Rural Areas Of Scotland Research Articles

Supporting school nurses to deliver emotional and mental health interventions: a service evaluation

School nurses often encounter children and young people with emotional and mental health needs and therefore need to be able to manage potentially distressing situations. A service evaluation explored the experiences and perceptions of a small school nursing team of the support they receive to deliver emotional and mental health interventions. Three school nurses and one child and adolescent mental health services (CAMHS) practitioner, all working in a remote and rural area of Scotland, took part in individual semi-structured interviews.Peer support emerged as the most important facilitator but participants lacked time to access it. Training was identified as another crucial source of support, but again time for it was lacking. Moreover, limited access to further support services for children and young people, and a lack of recognition and understanding of participants’ role by others, made it more challenging for participants to deliver emotional and mental health interventions. School nurses could be better supported in that aspect of their role by ensuring they have time for reflection and learning; by enhancing the training, tools and resources available to them; and by improving their professional recognition within and outside the NHS.

RuralCovidLife: A new resource for the impact of the pandemic on rural Scotland.

RuralCovidLife is part of Generation Scotland's CovidLife project, investigating the impact of the COVID-19 pandemic and mitigation measures on people in Scotland. The RuralCovidLife project focuses on Scotland's rural communities, and how they have been impacted by the pandemic. During survey development, Generation Scotland consulted with people living or working in rural communities, and collaborated with a patient and public involvement and engagement (PPIE) group composed of rural community leaders. Through this consultation work, the RuralCovidLife survey was developed to assess the issues most pertinent to people in rural communities, such as mental health, employment, transport, connectivity, and local communities. Between 14th October and 30th November 2020, 3,365 participants from rural areas in Scotland took part in the survey. Participant ages ranged from 16 to 96 (mean = 58.4, standard deviation [SD] = 13.3), and the majority of the participants were female (70.5%). Over half (51.3%) had taken part in the original CovidLife survey. RuralCovidLife includes a subsample (n = 523) of participants from the Generation Scotland cohort. Pre-pandemic data on health and lifestyle, as well as biological samples, are available for these participants. These participants' data can also be linked to past and future healthcare records, allowing analysis of retrospective and prospective health outcomes. Like Generation Scotland, RuralCovidLife is designed as a resource for researchers. RuralCovidLife data, as well as the linked Generation Scotland data, is available for use by external researchers following approval from the Generation Scotland Access Committee. RuralCovidLife can be used to investigate mental health, well-being, and behaviour in participants living in rural areas during the COVID-19 pandemic, as well as comparisons with non-rural samples. Moreover, the sub-sample with full Generation Scotland data and linkage can be used to investigate the long-term health consequences of the COVID-19 pandemic in rural communities.

RuralCovidLife: Study protocol and description of the data

RuralCovidLife is part of Generation Scotland’s CovidLife project, investigating the impact of the COVID-19 pandemic and mitigation measures on people in Scotland. The RuralCovidLife project focuses on Scotland’s rural communities, and how they have been impacted by the pandemic. During survey development, Generation Scotland consulted with people living or working in rural communities, and collaborated with a patient and public involvement and engagement (PPIE) group composed of rural community leaders. Through this consultation work, the RuralCovidLife survey was developed to assess the issues most pertinent to people in rural communities, such as mental health, employment, transport, connectivity, and local communities. Between 14th October and 30th November 2020, 3,365 participants from rural areas in Scotland took part in the survey. Participant ages ranged from 16 to 96 (mean = 58.4, standard deviation [SD] = 13.3), and the majority of the participants were female (70.5%). Over half (51.3%) had taken part in the original CovidLife survey. RuralCovidLife includes a subsample (n = 523) of participants from the Generation Scotland cohort. Pre-pandemic data on health and lifestyle, as well as biological samples, are available for these participants. These participants’ data can also be linked to past and future healthcare records, allowing analysis of retrospective and prospective health outcomes. Like Generation Scotland, RuralCovidLife is designed as a resource for researchers. RuralCovidLife data, as well as the linked Generation Scotland data, is available for use by external researchers following approval from the Generation Scotland Access Committee. RuralCovidLife can be used to investigate mental health, well-being, and behaviour in participants living in rural areas during the COVID-19 pandemic, as well as comparisons with non-rural samples. Moreover, the sub-sample with full Generation Scotland data and linkage can be used to investigate the long-term health consequences of the COVID-19 pandemic in rural communities.

Valuing the whole community: Children, schools and language

AbstractWhat help is given to children in exploring linguistic and cultural diversity in their local communities? Drawing on a comparative study of Place‐Based Learning (PBL) in three predominantly rural areas in Scotland, Norway and the USA, the article examines educational and cultural approaches to supporting indigenous and minority community languages. It offers examples of the potential these offer in contributing to children's personal language awareness and development and cultural learning, but finds that language and education policies are fragmented and failing in particular to take advantage of newer migrant languages as a tool for developing linguistic and intercultural skills.

We've got what the NHS ultimately intended for us: Experiences of community engagement in rural primary care services change

Policy promotes service user engagement in health services design and delivery. Various tools exist to support the engagement of citizens within health services design. We consider community engagement within the context of primary care delivery in remote and rural areas of Scotland. We present findings from three years of qualitative work with community members and healthcare professionals within five different remote and rural areas, undergoing primary care service changes. 364 interviews were carried out with community members and healthcare professionals on their experiences of, and feelings towards, the services changes. A key theme to emerge from our thematic analysis of the qualitative data is experiences of community engagement. In this paper we present our analysis of this theme. We identify different types of community engagement discourse within community and healthcare professional interviews. We illustrate these themes and, through consideration of five case study areas, demonstrate how these discourses can co-exist within the same service change process. The paper presents our sub-themes on community engagement relating to discourses of inclusion and exclusion; the role of the General Practitioner (GP); conceptualisations of the organisational role of the NHS; discourses of fear and, finally, community members understandings of what it means to be active “agents of change” (or not) within health services redesign. We argue that context is as important as method when it comes to facilitating a positive community engagement experience for citizens. Our findings have relevance to the emerging social science literature on citizen experience of public sector community engagement activities.

Does driving using a Green Beacon reduce emergency response times in a rural setting?

Green Beacons are used by many doctors across the UK when responding to emergencies, particularly in rural areas. These are used to alert other road users to the doctor's urgent need to reach a destination, with the hope that members of the public will make provisions for the doctor to make progress unhindered. While such warning lights have been used for many years, there is a paucity of research into the safety and efficacy of their use. This pilot study aimed to explore whether the use of Green Beacons does lead to reduced response times in rural areas of Scotland, and recorded any accidents occurring during such emergency response journeys. A repeated measures design was devised to investigate this question. The response times and distances travelled for 10 consecutive emergency journeys undertaken by a rural primary care and prehospital doctor during the winter of 2019 using Green Beacons were recorded. The same journeys were then repeated, at a later date by the same driver, under normal driving conditions, with no Green Beacon use. Travel times were compared for both journey types. Travel times were on average 4 minutes shorter when responding using Green Beacons (range 0-13 minutes), with statistically significantly faster average speeds during the emergency response journeys. There was a trend towards higher average speed with longer journeys. No accidents occurred during either type of journey. The use of Green Beacons when responding to emergencies in rural Scotland appears to reduce journey times and appears safe in this exploratory work. This is in keeping with other researchers' work into the use of blue and red emergency vehicle lighting, and does not dissuade from continuation of current practice among doctors in the UK. Further research in this area would benefit from a larger dataset, and quantitative time-motion data from the vehicles involved.

Transition into remote and rural nurse education and careers: a qualitative study of student nurses.

BackgroundGlobal nurse shortages present a threat to the sustainability of remote and rural healthcare. Interventions have been developed to support recruitment and retention of nurses that focus on providing pre-nursing experience for school pupils who intend to pursue nursing careers. However, there is a lack of evidence around how pre-nursing experience supports transition into nurse education.AimsThis study aims to explore the impact of a pre-nursing scholarship for school pupils in remote and rural areas of Scotland on experiences of transition into nurse education.MethodsThis was a qualitative study involving semi-structured telephone and face-to-face interviews with pre-nursing scholarship participants.ResultsAn authentic pre-nursing experience supported school pupils’ transition to nurse education. First, it increased students’ self-efficacy, both in their decision to choose nursing as a career and their ability to nurse. Second, it helped students to realise that the opportunity to study closer to home was available to them. Third, it supported students’ educational and social integration, helping them feel prepared for university teaching and learning approaches and the social experience of being a student.ConclusionsPre-nursing experience can support transition into nurse education and contribute to career pathways that support recruitment and retention of nurses in remote and rural areas.

The relationship between living in urban and rural areas of Scotland and children\u2019s physical activity and sedentary levels: a country-wide cross-sectional analysis

BackgroundLiving in urban or rural environments may influence children’s levels of physical activity and sedentary behaviours. We know little about variations in device-measured physical activity and sedentary levels of urban and rural children using nationally representative samples, or if these differences are moderated by socioeconomic factors or seasonal variation. Moreover, little is known about the influence of ‘walkability’ in the UK context. A greater understanding of these can better inform intervention strategies or policy initiatives at the population level.MethodsCountry-wide cross-sectional study in Scotland in which 774 children (427 girls, 357 boys), aged 10/11 years, wore an accelerometer on one occasion for at least four weekdays and one weekend day. Mean total physical activity, time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA), per day were extracted for weekdays, weekend days, and all days combined. Regression analyses explored associations between physical activity outcomes, urban/rural residence, and a modified walkability index (dwelling density and intersection density); with interactions fitted for household equivalised income and season of data collection. Sensitivity analyses assessed variation in findings by socioeconomic factors and urbanicity.ResultsRural children spent an average of 14 min less sedentary (95% CI of difference: 2.23, 26.32) and 13 min more in light intensity activity (95% CI of difference, 2.81, 24.09) per day than those from urban settlements. No urban-rural differences were found for time spent in MVPA or in total levels of activity. Our walkability index was not associated with any outcome measure. We found no interactions with household equivalised income, but there were urban/rural differences in seasonal variation; urban children engaged in higher levels of MVPA in the spring months (difference: 10 mins, p = 0.06, n.s) and significantly lower levels in winter (difference: 8.7 mins, p = 0.036).ConclusionsExtrapolated across one-year, rural children would accumulate approximately 79 h (or just over 3 days) less sedentary time than urban children, replacing this for light intensity activity. With both outcomes having known implications for health, this finding is particularly important. Future work should prioritise exploring the patterns and context in which these differences occur to allow for more targeted intervention/policy strategies.

Prescribers' perceptions of benefits and limitations of direct acting oral anticoagulants in non-valvular atrial fibrillation.

Background:There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF).Objective:The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations.Methods:A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes.Results:One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents’ descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances.Conclusions:While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs.

Unlocking the potential of rural social enterprise

In this paper, we argue that social enterprise could represent a means of tackling rural challenges of providing sustainable economic development, addressing the withdrawal of public services and promoting community cohesion. The paper draws upon a review of existing academic as well as policy literature and develops a conceptual framework that helps to understand how to unlock the potential contribution of social enterprises to rural development. Drawing on an exploratory study conducted in two rural areas of Scotland we use interview data from social enterprise stakeholders to populate the conceptual framework and its rural (geographic), policy and social enterprise domains. Our study suggests that social enterprises can potentially enable an integrated approach to addressing local issues at the local level. They can create locally responsive services that fit the rural context. However, unlocking the potential of rural social enterprise may require moving beyond traditional policy silo approaches that treat economic development, community cohesion and public services as separate and disconnected since national policy-making frameworks have not always translated into practice at the rural level. Additionally, policy treatment of social enterprise needs to move beyond efforts to ‘scale up’ and achieve economies of scale. Collaborations between groups of social enterprises, and between social enterprises and public authorities can lead to economies of scope, particularly where strong trust-based relations within communities harness self-help and the co-production of services. With appropriate guidance and support, many rural challenges and needs could be transformed into opportunities for social enterprise development. In highlighting the opportunities and challenges faced by rural social enterprises, the paper suggests potential research gaps that, if filled, could contribute towards recognising and unlocking their full potential.

Exploring young people's perceptions and attitudes towards their progression to university: A Scottish rural perspective

This paper presents an exploratory analysis of young people’s perceptions and attitudes towards their potential progression to higher education in rural areas of Scotland. These young people belonged to three state secondary schools whose catchment areas were mainly rural. All were in S5/Year 12 or S6/Year 13 and aged 16 years and over. They filled in a serial questionnaire in November 2014 and again in March 2015. Firstly, the analysis reveals that 40% of the respondents were not aware of any obstacles to their going to university. Secondly, it points out that if the majority of the respondents perceived financial barriers, the perception of these obstacles tended to decline over time. Thirdly, while their enthusiasm and motivation towards their potential progression to higher education remained high in March 2015, more had reported these positive attitudes in November 2014. Finally, although most perceived their parents’ enthusiasm about their going to university, fewer acknowledged it in March 2015 and many more recognised the enthusiasm of their schools.

Migrants' experiences of material and emotional security in rural Scotland: Implications for longer-term settlement

Drawing on qualitative research with Central and East European (CEE) migrants living and working in rural areas of Scotland, this article explores what it is that facilitates a desire to stay longer term and how this relates to theorisations of social security and migrant-led understandings of normality. The article makes three original contributions: (i) new empirical insight into the relationship between material and emotional aspects of migration and settlement in Scottish rural contexts; (ii) greater understanding of rural migrants' diverse lived experiences; (iii) attention to the changing nature of migration to rural contexts through a focus on longer-term settlement rather than seasonal or circular migration. The article is structured by three key questions: To what extent are rural destinations actively chosen by migrants? How are migrants' experiences shaped by the realities of rural life in the particular Scottish contexts studied? How do migrants interpret these experiences through their understandings of a normal life and how does this impact on longer-term plans? The qualitative insight which the article provides has wider relevance and significance for policy and practice across other rural contexts and can help to reveal ways in which rural social systems could better respond so that areas of ‘new’ migration may develop into positive places of settlement.

What gets left behind for future generations? Reproduction and the environment in Spey Bay, Scotland

What gets left behind for future generations? Reproduction and the environment in Spey Bay, Scotland

Delivering midwifery care in difficult to access areas

British Journal of Midwifery • March 2015 • Vol 23, No 3 Earlier this month, a temporary suspension of out-of-hours midwifery services for Skye and Lochalsh was announced. This suspension—a problem that is especially significant in an area where there is an ageing midwifery workforce—was reportedly due to staff shortages—. It is not news that there is a shortage of midwives in the UK; however, something needs to be done to entice new midwives to these remote areas. Gillian Smith, Director of the Royal College of Midwives (RCM) for Scotland said to BJM: ‘This is an ongoing struggle in the remote and rural areas of Scotland. It is a real life-changing decision to move to these areas from the central belt. Although the areas are beautiful, they are often quite challenging with transport infrastructure and local facilities. Skye is not the first area to present problems; the Head of Midwifery on the Western Isles has also had difficulty recruiting over the last year and with the ageing midwifery workforce in Scotland, this will present further challenges over the next few years. The interesting thing is working in places like Skye, the Western Isles and some of the other island and remote communities in Scotland allows you to practise midwifery as a member of the community and develop a different, but highly expert, set of skills.’ These closures also highlight the issue of accessing maternity care in remote and hard to access areas—something that many women have to face all over the UK. NHS Highland hopes the situation will improve after a month. However, in the mean time, women will have to travel over 100 miles to access services in Inverness for their birth if it occurs during out-of-hours—which is likely to be the case for most. For many women, travelling this far while in labour will be uncomfortable and potentially dangerous if the baby is born before arrival to hospital. Failure to maintain body temperature poses a significant risk to the baby if it is born before arrival to a hospital and women are also more likely to experience retained placenta requiring manual removal and increased blood loss (Loughney et al, 2006). These complications may lead to more claims to the NHS Litigation Authority. Already, maternity claims represent the highest value and third highest number of clinical negligence claims reported to the NHSLA (NHSLA, 2014) and shutting services may only exacerbate this. Closing maternity services in remote areas, whether temporarily or permanently, is dangerous and not sustainable. Unless long-term strategies are put in place, this may happen again. Whatever the solution, it is important to remember that every woman has the same right to access high-quality care wherever she lives. BJM

Molecular characterization of Cryptosporidium parvum isolates from human cryptosporidiosis cases in Scotland.

Cryptosporidium parvum (C. parvum) is one of the most prevalent protozoan pathogens responsible for inducing human and animal disease worldwide. In this study, the glycoprotein-60 (gp60) subtyping tool was employed to assess the molecular diversity of C. parvum from human feces throughout Scotland during potential outbreaks. Over a 24-month period, microscopy analysis revealed 1139 positive feces containing Cryptosporidium species with 256 identified by molecular methods specifically as C. parvum. Cryptosporidium parvum was shown to be more prevalent in rural areas of Scotland and subtyping of 87 isolates demonstrated the predominant family as IIa, which occurred in 94% (n=82) of isolates. The IIaA15G1R1 subtype was most common, being isolated from 47% (n=41) of Scottish human cases. Non-IIa strains constituted a total of 5 isolates and included subtypes from the IIc, IId and IIg families. This information contributes significantly to existing knowledge and understanding of C. parvum subtypes in Scotland which is vital in assisting with the management of future local and national outbreaks.

‘Trochars no more’: Teaching chest drain insertion to remote and rural practitioners using a mobile skills unit

Background: There are a number of approaches to teaching high-risk clinical skills, such as a large bore chest drain insertion, although effectiveness is limited and realism is only achieved at great expense.Summary of work: In response to a training needs’ analysis of practitioners in remote and rural areas in Scotland, training in chest drains was identified as an urgent priority need. Subsequently, the Clinical Skills Managed Educational Network (CSMEN) developed an evidence-based multi-professional clinical skills pack. This e-learning resource encompasses all aspects of chest drain management, both pre and in-hospital. The pack and an interactive workshop is used to deliver ‘blended’ chest drain training on a mobile clinical skills unit. Evaluation confirms that the chest drain training is a valuable resource and has been widely used to deliver skills training in remote and rural areas. Feedback from all professional groups is positive.Conclusions: Developing shared national resources, with standardised workshops taught in local contexts via a mobile skills unit is one approach to the challenges associated with delivering high-risk clinical skills education.

Prostate cancer in Scotland: does geography matter? An analysis of incidence, disease characteristics and survival between urban and rural areas

Objective: The objective of this article is to identify whether there is a difference in survival from prostate cancer in urban and rural areas of Scotland and to identify potential inequalities in incidence, disease characteristics and the treatment of prostate cancer between these areas. Subjects/patients and methods: A retrospective cohort study was undertaken. Retrospective analysis of data from Information Services Division and regional cancer databases from 2005 to 2010 was performed. A comparison of NHS Highland & Western Isles as the rural group with NHS Lothian as the urban group was made. Data were collected on patient and disease characteristics, first treatment and mortality. Non-parametric continuous data were analysed using the Mann-Whitney U test. Categorical data were assessed using a two-tailed Z test. The p value for statistical significance was set at < 0.05. Results: The incidence of prostate cancer was higher in rural areas. Rural patients were older at diagnosis ( p < 0.0001), presented with higher risk disease ( p < 0.0001) and underwent less curative treatment ( p < 0.0001). There was potentially poorer survival in rural areas. Conclusions: Men living in rural areas of Scotland present with more aggressive prostate cancer and may have poorer survival. This could be due to high levels of PSA testing in urban areas, therefore further studies are needed to identify patterns of PSA testing in Scotland. These inequalities will be highlighted to the Scottish Government to inform the ‘Detect Cancer Early’ campaign for its second phase in 2015.

Food Security: A Churches Together Approach

Food is one of the few essentials for life. The churches have long been involved with issues relating to its production, distribution and use. The linkages between food and farming are critical to the prosperity of rural areas across the UK. Food has always been a heavily politicized issue. Progress with current food issues requires engagement with Government and with the organizations controlling the food chain such as supermarkets. Here we detail our approach to dialogue and the development of our thinking about the role of the market economy, food security, universal affordability and food access in rural areas of Scotland. Examples such as fair trade and genetic engineering are used to explore how values become embedded in food. We argue for the importance to the UK of food becoming a primary locus for policy-making.

Attracting healthcare professionals to remote and rural medicine: Learning from doctors in training in the north of Scotland

Background: Research exploring the experiences of trainee doctors in remote and rural locations is scarce. Our aim was to gain an understanding of the experiences and perceptions of Foundation Programme (FP) doctors training in placements in remote and rural areas of the north of Scotland.Methods: FP doctors training in remote and rural areas in Scotland took part in a qualitative study (focus groups and individual interviews) exploring their training experiences and career plans. To make sense of a potential multitude of factors, we selected social cognitive careers theory (SCCT) to underpin data collection and analysis.Results: A total of 20 trainees participated. Using data-driven analysis, three themes relevant to the SCCT emerged. These are the educational experience (e.g., opportunities to develop skills, greater responsibility), geographical isolation factors (e.g., the impact of staff shortages, poor accommodation, travel) and personal factors (e.g., social isolation, attitudes towards the experience).Conclusion: Many factors impact on trainees’ experience of learning and living in remote and rural medicine (R&R) environments. These experiences can be very positive for some individuals but factors external to the educational environment influence the perception of the overall experience. SCCT helps clarify the interaction between individual and contextual factors in career decision making.

Multiprofessional education: improving care for acutely ill children

A three-year programme was established for practitioners who work with acutely ill and injured children and young people. Courses were held in urban and rural areas of Scotland and more than 2,000 NHS staff, including nurses, paramedics, doctors and allied health professionals, took part. Three-day training comprised clinical skills updates, scenario-based teaching and observed structural clinical examinations. As a result, NHS Scotland says care delivery to children, young people and their families has improved in community and hospital environments.