Rural Areas Of Canada Research Articles

The migration decisions of physicians in Canada: The roles of immigrant status and spousal characteristics

Around 25% of practicing physicians in Canada are graduates of medical schools outside of Canada. These physicians are more likely to be working in rural communities, and in particular account for more than half of new physicians starting practice in rural regions. The extent to which particular health regions and provinces are able to retain their physicians is crucial if shortages in the delivery of physician and surgeon services in both the short and longer terms are to be avoided. In this paper, we use data from the confidential master files of the Canadian Census over the years 1991–2006 to study the geographic mobility of immigrant and non-immigrant physicians who are already resident in Canada. We consider both inter- and intra-provincial migration, with a particular focus on migration to and from rural areas of Canada. We exploit the fact that it is possible to link individuals within families in the Census files in order to investigate the impact on the migration decision of the characteristics of a married physician’s spouse. Our results indicate that the magnitude of outflows is substantial and that the retention of immigrant physicians in rural areas and in some provinces will continue to be difficult. We find strong evidence that migration is a family decision, and spousal characteristics (education, age, years in Canada for immigrants) are important. As well, we find that large Canadian cities (mainly in Ontario) are the likely destination for the types of immigrant physicians typically able to be recruited to other areas, implying recruitment efforts of smaller provinces may have significant implications for the size of health care costs in larger provinces.

Examining variations in health within rural Canada

Differences in health between urban and rural areas of Canada are well documented. Canadian rural communities are remarkably heterogeneous in terms of social, economic, and geographic characteristics. There is reason to believe that there is also considerable heterogeneity in health within rural Canada but existing literature has not given this adequate consideration. This article describes heterogeneity in health along the urban-rural continuum, both between and within categories of rural areas. Factors that may explain observed variations are then examined. The study population included all adult (>18 years) respondents on the Canadian Community Health Survey Cycle 1.1, linked to census subdivision-level data from the corresponding Canadian Census. Study areas were classified according to Metropolitan Influenced Zones (MIZ), which group rural areas based on their degree of connectivity with nearby urban areas. Dichotomized Health Utilities Index (HUI) scores were the outcome variable. Random-intercept logistic regression models investigated the associations of HUI with individual and area characteristics. To describe between-area variation in health, the proportion of the total variation accounted for by the area random effect (the intra-class correlation coefficient [ICC]) was estimated. To aid interpretation of the magnitude of the effect of area relative to other variables in the models, the ICC was also expressed as a median odds ratio (MOR), or the median amount by which the probability of disability will change for an individual who moves from one area to another. On a descriptive level, poorer health was observed in more remote rural areas, but the size of estimated effects for categories of rural areas was generally small compared with effects of other individual and area variables, and with the degree of heterogeneity between areas. The composition of rural areas is important in order to understand patterns in health. Individual income, education, and employment, and area characteristics such as Francophone or Aboriginal populations, and migration patterns help explain the gradient in health by MIZ, but considerable heterogeneity in health within categories of MIZ remains. In models stratified by MIZ, significant between-area heterogeneity was observed in all models, with MORs ranging from 1.18 to 1.53. It was observed that heterogeneity in health among rural areas is substantial, and generally larger than the effect of rurality, itself, on health. More attention is needed to understand the characteristics of Canada's heterogeneous rural communities, and the different processes by which disparities in health emerge and persist. The findings suggest that a focus on rurality alone, emphasizing urban versus rural disparities, or even continuum-based approaches like MIZ, may be less informative than finding ways to classify and examine different types of rural areas according to factors relevant to health.

Transitioning a master’s of nursing course from campus to on-line delivery: Lessons learned

Distance education continues to expand in nursing programs to service students in urban as well as rural areas in Canada. This article discusses the author's experience with transitioning a master's course in nursing from a traditional seminar format with 7-8 students to one that included distance students joining the classroom in real-time. The course, 'Nursing in Tertiary Health Care' which covers the fall and winter semesters addresses issues and concepts associated with advanced practice nursing for clients of all ages in tertiary care settings. The associated practicum selected by the student with the assistance of the faculty member provides an opportunity to examine the five domains of the Clinical Nurse Specialist role (consultation, education, research, leadership and practice) as one example of advanced practice nursing. The author has taught this course for 12 years in a traditional seminar format. During 2006-2007, a synchronous on-line version of this course was also offered whereby distance students joined the classroom at the same time as the other students in house at the university. This was done using personal computers from home or office, and a bridging program called 'Bridgit'. Lessons learned in making this transition will be discussed.

Developing Capacity for Large-Scale Rainwater Harvesting in Canada

Abstract Rainwater harvesting (RWH) is the ancient practice of capturing rainwater from impervious surfaces and storing it for future use. Harvesting roof runoff for domestic purposes has historically been prevalent in rural areas of Canada and the practice is currently experiencing revived interest and uptake in the urban environment. When implemented on a wide scale, RWH can contribute to both stormwater abatement and water conservation, serving to relieve pressure on existing infrastructure and potentially delay the need for infrastructure expansion. While such benefits are known, there remain several barriers that impede widespread implementation. These include cost, liability concerns, and a lack of clear policy for RWH. This paper outlines the benefits of RWH and describes findings of recent research that has attempted to develop some of the technical, administrative, and market capacity needed to overcome these barriers, focussing on water quality, design practices, economic analysis, and policy development.

A Secure Mobile Multimedia System to Assist Emergency Response Teams

Long wait times after injury and greater distances to travel between accident scenes and medical facilities contribute to increased, possibly unnecessary deaths. This paper describes a mobile emergency system aimed at reducing mortality by improving the readiness of hospital personnel, therefore allowing for more efficient treatment procedures to be performed when the victim arrives. The system is designed to provide a secure transmission of voice, medical data, and video in real-time over third-generation cellular networks. Test results obtained on a commercial network under real-life conditions demonstrate the ability to effectively transmit medical data over 3G networks, making them a viable option available to healthcare professionals.

Facilitation strategies to improve the use of evidence in integrated stroke care

Purpose: Research evidence has identified practices across the care continuum which can improve the chronic condition of stroke; however, challenges remain to implementing this evidence. The two research projects presented evaluated whether facilitation can increase evidence-informed stroke care. Theory: The Promoting Action on Research Implementation in Health Services framework was used to design and evaluate the facilitation strategies. Methods: Project one evaluated the effect of a knowledge network, centralised around a knowledge broker, on increasing the awareness and application of evidence across the health care system. Project two used an interactive workshop to help family practitioners contextualise best practice recommendations for the secondary prevention of stroke. The research projects were conducted in primarily rural areas of Canada, and used mixed methods for evaluation. Results and Conclusions: The results indicate that the knowledge brokerynetwork intervention effectively increased the awareness of evidence, and stimulated improvements in stroke care through increased communication networks. The workshop increased practitioner knowledge and support for health system changes necessary for integrated stroke care. The evaluation identified healthsystem barriers which affect implementation. Discussion: These findings identify the need and methods for improving communication, which if implemented can reduce health system barriers to improving integrated stroke care.

Generalizability of the emotional intelligence construct: A cross-cultural study of North American aboriginal youth

The concept of emotional intelligence (EI) has attracted growing interest from researchers working in various fields. Because culture can influence the experience and expression of emotions, special care needs to be taken when using the EI construct in different cultures. The present study examined the generalizability of the youth form of a widely used self-report measure of EI (EQ-i:YV) in a sample of 384 aboriginal youth from several rural areas in Canada (mean age = 12.5 years). This sample was matched (by age and gender) with a second rural Canadian sample of non-aboriginal youth ( N = 384). The four-factor model for the measure (separate dimensions for interpersonal, intrapersonal, adaptability, and stress management abilities) was tested using confirmatory factor analysis with both samples. Multiple goodness-of-fit indicators revealed that the model had good fit to the data from both samples. The aboriginal respondents were found to score significantly lower on the interpersonal, adaptability and stress management dimensions compared to the non-aboriginal children. Results are discussed in the context of EI as a vulnerability factor for a number of health-related problems in children and adolescents.

Canada Must Make Broadband Infrastructure a Priority

This article argues that just as universal access to traditional communications media, such as the post office and the telephone, is considered an essential service, so also should access to high-speed Internet, particularly in areas that currently lack the infrastructure to make this possible. This paper illustrates the need for high-speed Internet connectivity, or broadband access, in remote and rural areas of Canada. The article outlines the rationale for establishing high-speed access throughout Canada and provides an overview of infrastructure implementation barriers faced by the private and public sectors. It concludes with a discussion of the ways in which community-based networks could play a role in the strategic planning, implementation, and application of broadband infrastructure.

Making best use of every healthcare provider's knowledge and skills.

In "Organizing Primary Care for an Integrated System" Rosser and Kasperski propose changing the way family physicians practice to address deficiencies in the current primary-care delivery system in Canada. These deficiencies include a growing shortage of physicians, particularly in rural areas of Canada; the growing dependence of Canadians on acute hospital emergency units or "walk- in clinics" for primary care; fragmentation and unnecessary duplication in the delivery of primary-care services; lack of understanding on the part of the community and hospital sectors of the role of the family-practice physician; a fee-for-service funding model that does not reward prevention and health-promotion initiatives by physicians and makes high-problem visits the most lucrative; and lack of clarity with regard to what the public should expect from their physicians.

Teaching in a Canadian Rural School: a taste of culture shock

Abstract A teacher shortage is anticipated in the rural areas of Canada over the next decade. Until the early eighties, most rural school districts experienced a high mobility of teaching staff. Decreasing demand for teachers, declining student enrolments and tighter government fiscal policies for several years changed traditional patterns of professional employment and mobility. This paper examines the professional life of a rural teacher in British Columbia, Canada, provides a description of who teaches in a rural school and offers insights as to why many teachers do not remain in rural communities. A new personalised rural teacher preparation programme, developed by professional collaboration, is described briefly, and the importance of training in assisting teachers overcome culture shock is discussed. The conclusion emphasises that unless new teachers are adequately trained and socialised for a professional life in a rural community, traditional patterns of professional mobility will once again becom...

A rural integrated distribution trial with fiber optics

The author discusses applying fiber optic technology in two remote towns. Current efforts by Canadian telephone companies are aimed at ther eduction of multiparty line loads to a maximum of four customers per rural line. The telephone companies providing service to rural areas of Canada share a common problem, that of economics. Recognizing this fact, studies have been undertaken to come up with solutions. The outcome of these studies indicatetsh at the increasedv alue of new rural services integrated on a common carrier system would greatly reduce the present economic barriers. These studies also led to the Department of Communications (DOC) and the Canadian Telecommunication Carriers Association (CTCA) jointly sponsoring the Elie-St. Eustache Fiber Optic Technology Trial.

Regional Planning For Depressed Rural Areas —The Canadian Experience1

Attempts are being made to improve the level of living of people in depressed rural areas in Canada. The most significant institutional efforts are those by the Agricultural and Rural Development Administration's comprehensive planning programs. A description is given of the problem confronted both from an economic development and practical planning viewpoint. The evolving federal program including general research procedures are discussed along with the specific area programs that are being developed and implemented.