Rural Canadians Research Articles

Behavior Change Techniques for the Maintenance of Physical Activity in Cancer.

Ester et al report the findings from a 2-arm cluster randomized controlled trial nested within a hybrid effectiveness-implementation study, which involved a 12-week exercise and behavior change program for rural and remote Canadians (Exercise for Cancer to Enhance Living Well [EXCEL]). The addition of 23 weeks of app-based physical activity monitoring to the EXCEL program did not result in significant between-group differences in physical activity at 6 months. While several behavior change techniques were included in the initial 12-week intervention, additional techniques were embedded within the mobile app. However, there is currently a lack of evidence regarding how many and which behavior change techniques are the most effective for people with cancer and if these differ based on individual characteristics. Potentially, the use of the mobile app was not required in addition to the behavior change support delivered to both groups as part of the EXCEL program. Further research should involve participants who may be in most need of behavioral support, for example, those with lower levels of self-efficacy. Suggestions for future research to tailor behavior change support for people with cancer are discussed.

Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial.

Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome-self-reported moderate-to-vigorous PA (MVPA) minutes-and secondary outcomes-objective MVPA minutes and steps and app usability ratings-were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578. RR2-10.1016/j.cct.2021.106474.

Rural Perspectives on Suicide Prevention in Canada

Rural residence has been identified as a risk factor for suicide, especially for men. Little qualitative research exists on rural suicide, which might help deepen understandings of prevention strategies within rural places. Therefore, virtual focus groups were held across six Canadian provinces to give voice to rural community members and service workers about suicide prevention. Barriers to accessing services and the need to strengthen rural support networks were discussed. Enhancing peer support was highlighted as a strategy to better address the needs of rural Canadians.

Place-based generosity during the pandemic: Innovative rural philanthropic organizations’ responses to COVID-19 and (re-)building resilient rural communities in Canada

ABSTRACT The COVID-19 pandemic has exposed various vulnerabilities of rural communities in Canada. Place-based philanthropic organizations are key players in rural economies with capacity to foster resilience through development. Amid this global crisis, rural Canadians have felt an increased need for the services that philanthropic organizations provide. Drawing on semi-structured interviews with participants representing place-based philanthropic organizations in three regions across Canada (Atlantic Canada, Ontario, and British Columbia), our findings suggest that, despite the collective difficulty of adjusting to a “new normal,” Canadian place-based philanthropic organizations remain deeply committed to their service area, with many pivoting to meet the changing needs of rural Canadians and devising innovative strategies to overcome these new challenges. These insights aim to inform strategic planning and sustainability of place-based philanthropic organizations and connect with policy governing the philanthropic sector to better foster rural resiliency as Canada navigates its pandemic recovery efforts.

The Rural Road Map For Action: an examination of undergraduate medical education in Canada.

There is currently a maldistribution of physicians across Canada, with rural areas facing a greater physician shortage. The taskforce between the College of Family Physicians and the Society of Rural Physicians created a report, "The Rural Road Map for Action" (RRMA) to improve rural Canadians' health by training and retaining an increased number of rural family physicians. Using the RRMA as a framework, this paper aims to examine the extent to which medical schools in Canada are following the RRMA. Researchers used cross-sectional survey and collected data from 12 of 17 medical school undergraduate Deans from across Canada using both closed and open ended survey questions. Results were analyzed using quantitative (frequencies) and qualitative methods (content analysis). Medical schools use different policies and procedures to recruit rural and Indigenous students. Although longitudinal integrated clerkships offer many benefits, few students have access to them. Leadership representation on decision-making education committees differed across medical schools pointing to a variation in the value of rural physicians' perspectives. This study illustrated that medical schools are making efforts that align with the RRMA. It is critical they continue to make strategic decisions embedded in educational policy and leadership to reinforce the importance of and influence of rural medical education to support workforce planning.

Increasing diabetes testing adherence with incentives in rural Northwestern Ontario.

The health outcomes of rural Canadians have been described as poor and can in some part be related to diabetes mellitus. Despite the high mortality and morbidity rates associated with the disease, compliance with management remains low. Research has shown that a small financial incentive used to modify patient behaviour, can improve outcomes in cardiac disease and exercise adherence. This study aims to evaluate if a small financial incentive awarded to rural Northwestern Ontario patients with diabetes who complete an haemoglobin A1c (HbA1c) test, would result in greater compliance in test completion. Patients were recruited through two Northern rural clinics. Participants were divided into two groups: Group A received a financial incentive, whereas Group B received a letter of reminder. HbA1c tests were recorded every 6 months for 2 years and compliance was analysed using a t-test and Chi-square. One hundred and forty-six participants were recruited with 30 lost to follow-up. Overall, the incentive group completed a statistically significantly higher number of HbA1c tests compared to those in the control group. In addition, it was noted that there was an increase in test adherence for participants that received reminder letters, although not an initially expected outcome of the study. The results suggest that either a financial incentive or a reminder directed towards rural Canadians could have a benefit in promoting health behaviours to subsequent medical management of diabetes mellitus.

Rural-Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada.

Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient’s postal code to the physician’s postal code was calculated using origin–destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3–25.7) to GPs, 28.9 (IQR = 14.8–65.0) to Ortho, and 33.7 (IQR = 23.1–47.3) to PTs. We observed significant rural–urban disparities in realized access to GPs (2.9 and IQR = 0.0–92.1 in rural remote areas vs. 12.6 and IQR = 6.4–21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3–363.7 in rural remote areas vs. 21.3 and IQR = 14.0–29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0–232.1 in rural remote areas vs. 32.1 and IQR = 25.2–39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.

Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy.

The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video (M = 4.18) compared to those who used phone alone (M = 3.79) (p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated (r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.

Protecting rural Canadians from extreme heat.

KEY POINTS The frequency, intensity and duration of extreme heat events are increasing across Canada.[1][1] However, as reflected in recent reports by Environment and Climate Change Canada[1][1] and the Council of Canadian Academies,[2][2] extreme heat events are regarded as primarily an urban issue

Rural 2.0?: Investigating Place-Based Rural Innovation Systems &amp; their Implications for Public Policy &amp; Community Development Practice

We live in an era obsessed with innovation. So much so that in 2016, the Government of Canadabegan work on a new national‘Innovation Agenda’ with the following proposition: “Innovationis a Canadian value. It’s in our nature, and now more than ever, it will create jobs, drive growthand improve the lives of all Canadians. It’s how we make our living, compete and providesolutions to the world. We have the talent, the drive, the dedication and the opportunity tosucceed. So, what’s next?” However, as every public consultation on the Innovation Agenda tookplace in a major city and produced initiatives with names like ‘the Smart Cities Challenge,’ itseems like ‘what’s next’ is a national innovation conversation so steeped in unquestioned urbanism that it fails to even acknowledge, let alone include, rural Canadians. This doctoralresearch project will use a comparative case study approach to investigate the complexrelationships at play in place-based rural innovation systems and provide grounded, illustrativenarratives for informing public policy.

Rural 2.0: Place-Based Rural Community Innovation Systems

We live in an era obsessed with innovation. So much so that in 2016, the Government of Canada began work on a new national ‘Innovation Agenda’ with the following proposition: “Innovation is a Canadian value. It’s in our nature, and now more than ever, it will create jobs, drive growth and improve the lives of all Canadians. It’s how we make our living, compete and provide solutions to the world. We have the talent, the drive, the dedication and the opportunity to succeed. So, what’s next?” However, as every public consultation on the Innovation Agenda took place in a major city and produced initiatives with names like ‘the Smart Cities Challenge,’ it seems like ‘what’s next’ is a national innovation conversation so steeped in unquestioned urbanism that it fails to even acknowledge, let alone include, rural Canadians. This doctoral research project will use a comparative case study approach to investigate the complex relationships at play in place-based rural innovation systems and provide grounded, illustrative narratives for informing public policy.

Rural‐Urban Disparities in Total Physical Activity, Body Composition, and Related Health Indicators: An Atlantic PATH Study

To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada. Cross-sectional analyses of baseline data from the Atlantic Partnership for Tomorrow's Health cohort were conducted. Specifically, 17,054 adults (35-69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable-adjusted beta coefficients (β), odds ratios (OR), and related 95% confidence intervals (CI). After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11-1.27), be obese (OR: 1.13, 1.05-1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01-1.15), and have a higher body fat percentage (β: 0.40, CI: 0.12-0.68) and fat mass index (β: 0.32, CI: 0.19-0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78-0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found. As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations.

Community Spirit, Cultural Connections, and Authentic Learning in Rural Preceptorship.

An authentic learning environment fosters socialization of nursing students to a particular community context and unique culture of the individuals who reside in that culture. The final preceptorship provides an extended clinical practice experience allowing for this immersion, while providing consolidation of learning as preparation to enter practice. PhotoVoice was used as an innovative data collection method to engage participants throughout the research process. Participants self-selected photographic images that represented the unique rural preceptorship experience through their eyes. Rurality was described by participants as more than a geographic location, but as a sense of place, or a way of being and doing, that represented rural life. Rurality was depicted more specifically by participants in terms of community spirit and cultural contexts. Rural practice placements have the potential to enrich undergraduate nursing education and to expose undergraduate nursing students to the role of the rural nurse. More research is needed about rural health to understand the cultural and contextual factors that uniquely affect the health status of rural Canadians. [J Nurs Educ. 2019;58(3):144-151.].

Furnishing a Lodge Room on the Canadian Frontier

A small artefact collection and a substantial archival fonds from Rideau Lodge No. 25 offer an unusual glimpse into the material practices of freemasons in early 19th century rural Canada. Organized in 1815, Rideau Lodge operated for about 30 years in and around the hamlet of Burritts Rapids, in presentday eastern Ontario. Their surviving artefacts and accounts reveal how the brethren procured the material necessities of masonic ritual in the context of emerging frontier capitalism. The Rideau Lodge masons developed a hybrid material strategy, purchasing some items from distant suppliers, including those in the United States, while making or repurposing other items locally. A case study in the relationship between local production and the market economy on the Canadian frontier, this article adds to the general literature on early Canadian capitalism by illustrating how cultural considerations - in this case the practices and values of freemasonry - influenced rural Canadians' consumption strategies.

A Presentation to the Standing Committee on Public Safety and National Security, Bill C-71: Speaking Notes

Bill C-71 is fundamentally misguided. Public gun ownership does not threaten public safety. High-quality, peer-reviewed research finds no evidence that public gun ownership is linked to criminal violence. Based on StatsCan data, PAL holders are much less apt to commit murder than are other Canadians. Rural Canadians have more guns per capita than urban Canadians, but firearm homicide rates are lower in rural areas than in bigger cities. Guns can be mis-used, but they can also be used for good. It is vitally important to teach proper firearms handling at a young age. It teaches character. Bill C-71 falsely assumes gangsters get their guns from lawful domestic sources. This claim is based entirely on secret changes to the traditional definition of “crime gun.” There is no evidence that the source of crime guns has recently changed other than what is hidden in secret police reports. In reality -- only the definition has changed. The new definition of “crime gun” includes paper crimes -- firearms found at the homes of suicides and absent-minded PAL holders. But the police secretly changed the definition – to include “illegally acquired” – which now means that “found guns” are now “crime guns.” “Found guns” have not been used in a crime, but are just found by police during or after a contact, Any kind of contact, including suicides. This new definition equates paper crimes with criminal violence. A firearm unsafely stored – is a “crime gun.” The Minister uses “domestic sources” as if it meant PAL holders. This is false. There is a large pool of firearms with questionable legality. In 2001, between one-third and one-half of then-law-abiding Canadian gun owners declined to apply for a PAL or POL. Government has not provided solid justification why more regulations would improve public safety. Nor has the government published an evaluation of the present regulatory system showing that it is effective in preventing violence. Other than police claims, based on a secret, bloated definition, there is no support for a change in the source of crime guns. According to StatsCan, lawful owners cannot be a major source of crime guns. According to StatsCan data, PAL holders are much less apt to commit murder than are other Canadians.Increased regulatory complexity does not mean greater public safety. Additional rules merely increases the work load for the Firearms Program staff. This can only harass legitimate owners and decrease public safety. Why is the government scapegoating PAL holders?

Su1835 - Disparities in the Care of Rural and Urban Canadians with Inflammatory Bowel Disease: A Population-Based Study from the Canadian Gastro-Intestinal Epidemiology Consortium

Su1835 - Disparities in the Care of Rural and Urban Canadians with Inflammatory Bowel Disease: A Population-Based Study from the Canadian Gastro-Intestinal Epidemiology Consortium

Ongoing Policy, Regulatory, and Competitive Challenges Facing Canada's Small Internet Service Providers

Abstract Many rural and remote Canadians continue to experience a digital divide. Internet Service Providers (ISPs) operating in these communities play a crucial role in connecting Canadians, yet they are understudied. This study aims to address this gap in the literature by focusing on policy, regulatory, and competitive challenges and issues facing small ISPs. Small ISPs face competitive pressures, but more importantly deal with regulatory challenges induced by the lack of a coherent national approach to rural broadband. Ten Canadian ISPs were interviewed as part of this study. The paper recommends the Government of Canada develop a national broadband strategy informed in part through consultation with small ISPs.

Ongoing Policy, Regulatory, and Competitive Challenges Facing Canada's Small Internet Service Providers

Abstract Many rural and remote Canadians continue to experience a digital divide. Internet Service Providers (ISPs) operating in these communities play a crucial role in connecting Canadians, yet they are understudied. This study aims to address this gap in the literature by focusing on policy, regulatory, and competitive challenges and issues facing small ISPs. Small ISPs face competitive pressures, but more importantly deal with regulatory challenges induced by the lack of a coherent national approach to rural broadband. Ten Canadian ISPs were interviewed as part of this study. The paper recommends the Government of Canada develop a national broadband strategy informed in part through consultation with small ISPs.

Heating and cooking in rural Canada: home energy in transition, 1850–1940

ABSTRACTContextualized in very recent histories of energy and in the rich scholarly literature focused on the consumption practices within the home, this article examines the ways that rural Canadians experienced the shift from the organic energy regime (characterized by relatively low energy use and reliance on local rural environments) to the mineral energy regime of fossil fuels and electricity (characterized by high energy use, dense population clusters, and complex networks that distribute energy). Modern grid-supplied energy came very late to rural Canada; the great majority of rural Canadians were still relying on kerosene (paraffin) for lighting and wood for heating and cooking as late as 1941. This article focuses on rural Canadians' long reliance on the wood stove to explore the distinctively slow and late transition that characterized the Canadian transition to the modern energy regime. Although the cast iron wood-burning stove eventually became as emblematic of the ‘backwardness’ of rural life as the coal-oil lamp, the author argues that the wood stove, like the coal oil lamp, was in fact a product of the modern energy regime, and was entangled in networks of extraction, processing, and transportation of fossil fuels along modern coal-and steam networks already transforming rural life.

O DESAFIO DO ATENDIMENTO À CRIANÇA RURAL NO CANADÁ

RESUMO: No Canadá, o atendimento à infância é pouco desenvolvido, apesar de o país ser uma federação rica. Ao contrário de muitas políticas sociais bem desenvolvidas, os serviços de atendimento à infância são principalmente ofertados por meio de mercados voluntários, comerciais ou sem fins lucrativos, em vez de iniciativas governamentais. Essa estrutura política desfavorece todas as crianças e famílias e tem consequências severas, particularmente para canadenses de áreas rurais, remotas e do norte do país. Este artigo fornece uma visão geral dos servidos de atenção à infância fora das cidades, considerando (a) como o sistema político canadense de federalismo e (b) sua arquitetura política liberal de bem-estar social trabalham contra a alta qualidade e equidade dos serviços.