Rural Geography Research Articles

Rural Geographies of Refugee Activism: The Expanding Spaces of Sanctuary in the UK

The steep rise in the number of migrants and refugees arriving in Europe in 2015 prompted widespread pro-migrant political mobilisation in the UK, including in rural areas. This article argues that more account should be taken of rural sanctuary movements in academic and popular understandings of pro-migrant activism, which remain largely urban-centric. It examines why the growth of rural sanctuary movements is significant, identifies how the distinctive qualities of rural communities shape the configuration of social relationships and networks within them, and contributes to scholarship on the nexus between rurality, migration and activism. In so doing, the article demonstrates the unique opportunities that rural communities offer to address social issues such as migrant exclusion and disadvantage.

Beneficiary satisfaction with mobile medical units in the state of Andhra Pradesh

Background: Mobile health services in India have gained significant attention recently. However, there is little information regarding the beneficiary satisfaction of such services. Beneficiaries’ satisfaction and perception plays significant role in utilization of services. We assess the program beneficiaries’ satisfaction of using mobile health services in rural Andhra Pradesh.Methods: We used a cross-sectional study design to survey the mobile health services program beneficiaries in rural Andhra Pradesh (October 2016 to October 2018). Beneficiaries availing the mobile health services from 277 mobile medical vans across 13523 villages were selected using multistage sampling. Exit interviews (using Likert-scale questions) were used to reveal the ease of access in utilising mobile health services and satisfaction among the program beneficiaries.Results: A total, 1080 exit interviews were conducted. Above ninety percent of beneficiaries completed the exit interviews (response rate: 95%). More than two-thirds (72%) of the respondents were females and aged >45 years (71%). Of all respondents, the majority were Hindu (89%), belonging to socially disadvantaged groups (80%), and illiterate (56%). Nearly all (95%) program beneficiaries found mobile health services easily accessible and building their knowledge and awareness (94%) on key health issues. Ninety-five percent of the program beneficiaries strongly favoured recommending the use of mobile health services to others. The overall satisfaction rate was 95% (Cronbach alpha 0.925).Conclusions: Mobile health services in rural areas are effective in meeting the beneficiaries’ expectations. High beneficiary satisfaction and trust in mobile health services strongly favours such services in other rural geographies.

Intergenerational connections through technology: Insights from the Technology Use in Later Life multi-site study

With enhanced challenges to maintain social connections especially during times of social distancing due to the COVID-19 pandemic, the need for technology solutions grow. Technologies have become interwoven into the daily lives for many older adults. The Technology Use in Later Life (TILL) study investigated how the perceptions and use of technology both can foster new and leverage existing intergenerational relationships. Through a mixed methods study engaging older adults aged 70 years of age and greater across rural and urban sites in Canada and the UK (N=37), participants described how the interconnection between technology and intergenerational relationships was an integral component to social connectedness with others. Through a qualitative descriptive approach, it was noted that older adults leveraged intergenerational relationships with family and friends to adjust to new technologies and to remain connected to adult children and grandchildren especially when there is high geographic separation between them. Especially during times of COVID-19, younger family members can play an important role to introduce and teach older adults how to use, technologies such as digital devices, computers, and social networking sites. Participants emphasized the benefits of intergenerational connections to adopt and use technology in later life noting flexibility and willingness to overcome barriers to technology adoption and remain connected across the generations. The adoption and uptake of technologies may continue as viable options during times of social distancing to support older persons to remain independent, age in place, in both age-friendly cities and across rural geographies during and post COVID-19.

Network Value Drivers in a 5G World

5G upends many assumptions about the wireless industry. From the consumer perspective, speed, latency and number of connections will far surpass current expectations. From network operators’ perspective, integrating previously unusable mmW (mmW) and upper mid-band frequencies and significantly increased demand for backhaul will rearrange the relative value contribution of these network components. Traditional valuation relationships will change and will require updating in a 5G world, such as the economic relationships that drive spectrum and backhaul value. Although the rules of value creation have not changed, the realization of value creation is changing. In particular, based on FCC auction data, this paper empirically evaluates the factors that influenced value of traditional wireless spectrum and evaluates whether the same models can be applied to make value inferences for mmW spectrum bands, as well as the change in relative value between urban and rural geographies. We find that the factors that explain spectrum value for lower and mid-band spectrum are not the value drivers for the mmW spectrum, and do not perform well in explaining the geographic variation in value either. Based on this finding we investigate whether the strategic relationship between wired networks and wireless networks had greater complementarity for mmW than the traditional spectrum bands

Mining sick: Creatively unsettling normative narratives about industry, environment, extraction, and the health geographies of rural, remote, northern, and Indigenous communities in British Columbia.

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely—as Cree Elder Willie Ermine says—pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as “sick”? Constructions of “sick” geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively “mined” for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro‐white‐settler imaginations. Drawing from multi‐year, relationship‐based, cross‐disciplinary qualitative community‐informed experiences, and anchored in feminist, anti‐colonial, and anti‐racist methodologies that guided creative and humanities‐informed stories, this paper concludes with different stories. It unsettles settler‐colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well‐being and the environment.

The Role of Rural and Urban Geography and Gender in Community Stigma Around Mental Illness.

Empirical evidence describes the negative outcomes people with mental health disorders experience due to societal stigma. The aim of this study was to examine the role of gender and rural-urban living in perceptions about mental illness. Participants completed the Day's Mental Illness Stigma Scale, a nationally validated instrument for measuring stigma. Directors of Chambers of Commerce in North Dakota distributed the electronic survey to their members. Additionally, distribution occurred through use of social media and other snowball sampling approaches. Analysis of data gathered from 749 participants occurred through examination of the difference in perceptions based on geography and gender. The zip codes of residence were sorted to distinguish between rural and urban participants. Application of weighting measures ensured closer alignment with the general population characteristics. Findings indicate that for the majority of the seven stigma measures the Day's Mental Illness Stigma Scale examines, the coefficient of rural-gender interactions was positive and highly significant with higher levels of stigma in rural areas. Females exhibited lower stigma perceptions than males. However, women living in rural areas held higher degrees of stigma compared to urban residing females. Implications of the study include the need to advance mental health literacy campaigns for males and people residing in rural communities. Additional empirical studies that examine the role of geography and gender in understanding stigma toward people with mental health disorders will result in improved treatment outcomes due to increased and focused educational efforts.

Biogeographical and Altitudinal Distribution of Cataract: A Nine-Year Experience Using Electronic Medical Record-Driven Big Data Analytics in India

ABSTRACT Purpose: To use electronic medical record data to study the altitude, UV exposure, and biogeographical distribution of senile cataract in India. Methods: This is a hospital-based, cross-sectional study of patients over 40 years old with an ophthalmologist-confirmed diagnosis of senile cataract (cortical, nuclear, posterior subcapsular, or a combination) in either or both eyes. Electronic medical record data entered between August 2010 to December 2019 were extracted from a large multi-tiered ophthalmology network in India. Residential districts were classified into their respective biogeographical zone based on nationally reported boundaries, and altitude at the geographic centroid was determined using Google Earth. Occupations were classified as low UV exposure and high UV exposure. Descriptive statistics, hypothesis testing, and multiple logistic regression analysis were done. Results: In the 1,127,232 eligible patients, associations were found between high UV exposure (OR = 1.47, 95%CI: 1.45–1.49), low socioeconomic status (OR = 1.54, 95%CI: 1.52–1.55), rural geographies (OR = 1.32), female gender (OR = 1.33, 95%CI: 1.32–1.34), and older age (OR) with cataract. This Indian patient population did not demonstrate increased formation of cataracts at higher altitudes (OR). Patients residing in the Deccan Peninsula (OR) and those with high UV exposures within each increasing altitude category, except >750 m, (OR had higher odds of senile cataract comparatively. Conclusion: Female gender, occupations with high UV exposure, rural geography and increasing age were observed to have greater odds of developing senile cataract. Increased likelihood of cataracts in populations residing at low altitudes and within the Deccan Peninsula may be attributed to greater hospital development in those areas.

New extractive frontiers in Ireland and the moebius strip of wind/data

This article maps the interconnections between two emergent resource frontiers in Ireland: wind and data. Adding to literature about extraction and extractivism, we account for how these expanded extractive frontiers are mobilised within self-sustaining and automated formations. In Ireland, digital infrastructures such as data centres are developed by multinational tech companies to avail of a naturally cool climate and business environment friendly to their investment, part of a wider extractive system by which data are made valuable for their expansive operations. Wind farms similarly make use of Ireland’s climate to generate energy, often used to power digital infrastructures, and are increasingly embedded within ‘smart’ energy and data systems. Wind and data are seen discretely as ‘abundant’ resources, their infrastructures built on terra or (offshore) mare nullius, and their operations ‘green’. However, their infrastructures are entangled with non-renewable energy systems and tax evasive capital, and built across existing communities and environments through policy, planning logics and increasingly automated methods of maintenance and optimisation. Through what we call ‘the moebius strip of wind/data’, wind and data infrastructures are increasingly formidable in dictating our energy futures. In this article, we articulate how they are connected and how we can disentangle them, especially in their operation across urban and rural geographies.

Deaths From COVID-19 in Rural, Micropolitan, and Metropolitan Areas: A County-Level Comparison.

The United States has experienced a surge of COVID-19 cases and deaths. Regardless of the overall increase in the prevalence and mortality, there are disagreements about the consequences of exposure and contracting COVID-19, specifically in rural areas. Rural areas have inherent characteristics that increase their vulnerability to contracting COVID-19. The objective of this study was to investigate the differences in death rates from COVID-19 between urban and rural areas in the United States. This study used county-level data. The data set consisted of confirmed COVID-19 cases and deaths along with county-level demographics. The sample consisted of all counties in the 50 US states and DC. Counties were designated as metropolitan, micropolitan, and rural. A zero-inflated negative binomial regression was used to estimate county-level number of deaths conditional on contracting COVID-19. The study focused on COVID-19-related mortality from February 10, 2020, to June 12, 2020. After controlling for county-level characteristics, the rate of COVID-19 deaths was 70.3% (P < .001) for rural counties and 53.4% (P < .001) for micropolitan counties, both significantly lower than metropolitan counties during the study time period. Over time, rural geography and social isolation may not provide sustainable protection to rural residents from the pandemic. The slow progression provides rural areas additional time and opportunity to learn from the experiences in urban areas that were most affected. Rural areas need to be proactive and develop prevention strategies and response plans to manage and control the spread of COVID-19.

Patients with hepatocellular carcinoma from more rural and lower-income households have more advanced tumor stage at diagnosis and significantly higher mortality.

Patients from rural and low-income households may have suboptimal access to liver disease care, which may translate into worse HCC outcomes. The authors provide a comprehensive update of HCC incidence and outcomes among US adults, focusing on the effect of rural geography and household income on tumor stage and mortality. The authors retrospectively evaluated adults with HCC using Surveillance, Epidemiology, and End Results data from 2004 to 2017. HCC incidence was reported per 100,000 persons and was compared using z-statistics. Tumor stage at diagnosis used the Surveillance, Epidemiology, and End Results staging system and was evaluated with multivariate logistic regression. HCC mortality was evaluated using Kaplan-Meier and multivariate Cox proportional hazards methods. HCC incidence plateaued for most groups, with the exception of American Indians/Alaska Natives (2004-2017: APC, 4.17%; P < .05) and patients in the lowest household income category (<$40,000; 2006-2017: APC, 2.80%; P < .05). Compared with patients who had HCC in large metropolitan areas with a population >1 million, patients in more rural regions had higher odds of advanced-stage HCC at diagnosis (odds ratio, 1.10; 95% CI, 1.00-1.20; P = .04) and higher mortality (hazard ratio, 1.05; 95% CI, 1.01-1.08; P = .02). Compared with the highest income group (≥$70,000), patients with HCC who earned <$40,000 annually had higher odds of advanced-stage HCC (odds ratio, 1.15; 95% CI, 1.01-1.32; P = .03) and higher mortality (hazard ratio, 1.23; 95% CI, 1.16-1.31; P < .001). Patients from rural regions and lower-income households had more advanced tumor stage at diagnosis and significantly higher HCC mortality. These disparities likely reflect suboptimal access to consistent high-quality liver disease care, including HCC surveillance.

Rural geographies and the New Chinese Cinemas: Imaging progressive places in Hou Hsiao-Hsien’s Dust in the Wind and Jia Zhangke’s Platform

The New Chinese Cinemas were unprecedented in critiquing official narratives of progress through dramatic location-shot images of rural Taiwan and China. Much more than standing in as a picturesque backdrop, the rural was a site of complex ideological contestations. Yet, existing scholarship overlooks the richness of rural representations, reductively interpreting rural films as works of nostalgia and cultural salvage. Through a comparative analysis of representations of landscape, travel and visual perception in Hou Hsiao-Hsien’s Dust in the Wind () and Jia Zhangke’s Platform (), this article brings into focus the important but largely ignored roles that Hou and Jia have played in envisioning new frameworks for thinking about rural geographies. Drawing from Doreen Massey’s notion of the ‘progressive place’, I investigate how Jiufen and Fenyang – the films’ shooting locations – are stages upon which the directors experimented with imaging and imagining communities. Jiufen is represented in Dust as a porous interface between the urban and rural, a metonym for the film’s representation of Taiwan as a contact zone with China. Platform, by contrast, fashions an image of Fenyang as a non-place, a microcosm of China as it undergoes unchecked neo-liberal development. Significantly, these films went beyond revising rural imaginaries on-screen, to making a material impact on Jiufen and Fenyang by transforming them into landmarks of global film tourism. This work demonstrates how Hou and Jia responded to disorienting social changes not by resisting, but by tactically embracing the blurring of divides between the urban and rural, and local and global.

The spatial evolution process, characteristics and driving factors of traditional villages from the perspective of the cultural ecosystem: A case study of Chengkan Village

The traditional village research is a popular topic in rural geography. The traditional village space contains rich human settlement cultural ideas, and thus, revealing its formation and evolutionary law is a practical need for the protection and development of a traditional village. Based on the theoretical analysis, this paper constructs a cultural-ecological environmental framework to analyse the spatial evolutionary process and characteristics of traditional villages. The Chengkan traditional village space displays the evolutionary process of formation, development, prosperity, decay, and regeneration. The natural, economic, and social environments together are regarded as an ecological environment support system that interacts with the traditional village space, drives the spatial evolutionary process. The spatial evolution of the traditional village is an orderly and dynamic process of spatial adaptability transformation that reflects the wisdom of the creation of the ancient Chinese living environment and provides useful inspiration for contemporary village planning and traditional village activation and utilization. The results show that it is necessary to grasp the spatial evolution process, characteristics and driving factors analysed from the perspective of the cultural ecosystem.

Towards a material approach in rural geography: Architectural experiments in China’s rural renaissance and reconstruction movements

Existing literature in rural studies and rural geography has tended to examine rurality as a representational, discursive and cultural construction, while there have been limited efforts that examine how material processes and practices co-produce and co-constitute the social relations and cultural subjectivities that contour rural changes. This paper addresses this gap by arguing for the relevance and necessity of a material approach in rural studies, building on but also advancing existing works that look beyond social constructivist conceptualisations of rurality. To this end, it reports on a case study of architectural experiments in Haotang Village in Henan Province, as part and parcel of the proliferating rural renaissance and reconstruction (RRR) movements in reform-era China. To illustrate the empirical nuances, this study draws insights from the literatures on the critical geography of architecture, with focus on three theoretical registers: event-ness, cultural meaning and relational effect. It puts forward two arguments in relation to architectural experiments in Haotang. First, it suggests that the embodied practices that produce, consume and maintain architectural materiality continue to mediate or effectuate the production of unstable, dynamic cultural meanings; and second, it claims that the encounters between humans and the material world involve a redefinition and reorganisation of social life and relations, catalysing progressive changes such as enhanced community solidarity and motives for self-governance.

Community Tele-pal: A community-developed, culturally based palliative care tele-consult randomized controlled trial for African American and White Rural southern elders with a life-limiting illness

BackgroundPatients living in rural areas experience a variety of unmet needs that result in healthcare disparities. The triple threat of rural geography, racial inequities, and older age hinders access to high-quality palliative care (PC) for a significant proportion of Americans. Rural patients with life-limiting illness are at risk of not receiving appropriate palliative care due to a limited specialty workforce, long distances to treatment centers, and limited PC clinical expertise. Although culture strongly influences people’s response to diagnosis, illness, and treatment preferences, culturally based care models are not currently available for most seriously ill rural patients and their family caregivers. The purpose of this randomized clinical trial (RCT) is to compare a culturally based tele-consult program (that was developed by and for the rural southern African American (AA) and White (W) population) to usual hospital care to determine the impact on symptom burden (primary outcome) and patient and care partner quality of life (QOL), care partner burden, and resource use post-discharge (secondary outcomes) in hospitalized AA and White older adults with a life-limiting illness.MethodsCommunity Tele-pal is a three-site RCT that will test the efficacy of a community-developed, culturally based PC tele-consult program for hospitalized rural AA and W older adults with life-limiting illnesses (n = 352) and a care partner. Half of the participants (n = 176) and a care partner (n = 176) will be randomized to receive the culturally based palliative care consult. The other half of the patient participants (n = 176) and care partners (n = 176) will receive usual hospital care appropriate to their illness.DiscussionThis is the first community-developed, culturally based PC tele-consult program for rural southern AA and W populations. If effective, the tele-consult palliative program and methods will serve as a model for future culturally based PC programs that can reduce patients’ symptoms and care partner burden.Trial registrationClinicalTrials.gov NCT03767517. Registered on 27 December 2018.

Land use transition and rural spatial governance: Mechanism, framework and perspectives

The pattern for utilization of rural space is closely related to rural transformation development (RTD). The problem of rural space utilization is an important manifestation of the uncoordinated relationship between land use patterns and rural development status during a transformation period. Considering the rural space utilization issue, this article seeks to analyze the interaction mechanisms between land use transition (LUT) and rural spatial governance and then build a rural spatial governance analysis framework based on LUT. Also, the paper explores the internal relationship between rural spatial governance and rural vitalization and discusses the research prospective of the interaction. The study found that: (1) Rural space utilization has systemic problems such as limited development space, ill-defined ownership and poor organization, which have become important obstacles for rural development. (2) The uncoordinated relationship between LUT and RTD is an important reason for the dilemma surrounding rural space utilization. (3) The LUT provides a basis for determining the timing of rural spatial governance, specifying spatial governance objectives, and clarifying rural spatial governance methods. (4) The construction of a comprehensive analysis framework of “matter-ownership-organization” of rural space based on the LUT has created conditions for the orderly promotion of rural spatial governance. (5) Rural spatial governance which facilitates the integration of urban-rural development is an important foundation for rural vitalization. (6) Interaction analysis of LUT, RTD and rural spatial governance is conducive to facilitating research on the operational mechanism of rural regional systems and to expanding the research field of rural geography.

Equipping Community Based Psychologists to Deliver Best Practice ASD Diagnoses Using The ECHO Autism Model

ABSTRACT Timely diagnosis of autism spectrum disorder (ASD) is paramount to ensuring access to evidence-based intervention for individuals with ASD and their families, but the receipt of ASD diagnoses continues to be delayed. Nationwide, demand for appropriately trained healthcare providers has outpaced availability with many families unable to access timely care. This is particularly evident in underserved (e.g., rural, lower socioeconomic) populations. The current project used a quasi-experimental design to test an innovative model (i.e., ECHO Autism: Diagnostics) designed to educate, train, and mentor community-based psychologists (CBPs) serving families in Missouri. ECHO Autism: Diagnostics was designed to increase the number of CBPs who are knowledgeable in ASD and equipped to work with families seeking ASD-specific evaluations. Nine CBPs representing unique rural geographies from across Missouri completed this pilot project. Results indicated significant improvement in participants’ self-efficacy related to working with individuals with ASD. Participants also reported significant improvement in self-efficacy related to recognizing red flags of ASD and administering the ADOS-2. CBPs who participated in the project demonstrated increased ASD knowledge and perceived fewer barriers to caring for individuals with ASD in their practice. Results from this project suggest that the ECHO Autism: Diagnostics model may be a feasible and potentially scalable means of reducing disparate access to ASD-diagnostic evaluations.

The evolution of rural areas influenced by large-scale farming: four case studies from Hungary

In order to study complex transformation of rural areas in the long term, our paper aims to integrate the concepts of rural restructuring and evolutionary economic geography. We argue that these approaches can complement each other to understand the mechanisms shaping rural evolutionary paths. We apply our theoretical framework to the case of rural areas evolving under the influence of large-scale farms in Hungary, namely the so-called manorial settlements. Tracing the processes on three different scales (global, national and local) we claim that during the last one hundred years the rural configuration in these areas shows a number of continuities despite the significant political-economic transitions throughout this period. The global dependency and semi-peripheral position of Hungary is apparent, and also the role of global agri-food regimes can be observed. Political transitions on the national scale appear primarily as ‘external shocks’. Despite the strong path dependency in terms of powerlessness and passivity of local societies at manorial settlements, the role of certain local actors in path creation should not be ignored.

70-OR: Change in A1C with and without Intermittent Use of CGM in Adults with Type 2 Diabetes Participating in the Onduo Virtual Diabetes Clinic

The Onduo Virtual Diabetes Clinic (VDC) for people with T2D combines a mobile app, remote personalized lifestyle coaching and connected devices. Differentiating features are live video consultations with board-certified endocrinologists for medication management and prescription of real-time CGM devices for intermittent use as clinically indicated. This analysis examined change in A1c from enrollment to follow-up at 6 mo in CGM vs. non-CGM user groups. Characteristics of CGM (n=213) and non-CGM (n=399) groups were similar. Overall, participants (n=612) were 53.5±8.7 yr, 61.1% female and 26.5% lived in a rural geography. Baseline A1c was 7.8%±1.7, 33.0% were on insulin and 23.5% on a sulfonylurea. A1c decreased significantly in CGM and non-CGM groups by 0.9%±1.7 and 0.4%±1.3, respectively (both p&amp;lt;0.001). Change in A1c stratified by CGM use and baseline A1c categories of &amp;gt;9.0%, 8.0-9.0%, 7.0-&amp;lt;8.0%, &amp;lt;7.0% are presented in the Table. These real-world data suggest that participation in the Onduo VDC was associated with significant improvement in A1c for participants not meeting ADA treatment targets. There was an approximately two-fold greater improvement in A1c with intermittent CGM use. In conclusion, the VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialist care and advanced diabetes technology. Disclosure J.E. Layne: Employee; Self; Onduo. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson &amp; Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. N.A. Barleen: Employee; Self; Onduo. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.F. Dixon: Employee; Self; Onduo.

1193-P: “TechQuity” in Diabetes: Does Digital Health Technology Improve Equity?

Introduction: Higher diabetes mellitus (DM) burden and disparities in healthcare have been linked to factors including race/ethnicity, low socioeconomic status (SES), and geographic location. Objective: To identify digital health interventions (DHIs) that improve health and healthcare delivery outcomes in populations disproportionately affected by DM. Methods: A systematic scoping review evaluated DHIs to address global health disparities in cardiovascular (CV)-related diseases/disorders or cardiovascular disease (CVD). A subgroup analysis was performed to identify the impact of DHIs in DM populations. Pre-post DM-specific health (clinical/intermediate and patient-reported) and healthcare delivery outcomes (quality, utilization, and access to care including DHI technical evaluations) were abstracted. Results: In the subgroup analysis, 21 of the 58 included studies (out of 4,298 relevant citations) examined DM populations. DM-specific health data were obtained from 13 of those studies examining primary (e.g., weight loss), secondary (e.g., diabetic retinopathy screening), tertiary (e.g., glucose control), or quaternary (e.g., overmedicalization) preventive DHIs. DHIs primarily targeted Black (29%), Hispanic (24%), low SES (62%), and/or rural (52%) populations in the United States (52%). DHIs commonly used electronic health records (28%) and decision support systems (19%). Eleven (85%) studies showed DHIs significantly improved outcomes, nine (70%) studies had no effect, and seven (54%) studies negatively impacted disparity populations. Eight (62%) studies were high-quality (e.g., RCTs). No trends could be identified to find associations of DHI type nor disparity group with preventive intervention success. Conclusions: Preventive DHIs improved both health and healthcare delivery outcomes in DM-specific disparities identified in racial/ethnic groups and low SES populations in both rural and urban geographies globally. Disclosure K. Craig: Other Relationship; Self; Medtronic. K.B. Rhee: Employee; Self; IBM.

Abstract A019: Community-based intervention leads to increased cancer knowledge and prevention behaviors in a rural population

Abstract Introduction: We conducted a community-based participatory research pilot project to adapt Cancer Clear &amp; Simple (CC&amp;S) for easier dissemination in a rural population, and to evaluate the impact of providing this education on cancer knowledge and risk reduction behaviors. Procedures: We conceived and implemented this project collaboratively with local rural partners, including a multicounty rural electric cooperative. Our aims were to (1) conduct qualitative interviews with community stakeholders, past CC&amp;S participants, and a sample of prospective participants, and use the findings to revise CC&amp;S for easier dissemination; and (2) test whether CC&amp;S increased cancer knowledge and risk-reduction behaviors by randomizing 66 community members to either the CC&amp;S condition (n=32) or meal planning control condition (n=34) in two rural communities. We surveyed participants before the intervention, immediately following, and 6 months later. We collected data both online and in paper-based surveys, and through clinic verification of reported cancer screenings at 6 months. Results: We found cancer knowledge increased from pre- to post-intervention for the CC&amp;S group (63% to 81%, p &amp;lt; .001) but not the control group (56% to 59%, p = .23) and, further, the increased knowledge of CC&amp;S participants was sustained at 6 months. The CC&amp;S group was more confident about talking with their doctors about cancer (4.7 v. 4.3, p &amp;lt; .001) and reducing cancer risk (4.7 v. 4.2, p &amp;lt; .001) after the intervention than before, and their increased confidence was sustained 6 months later. We also found a greater intent to participate in cancer risk-reduction behaviors immediately after the intervention for the CC&amp;S group versus the control (99% v. 95%, p = .08) and significantly greater levels of self-reported healthy behaviors among the CC&amp;S group versus the control at 6 months (87% v. 74%, p = .02). Further, 59% of participants consented to allowing clinic-based objective confirmation of screening rates, but numbers of participants due for screening tests resulted in limited power to employ these data as an outcome. Conclusions: We found that the modified version of CC&amp;S increased cancer knowledge and the intent to participate in risk-reduction behaviors, and likely led to sustained healthy behaviors over time. The research team also confirmed that participants would consent to clinic verification of their screening behavior. As this was a pilot, we plan to conduct a study with a larger number of participants and a cohort of rural residents across a broader, more diverse rural geography. Citation Format: Cody Fredrick, Amanda T. Eggen, Amy Amessoudji, Tracy M. Downs, Elizabeth A. Jacobs. Community-based intervention leads to increased cancer knowledge and prevention behaviors in a rural population [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A019.