Health Services In Rural Communities Research Articles

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 < 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.

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

IntroductionMost new-born babies are born at home in rural communities which is not new phenomenon due to lack of access to primary healthcare services and trained skilled health attendants, exposing mothers and children to a high risk of labour complications. The purpose of this study was to better understand factors influence rural women's access to primary health care and skilled delivery services as well as their reasons for using or not using maternal health care and skilled delivery services.MethodsThe study employed a social survey design with a quantitative approach to data analysis. Cluster Sampling was used, possibly based on rural communities, to efficiently collect data from different geographic locations. Simple random sampling individuals from each cluster ensures that all eligible individuals have an equal chance of being included in the study. This enhances the representativity of the sample. A total of 366 mothers were selected from four rural communities in the North East Region of Ghana. The choice of sample size considered factors like the study's objectives, available resources, and the desired level of statistical power. Data was primarily gathered through the administration of a questionnaire to the respondents. Factors considered for achieving representativity include, geographic representation, accessibility, healthcare infrastructure and healthcare professionals’ attitudes.FindingsThe study found that distance to health centres limits women's access to skilled delivery services. Lack of primary health facilities in the rural communities hamper maternal and child care services delivery. The attitude of health care professionals determines a mother’s utilisation of maternal health care and skilled delivery services.ConclusionThe study contributes to the limited research on maternal health services and their impact on mother and child health in the study area. This study is one of the first to investigate into maternal health care as a key predictor of mother and child health in the study area. The study's theoretical lens was the Andersen and Newman Health Behavioural Model theory, which supports the explanation of distance, lack of primary health centres, attitudes and lack of skilled personnel to the non-utilisation of maternal and health services in rural communities. The study recommended that primary healthcare facilities and trained health professionals should be a priority of government in rural communities to promote maternal and child healthcare.

The relationship between perceptions of health- illness with the utilization of health services in rural coastal communities in the working area of Kapoiala Health Center and Soropia Health Center, Konawe Regency, Southeast Sulawesi Province, Indonesia, 2

Background: Correct perception of pain will give rise to concern for the condition of the body and immediate action to seek help. The morbidity rate according to gender in Konawe Regency in 2021 reached 11.21%, while the percentage of the population who had health complaints and sought outpatient treatment in Konawe Regency in 2021 reached 28.86% Method: The type of research used is descriptive quantitative with a cross-sectional study approach, namely determining the relationship between perceptions of health and illness and the utilization of rural coastal community health services. The number of samples in this research was 535 respondents. The sampling techniques are purposive sampling and accidental sampling. The analysis used is chi-square. Results: Statistical test results show that the ρ value (0.942)>0.05, which means there is no significant relationship between perceptions of health and illness and utilization of rural coastal community health services in Konawe Regency. Of the 442 who utilized health service facilities (Puskesmas), there were 320 (72.40) respondents who had a good perception of health and illness and 112 respondents (27.60% who had a perception of health and illness in the bad category. Meanwhile, of the 93 respondents who did not utilize the facilities health services, there were 73 respondents (78.49%) who had a good perception of health and illness and 20 respondents (21.51%) who had a bad perception. Conclusion: There is no significant relationship between perceptions of health and illness and utilization of health services in rural coastal communities. Therefore, the Health Service needs to consider policies regarding placement, workload analysis and even distribution of health workers so that the workload of officers is not too high and can provide maximum health services and increase public knowledge by carrying out health promotions or providing health education to the public regarding services available at the Community Health Center.

The relationship of health insurance ownership with the utilization of health services in coastal rural and urban communities (Case Study: Kapoiala Health Centre, Soropia and Nambo Health Centre) Southeast Sulawesi Province, Indonesia, 2023

Background: Health is a human right and every citizen has the right to receive health services. Therefore, the Indonesian government must guarantee that every resident gets quality health services through the implementation of national health insurance as a global commitment for every country to implement universal health coverage. In Indonesia, the number of Social Security Administrator participants reached 248.77 million people or the equivalent of 90.73% of the entire population of Indonesia which was recorded at 274.20 million people, while in Southeast Sulawesi the number of Social Security Administrator participants was 8,071,716 people. Method: The type of research used is descriptive quantitative with a cross-sectional study approach, namely looking for the relationship between ownership of health insurance and utilization of rural and urban coastal community health services (case studies: Kapoiala Health Center, Soropia Health Center and Nambo Health Center) The number of samples in this research was 1,040 people consisting of 535 urban coastal respondents and 505 rural coastal respondents. The sampling techniques are purposive sampling and accidental sampling. The analysis used in this research is chi-square analysis. Results: The results of the study show that there is a significant relationship between ownership of health insurance and utilization of health services with a ρvalue (0.037) < 0.05 in the working areas of the Kapoiala Health Center, Soropia Health Center and Nambo Health Center, Southeast Sulawesi Province, Indonesia. Conclusion: There is a significant relationship between ownership of health insurance and utilization of rural and urban coastal community health services in the working areas of Kapoiala Health Center, Soropia Health Center and Nambo Health Center, Southeast Sulawesi Province. Therefore, it is necessary to increase the acceleration of social security administrator membership to reach 100% UHC through regional government and central government schemes. social security administrator needs to increase socialization with various media that are more effective in increasing community participation in becoming social security administrator participants.

Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study.

The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic.

Women’s experience of obtaining health and social services following intimate partner violence: Lesbian, gay, bisexual, transgender, and queer relationships in rural communities

The purpose of this secondary analysis was to explore the intersection of gender, sexuality, and rurality in a person’s experience of seeking health and social services following intimate partner violence (IPV). Data from the primary study, SPEAK: Sharing Personal Experiences of Accessibility and Knowledge of Violence, were used for this secondary analysis. This study reviewed the experience of women who identified as being lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) and lived in a rural community. With an intersectional lens, this study employed an interpretive description approach utilizing a case-study design, and the experiences of LGBTQ women who had experienced IPV seeking health and social services in rural communities were explored. Data collected from demographic questionnaires and one-to-one interviews indicated that gender and sexual identity present challenges when intersecting with rurality and IPV. Identifying as LGBTQ may hinder a woman’s ability to seek help from healthcare and social services. These findings may be useful to inform future practice and policies pertaining to resources and services available for rural LGBTQ women who have experienced IPV when seeking care.

Ehealth Literacy in Improving Rural Community Health Services in Indonesia

The Ministry of Health has designed the TEMENIN (Telemedicine Indonesia) application since 2017 for health workers in all regions of Indonesia.The use of TEMENIN is expected to accelerate patient health services, not only during the COVID-19 pandemic but also in other health services. For this reason, human resources for health workers who can adopt e health are needed. However, because of its implementation, there are still some areas for improvement in the TEMENIN application. The Indonesian Ministry of Health issued the KOMEN 2.0 application (Online Medical Consultation) as an update from TEMENIN. This study aims to identify and find out the activities of various e-health-based communication platforms used to improve the quality of health in Indonesia, especially the use of the KOMEN Application. The theories and concepts used in this research are the theory of Diffusion of Innovation, health communication, and telehealth literacy.The method used is descriptive qualitative by conducting in-depth interviews with the parties involved in using the KOMEN application in the Indonesian region, observing and studying the literature. The validity of the research uses source triangulation. Based on the research results, the activity of using the KOMEN application is still not optimal. This is because only some health workers have the same e-health literacy regarding the same KOMEN application, and the availability of infrastructure still needs to support the maximum use of KOMEN, especially in the 3T region in Indonesia.

The Opioid Epidemic: A Review of the Contributing Factors, Negative Consequences, and Best Practices.

The opioid epidemic is a significant public health crisis that has caused extensive harm and devastation in the United States. This literature review aimed to identify the contributing factors and negative consequences of the epidemic, as well as best practices for healthcare providers in managing the epidemic. Overprescribing opiates and opioids, lack of education and opportunity, and being unmarried or divorced were some of the identified contributing factors to dependence on opioids. The epidemic's negative consequences are substantial, leading to increased access to opioids for vulnerable populations, which consequently causeaccidental death among men and the degradation of rural community health services. As part of the literature review, we also analyzed the best practices for healthcare providers, including implementing prescription drug monitoring programs (PDMPs). However, we found that while PDMPsresulted in a decrease in opioid overprescription and an increase in provider confidence when prescribing medication, the evidence for their effectiveness in improving rural community health services or reducing opioid overdoses and opioid-related deaths was inconclusive. Our review highlights that the greatest challenge to overcome is a lack of legal mandates and proper education for healthcare providers on best practices for addressing the epidemic. To regulate and control opioids effectively, tracking and standardizing prescription models by federal agencies and medical institutions is necessary but not enough. Legal action is vital for the successful containment of the opioid crisis.

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

Determinan Pemanfaatan Pos Kesehatan Desa (POSKESDES) Pada Keluarga Di Desa Keude Lueng Putu Kecamatan Bandar Baru Kabupaten Pidie Jaya

Village Health Posts (Poskesdes) are community-based health efforts (UKBM) established in villages in order to bring/provide basic health services for rural communities. Activities carried out include promotive, preventive, and curative activities including monitoring of nutritional status, as well as the health of pregnant women, disease management, preparedness and disaster management. The purpose of the study was to determine the determinants of the use of Village Health Posts (Poskesdes) in families in Keude Lueng Putu Village, Bandar Baru District, Pidie Jaya Regency. The research design used a quantitative method which was carried out by an analytical survey with a Cross Sectional Study approach. The population in this study was the entire community as many as 1,132 housewives. The sample used the purposive sampling technique of 91 housewives. Data analysis used univariate, bivariate and multivariate analysis. The results showed that there was an influence of knowledge p = 0.027, family support p = 0.004 and distance p = 0.037 variables that did not have a relationship, namely the attitude and support of health workers on the use of Village Health Posts (Poskesdes) in families in Keude Lueng Putu Village, Bandar Baru District. Pidie Jaya Regency. While the most dominant factor is family support p = 0.001, 95% CI = 2.655-39,141 with OR = 10,195. The conclusion of this study is that there is an influence of knowledge, family support and distance while the most dominant factor is family support for the use of Village Health Posts (Poskesdes) in families in Keude Lueng Putu Village, Bandar Baru District, Pidie Jaya Regency. It is recommended to Poskesdes officers to provide information and provide counseling to families in order to increase family knowledge so as to support other family members to take advantage of Poskesdes.

Extreme Adjustments to Telehealth Services among Rural Public Health Nurses during the Covid-19 Pandemic in Padang Indonesia

Objective: During the COVID-19 pandemic, rural community health nurses selected telehealth as a novel approach for providing health service. This research describes the interactions between public health nurses and the health service system concerning telehealth implementation. Method: Qualitative research was conducted on rural community nurses at Community Health Center of Padang, Indonesia. The sample was determined based on data saturation. The data was collected using in-depth interviews with open and semi-structured questions. The findings were analyzed utilizing thematic analysis as the primary focus. Result: An overview of telehealth implementation in rural communities is obtained in terms of device aspects, long-distance communication ethics, communication collaboration, and communication interactions in health services. Conclusion: The study’s finding demonstrate that telehealth assisted extend the reach of rural community health service. Adjusting communication patterns using communication technologies and designing the most influential information for symptom detection and education sessions represented a challenge for nurses

Post Covid-19 Agenda: Maximizing human resources for health towards Universal Health Coverage in Africa

Aim: To analyse options for maximising the capacity of human resources for health to achieve Universal Health Coverage (UHC) in Africa. Methods: Articles were retrieved from a Pubmed search and additional snowballing was conducted to provide other relevant sources. Further utilizations were made of Campbell's modified framework of the Human Resources for Health (HRH) and Universal Health Coverage with the WHO labour market dynamics framework for Universal Health Coverage. Four sub-themes viz improved HRH performance, Labour Market Factors, Rural Health Workers Retention Factors, and Information Technology Factors were analysed. Results: Labour market factors such as the dynamics of demand and supply of health workers determine the availability of health workers. Supportive supervision enables the health workers to improve in their performance and enhance optimised utilisation of available resources. This supervision can be more effective by complementing it with tools such as information technology that focus on improving the quality of health care, considering the growth in the number of internet and broadband users in the continent. Conclusion: Expanding the training opportunities for health workers and also increasing the funding to human resources for health are useful policy options to consider. Cost-effective approaches such as a focus on community health committees which stimulate the demand for health services in rural communities to tackle the disproportionate distribution of health workers should be considered in the context of the uncertain economic aftermath of the covid-19 outbreak. Sources of Funding Nil Acknowledgement We express profound gratitude to Prof Flavia Senkubuge for providing technical help and writing assistance during the preparation of this manuscript. We also appreciate Dr. Aborisade Adetayo for assisting with editing of the manuscript. Conflicts of Interest The authors declare no conflict of interest. Author Contributions MIA drafted the entire manuscript. ICE provided a critical review and made substantial contributions to the design of the manuscript.

The Roles and Challenges of Traditional Health Practitioners in Maternal Health Services in Rural Communities of Mthatha, South Africa.

Traditional health practitioners (THPs) are considered as the entry level of care in African societies and play an important role in the delivery of health services to the population. A phenomenological qualitative study was carried out among purposefully selected THPs in Mthatha to understand their roles and the challenges they face in providing maternal health services. The study included a focus group discussion with seven participants which yielded three themes and seven subthemes. The content analysis of descriptive data from the focus group discussion revealed threats posed by unregistered and counterfeit THPs to the lives of pregnant women in rural settings. The THPs’ wide range of services allowed pregnant women to receive prenatal, antenatal, and postnatal care in proximity. However, this community level of care was marked by high levels of secrecy and counterfeit practitioners who used human body parts, which compromised the practice and rendered it unpopular. The South African government recommended the establishment of a register for THPs in order to protect the public, including the clarification of functional referral pathways between THPs and conventional health services.

Community-based health extension policy implementation in Ethiopia: a policy experience to scale-up.

Ethiopia has launched innovative community-based health policy in 2003. It was designed to accelerate the expansion of community-based health facilities and basic health services. The program established a health post at the lowest administrative unit level to serve in the villages. The policy implementation was supported by many stakeholders to improve the health indicators of the country. All the concerted efforts and public participation has helped the implementation of the policy and improvement of primary health services in rural communities. Thus, participating communities through grassroots mobilization in similar resource limited settings as experienced in this policy review could be scaled up to other health policies for its successful implementation.

Medical student’s attitude towards serving rural areas: A cross sectional study in Maharashtra, India

Rural population of India is grossly underserved by healthcare professionals. Gap exits between health services for urban and rural communities. 1) To determine the attitude of medical students towards serving rural areas and factors affecting it. 2) To explore reasons behind willingness and unwillingness to work in rural areas.It was a cross-sectional study conducted in medical colleges. Among three medical colleges in city, two medical colleges were selected by simple random sampling using lottery method. All 450 undergraduate medical students in both selected medical colleges were included into the study. Binary logistic regression analysisOdds ratio,Chi-square test and percentages were used to analyse the data.35.82% medical students were interested in working at rural areas. Age, parental education, place of residence, type of college and year of undergraduation of medical students had significant association with their preference towards rural practice. Social service was commonest reason students being interested in working rural area while scarcity of health facilities was major cause for negative attitude towards rural practice. Majority of medical students were not in favour of working in rural areas. Urban rural disparity was more obvious among Allopathy students. There is need to focus on working environment at rural areas as lack of amenities in the rural areas was a common reason behind unwillingness of students towards rural practice.

Community-based assessment and rehabilitation of hearing loss: A scoping review.

Although the World Health Organization (WHO) recommends the use of a Community-Based Rehabilitation (CBR) model, little is known about how CBR has been applied in the hearing healthcare setting. The purpose of this scoping review was to identify and describe studies on Community-Based Hearing Rehabilitation (CBHR) programs within the applied context. The review was conducted in September 2020 with updated searches in November 2021 according to the Joanna Briggs Institute (JBI) methodology and reported using the guidelines and checklist for Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews (PRISMA-ScR). Fifty-nine peer-reviewed research articles were included in the review. A narrative synthesis was conducted to map out the types of CBHR programs. Studies were classified into audiological themes: awareness, screening and assessment of hearing in newborn/infants, children and adults, training of community health workers, rehabilitation, cost-effectiveness and describing the service delivery models. Further categorisation was made based on CBR aspect matrices for each study. Most of the studies come from high-income countries in North America and Europe. CBHR studies predominantly focused on creating awareness, training and hearing screenings and/or assessments in communities and evaluating effectiveness in providing knowledge and access to hearing health services in rural or underserved communities. Further work is needed to examine the outcomes and effectiveness of CBHR using controlled studies. Moreover, more work is needed in low- and middle-income countries where the application of CBHR is critical for increased access and affordability.

Protocol for integrating mental health services into primary healthcare facilities: a qualitative study of the perspectives of patients, family members and healthcare providers in rural Bangladesh

IntroductionIn Bangladesh, Non-communicable diseases (NCDs) account for 67% of all deaths. Mental health services are not available in routine healthcare at the primary facilities in Bangladesh. The protocol is for...

Contributions of village animal health workers to foot-and-mouth disease control in Cambodia.

Local animal health services in rural communities in Cambodia are mainly provided by village animal health workers (VAHWs), although the participation and contribution of VAHWs to livestock disease prevention are uncertain. The participation of the VAHWs as identified by their 'dropout rate' was examined in a desktop review in December 2020 of the national data on VAHWs recorded between 2011 and 2020. The contribution and involvement of VAHWs in disease prevention programmes were examined in a survey conducted between February and March 2014, then analyzed in the context of other surveys of VAHW knowledge, attitudes and practices. The survey involved guided group discussion with VAHWs (n=198) from the two Cambodian provinces of Kampong Cham and Pursat. This study identified that VAHWs generated less than 22% of their annual household incomes from animal health services. Less than one-third had vaccinated livestock against foot-and-mouth disease (FMD), with none having vaccinated cattle every 6 months during the study period, and nearly half of the VAHWs having never vaccinated their own cattle against FMD. As no privately provided FMD vaccination services occurred in these communities, with all vaccines delivered through the government-subsidized programme, the findings confirmed that VAHWs only vaccinated animals against FMD when vaccines were made available by the Government. The desktop review found that the number of VAHWs in 2020 declined by more than 24% since 2017, and the proportion of female VAHWs was consistently low, with a mean of 8.26 (±1.019). These findings confirm findings from previous studies that identified considerable weaknesses in the VAHW system in Cambodia, particularly in contributing to FMD control. Cambodian animal health authorities require more effective policies to strengthen the current VAHW system, improving their services delivery; their retention as 'active'; their development of more sustainable roles with lower 'dropout' rates and the prolonged gender inequity. With the limited availability of government-subsidized FMD vaccination currently, extension programmes that engage VAHWs and farmers in seeking privately funded and delivered FMD vaccination that incorporates appropriate multivalent FMD serotype vaccines of high quality, delivered in small dose vials from a robust cold chain, is suggested. This strategy would assist VAHWs to contribute to the provision of private livestock vaccination services that are likely essential for sustainable FMD prevention and control in Cambodia.

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting.

The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.

Rural Hospitals and Rural Health Challenges: An Analysis of Recent National Health Rankings and Hospital Data

Rural hospitals play a critical role in providing acute care and other essential medical services to rural populations. However, they are increasingly unable to meet the needs for health services in rural communities. This paper utilizes the data from the recent County Health Rankings and Definitive Healthcare to identify the health care challenges in rural counties and evaluate the operating and financial condition of rural hospitals in the context of the health care needs in rural areas and in comparison with urban hospitals. Our data analysis finds that while there are major health challenges and increased needs for hospital service in rural areas, the operating and financial performance of rural hospitals has been worsening in key aspects. We argue that continued policy support as well as health system innovations will be critically important to address the health care needs of rural America.