infant feeding and care of the newborn. Creating an awareness of the advantages of exclusive breastfeeding will further strengthen and support this common practice in rural communities and avoid an early introduction to complementary foods for sociocultural reasons.

Rural General Surgery: A Review of the Current Situation and Realities from a Rural Community Practice in Central Nebraska

Purpose: To examine the reasons fewer students and residents are entering general surgery, to educate residents about the realities of rural general surgery based on the experience of three general surgeons in central Nebraska, and to suggest a strategy for individual general surgeons and for residency programs to maintain the rural surgical workforce. Methods: A systematic literature review of surveys, review articles, and editorials through PUBMED was performed. Relevant studies were included in a review of the current literature on the rural general surgery workforce, general surgery residency, fellowship training, and rural surgery education. Findings: There is an insufficient supply of general surgeons in many parts of the country, particularly in rural settings. More general surgery residents are entering into subspecialty fellowship training and fewer are practicing general surgery than in the past. Residents may have inaccurate perceptions about rural general surgery practice. Those residency programs with dedicated rural and community surgery rotations have had more success in producing rural general surgeons. Conclusions: Although specialization in surgery has many positive effects, maintenance of a general surgical workforce in rural America is crucial to the health care of many citizens. Increasing the numbers of mentoring and training programs could provide medical students and general surgery residents with more educational opportunities that may lead to increased interest in rural surgery.

Collaborative Rural Healthcare Network: A Conceptual Model

Healthcare is a critical issue in rural communities throughout the world. Provision of timely and cost effective health care in these communities is a challenge since it is coupled with a lack of adequate infrastructure and manpower support. Twenty percent of the United States of Americaâ??s population resides in rural communities, i.e., 59 million people; however, only nine percent of the nationâ??s physicians practice in rural communities. Shortage of health care personnel and the lack of equipment and facilities often force rural residents to travel long distances to receive needed medical treatment. Researchers and practitioners are in search of solutions to address these unique challenges. In this research, we present a proposed collaborative model of a health information system for rural communities and the challenges and opportunities of this global issue.

Prevalence of psychosocial distress in a rural community oncology practice and impact of interventions.

9114 Background: The prevalence of psychosocial distress in cancer patients in rural areas is not well studied. In our rural community practice a partnership has been developed with an off-site local not-for-profit cancer wellness center. The services offered free at this wellness center are individual counseling, support groups, and wellness services such as yoga and massage. In addition, a diagnosis specific psychoeducational program has been established for patients at the clinic location. Methods: All patients at the outpatient oncology clinic were administered the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and Problems List (PL). Those patients who scored a five or more on the DT were contacted by a social worker at the partnering agency and offered psychosocial intervention. Results: Out of 290 patients, 268 patients completed the DT and PL. The mean distress level of the patients who completed the DT was 4.18. Of the total 268 patients who completed the DT, 46% scored a 5 or greater and were therefore contacted for psychosocial intervention. In relation to patient demographics, results are shown in the table. Only 10% of patients accepted interventions at the off-site wellness center. The reasons many gave for nonacceptance include lack of transportation, psychosocial services were too far, belief that psychosocial intervention is not necessary, and not enough time. More than 60% of a disease specific group attended a psychoeducational group led by physicians, nurses, and social workers held at the clinic location and expressed decrease in the distress level. Conclusions: The prevalence of psychosocial distress in this rural population is greater than that reported from urban/academic outpatient clinics. Rural oncology practices pose a unique challenge in regard to patient distress as barriers to utilizing intervention services exist. In our practcice we plan to expand on on-site cancer specific support groups. Patient demographics DT score ≥ 5 (%) Breast cancer 65 Leukemia, lymphoma, multiple myeloma 39 Lung cancer 46 Gynecologic cancers 42 Colorectal cancers 58 Women (overall) 51 Men (overall) 42 Age 20-39 65 Age 40-59 49 Age 60-79 45 Age 80 + 35

Complementary and Alternative Medicine in Rural Communities: Current Research and Future Directions

CONTEXTS: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings. Research findings are grouped and examined according to 3 key themes: "prevalence of CAM use and practice,""user profile and trends of CAM consumption," and "potential drivers and barriers to CAM use and practice." Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.

Motivations and Barriers for Recruitment of New Emergency Medicine Residency Graduates to Rural Emergency Departments

We sought to understand the motivations and barriers for recruitment of new emergency medicine residency graduates to rural emergency departments (EDs). We used the American Medical Association Physician Masterfile to identify 2006 to 2008 emergency medicine residency graduates and then surveyed everyone currently practicing in rural EDs and a random sample of those practicing in urban EDs. We asked these emergency physicians about the importance of various factors in their choice of practice location. We received responses from 197 (67%) of 296 eligible emergency physicians in 47 states. The factors most often rated as "somewhat" or "very" important in choice of practice location were lifestyle (98%), access to amenities/recreation (95%), ED volume/acuity (93%), and family/spouse (90%). Access to specialists was the biggest difference between groups (very important=20% for rural versus 44% for urban; Δ24%; 95% confidence interval -37% to -11%). More rural emergency physicians spent their entire childhood in rural areas than urban emergency physicians. The changes that would have most influenced urban emergency physicians to practice in rural communities were family/spouse connection (92%), higher salary/signing bonus (90%), and increased access to specialists (90%). Of urban emergency physicians who did not participate in a rural rotation during residency, 44% said they would have, if it had been available. Promising strategies for recruiting new emergency medicine residency graduates to rural EDs are emergency medicine residency selection of individuals with a rural upbringing and higher salaries. Increasing the availability of rural rotations during emergency medicine residency also may help to motivate and prepare some new graduates to practice in rural EDs.

US physician assistant (PA) supply by state and county in 2009

Objective: Understanding the geographic distribution of physician assistants (PAs) can inform health care workforce planning. This study examines PA supply by state and county. Also examined is the relationship between PA supply and level of urbanization as well as state laws governing PA practice. Methods: The addresses of all NCCPA-certified PAs were identified from the AAPA Masterfile and used to estimate PA to population ratios. PA supply in rural and urban communities was analyzed by linking records from the AAPA Masterfile to the 2007 Federal Area Resource File using county identifiers. PA supply was also examined according to the favorability of state laws towards PA practice. Results: State PA supply varies from 0.6 PAs per 10,000 population in Mississippi to 5.6 PAs per 10,000 population in Alaska. Counties with PAs were more likely to be urbanized, whereas those without PAs were more likely to be rural. States identified as “unfavorable” for PA practice were found to have notably lower PA supply compared to other states. Conclusions: Substantial variation exists in the PA-to-population ratio among states, which may be related in part to state practice laws. At a more local level, counties without PAs are more likely to be rural than counties with PAs. The distribution of PAs is likely to remain geographically uneven in the absence of significant policy efforts to attract PAs to practice in rural communities.

Factors and outcomes in primary care physician retention in rural areas

Background: This paper examines factors influencing physicians’ decisions to practise in rural communities as well as the results of a programme focused on rural recruitment and retention. Methods: Data from two sources were analysed and discussed: 1) telephone interviews with 20 of 33 (61%) recently located rural physicians regarding practice and community factors influencing their practice decisions and 2) a database of 107 graduates of a rural medical education programme who have been in practice for at least three years to examine specialty choice and practice location(s), including moves from their original practice sites.Results: Most rural physicians in this study decided to practise in rural areas because of family ties. Eighty per cent of the physicians participating in the interviews mentioned no negative personal or family factors related to their community of practice. Outcome data on graduates from the rural medical education programme are encouraging. Over 70% opt for primary care and rural practice. Over 80% have remained in their original rural practice location. Conclusion: Keys to success in rural physician retention seem to include identifying and recruiting medical students of rural origin and focusing on a healthy practice environment. Policy makers need to work with local government, schools and employers to offer programmes that provide information on health careers in rural areas and begin to identify local youth for induction in rural health care. Keywords: retention; rural; primary care; physicians; workforce