Rural Health Services Research Articles

Growing the peer workforce in rural mental health and social and emotional well-being services: A scoping review of the literature.

Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings. Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature. A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search. A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'. While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services. The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

Enhancing Clinical Data Quality to Improve Patient Care in Rural Health Facilities

WHO recognizes that high-quality research is not just a scientific pursuit but a crucial factor in achieving global health, health equity, and economic development. It is not just about the numbers but about the lives we can save and improve. In this context, four research priority areas have been identified: prioritizing health needs, building research capacity, ensuring good research practice, and ensuring good evidence is translated into practice. Local health research tailored to local needs remains an important global health goal, with the potential to revolutionize patient care in rural health facilities. Researchers and policymakers in low- and middle-income countries have expressed serious concerns about the limited access to high-quality data, a fundamental requirement for reliable and valid research. The assessment of data quality is typically categorized into five key areas: availability, usability, dependability, relevance, and presentation quality. This concept is further clarified by demonstrating how a robust healthcare data environment can enhance patient management through research efforts. The term ‘health data environment' encompasses the entire process of gathering, storing, managing, analysing, and utilizing health-related data to improve patient care and healthcare policies through informed decision-making. In this context, we present the challenges that undermine the quality of research data and propose solutions. Specifically, we identify the lack of adequate human resources, reliance on paper-based records systems, and the high costs of internet connectivity as the primary barriers to collecting and sharing high-quality data for research in low-resource settings. To tackle these challenges, we advocate for governments and funding institutions to invest in data management and communication systems, recruit and train data management staff to support clinicians, and reduce connectivity costs. Furthermore, we propose the deployment of a decentralized system as a cost-effective and less labor-intensive solution that only requires data entry staff at health facilities in resource-limited settings. This article explores current data collection, storage, and interpretation challenges and proposes innovative improvement solutions. It emphasizes the transformative potential of digitization, standardization, and staff training to enhance data quality. It further addresses the impact of quality data on evidence-based practice, ultimately leading to improved health outcomes. Focusing on rural healthcare facilities sheds light on the unique barriers these settings face, proposing tailored strategies that can bridge the gap between urban and rural health service delivery. These insights offer valuable guidance for policymakers, healthcare administrators, and practitioners striving to improve patient care in rural areas through data-driven strategies.

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

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

Examining multidimensional health poverty and determining factors among rural women of childbearing age in ningxia, china

BackgroundThe multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies.MethodsBased on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age.ResultsWith k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer.ConclusionsEven with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age.

Evaluating Age-Friendly Health Care Approaches in Rural Primary Care Settings: A Multi-Case, Mixed-Methods Hybrid Type 2 Effectiveness-Implementation Study.

Maintaining and improving the health and well-being of older people in rural communities through integrated care is essential to address this cohort's frailty risk. The Indigo 4Ms Tool for health workers is a rural-specific approach to providing care that addresses the common conditions of ageing. With Australian government funding, five small rural health services are implementing the tool. This paper describes the protocol for a hybrid type 2 implementation-effectiveness study to evaluate the tool's impact on multidisciplinary comprehensive care planning and the implementation strategies that enhance the adoption and sustainability of the tool across diverse rural health settings.

Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments.

To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs). Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change. The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia. Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs. Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019. Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care. This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.

Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States.

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

Reflections on being an insider researcher: a study exploring the experiences of men accessing rural mental health services.

An embedded single case-study design was used to explore the experiences of men in rural New Zealand accessing mental health services. It is essential for researchers to acknowledge positionality in case study research and the lead author used reflexive practice to acknowledge his values and beliefs. To explore and demonstrate the reflexive process of the lead author's position as an inside researcher. Three groups were involved in the research: men with mental health challenges, their partners, and mental health clinicians. The article presents the initial research through memos and diarying in the context of current literature. Reflexivity is essential for ensuring the research process is complete and biases are identified. Positionality exists on a continuum and it is critical for researchers to be honest with themselves, the topic and the group being investigated, to show respect for the participants and the people they represent, as well as to be committed to revealing the truth. Insider research has the potential to bridge the gap between academia and practice. It facilitates the transfer of research knowledge directly to practitioners, leading to more evidence-informed decision-making and practice.

Shared decision making in rural general practices: a qualitative exploration of older rural South Australians’ perceived involvement in clinical consultations with doctors

BackgroundShared decision-making (SDM) implementation is a priority for Australian health systems, including general practices but it remains complex for specific groups like older rural Australians. We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices. MethodsWe conducted a patient-oriented research, partnering with older rural Australians, families, and health service providers in research design. Participants who visited general practices were purposively sampled from five small rural towns in South Australia. A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted. ResultsTelephone interviews were held with 27 participants. Four themes were identified around older rural adults’ involvement in SDM: (1) Understanding of “patient involvement”; (2) Positive and negative outcomes; (3) Barriers to SDM; and (4) Facilitators to SDM. Understanding of patient involvement in SDM considerably varied among participants, with some reporting their involvement was contingent on the “opportunity to ask questions” and the “treatment choices” offered to them. Alongside the opportunity for involvement, barriers such as avoidance of cultural care and a lack of continuity of care are new findings. Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices. Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers. ConclusionAdequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia. Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians’ involvement in general.

Exploring factors associated with failure of totally implanted vascular access devices in a regional and rural health service: a retrospective case–control study

BackgroundThe assessment and management of totally implanted vascular access devices (TIVAD) prior to the administration of medications/fluids are vital to ensuring the risk of harm is mitigated. While numerous guidelines...

Continuing professional development training needs of allied health professionals in regional and rural Victoria.

The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria. This study was an online cross-sectional design conducted between December 2022 and February 2023. AHPs employed at a large multi-site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia. The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers. The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6-10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self-perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment. CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities.

The prevalence of the risk factors associated with cardiovascular diseases among Iranian adults: Findings of a cross-sectional study.

Cardiovascular diseases are among the leading causes of death worldwide. Lack of accurate estimation of the risk factors associated with these diseases can impair the designing of effective interventions in this field; the present study aimed to investigate the risk factors attributable to cardiovascular diseases in males and females visiting comprehensive health service centers in 2018. This cross-sectional study is part of the national health transformation plan shaped in response to the emerging epidemic of noncommunicable diseases. In the present study, 6,331 participants aged 30 years and older were randomly and census selected from comprehensive urban and rural health service centers in Naein County, in Isfahan, Iran, respectively. The data were collected using the electronic health record from the IraPEN program in two sections: demographic information and the prevalence of cardiovascular disease risk factors. They were then analyzed with Statistical Package for the Social Sciences (SPSS) 24 software using descriptive statistics, Chi-square test, one-way ANOVA, and logistic regression. The participants' mean age was 55.09 ± 16.11 years. The main risk factor was insufficient consumption of fruits and vegetables while smoking was a negligible risk factor. Low physical activity, diabetes, hypertension, hypercholesterolemia, and high body mass index were more prevalent in females than in males, whereas smoking was more frequently reported in males (P < 0.001). Risk factors such as age, gender, education level, place of residence, and marital status, played a significant role in determining CVD risk factors. More than half of Iranian adults had one or older cardiovascular disease-related risk factors, and the prevalence of such factors was higher in females than in males. Given the importance of gender differences in cardiovascular disease-related health habits, it is necessary to reduce the majority of these diseases in society, especially in women, by controlling modifiable risk factors.

Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families – implementation and evaluation study protocol

IntroductionComplex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a ‘critical window’ for recovery and transforming cycles...

A new intuitionistic fuzzy scheme of data envelopment analysis for evaluating rural comprehensive health service centers

In this study, the classical CCR-IO DEA model (an input-oriented form of the DEA model of Charnes, Cooper, and Rhodes [24] is extended to an intuitionistic fuzzy environment. For this aim, the trapezoidal intuitionistic fuzzy numbers are used to show the values of inputs and outputs. An intuitionistic fuzzy number is characterized by membership, non-membership, and hesitancy degrees. Therefore, such type of fuzzy numbers is more complete and contains more information to reflect a fuzzy type of uncertainty comparing to the conventional fuzzy values. In order to solve the proposed intuitionistic fuzzy CCR-IO model, for the first time a possibility-based approach is developed for the intuitionistic fuzzy DEA models. In this approach for the first time the ME measure of fuzzy events is extended to intuitionistic fuzzy DEA models, therefore, some new definitions and propositions are presented and clarified. This measure is more flexible and effective comparing to the other measures such as credibility, necessity, and possibility measures. A case study from the health care sector of Iran is considered to evaluate the proposed solution approach numerically. The case study is solved under different scenarios, a full sensitivity analysis is performed, and finally some useful managerial insights are presented. In addition, the results of the proposed intuitionistic CCR-IO model are compared to the classical models of the literature.

The potential value of e-health in a rural Limpopo Province municipality

This qualitative study aims to assess the value of e-health in rural areas of the Limpopo Province of South Africa. The study was meant to appraise the current state of e-health readiness in rural Limpopo areas and identify any barriers to effective health service delivery. Data were collected through interviews with rural health providers from the province. The study defined e-health as an approach in which health services can be provided comprehensively by using information and communication technologies (ICTs) in a more cost-effective, efficient, and quicker way than when manual methods are used. It then established that rural health in Limpopo is deficient and almost dysfunctional because of rural health in Limpopo is deficient and almost dysfunctional because of lacking infrastructure and other problems due to scarcity of resources. Transport and road conditions, as well as a lack of patient transport, made rural health services extremely poor. The study realised that by restructuring the rural health systems in the province, there are ample opportunities to enable e-health mode to rural health service. Therefore, the study recommended restructuring rural health and then introducing it.

Acceptability of a virtual prostate cancer survivorship care model in rural Australia: A multi-methods, single-centre feasibility pilot.

A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. A rural Australian hospital and health service. Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. Primary outcome: program acceptability. quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.

Lithium-ion point-of-care ultrasound battery joint state of charge estimation

With recent advances in ultrasound technology, including accessibility and portability, point-of-care ultrasound systems (POCUS) are becoming ubiquitous in urban and rural health services. The efficient use of POCUS battery power is necessary due to the limited access to electricity in rural locations. Accurate estimation of the state-of-charge (SOC) of the onboard lithium-ion battery is crucial in ensuring the safe, efficient, and reliable operation of the battery management system (BMS). This research suggests a novel approach for striking a reasonable balance between the POCUS battery management systems computation time and SOC estimate accuracy. Given that the lithium-ion battery is a non-linear and time-varying system, it is modelled by a second-order RC equivalent circuit model (2-RC ECM). Real-time parametric identification is carried out using the method of recursive least squares with respect to an adaptive forgetting factor (AFFRLS). The joint SOC evaluation technique, ordering the results of real-time identification and the Extended Kalman Filter (EKF) recommended for estimating battery SOC at temperatures between 0 and 45 °C. Simulations were carried out using experimental data from the DST (Dynamic Stress Test), incremental current and, the Federal Urban Driving Program (FUDS) of the CALCE research group to evaluate the proposed approach. Based on the monitoring of dynamic changes in model parameters and the computational complexity of existing algorithms, the results reveal that the joint AFFRLS-EKF estimation proposed for the SOC strategy achieves good accuracy, high adaptability and rapid convergence of SOC estimation.

Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol

IntroductionNegative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive–behavioural therapy...

Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders

BackgroundLow population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning. Methodology and methodsInterviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically. ParticipantsThirty-three participants included health service leaders in executive, clinical, and administrative roles. FindingsSix major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework. ConclusionThe study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.

Exploring opportunities to strengthen rural tuberculosis health service delivery: a qualitative study with health workers in Tibet autonomous region, China

ObjectivesThis qualitative study aimed to explore opportunities to strengthen tuberculosis (TB) health service delivery from the perspectives of health workers providing TB care in Shigatse prefecture of Tibet Autonomous Region,...