Rural Health Department Research Articles

Experiences of Nursing and Allied Health Students Undertaking a Rural Placement: Barriers and Enablers to Satisfaction and Wellbeing

Australia's rural health services commonly face serious and protracted workforce shortages. To help address such shortages in rural and remote areas, a range of programs exist to support university students to undertake placements in a rural setting. In particular, University Departments of Rural Health (UDRHs) are funded to support nursing and allied health students to undertake a rural placement. As UDRHs encourage students to 'go rural' and as they coordinate and facilitate placements in rural settings, a range of enablers and barriers emerge. This study investigates the lived experiences of nursing and allied health students on placement in public health services in rural and regional Victoria. Its purpose was to identify the enablers and barriers most strongly affecting placement satisfaction and personal wellbeing. The intended outcome was to identify modifiable factors that could potentially improve the rural placement experience. Eighteen students were interviewed by a student undertaking her placement. Interviews were 45-60 minutes in length and all face-to-face. The 18 participants were from five universities and were undertaking their placement at one of seven public hospitals operating in northeast Victoria. The researcher recruited participants by attending scheduled debrief meetings at their placement organisation, briefly discussing the research and inviting students to participate. Data were analysed using a thematic analysis approach. The study found that most participants were positive and enthusiastic about their rural placement, both professionally and personally. Three key enablers were identified: 1) enjoyment of the rural environment and community; 2) working in a positive, friendly and supportive workplace; and 3) exposure to broad practice and enhanced learning opportunities. Simultaneously many had also experienced significant barriers before, during or as a consequence of undertaking their placement, and these negatively affected placement satisfaction and personal wellbeing. Identified barriers were: 1) increased financial stress; 2) travel and accommodation challenges and concerns; 3) study-work-life balance and isolation issues; 4) encountering stressful work situations and/or personal events while on placement; and 5) communication issues with universities. The findings are strongly consistent with those identified in the extant literature. The findings add to previous research by deepening understanding about the financial burden and barriers experienced by nursing and allied health students as a result of undertaking rural placements. Disruption to students' lives socially, psychologically, financially and in terms of employment were significant. The study identified some important aspects of the placement experience, suggesting that nursing and allied health students can be dissatisfied with increased financial stress, isolation and inflexibility from universities.

Creating place-based health and wellbeing networks in rural and remote communities.

Creating place-based health and wellbeing networks in rural and remote communities.

Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools.

This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers - half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.

Hearing and quality of life in older adults.

We assessed quality of life (QoL) in older adults with and without hearing loss (HL) and studied how hearing aids were associated with QoL. We hypothesized participants with normal hearing would have significantly better QoL than participants with HL and hearing aids, and participants with HL but no aids would have the worst QoL. At the University of Alabama and rural public health departments in surrounding counties, we tested 100 males and females aged 60-87 using pure-tone audiometry. They completed Short Form-36 and Medical Outcome Study assessments. We analyzed data with MANCOVA (covariate income). Participants without hearing aids had significantly poorer QoL than participants with normal hearing, who did not significantly differ from participants with aids. General health drove the difference. Hearing aids are associated with better QoL than having HL and going without aids. Clinical psychologists can improve coping among those with HL and motivate hearing aid use.

University Departments of Rural Health: is a national network of multidisciplinary academic departments in Australia making a difference?

University Departments of Rural Health: is a national network of multidisciplinary academic departments in Australia making a difference?

Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey.

The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Cross-sectional survey comprising 21 core questions used by all UDRHs. Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post-placement rural practice intention. The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention.

Availability of Long-Acting Reversible Contraception in Kansas Health Departments.

Unintended pregnancy persists as a public health problem in the United States. Local health departments (LHDs) could play an important role in preventing unintended pregnancy by promoting and providing long-acting reversible contraception (LARC, intrauterine devices [IUDs] and implants), particularly in rural states that may lack robust family planning service infrastructure. The objective of this study was to determine availability of LARC in LHDs in Kansas. From October 2015 to January 2016, LHD administrators in Kansas were contacted to participate in a structured, cross-sectional phone survey assessing LARC availability, staff trained to place LARC, the process for obtaining LARC, and barriers to offering LARC. The main outcome measure was the proportion of Kansas LHDs offering LARC. Of 101 eligible LHDs, staff from 98 agreed to be interviewed (97.0%). Of 69.4% providing family planning services, 20.6% provided LARC (20.6% provided IUDs, 11.8% provided implants and IUDs, and none provided implants only). Overall, only 29.4% of LHDs reported discussing contraception routinely regardless of reason for visit. Rural health departments were less likely to offer testing for sexually transmitted infections and LARCs and less likely to have trained staff on site to insert LARCs when compared to nonrural LHDs. LARC methods are not commonly available in Kansas LHDs. Small LHDs in a rural state like Kansas could benefit from increased capacity to provide LARC to populations with limited access to health care. An increase in funding to prevent unintended pregnancy through expanded LARC access could result in substantial state savings and lead to fewer unintended pregnancies.

Surviving or thriving in the primary health care research workforce: the Australian experience.

Primary healthcare research strives for high-quality, priority-driven research to inform policy and practice. This relies on a robust and sustainable workforce to tackle complex problems faced in primary health care locally and globally. The current study investigated characteristics, experiences and career paths of the Australian primary healthcare research workforce. Thirty-seven former Research Higher Degree students from University Departments of General Practice and Rural Health completed a survey. Number of provisions for researchers and career path clarity were associated with job satisfaction. Motivators to stay in research included job satisfaction, research in role descriptions, and identification of problems requiring change. Barriers related to funding, time, and other work roles taking priority were identified. Comparisons were made between participants self-identifying as working in primary healthcare research ('stayers'; n=22) and those no longer part of this workforce ('leavers'; n=15). Leavers were more likely to be in permanent full-time work whereas stayers had experienced more career progression and mentoring. This study raises challenges faced by primary healthcare researchers and will inform strategies for supporting the sustainability of this workforce.

Mental health academics in rural and remote Australia

The significant impact of mental ill health in rural and remote Australia has been well documented. Included among innovative approaches undertaken to address this issue has been the Mental Health Academic (MHA) project, established in 2007. Funded by the Australian Government (Department of Health), this project was established as a component of the University Departments of Rural Health (UDRH) program. All 11 UDRHs appointed an MHA. Although widely geographically dispersed, the MHAs have collaborated in various ways. The MHA project encompasses a range of activities addressing four key performance indicators. These activities, undertaken in rural and remote Australia, aimed to increase access to mental health services, promote awareness of mental health issues, support students undertaking mental health training and improve health professionals' capacity to recognise and address mental health issues. MHAs were strategically placed within the UDRHs across the country, ensuring an established academic base for the MHAs' work was available immediately. Close association with each local rural community was recognised as important. For most MHAs this was facilitated by having an established clinical role in their local community and actively engaging with the community in which they worked. In common with other rural health initiatives, some difficulties were experienced in the recruitment of suitable MHAs, especially in more remote locations. The genesis of this article was a national meeting of the MHAs in 2014, to identify and map the different types of activities MHAs had undertaken in their regions. These activities were analysed and categorised by the MHAs. These categories have been used as a guiding framework for this article. The challenge to increase community access to mental health services was addressed by (i) initiatives to address specific access barriers, (ii) supporting recruitment and retention of rural mental health staff, (iii) developing the skills of the existing workforce and (iv) developing innovative approaches to student placements. Strategies to promote awareness of mental health issues included workshops in rural and remote communities, specific suicide prevention initiatives and targeted initiatives to support the mental health needs of Indigenous Australians. The need for collaboration between the widely dispersed MHAs was identified as important to bridge the rural divide, to promote project cohesiveness and ensure new ideas in an emerging setting are readily shared and to provide professional support for one another as mental health academics are often isolated from academic colleagues with similar mental health interests. The MHA project suggests that an integrated approach can be taken to address the common difficulties of community awareness raising of mental health issues, increasing access to mental health services, workforce recruitment and retention (access), and skill development of existing health professionals (access and awareness). To address the specific needs and circumstances of their community, MHAs have customised their activities. As in other rural initiatives, one size was found not to fit all. The triad of flexibility, diversity and connectedness (both to local community and other MHAs) describes the response identified as appropriate by the MHAs. The breadth of the MHA role to provide university sponsored educational activities outside traditional student teaching meant that the broader health workforce benefited from access to mental health training that would not otherwise have occurred. Provision of these additional educational opportunities addressed not only the need for increased education regarding mental health but also reduced the barriers commonly faced by rural health professionals in accessing quality professional development.

Service providers’ experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service

BackgroundDespite evidence of benefits of telehealth networks in increasing access to, or providing, previously unavailable mental health services, care providers still prefer traditional approaches. For psychiatric assessment, digital technology can offer improvements over analog systems for the technical and, subsequently, the social quality of provider-client interaction. This is in turn expected to support greater provider uptake and enhanced patient benefits. ObjectiveWithin the framework of Innovation Diffusion Theory, to study service providers’ experiences of an existing regional telehealth network for mental health care practice twelve months after digitisation in order to identify the benefits of digital telehealth over an analog system for mental health care purposes in rural Australia. MethodsQualitative interviews and focus groups were conducted with over 40 service providers from June to September 2013 in South Australia, ranging from the metropolitan central operations to health providers located up to 600km away in rural and remote areas of the same state. Participants included rural mental health teams, directors of nursing at rural hospitals, metropolitan-based psychiatrists and registrars, the metropolitan-based mental health team dedicated to rural provider support, rural GPs, administrative staff, and the executive group of the state rural health department. Fieldwork was conducted 12 months after the analog system was digitised. The interview and focus group data were analysed using thematic analysis, focusing on three key areas of innovation diffusion theory: relative advantage, technical complexity and technical compatibility. ResultsFive themes with 11 sub-themes were identified: (1) “Existing Uses”, with three sub-themes: current mental health use, use by GPs, and use for staff support; (2) “Relative Advantage”, with four sub-themes: improved technical quality, improved clinical practice, time and cost benefits for providers, and improved patient care; (3) “Technical Complexity”; (4) “Technical Compatibility” with two sub-themes: technical-clinical and technical-administrative; and (5) “Broader Organisational Culture”, with two sub-themes: organizational policy support and ‘digital telehealth' culture. ConclusionsThe digitised telehealth network was generally well received by providers and adopted into clinical practice. Compared with the previous analog system, staff found advantages in better visual and audio quality, more technical stability with less “drop-out”, less time delay to conversations and less confusion for clients. Despite these advantages, providers identified a range of challenges to starting or continuing use and they recommended improvements to increase uptake among mental health service providers and other providers (including GPs), and to clinical uses other than mental health. To further increase uptake and impact of telehealth-mediated mental health care in rural and remote areas, even with a high quality digital system, future research must design innovative care models, consider time and cost incentives for providers to use telehealth, and must focus not only on technical training but also how to best integrate technology with clinical practice and must develop an organization-wide digital telehealth culture.

Latina and Non-Latina Mothers' Perceived Health Barriers and Benefits and Their Relationship to Children's Health Behaviors.

Objectives Disparities exist in rates of overweight/obesity between Latino and non-Latino populations. Attention should be given to risk factors that may be modifiable through interventions involving both the parent and child. The current study sought to identify ethnic differences in parental health beliefs and their relation to children's health behaviors. Methods Latina and non-Latina mothers (N=203) at rural and urban clinics and health departments completed self-report questionnaires. Key information included beliefs about barriers and benefits to health practices and children's health behaviors. Results Children of Latina mothers consumed significantly more soda and fried foods and exercised less than children of non-Latina mothers. Latina mothers were significantly more likely to perceive barriers to healthy eating and significantly less likely to perceive benefits to healthy eating and physical activity than non-Latina mothers. Ethnicity mediated the relationship between maternal views of health benefits and soda consumption. Conclusions Policy changes are needed to promote health education and increase the accessibility of healthy foods and safe places to exercise for Latino families.

Barriers and Incentives to Rural Health Department Accreditation.

Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52,000 for accredited RLHDs and from 7200 to 73,000 for unaccredited RLHDs. Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

Contribution of university departments of rural health to rural health research: An analysis of outputs

To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82); most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56%; n = 102) of the articles addressed rural health issues; Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1-19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2-5 universities/organisations but only 5% of articles included an author from more than one UDRH. Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.

A rural local health department-hospital collaborative for a countywide community health assessment.

In mid-2012, the Polk County Health Department initiated a community health needs assessment process with the 3 medical centers serving this rural Wisconsin county of 45 000 residents. The collaborative process drew on primary and secondary data, including clinical data pooled from health care organizations, to assess population health. Community health assessment ultimately engaged more than 1800 county residents through coordinated surveys and community forums. Although the Polk County Health Department has a long history of collaboration with the local health care community, the Patient Protection and Affordable Care Act, coupled with meaningful use requirements for health care providers, sharply increased engagement, contributed to shared priorities, and brought this relationship to a new level. Partners have now convened community-based workgroups around the top 3 health focus areas selected from the assessment process. Community health assessment emphasized the social determinants of health as a step toward a more "upstream" orientation to population health goals.

Bibliometric analysis on Australian rural health publications from 2006 to 2012.

To review Australian rural health (ARH) publications in PubMed from 2006 to 2012 and address ARH issues raised by the 2013 Health and Medical Research report. Retrospective observational study. Internet-based bibliometric analysis using PubMed. MEDLINE-indexed ARH publications from 2006 to 2012 were retrieved using PubMed queries. ARH publications were defined as Australian publications that explore issues relevant to the health of the regional, rural or remote Australian population. Two authors independently reviewed a random sample of 5% of publications for validity. Analysis determined country of origin (Australia); publications relevant to the National Health Priority Areas, the 2013 National Rural Health Alliance priority areas and Rural Clinical Schools/University Departments of Rural Health; and journal frequencies and publication types. ARH publications increased from 286 in 2006 to 393 in 2012 and made up 1.4% of all Australian PubMed publications. Combined, the health priority areas were addressed in 52% of ARH publications. Rural Clinical Schools/University Departments of Rural Health articles made up 7% of ARH publications. An increase in cohort studies, systematic reviews and reviews indicated improved quality of articles. ARH articles were most commonly published in the Australian Journal of Rural Health (15.9%), Rural and Remote Health (13.4%) and the Medical Journal of Australia (6.3%). Striking a balance between broadening the queries (increasing sensitivity) and limiting the false positives by restricting the breadth of the queries (increasing specificity) was the main limitation. This reproducible analysis, repeated at given timelines, can track the progress of ARH publications and provide directions regarding future rural health research.

Preventing Obesity

Low-income women are at risk for excessive gestational weight gain. Inactive lifestyle and lack of regular moderate exercise may contribute to the risk of weight gain. This study was conducted to (1) determine the rate and characteristics of low-income pregnant women who exercised regularly and met the American College of Obstetricians and Gynecologists recommendation and (2) describe how these women spent time for other physical activities compared with those who did not exercise regularly. Medicaid-recipient or uninsured pregnant women (n = 816) were asked to complete a physical activity questionnaire at rural and urban county health departments located in North Carolina. Twenty percent of low-income women met the American College of Obstetricians and Gynecologists recommendation for moderate exercise (≥10 METs-h/wk [metabolic equivalent task-hours per week]). The women who met the recommendation spent 3 hours 45 minutes per week walking as exercise, whereas those who did not meet the recommendation spent 1 hour per week (P < .0001). Women who exercised regularly spent longer hours at work (4.25 vs. 1.75 hours per day; P = .019) and on household tasks (5.25 vs. 4.0 hours per day; P = .002) than women who did not exercise regularly. Time spent on domestic and occupation activities does not seem to prohibit low-income women from engaging in moderate exercise on a regular basis.

Effectiveness of an Intervention for Adherence to Follow-up Recommendations for Abnormal Pap Tests in Appalachian Kentucky.

In collaboration with rural county health departments (CHDs), we developed a patient navigation intervention to increase adherence to follow-up recommendations for women with abnormal Pap tests. Local women were recruited, trained and placed in CHDs. Navigation was tailored to the follow-up care recommended. Effectiveness was evaluated in a quasi-experimental trial that included 13 intervention CHDs and 13 comparison group CHDs. Participants were enrolled from September 2008 through July 2010. A total of 478 participants were enrolled. The proportion that received recommended follow-up care was greater in the intervention CHDs (91.6%) than in the comparison group CHDs (80.8%) (p = .01). These results suggest that development of policy to promote navigation with rural health care delivery systems has great potential to improve patient outcomes.

What is the evidence for clinical placements in underserved areas?

What is the evidence for clinical placements in underserved areas?

Better rural health through research?

Better rural health through research?

A PowerPoint is for a conference, an article is forever

A PowerPoint is for a conference, an article is forever