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  • New
  • Research Article
  • 10.1016/j.cities.2025.106700
The uneven power of the platform: Variations in E-commerce entrepreneurial behaviours in urban, suburban, and rural contexts
  • Apr 1, 2026
  • Cities
  • Jia Zhang + 2 more

The platform economy is increasingly digitally mediating a wide range of everyday practices, though its influence on spatial relationships of economic activities remains in the early stages of exploration. This study draws on data from 300 structured questionnaires collected from e-commerce businesses located in urban, suburban, and rural areas to identify and compare how e-commerce entrepreneurs interact with platform space and different physical places. Our analysis captures three distinct spatial interaction patterns of e-commerce firms in urban, suburban and rural areas. The power of platforms is geographically uneven. Platforms do not necessarily alleviate the challenges faced by rural areas. Nor do they only further concentrate activity in existing urban agglomerations. Instead, they further complicate the economic geographical landscape found between urban economic agglomeration and dispersion. • Digital platforms reshape the landscape of economic activities within urban systems. • Urban, suburban, and rural e-commerce firms exhibit distinct spatial interaction patterns. • Platform networks exert uneven power across different spatial contexts. • Rural e-commerce entrepreneurs still rely heavily on local economies. • Geography continues to shape entrepreneurial activities in platform economy.

  • New
  • Research Article
  • 10.1111/ajr.70156
Rural Immersion Placements Help Develop Critical, Community-Focussed Allied Health Students: A Qualitative Study of Student Perspectives.
  • Apr 1, 2026
  • The Australian journal of rural health
  • Luke Wakely + 3 more

To explore allied health students' perspectives on rural immersion placements facilitated by the University of Newcastle Department of Rural Health (UONDRH), and how these experiences influence learning quality and rural career intent. Four rural UONDRH sites across New South Wales, Australia, where students undertook extended placements ranging from 12 weeks to a full academic year. Sixty final-year allied health students from nutrition and dietetics, occupational therapy, medical radiation sciences, physiotherapy, and speech pathology programs. A qualitative study using semi-structured interviews was conducted post-placement. Data were analysed using qualitative content analysis, supported by field notes and student co-analysis to enhance rigour and authenticity. Four themes emerged: (1) Focusing inwards-students initially prioritised their own needs; (2) Focusing nearby-support networks and interprofessional learning enriched the experience; (3) Focusing outward-community engagement fostered critical reflection and cultural awareness; (4) Focusing forward-considered their career intent, but now with a knowledge of rural health care context. The extended duration of placements enabled deeper immersion, reflective practice, and a broadened understanding of rural health contexts. Rural immersion placements offer transformative learning experiences that foster clinical competence, interprofessional collaboration, and rural career interest. Addressing structural barriers and enhancing rural job opportunities are essential to harnessing this intent and strengthening the rural allied health workforce.

  • New
  • Research Article
  • 10.1016/j.actpsy.2026.106509
Guardians in adversity: Job demands, resources, and teachers' willingness to support rural revitalization in Tibetan areas of western China.
  • Apr 1, 2026
  • Acta psychologica
  • Zibin Wang + 3 more

This study examines why rural teachers persist and support revitalization in a high-altitude Tibetan region of western China. Drawing on survey data from 2936 primary-school teachers and a theory-informed structural equation model, we analyzed links among job demands (burnout, career challenge, effort-reward imbalance), psychological resources (self-efficacy), well-being, job satisfaction, and willingness to contribute. Results showed that demands were negatively related to well-being and satisfaction, whereas self-efficacy was positively associated with both. Unexpectedly, demands also displayed direct positive paths to willingness, and burnout showed a notably strong positive link to willingness and even to well-being. These findings extend dominant models by demonstrating that in frontier rural contexts, certain demands are reframed as meaningful challenges tied to community contribution. The study highlights the importance of efficacy, collegial climates, and recognition of community-facing roles, and calls for longitudinal and multilevel research to probe scope and mechanisms.

  • Research Article
  • 10.36901/em.v11i2.1825
Impact evaluation of Centers for Childhood Development and Community-Based Monitoring on child development and health
  • Mar 11, 2026
  • Educationis Momentum
  • Juan León Jara Almonte + 2 more

In Peru, the implementation of Community-Based Monitoring (CBM) programs focusing on early childhood development outcomes particularly in rural areas is a phenomenon relatively unexplored. Using home visits for improving and strengthening health care practices and interactions of positive parenting in adults with children under the age of three, the goal of the CBM program is to improve different dimensions of child development. The study uses a quasi-experimental design with children aged 6-36 months from four districts of Maynas, province in the Amazon area of Peru. Data were collected at baseline (2016) and follow-up (2017). To estimate causal effects, we used Propensity Score Matching (PSM) to construct comparable treatment and control groups, followed by a Difference-in-Differences (DiD) approach to control for time-invariant unobserved factors. Results show positive and statistically significant effects on overall early childhood development, particularly in fine motor skills and language development. The program also reduced chronic malnutrition, although no significant effects were found on acute malnutrition or morbidity indicators. Impacts were stronger in rural areas, where program implementation was more established. The study concludes that CBM programs with home visits can improve developmental outcomes and reduce inequalities, highlighting the importance of implementation quality and suggesting potential for scaling in rural contexts.

  • Research Article
  • 10.3126/smcjsmc.v2i01.91612
The Use of Nepali in Secondary-Level English Classrooms: Challenges and Strategies for Promoting English Medium Interaction
  • Mar 11, 2026
  • SMC Journal Shadananda Multiple Campus
  • Nabin Pokharel

As part of a mini-research conducted in Shadananda Municipality, Bhojpur district, this article examines the role of Nepali in secondary-level English classrooms in a rural multilingual context. The study is guided by two research questions: what factors influence Nepali use in English classrooms, and how teachers, students, and parents perceive the challenges and strategies for promoting English-medium interaction. The study follows a qualitative, exploratory research design and uses purposive sampling to select 12 students from two secondary schools: grade 10 students from Arun Secondary School and grade 12 students from Shadananda Secondary School. Data were collected through classroom observations, semi structured interviews with teachers, and focus group discussions with parents, and analyzed by developing codes, categories, and themes that reflect classroom practices and stakeholder perceptions. The study reveals that English-medium instruction is implemented in a mixed-mode approach, with Nepali frequently used to mediate classroom communication. The findings highlight challenges in teachers’ fluency and student confidence, classroom management, and the lack of an English-friendly environment. The study concludes that promoting English interaction requires a balanced and context-sensitive approach. It recommends structured activities, role-plays, group discussions, a gradual increase in English input, teacher training, student-oriented confidence-building tasks, and institutional support.

  • Research Article
  • 10.54373/imeij.v7i2.5203
Model Pengabdian Terintegrasi Mahasiswa KKN dalam Meningkatkan Literasi Pendidikan, Tata Kelola Administrasi, dan Digitalisasi Informasi Dusun Waru, Samigaluh, Kulon Progo
  • Mar 11, 2026
  • Indo-MathEdu Intellectuals Journal
  • Retna Mega Kartika + 10 more

This article aims to describe the implementation of an integrated community service model conducted by KKN students to enhance educational literacy, administrative governance, and digital information systems in Dusun Waru, Samigaluh, Kulon Progo. The method employed a participatory approach consisting of socialization, planning, implementation, and evaluation stages based on social reflection. The programs included interactive learning media and learning motivation sessions for elementary students, assistance in school and TPA accreditation preparation, administrative data collection for residents and Posbindu, early marriage awareness socialization, compost-making training, renewal of administrative signboards, and the development of an official village website. The results indicate increased student learning enthusiasm, improved administrative order, enhanced institutional readiness for accreditation, and the establishment of a website to support transparency and public information access. This integrated service model effectively strengthens community capacity in educational, administrative, and digital aspects and has the potential to be replicated in similar rural contexts.

  • Research Article
  • 10.1177/10499091261434574
Tele-Palliative Care in Rural Areas, Implementation and Patient Experiences: A Systematic Review.
  • Mar 11, 2026
  • The American journal of hospice & palliative care
  • Athanasios Pitis + 2 more

BackgroundSpecialist palliative care remains highly uneven in rural and remote settings for patients with life-limiting illness and their families. This review aimed to examine the implementation characteristics, clinical and service-level outcomes, and patient experiences of tele-palliative care interventions for individuals living in rural or remote settings with limited access to specialist palliative care.MethodsA systematic review was conducted in accordance with the PRISMA 2020 guidelines across PubMed, Scopus, CINAHL, and Google Scholar (August-October 2025). Eligible studies were published within the past 20years and evaluated tele-palliative care interventions among rural populations. Data were extracted and outcomes were narratively synthesized.ResultsThirteen primary studies were included, conducted in the United States (n = 8), Australia (n = 2), Canada (n = 1), Japan (n = 1), and England (n = 1). Interventions included video consultations, hybrid tele-palliative programs, and remote symptom monitoring. Across studies, reported outcomes included implementation and process outcomes, patient and caregiver experiences and communication outcomes, clinical and care-process outcomes and health service utilization and economic outcomes. Challenges included technological instability, internet access limitations and inconsistent implementation fidelity.ConclusionsTele-palliative care can extend specialist palliative care to rural and remote communities by reducing travel burden and supporting continuity, particularly when delivered through hybrid models embedded in local care pathways. However, the evidence base remains limited and concentrated in high-income settings, with heterogeneity in intervention models and outcome reporting. Future studies should use standardized implementation outcomes, evaluate equity impacts, and compare hybrid tele-palliative models with usual care in diverse rural contexts.

  • Research Article
  • 10.58721/rjetcs.v4i1.1560
Teachers’ Lived Experiences and Intervention Strategies in Managing Substance Abuse among Rural Secondary School Learners in South Africa
  • Mar 10, 2026
  • Research Journal of Education, Teaching and Curriculum Studies
  • Rendani Tshifhumulo + 2 more

Substance abuse among secondary school learners has emerged as a critical challenge confronting educators in rural South African contexts, yet the voices and experiences of teachers navigating this complex phenomenon remain underexplored in scholarly literature. This qualitative study investigates the multifaceted challenges teachers encounter when working with learners who abuse substances at School A Secondary School in Thohoyandou (pseudonym), Limpopo Province. Through semi-structured interviews with five educators, the research reveals a disturbing landscape characterised by classroom disruptions, aggressive learner behaviour, emotional exhaustion among teaching staff, and systemic gaps in professional support structures. The findings illuminate how substances such as cannabis, chove, nyaupe, and alcohol, among others, profoundly compromise the teaching-learning environment, whilst teachers themselves, lacking specialised training in addiction counselling, struggle to balance disciplinary responsibilities with pastoral care obligations. Peer pressure, familial dysfunction, and easy accessibility to drugs near school premises emerged as primary drivers of substance abuse, compounded by parental denial and weak community oversight. The study underscores the urgent need for comprehensive intervention frameworks that incorporate professional counsellors, law enforcement collaboration, parental engagement programmes, and sustained teacher capacity-building initiatives. By foregrounding teachers' authentic narratives, this research contributes empirically grounded insights that challenge current educational policies whilst offering practical recommendations for creating safer, more supportive learning environments in resource-constrained rural contexts.

  • Research Article
  • 10.14738/abr.1403.20106
Relational and Local Dynamics in Informal Supply Chains
  • Mar 9, 2026
  • Archives of Business Research
  • Gilles A Paché

Informal supply chains ensure the circulation of essential goods despite significant local constraints. In rural villages in sub-Saharan Africa, community networks organize the transport of basic foodstuffs despite impassable roads, distant markets, and seasonal supply fluctuations. In urban diasporas in North America and Europe, communities structure the transnational circulation of food, clothing, and cultural products, overcoming limitations in market access and regulatory frameworks. Drawing on the concept of social capital—structural, relational, and cognitive dimensions—the analysis highlights how actors anticipate needs, adjust operations in real time, and maintain the continuity of flows under variable conditions. The illustrations from rural and urban contexts broaden understanding of logistical mechanisms beyond conventional approaches centered on efficiency and optimization. Insights gained from these illustrations suggest pathways for hybrid supply systems that reconcile formal efficiency with local adaptability. By linking anthropology and supply chain management, the article provides an original perspective on how social relationships, local knowledge, and embedded practices shape resilience and operational agility in informal supply chains.

  • Research Article
  • 10.36948/ijfmr.2026.v08i02.70931
“Wearing Many Hats”: A Multiple Case Study on the Impact of Ancillary Duties on Instructional Supervision and Teaching Quality in Public Schools
  • Mar 9, 2026
  • International Journal For Multidisciplinary Research
  • Junnard Deiparine + 5 more

This study explored the impact of ancillary duties on instructional supervision and teaching quality in public schools in Cebu, Siquijor, and Southern Leyte during the 2025–2026 academic year. Employing a qualitative multiple case study design, the research aimed to capture the lived experiences of teachers who balance instructional responsibilities with non-teaching tasks. Twenty public school teachers were purposively selected from three schools representing urban, rural, and island contexts. Data were collected through semi-structured interviews, document analysis, and observation, and analyzed using thematic analysis to identify key patterns and themes across cases. Findings revealed that teachers are frequently assigned ancillary duties such as administrative documentation, committee participation, program coordination, and extracurricular supervision, which significantly influence their instructional planning, lesson delivery, and assessment practices. Participants reported that these additional responsibilities often constrained the time and attention available for classroom instruction, reducing the frequency and effectiveness of instructional supervision. Teachers employed coping strategies, including time management, task prioritization, collaboration with colleagues, and selective delegation, to balance instructional and non-instructional roles. The study recommends workload rationalization, restructuring of supervisory processes, targeted professional development on time management and coping skills, and collaborative task distribution among school staff. Furthermore, an evidence-based teacher reskilling and upskilling program, TEACHER-PLUS 2026, was proposed to strengthen instructional supervision and optimize the management of ancillary duties. The study contributes to understanding the interplay between teacher workload, supervision, and instructional quality, providing actionable insights for school leaders, policymakers, and teacher education programs to foster sustainable and effective teaching practices in Philippine public schools.

  • Research Article
  • 10.35912/yumary.v6i3.5391
Strategi Pemberdayaan Generasi Muda dalam Gerakan Zero-waste Berbasis Bank Sampah
  • Mar 4, 2026
  • Yumary: Jurnal Pengabdian kepada Masyarakat
  • Suci Nurpratiwi + 4 more

Purpose: This study aims to explore youth empowerment strategies through a zero-waste movement based on waste bank management, highlighting the role of young people as agents of change in building sustainable urban environment. Methodology: This activity employed the Participatory Action Research method through dialogue, discussion, and hands-on practice in waste management. Fifteen participants, members of the youth organization in Bukit Duri, Jakarta Selatan, actively participated in this activity. Data were collected through observations, interviews, and documentation. The data were then analyzed through data collection, categorization, display, and conclusions. Findings: This community service activity was implemented through the socialization of environmental issues, involving Karang Taruna (youth organization) in the zero-waste movement, and creative practices in waste recycling. The activity also demonstrated that key empowerment strategies contributed to positive behavioral changes regarding sustainable waste management practices. Conclusions: The findings indicate that empowering youth through continuous training, collaboration with waste banks, and participatory practices can strengthen their role as agents of change in promoting zero-waste lifestyles. This approach fosters long-term sustainability and supports the creation of environmentally conscious community. Limitations: This study was limited to a specific urban area and youth group, which may affect the generalizability of the findings to broader populations or rural contexts. Contributions: This study provides insights into effective community-based youth empowerment models in the environmental sector. This study offers practical strategies to enhance youth participation in waste management.

  • Research Article
  • 10.1080/13467581.2026.2638659
Integrating topic clustering and sentiment analysis for visitor perception evaluation in historic blocks: insights from the Dadou Road case
  • Mar 4, 2026
  • Journal of Asian Architecture and Building Engineering
  • Xiao Gu + 4 more

ABSTRACT Historic blocks play a crucial role in sustainable urban and rural development by preserving cultural heritage while adapting to contemporary needs. However, visitor perspectives – particularly regarding spatial perceptions and satisfaction – remain underexplored, and few studies integrate social media data with advanced natural language processing techniques. This study applies BERTopic for thematic clustering of social media posts to identify key aspects of visitor experience, followed by a fine-tuned BERT sentiment analysis model that classifies comments into three categories – positive, neutral, and negative. To enhance validity, on-site interviews were conducted for qualitative verification, enabling comparison between online sentiment patterns and in-person perceptions. The insights derived from the analysis are translated into Importance-Performance Analysis (IPA) quadrants, furnishing actionable guidance for heritage managers in both urban and rural contexts to optimize conservation strategies and elevate visitor experiences. This research underscores the potential of deep learning-based text analytics for the stewardship of the built environment heritage, thereby proposing a replicable framework for evidence-based and contextually attuned decision-making.

  • Research Article
  • 10.3389/fsufs.2026.1757272
Measuring the maturity of the basket of territorial goods and services: evidence from Southern Brazil
  • Mar 3, 2026
  • Frontiers in Sustainable Food Systems
  • Isabela T Andrade + 5 more

The concept of a Basket of Territorial Goods and Services (BTGS) is a theoretical-methodological approach aimed at identifying and strengthening the unique material and symbolic elements that contribute to sustainable development in rural contexts. The BTGS considers three main axes: the construction of a territorial image, the valorization of local markets, and governance of territorial development initiatives by diverse social actors. Although the theoretical literature on BTGS has advanced in recent years, the lack of standardized empirical indicators has limited the ability of the BTGS framework to be used in longer-term and comparative monitoring and assessment programs related to sustainable rural and economic development. This study developed and tested an indicator panel for assessing the level of maturity of the BTGS in Southern Brazil. Since the 1990s, the Rural Credit Cooperative of Seara (Crediseara), has implemented a collective action project to enhance the recognition and value of the region's environmental, cultural, landscape, and productive attributes. We piloted the BTGS indicator panel using a participatory approach with 14 civil society organizations, cooperatives, and public institutions. The results indicate a BTGS at a moderate stage of maturity, with Crediseara and the Family Agriculture Forum standing out as important regional governance hubs for rural development. Significant challenges were also identified, such as Indigenous voices being underrepresented in shaping local strategies and the limited collaboration between public policies and local initiatives. The study reinforces the importance of social participation in building sustainable territorial development processes and proposes the BTGS Panel as a strategic tool for planning, monitoring, and political dialogue. The research contributes to Sustainable Development Goal (SDG) 17, particularly target 17.16, by strengthening collaborative models of evaluation and multisectoral governance.

  • Research Article
  • 10.5296/emsd.v15i1.23606
The Relationship between Urban Design and Social Behavior in Egypt: A Comparative Study of Rural and Urban Environments
  • Mar 3, 2026
  • Environmental Management and Sustainable Development
  • Rehab Abdallah Abd El Zaher

This study aims to examine the relationship between urban design and patterns of social behavior in rural and urban communities, with a focus on how built environments influence social interaction and the sense of community belonging. The study employs a comparative approach that combines a theoretical analysis of urban and behavioral concepts with a field study involving data collection from population samples in an urban area and a rural village. The study highlights the differences between the two environments regarding the impact of urban design on social behavior. In urban settings, urban design appears to enhance interaction in public spaces such as parks, squares, and pathways, whereas in rural settings, cultural and local social factors are closely linked to the importance of traditional shared spaces in strengthening social ties. The research also emphasizes the role of urban design in shaping daily behaviors and social interactions and provides recommendations to promote integration between urban design and social needs in both environments. This study contributes to understanding how urban design can be guided to enhance social cohesion while considering the differences between rural and urban contexts, and it opens avenues for future research on the relationship between the built environment and social behavior in diverse settings

  • Research Article
  • 10.1016/j.jenvman.2026.129143
Tertiary treatment of domestic wastewater for reuse: Implementation and evaluation in a rural context in Chile.
  • Mar 1, 2026
  • Journal of environmental management
  • Christopher González + 6 more

Tertiary treatment of domestic wastewater for reuse: Implementation and evaluation in a rural context in Chile.

  • Research Article
  • 10.1016/j.healthplace.2026.103612
"We are left alone": A qualitative study of life satisfaction of older adults in rural Nepal.
  • Mar 1, 2026
  • Health & place
  • Emilie Egger + 6 more

"We are left alone": A qualitative study of life satisfaction of older adults in rural Nepal.

  • Research Article
  • 10.1002/fsn3.71588
Food Security Determinants and Coping Strategies Among Rural Households in Ada'a District, Central Ethiopia.
  • Mar 1, 2026
  • Food science & nutrition
  • Alem Shumiye + 2 more

Achieving food security continues to be a persistent challenge for rural communities, even in seemingly food-secure areas such as Ada'a District, Central Ethiopia. Using a quantitative cross-sectional household survey, this study examined key determinants of multidimensional household food security and the coping mechanisms employed during food shortages in Ada'a District. Data were collected from 424 households, and a composite food security index was adapted from the World Food Programme's Consolidated Approach for Reporting Indicators of Food Security (CARI). Ordered logistic regression was used to identify determinants of food security, whereas a zero-inflated Poisson (ZIP) model was used to assess factors affecting coping frequency. Twelve out of seventeen predictors were statistically significant in the food security model. Using the CARI household food security variable (1 = food secure to 4 = severely food insecure), positive associations, indicating a movement toward a greater likelihood of moderate or severe food insecurity, were observed for households headed by single individuals, with a higher proportion of children under 14 years of age, experiencing seasonal labor migration, being located farther from the farm to the main road, and reporting rainfall variability or pest and disease infestations. In contrast, negative associations, indicating a greater likelihood of being food secure or marginally food secure, were observed for households with older heads, larger farmland holdings, participation in community-based organizations, access to extension services, adoption of high-yield varieties, and access to irrigation. In the ZIP model, rainfall variability, market distance, and market price shocks increased the frequency of coping. Conversely, extension access and remittance receipt reduced coping. The logit component showed that higher income and larger farm size increased the likelihood of households avoiding coping behaviors. The findings highlight the need for integrated interventions that provide climate-smart agriculture support, improve rural market infrastructure, strengthen extension services and community organizations, and facilitate access to remittances and financial services to reduce food insecurity and reliance on negative coping strategies. This study advances food security measurement by quantitatively combining a multidimensional index with robust modeling of coping behaviors, providing nuanced insights for policy in rural Ethiopian contexts.

  • Research Article
  • 10.53378/irssr.353306
Unpacking the challenges of land restitution in South Africa H. M. Tshivhase, E. Mahole & S. T. Matloga
  • Mar 1, 2026
  • International Review of Social Sciences Research
  • H M Tshivhase + 2 more

The purpose of this research is to examine the ongoing challenges in implementing land restitution in South Africa, particularly within a rural district context, to inform policy reform and suggest a model for enhancing the effectiveness of restitution efforts. Employing a qualitative research approach that relies on secondary data, the study utilises peer-reviewed literature, policy documents, and legislative frameworks, while being informed by Land Restitution Theory to explore institutional and governance dynamics. The results indicate that despite South Africa's robust constitutional and legislative framework for land restitution, the implementation is hindered by inadequate institutional capacity, poor coordination among state agencies, ineffective Communal Property Associations (CPAs), market-oriented acquisition methods, and insufficient community involvement. These obstacles have considerably impeded the progress of land reform and weakened its intended socio-economic benefits. Additionally, the study highlights that insufficient post-settlement support and limited empowerment of beneficiaries continue to threaten the sustainability of restituted land. This research contributes to the field of land reform by providing policy-focused recommendations that aim to strengthen institutions, enhance CPA capabilities, foster participatory governance, and explore alternative acquisition methods. Furthermore, it proposes a people-centered model for implementing land restitution that aims to enhance governance, accountability, and livelihood outcomes.

  • Research Article
  • Cite Count Icon 1
  • 10.1016/j.josat.2025.209867
Online community reinforcement and family training (CRAFT) for rural concerned significant others: A randomized controlled trial.
  • Mar 1, 2026
  • Journal of substance use and addiction treatment
  • Heidi Gray + 5 more

Despite Community Reinforcement and Family Training (CRAFT) being used throughout the United States of America and some parts of Europe, CRAFT has not been explored in rural Australia. This study aimed to evaluate the effectiveness on psychological scales of an online, practitioner-led delivery of Community Reinforcement and Family Training (CRAFT) in a rural Australian context. A randomized controlled trial (RCT) using a parallel-group, two-arm, superiority design, with a baseline assessment, and two follow-up assessments. Adult concerned significant others were recruited from rural areas across Australia, via Facebook and Instagram. Participants were randomized (1:1) into the CRAFT or Waitlist groups. The CRAFT intervention consisted of 6 sessions of 60min each, conducted over 6weeks. Participants randomized to the waitlist received reading resources from the Center for Motivation and Change (2022). The primary outcome was the psychological well-being of the participant. Psychological well-being scales included the DASS-21, SWLS, FS, and Brief-COPE. 126 participants were enrolled and randomly assigned to either the CRAFT intervention (n=64) or Waitlist (n=62). At baseline, the mean age of participants was 51.08years (SD=10.88). Females comprised of 92.06% of the sample. Most participants (86.4%) were born in Australia and 87.9% identified as White/Caucasian. Post-intervention scores found a statistically significant difference between the intervention and waitlist groups. This included in the intervention group, a decrease in depression scores (DASS-21), with an adjusted mean difference of -2.71 (95% CI: -5.36 to -0.06) between interventions and waitlist group, a significant increase in Satisfaction with Life scores (SWLS), with an adjusted mean difference of 1.98 (95% CI: 0.45 to 3.50) and a significant increase in the use of problem-focused coping with an adjusted mean difference of 2.92 (95% CI: 1.33 to 4.51). Online CRAFT for rural Australians decreased depression, increased life satisfaction and increased problem-focused coping.

  • Research Article
  • 10.1136/bmjresp-2025-003178
Barriers to implementing a pharmacist-led COPD CARE bundle in rural settings: a qualitative evaluation.
  • Mar 1, 2026
  • BMJ open respiratory research
  • Edward Christopher Portillo + 12 more

Patients living in rural settings are among the least likely to receive care, contributing to excess deaths in rural communities from respiratory conditions. We examine barriers that impede implementation of a care bundle for chronic obstructive pulmonary disease (COPD) management that was widely implemented across rural communities in the USA. 17 rural medical centres implementing the care bundle in the US Department of Veteran Affairs (VA). Medical centres were located across 13 states, with 3 VA medical centres (VAMC) in the Southeast, 4 in the South, 9 in the Midwest and 1 in the Northwest. Clinician participants engaged in programme implementation included pharmacy leaders, hired clinical pharmacists, nurse care managers and pharmacy technicians. Participation was offered to all clinicians engaged in the implementation process and was voluntary. This evaluation identifies barriers that impede implementation of a care bundle for COPD management. To guide our analysis, we identified challenges that strongly aligned with work system factors within the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Challenges experienced during the implementation of a COPD service in rural settings included (1) limited staff availability, (2) fragmentation of care, (3) technology challenges, (4) limited referral opportunities, (5) competing demands on pharmacist time and (6) clinician apprehension regarding their ability to manage a new disease state. This evaluation furthers what is understood regarding barriers to implementing care bundles within rural healthcare contexts. Our findings suggested that clinicians in rural settings felt constrained in their ability to take on new tasks and expand their practice models due to staffing shortages and heavy workload demands. Some clinicians reported approaches they used to address barriers they encountered, such as leveraging relationships with other healthcare practitioners to enhance communication and minimise technology limitations.

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