Rural Centers Research Articles

COMPARATIVE ANALYSIS OF COVID-19 PATIENTS DURING DELTA AND OMICRON WAVES OF COVID-19 PANDEMIC: AN EXPERIENCE FROM RURAL TERTIARY CARE HOSPITAL IN NORTH INDIA

Objective: In this study, an effort has been made to find out possible clinical parameters that may have played role in differences in the disease outcome in the delta and omicron waves. Methods: This is a retrospective observational study conducted at a rural tertiary care center of North India. We recorded sociodemographic and clinicopathological parameters of the admitted patients during delta and omicron waves in India. The outcome measures were demographic, baseline clinical, disease severity, ICU admissions and hospital mortality. Results: In our study, 1731 patients were tested positive for SARS-CoV-2, out of which 16 patients were admitted during the omicron wave and 878 admissions during the delta wave. In delta wave, the ratio of male to female was 1:2 and in omicron wave, it was 1:3. There were 271 deaths in delta wave and 2 deaths in omicron wave. A significantly lower number of admissions were noted during omicron wave (p<0.001). Patients without previous history of COVID-19 and unvaccinated status had significantly higher admission (p<0.001). The admission rate among comorbid patients was also significantly low in the omicron wave (p<0.001). 251 patients had one or more comorbidities and were mostly in severe (13.4%) or critical (88.4%) conditions in delta wave while among 13 comorbid patients in omicron wave, 7.7% were in severe and 15.4% were in critical condition. Conclusion: The hospital admissions were very low in comparison to delta wave. During delta wave, the degree of severity and number of deaths were also very high.

The effect of educational intervention based on the health belief model on the domestic violence coping skills in women referring to comprehensive rural health service centers

BackgroundDomestic violence, in addition to the destructive effects it brings to the mother of the family, also has a strong impact on the children. According to the evidence obtained, coping strategies have been successful in tackling this issue. The purpose of this study was to investigate the effect of education on coping skills with domestic violence based on the health belief model (HBM) in women referring to comprehensive rural health service centers in Marvdasht City, Iran.MethodsThis semi-experimental study was conducted on 120 women affected by domestic violence who were referred to rural health centers in Marvdasht City in 2022. The multi-stage cluster sampling method was used for assigning people to two experimental and control groups (60 people in each group). The data collection tool was a questionnaire based on the HBM and a coping strategies questionnaire that was completed before and two months after the intervention by both groups. After entering SPSS 24, the data were analyzed by paired t, independent t, and chi-square statistical tests.ResultsBefore the intervention between the two groups in terms of the constructs of awareness (P = 0.45), attitude (P = 0.23), behavior (P = 0.67), perceived sensitivity (P = 0.10), perceived severity (P = 0.84), perceived barriers (P = 0.31), perceived benefits (P = 0.21), perceived self-efficacy (P = 0.10), and cues to action (P = 0.19), no significant difference was observed, while after the intervention, a significant difference was observed between the two groups in terms of the structures expressed (P < 0.05). Likewise, before the intervention between the two experimental and control groups in terms of the ability to receive and send messages (P = 0.73), emotional control (P = 0.22), listening skills (P = 0.65), insight into the communication process (P = 0.15), communication combined with assertiveness (P = 0.98), and coping skills (P = 0.21), no significant difference was observed, while after the educational intervention, there was a significant difference between the two groups in terms of skill components (P = 0.001).ConclusionIn the current study, education based on the HBM with a focus on coping skills led to the improvement of the skills of women who have experienced violence, their attitude and awareness, perceived sensitivity and perceived severity, and finally the benefits and barriers they receive from using coping skills.

Electronic patient-reported outcomes improve postoperative gynecologic oncology care in a rural academic center

Electronic patient-reported outcomes improve postoperative gynecologic oncology care in a rural academic center

Improving Patient Experience and Team Engagement with Environmental Services: Application of Watson's Theory of Human Caring.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients' experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families. Few studies highlight how nursing theory may influence patient experience outside of the nursing role. This paper explores how ES staff at a non-profit rural 974-bed academic medical center impacted patient experience using nursing theory to promote a caring environment. Applying Watson's Theory of Human Caring and Caritas Processes© with ES team members beginning at leadership levels increased team engagement and improved patient experience. ES team members benefited from a professional nursing framework and from being integrated as a valued partner in advancing human caring.

Provider Perspectives on Healthcare System Barriers to Engaging Caregivers of Rural US Veterans in Firearm Suicide Prevention.

Firearms account for the majority of US Veteran suicides. Studies demonstrate that secure firearm storage can decrease risk of suicide. Veterans prefer to have discussions about secure firearm storage with familiar individuals, such as their caregivers. Providers in the Department of Veterans Affairs (VA) are well-positioned to engage caregivers of Veterans in firearm suicide prevention; however, challenges remain. Elucidate healthcare system barriers to caregiver engagement in firearm suicide prevention, as seen by Suicide Prevention and Caregiver Support Program staff, to inform development of an intervention to increase involvement of caregivers in efforts to reduce Veteran firearm suicides. An Advisory Board consisting of key stakeholders provided input regarding study methods and interpretation of findings. Participants included 16 Caregiver Support Program and 14 Suicide Prevention staff recruited from 8 geographically diverse rural VA medical centers. Interview topics and data analyses were guided by the Consolidated Framework for Implementation Research (CFIR). Rapid analysis and a team-based approach were employed to identify key barriers; emergent themes were mapped onto relevant constructs of the CFIR inner setting domain. Healthcare system barriers included structural characteristics (e.g., understaffing and heavy workloads), relational connections and communications (e.g., poor channels of communication between Caregiver Support Program and Suicide Prevention staff), culture (e.g., lack of recipient-centered care), and access to knowledge and information (e.g., lack of training in how to incorporate caregivers in Veteran care). The present study provides much needed perspective from VA staff in Suicide Prevention and Caregiver Support programs regarding barriers to involving caregivers in firearm suicide prevention efforts within the VA healthcare setting. Identifying these barriers and potential solutions is a critical step towards increasing engagement of caregivers in reducing firearm suicide among Veterans.

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Exploring the Impacts of Artificial Intelligence Interventions on Provider Practice practice

Abstract Background Despite the growing prevalence of AI in healthcare, there has been a lack of recent studies exploring its impact on providers’ practices and patient outcomes. This study investigates healthcare providers’ perceptions of AI interventions’ influence on their practice efficiency and patient outcomes, as well as the correlation between providers’ perceptions of AI and its effects on patient outcomes. Methods A self-administered questionnaire was mailed to 38 healthcare providers at a rural medical center in north Texas, with a 70% percent response rate (n = 27). In addition to descriptive statistics, multivariable logistic regression test was conducted to discern the relationship between their perceptions of AI and its impact on patient outcomes. Results The findings revealed that a majority of providers perceived AI to still be in its early stages, posing challenges for practice and having a limited impact on patient outcomes. Additionally, various factors such as age, gender, a user-centered design approach, AI experience, along with perceptions of workplace support and stress, significantly shape providers’ attitudes toward AI and ultimately affecting patient outcomes. Conclusions Before AI technology can fulfill its promise of transforming healthcare through integration with other technologies, the healthcare sector must address numerous hurdles. It is crucial to approach the development and testing of intricate systems like AI-integrated electronic health record (EHR) systems with caution to ensure their reliability and dependability in clinical decision-making. Additionally, navigating medico-legal responsibilities and pursuing fair distribution of benefits are equally crucial. Key messages • This study offers insights into the extent of AI interventions’ impact on healthcare. • This study specifically focuses on enhancing patient care, reducing costs, and improving the efficiency of the healthcare system.

Investigating the role of psychosocial stress factors in back pain patients

Abstract Background In 2022, 27.35 million people in Germany were diagnosed with back pain. This results in a 1-year prevalence of 32.64 percent of the population and 96,8 million days of incapacity to work. Moreover, patients with back pain often suffer from additional mental disorders (e.g. anxiety, depression). This study investigated the influence of other health-related factors such as psychosocial stress in these patients. Methods A randomized controlled study was conducted with 297 gainfully employed participants in a rural rehabilitation center in Germany Bad Zwischenahn who received a 4-week multimodal pain therapy. 150 participants were allocated to the intervention (IG) who received an additional 12-month relapse prevention treatment while 147 were allocated to the control group (CG) who received no such additional treatment. Data was obtained via questionnaire (three measurement points) and claims data. Among other health-related outcomes, the number of sick days was examined. A 10-item subscale of the Patient Health Questionnaire (PHQ) was included to measure common psychosocial stress factors. Results The evaluation of the PHQ (summary) scores revealed a mild stress level at all three dates. Of the ten psychosocial stress factors surveyed, the highest level was reported in the IG and CG on the scale “Worrying about health”. The IG improved significantly (p = .017) compared to the CG after one year reporting decreased health worries. Further analyses carried out by analysis of variance (ANOVA) showed that health worries are significantly associated to a higher number of sick days in the IG (p = .002) and CG (p = .010). Conclusions With regard to psychosocial stressors, the participants were primarily affected by health worries. The results indicate that health concerns are the primary psychosocial stress factor associated with back pain and should be taken into account in the treatment of back pain. Key messages • A 12-month relapse prevention treatment significantly reduced the psychosocial stress experienced by people with back pain after their rehabilitation treatment. • Concerning psychosocial stress factors, the participants of both groups were primarily affected by health worries.

Preference of Tooth Extraction Over Root Canal Treatment among Patients Visiting Rural Health Centers—a Cross-Sectional Study

Abstract Background Dental care decision-making is a multifaceted process influenced by various factors such as socioeconomic status, cultural beliefs, and access to healthcare resources. The research aims to elucidate the prevalence and determinants of the preference for tooth extraction over root canal treatment (RCT) in rural communities. Methodology A structured self-administered questionnaire comprising 15 close-ended questions was formulated for the purpose of data collection for this cross-sectional survey and a sample size of 384 was estimated. Following a total enumeration sampling technique, the study was performed on individuals visiting the rural center aged over 18 years and persons who are willing to participate in the study. The data were analyzed using descriptive statistics and subjected to multinomial logistic regression. Results Among the participants, 33.1% had undergone RCT in the past and 63.5% had undergone extraction in the past with decay being the most common reason for seeking treatment. About 60.2% individuals preferred extraction and only 39.8% individuals preferred RCT wherein age, gender, and area of residence had a significant influence on the decision-making. Conclusion Majority of the participants in the study preferred extraction over RCT. Understanding the dynamics driving patient preferences in rural health settings is crucial for tailoring effective oral health interventions. The findings of this study have implications for healthcare practitioners, policymakers, and public health initiatives, providing valuable insights to enhance dental care delivery and promote informed decision-making in rural communities.

Identifying measures for understanding and addressing county-level disparities in adolescent HPV vaccination coverage in North Carolina.

HPV vaccination coverage is characterized by geographic disparities in the US, with national studies finding lower coverage in rural versus nonrural areas. To direct quality improvement efforts in North Carolina, we sought to understand how different rurality measures characterize these disparities. We used separate negative binomial regression models to test associations between 5 dichotomized county-level rurality measures and HPV vaccination coverage (≥1 dose) among North Carolina adolescents, ages 11-12 (n=326,345). Rurality measures were derived from: Office of Management and Budget's Metropolitan Statistical Areas, Rural-Urban Continuum Codes, Index of Relative Rurality, US Census Bureau classifications, and North Carolina Rural Center classifications. Models controlled for Social Vulnerability Index (SVI) percentile and rate of pediatricians per county. Vaccination data came from the North Carolina Immunization Registry. HPV vaccination coverage was 29% across North Carolina's 100 counties (range: 13%, 46%). Agreement between rurality measures ranged from 54% to 93% of counties. In adjusted analyses, none of the 5 rurality measures correlated with HPV vaccination coverage, but higher SVI and higher rate of pediatricians were positively associated with coverage (p< 0.01). Exploratory moderation analyses suggested regional variation in the relationship between rurality and coverage, with a positive association in one region, a negative association in one region, and no association in four regions. County-level rurality measures did not identify disparities in HPV vaccination coverage in North Carolina. Measures related to social vulnerability and access to pediatricians may be better suited for understanding and addressing the state's substantial county-level vaccination disparities.

Multifaceted Interventions to Enable Elimination of Clinician-ordered Blood Smear Reviews: A Rural Academic Medical Center Experience

Abstract Introduction/Objective Blood smears (BS) evaluate a variety of clinical disorders. At Geisinger, clinician ordered pathologist review of blood smears (CBS) have increased despite usage of highly sophisticated hematology analyzers and automatic blood smear (ABS) review criteria. We hypothesized that CBS impact pathologists’ and technologists’ workloads and increase costs and turn-around times, with rare improvement in value-based patient care. This study aimed to analyze CBS ordering practices and improve the utilization of BS review. Methods/Case Report In October 2020, a prospective CBS utilization study was completed by 8 clinical pathologists for 172 CBS. Subsequently, a clinical question was required for CBS orders from January 1, 2022, to January 1, 2023, to investigate clinician ordering practices based on campus, department, and indications. Findings were used to support new interventions including: clinician education; cancellation of repeat BS ordered within 24 hours, creation of alternative tests (schistocyte technologist smear review, clinician order for independent slide review), standardization of morphology reporting, ABS audits, and elimination of orderable CBS replaced by an electronic BS review request, that is reviewed by a clinical pathologist prior to determine if a BS is indicated. Results (if a Case Study enter NA) Part of the Conclusions section for Lab Practice abstract. Conclusion Prospective utilization audit of 172 CBS orders showed 17% changed clinical management. Audit of 3,693 CBS orders demonstrated common reasons for review included tick-borne illness, hemolysis, erythrocytosis, thrombocytosis, and iron deficiency anemia. Systematic implementation of multiple interventions enabled the elimination of CBS, with no known adverse effect on patient management to date. The streamlined BS review guidelines allowed for better-allocation of resources, appropriate patient turn-around times, empowerment of laboratory technologists and reduced hospital costs. We propose maximizing the incorporation of technologist skills to improve the utilization and efficiency of BS reviews and establishing standardized, evidence-based, and institutional- specific guidelines to determine BS reviews.

A place to call our home: innovative rural physical therapy training in Canada

BackgroundTo promote rural practice and increase enrollment in the entry-level Master of Science Physical Therapy program at the University of Alberta, the Department of Physical Therapy developed a rural physical therapy satellite campus located in a farming region in central Alberta. A distributed learning format was used to connect the rural cohort to the main urban campus. Real time video conferencing was used to connect the two campuses for all lectures, seminars and clinical skills classes. This evaluation aimed to describe a unique rural training program for physical therapy students and its effectiveness in promoting work in rural communities after graduation.MethodsPhysical Therapy students in the first three years (2012–2015) of commencing the rural satellite program (n = 280) were surveyed, and six focus groups were held to capture student experiences, satisfaction and engagement. Data were collected on employment locations of the 2012–2019 graduates’ first physical therapy position and current employment.ResultsSurvey results suggested comparable levels of satisfaction and engagement for all physical therapy students regardless of campus. Focus group data revealed that students quickly accepted the distributed learning technological interface, enjoyed their local campuses, and felt connected to instructors and student colleagues. Compared to the overall physical therapy workforce, a higher percentage of physical therapists graduating from the rural campus reported working in rural centers for both their first and current jobs.ConclusionRegardless of campus, students were satisfied and equally engaged in the physical therapy program. Students who completed the physical therapy program in a rural setting tended to work rurally after graduation. A distributed learning model may be useful for other healthcare training programs to promote engagement in rural health.

Pola Spasial Pergeseran Pusat Pertumbuhan Desa di Kabupaten Kulon Progo

Kulon Progo is a poorest district and has the highest development inequality in Daerah Istimewa Yogyakarta (DIY) based on Badan Pusat Statistik (BPS) publication. The local government has made various efforts to overcome the problems, one of which is by establishing growth centers since 2003. However, Kulon Progo Regency has experienced rapid development with the existence of Yogyakarta International Airport, which affected the dynamics of regional growth centers. The purpose of this study is to identify the potential Rural Growth Center (PPD) and identify the spatial patterns of PPD shifts in Kulon Progo to see the trickle down effect. This study used descriptive quantitative methods using scalogram index, centrality index, urban network analysis, and gravity index, also moran’s I index and Local Indicator Of Spatial Association (LISA). The results showed that there was a shift in rural growth centers, but the spatial analysis did not show any trickle down effect from rural growth centers that had been formed before. However, new centers were formed that were not related to the previous rural growth centers. These results indicates that the rural growth centers in Kulon Progo cannot have a growth effect on the surrounding area.

Acceptance of Rubella-Containing Vaccine and Factors Associated with Acceptance among Women of Reproductive Age in China: A Cross-Sectional Study

Objectives: To investigate the acceptance and factors influencing acceptance of rubella-containing vaccine (RCV) among women of reproductive age in Guangdong, Henan, Hubei, Liaoning, Shanxi, Sichuan and Zhejiang provinces of China. Methods: Using a stratified sampling method, we selected one urban and one rural community health services center in each of two cities in seven provinces. From these centers, we recruited women 15–49 years of age to complete a questionnaire on their willingness to receive RCV and factors influencing willingness. The survey instrument was adapted from the behavioral and social drivers (BeSD) of vaccination survey tool developed by the World Health Organization. Results: Among 1286 participants, 981 (76.3%) were willing to receive RCV. Awareness of rubella ranged from 12.4% to 70.6%. Willingness to receive RCV differed significantly by region, occupation, vaccination history, and awareness. All latent variables of the structural equation model (SEM) were positively correlated with willingness, and all standardized paths were statistically significant (p &lt; 0.001). Thinking and Feeling had direct positive effects on Social Processes (β = 0.789) and Practical Issues (β = 0.542), thereby indirectly affecting motivation. Conclusions: Women of reproductive age had high willingness to receive the rubella vaccination, but their general awareness of rubella was relatively low. It is necessary to strengthen the health education of women of reproductive age regarding rubella to improve RCV coverage.

Differences in survival of patients with multiple myeloma in rural versus metropolitan regions: Analysis of population data of an Australian local health district.

The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes. Retrospective cohort study. Illawarra Shoalhaven Local Health District. A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022. Treatment and survival outcomes of these patients. Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, p = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, p = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, p = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre. Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.

Association Between Level of Pain and Depression Among Chronically Ill Older Adults in Rural Alabama: A Pilot Study

There is a paucity of research on pain and depression among older adults in rural communities. To address such a gap, this study examined the association between pain and depression among older rural-community-dwelling adults. Recruited from rural senior centers, 100 chronically ill older adults (age 55 or older) experiencing pain completed a cross-sectional survey. Data were collected on their level of depression (a five-item version of the Center for Epidemiologic Studies Depression scale), pain (the six-item Philadelphia Geriatric Center Pain scale), and sociodemographic factors. A multiple linear regression was conducted. With sociodemographic variables controlled, those reporting higher pain scores were significantly more likely to have higher depression scores (p &lt; .05). Older participants had lower depression scores than younger participants (p &lt; .05). In view of poorer health outcomes and limited health care access in rural areas, our findings warrant interventions to promote better access to pain management and mental health services for rural older adults.

Practitioners’ Experiences of School Readiness in Rural Early Childhood Centres in QwaQwa Free State, South Africa

The analysis of the school preparation experiences of rural early childhood practitioners. Multiple complex issues exist regarding school preparedness in South Africa. Research has found that many South African children are unprepared for formal schooling. Some of the challenges experienced by these young learners were low reading strength, learning setbacks and complications, and sluggish general development. As a result of these issues, young children face long-term repercussions. These include the inability to escape the cycle of poverty, lack of educational support, and poor socioeconomic conditions within their environment. Therefore, it can be argued that teaching within the South African public schooling context is marred with difficulties and unforeseen challenges. It is difficult to imagine how to modify South African infrastructure so all children can reach their full potential. Given that our ancient past is still rife with historical and power changes, the government must consider several factors while developing ways to aid transformation. This study investigated the perspectives of practitioners on school preparedness. At the same time, it investigates the significant learning at the grass-roots level that emerged from participation in a critical paradigm-based participatory action research project. The study is anchored in a philosophical methodology that leverages Practitioners’ idea that early childhood learners are ready for formal school. They do not emphasize play as a pedagogy for learning in preparation for school readiness. This paper is grounded in constructivism, which helps comprehend how school readiness knowledge improves formal education for young students. The author used the qualitative research approach with an interpretive paradigm to explore practitioners’ school readiness experiences. The author developed a semi-structured interview schedule to collect data from six practitioners in the Thabo-Mofutsanyana district in the Free State Province. The findings revealed practitioners lacked appropriate training and support in preparing young learners in ECD centres. Furthermore, practitioners lacked appropriate pedagogical skills to strengthen teaching and learning. The study recommended that practitioners receive ongoing professional teacher development in school readiness and use various teaching and learning strategies such as play pedagogy.

Reviving the poppy seed test for the diagnosis of colovesical fistula: A case report from a single rural center experience.

The poppy seed test is a valuable, cost-effective, and sensitive initial diagnostic investigation to identify the presence of colovesical fistula, particularly for clinicians in remote or rural areas with lack of access to specialist radiologic, endoscopic, surgical, or urological support. The poppy seed test therefore may act as a bridge toward the commencement of appropriate referral pathways for the management of colovesical fistula. The diagnosis of colovesical fistula is resource intensive, often requiring a combination of radiological investigation and endoscopy. The poppy seed test is a non-invasive and cost-effective alternative that has been demonstrated to identify presence of colovesical fistula with high sensitivity. There is however a noticeable paucity of recommendations for the poppy seed test in the diagnostic approach to colovesical fistula due to significant advancements in alternative radiologic and endoscopic technologies. Despite this, in resource-challenged areas with lack of specialist support, the poppy seed test is a cost-effective, accessible and safe test that can be performed to confirm the presence of colovesical fistula. We report a case of a 79-year-old man with a past history of colorectal cancer managed surgically with adjuvant chemoradiotherapy who develops noisy micturition, pneumaturia, and fecaluria 22 years after treatment. Given the suspicion of colovesical fistula, computed tomography imaging and cystoscopy were performed which was unable to demonstrate an overt fistula. The poppy seed test was utilized and demonstrated presence of poppy seeds in the urine, confirming the presence of a fistula. The patient was referred to a specialist surgical center for consideration of further management. The poppy seed test is a valuable initial diagnostic investigation for clinicians in remote or rural areas with lack of access to specialist radiologic, endoscopic, surgical, or urological support in confirming the presence of a colovesical fistula and initiating referral pathways for the management of this condition.

Nurses' health promotion practices in rural primary health care in Nigeria. A qualitative study.

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

Remote coaching for supporting the implementation of treatment for depression in primary care in Madhya Pradesh, India: protocol for a cluster randomized controlled trial.

Upwards of ninety percent of individuals living with depression in India do not have access to evidence-based treatments, especially in rural areas. Integrating these treatments into primary care is essential for bridging this care gap. This trial aims to evaluate whether a remote coaching implementation support strategy, referred to as Enhanced Implementation Support, is superior to routine support, referred to as Routine Implementation Support, in supporting the delivery of collaborative depression care in rural primary care centers. Employing a cluster-randomized hybrid type-III implementation trial design, 14 primary care facilities in Sehore district, Madhya Pradesh, will implement a collaborative depression care package based on the WHO's mhGAP program. Facilities will be randomized to either Enhanced Implementation Support or the Routine Implementation Support control condition. Enhanced Implementation Support consists of remote coaching and technical assistance, supplemented with in-person visits, and guided by the Plan-Do-Study-Act implementation cycles. The primary implementation outcome is the proportion of outpatients screened for depression by facility staff, with secondary outcomes including the proportions of outpatients who screen positive for depression, are referred to the medical officer, and initiate treatment. Secondary patient outcomes include proportion of patients who achieve reduction in depression symptom severity at 3-month follow up. Acceptability, feasibility, and fidelity of the depression care package will be assessed through routine observations collected during field visits, facility audits, and qualitative exit interviews with facility staff. Costs of delivering the Enhanced Implementation Support strategy will also be estimated. This trial can inform efforts to integrate depression care in rural primary care facilities in a low-resource setting, and illuminate whether external coaching support is superior relative to existing implementation support for achieving these goals. NCT05264792.