This case study describes the contributions made by the Broken Hill University Department of Rural Health (BHUDRH) to improving child health care access and health outcomes over almost three decades. Compared to their metropolitan counterparts, rural and remote children experience persistent inequities in health, development, and education, exacerbated by environmental and service access challenges. A retrospective synthesis of program documentation, evaluation reports, and peer-reviewed literature relating to four major BHUDRH-supported initiatives: lead management programs, the Allied Health in Outback Schools Program, School Health Hubs, and the School-Based Primary Health Care Registered Nurse initiative was undertaken. The BHUDRH contributed to the development and delivery of child health services through investments in program development; research and evaluation; workforce development; and service delivery. The BHUDRH used its intellectual capital to help guide these developments through leadership and cross sector collaboration; governance and oversight; and securing funding for infrastructure development. Outcomes included a 75% reduction in average blood lead levels; access to allied health services for approximately 150 school children annually; establishment of $4.7M School Health Hub infrastructure across seven primary schools; and creation of a new workforce of school-embedded primary health care nurses. This case study demonstrates how UDRHs act as catalysts for sustained, system-level change in response to community-identified health priorities. Lessons from Broken Hill highlight the value of university-community partnerships, research translation, and cross-sector governance in addressing complex rural health inequities. These contributions highlight the significant contributions made by UDRHs in rural contexts beyond health workforce parameters.

Unprepared and under pressure: Transitioning experiences to emergency nursing in rural and remote areas.

Minority stress, community involvement, and cognitive decline in rural SGM older adults: A longitudinal SEM and growth curve approach.

Rural Hispanic/Latino older adults experience significant mental health disparities due to intersecting factors of aging, culture, and geographic isolation. From a nursing perspective, addressing these gaps requires understanding cultural values, such as familismo, respeto, and religious coping, which influence symptom expression and help-seeking behaviors. Nurses in rural settings often serve as the first point of contact, making culturally sensitive screening and recognition of somatic presentations critical for timely diagnosis and treatment. Structural barriers include language differences, provider shortages, financial constraints, transportation challenges, and immigration fears, which are intensified in rural settings. Integrating mental health services into primary care, leveraging promotores de salud, and partnering with trusted community-based institutions can enhance engagement and trust. Nursing research should prioritize culturally adapted interventions, telehealth strategies for low-literacy populations, and workforce development to increase bilingual, bicultural providers. A nursing-led, culturally responsive approach is essential to close mental health gaps for this population.

Geographic and rural health care resource gaps in orofacial pain provider distribution across the United States.

Health care faces a shortage of direct patient care workers with a projected 3.2 million deficit by 2026. This study examined the impact of an in-facility, employer-paid nursing assistant training program to address certified nursing assistant retention in a Midwest rural health care system. Using a mixed-method retrospective cohort design, researchers compared the retention of program participants ( n = 557) and nonparticipants ( n = 3,326). Results showed program participants were retained at a 9% higher rate than those trained outside the organization.

Individual and community-level transportation barriers are known drivers of health disparities, especially in rural areas. In a 2021-2022 community-based project to improve cancer screening at federally qualified health centers in Virginia, Department of Transportation policy governing road signage emerged as an unexpected but actionable barrier. Following successful advocacy for road signs directing patients to a rural federally qualified health center, screening rates increased. This highlights the need to recognize unexpected access barriers and engage nontraditional partners, such as transportation agencies, to reduce regulatory-level barriers. (Am J Public Health. 2026;116(2):175-179. https://doi.org/10.2105/AJPH.2025.308285).

Rural health disparities in the utilization of biologics for the treatment of allergic diseases.

Introduction: Interhospital transfer for ischemic stroke is increasingly common, resulting in rural patients receiving treatment outside of their local health system. It is unclear if admission for stroke has an impact on where patients seek healthcare in the future. This analysis evaluates the likelihood that a patient changes their outpatient home health system after being admitted to a different health system for ischemic stroke. Methods: Using a 5% sample of Medicare Fee-for-Service (FFS) claims, we identified patients admitted for ischemic stroke from 2017 to 2021. We excluded patients <66 years old, who died <18 months after stroke, or who were not continuously enrolled in Medicare FFS for 1 year prior to and 2 years following the index stroke. We assigned each hospital to a health system using the Agency for Healthcare Research and Quality’s (AHRQ’s) Compendium of US Health Systems. We assigned outpatient specialist visits to a health system using office-based claims, CMS facility affiliation data, and AHRQ’s Compendium. The health system with which the majority of a patient’s specialists were affiliated in the year prior to stroke was defined as that patient’s “Pre-stroke home health system”. This process was repeated two years after the stroke to define the “Post-stroke home health system”. We conducted logistic regression to examine the odds that a patient admitted for stroke outside their home health system would change their home health system after admission. Results: We identified 21,087 patients hospitalized for ischemic stroke from 2017 to 2021. The mean age of the population was 77.9 years old, 56% female, 86% non-Hispanic White, and 68% urban. 13% received thrombolytic, 4% thrombectomy, and 10.2% were transferred for ischemic stroke admission (Table 1). 51% of patients were admitted outside their home health system and only 49% of patients had the same home health system before and after their stroke (Table 2). Patients admitted for ischemic stroke outside their home health system were significantly more likely to change their home health system after the stroke [unadjusted OR 5.03, 95% CI: 4.687-5.398, p<0.0001; adjusted OR 5.088, 95% CI: 4.687-5.398, p < 0.0001] (Table 3). Conclusion: As admission for ischemic stroke outside the home health system is associated with changing home health systems, transfer for stroke care could result in the siphoning of patients away from smaller rural health systems.

India had an estimated three to five million excess deaths from causes attributable to SARS-CoV-2 during 2020-2021, far exceeding official government statistics. Most deaths in India occur in rural areas, where medical certification of deaths is limited. Yet, the effects of the pandemic in rural settings remain largely undocumented. We estimated the cause-specific excess mortality in rural areas of selected states of India. Longitudinal analyses of hospital mortality data. India's Health Management Information System (HMIS) reports the number of deaths by cause for adolescents or adults aged 10 years or more. We examined eight states with high coverage of the expected number of deaths in rural areas. We analysed monthly death reports from the HMIS, which covered approximately 0.2 million health facilities during 2018-2023. We compared excess deaths during the peak COVID-19 months in rural health facilities to pre-COVID-19 and non-peak periods of 2021, and categorised reported causes by their probable association with COVID-19. Excesses of cause-specific and total mortality. During the April-June 2021 SARS-CoV-2 wave, predominantly driven by the Delta variant, monthly deaths in rural health facilities across India surged from approximately 200 000 to 500 000. In eight states with high-quality reporting, rural facility deaths increased by 270% (95% CI 267% to 272%) compared with the same months in 2018-2019, prior to the COVID-19 pandemic. Notably, this surge occurred despite a sharp decline in hospital admissions following the national lockdown in March 2020. The largest relative increase was for fever-related and respiratory diseases, and these deaths were markedly elevated even when compared to non-peak months of 2021. Generalising these findings from eight states to all of rural India yields an estimate of approximately 2.6 million excess rural deaths in April-June 2021. In contrast, there were few excess deaths during the Omicron viral waves in 2022-2023. COVID-19 substantially increased deaths in rural India during April-June 2021, but reassuringly, no significant excess mortality was observed in subsequent years. The HMIS provides an important opportunity to strengthen routine mortality surveillance in rural India.

Accuracy of self-reported vaccination status using surveys in safety-net, integrated and rural health systems in Colorado.

Introduction: Increase in cerebrovascular mortality among middle-aged rural residents have been described between 2013 and 2018. Aim: We aimed to obtain a broader understanding of the rural-urban cerebrovascular mortality gaps in the past 2 decades among middle-aged female and male US residents. Methods: Age-adjusted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle-aged adults (age 25-64) stratified by urbanization and sex from 1999 to 2023 were obtained from the Underlying Cause of Death database of the National Center for Health Statistics. Joinpoint regression was used to estimate the annual percentage change (APC) for mortality rates and the linear slope for mortality rate ratios between urbanization strata. Confidence intervals at 95% probability are indicated in brackets. Results: Between 1999 and 2012, cerebrovascular mortality rates decreased among middle-aged rural and urban residents, with APC ranging from -1.4% (-1.9% to -0.9%) among male residents of small and medium metropolitan counties to -3.2% (-3.6% to -2.8%) among female residents of large metropolitan counties. Since 2013, cerebrovascular mortality rates increased among rural and urban residents, with APC ranging from +0.8% (+0.2% to +1.4%) among female residents of large metropolitan counties to +2.2% (+1.5% to +2.9%) among male residents of rural counties (Figures 1 and 2). The mortality rate ratio of rural-to-large-metropolitan counties linearly increased throughout the 25 years studied, at an annual slope +0.0174 (+0.0154 to +0.0193) among female and +0.0124 (+0.0115 to +0.0133) among male residents (Figure 3). The small-and-medium-to-large-metropolitan mortality ratio increased at a smaller slope (Figure 3). Conclusion: The linear trend of widening rural-urban divide in cerebrovascular mortality among middle-aged males and females has been present for at least 25 years. Cerebrovascular mortality increased among all middle-aged persons from 2013 to 2023 with a larger increase among rural residents. Further efforts are needed to address the rural health crisis.

Digital health services and rural healthcare access: Evidence from China

In 2020, China introduced an innovative case-based payment method called "Diagnosis-Intervention Packet (DIP)." However, the implementation of DIP may present significant challenges to county hospitals. Therefore, this study aims to assess the impact of DIP on inpatient Volume and inpatient medical revenue at county hospitals, as well as its effect on patient flow. We collected detailed data on inpatient expenses and reimbursements from the Z City Medical Insurance Bureau for the years 2020-2022, encompassing a total of 5,339,996 records. A single-group interrupted time series analysis was conducted to examine changes in inpatient volumes and their regional distribution across municipal hospitals, county hospitals, and primary healthcare institutions before and after the DIP reform. Additionally, the impact of the reform on medical revenue at county hospitals and its regional share was analyzed. Heterogeneity by insurance type was also explored. Following the implementation of the DIP reform, county hospitals experienced significant declines in both inpatient volume and inpatient medical revenue growth. Monthly inpatient visits decreased by 610.4 (p=0.063), with their market share dropping 0.28% (p=0.003). The impact was particularly pronounced for patients with Urban-Rural Residents Basic Medical Insurance (URRBMI), where monthly volume fell by 1,228.13 (p=0.012) and share decreased by 0.39% (p<0.001). Inpatient medical revenue growth reversed significantly, with the slope decreasing 3.58% (p=0.014) and regional share falling 0.38% (p=0.008). DIP implementation creates significant challenges for county hospitals through patient diversion to primary facilities and increased competition with municipal hospitals. This threatens to create a cycle of declining volume, revenue, and capabilities. To prevent rural patients from being forced to seek care at distant urban facilities, policy interventions should focus on providing targeted support to maintain county hospitals' vital role in rural healthcare delivery.

Background: Non-communicable diseases (NCDs) result from genetic, physiological, environmental and behavioural factors in combination. NCDs kill around 41 million people a year, equivalent to three-quarters of deaths worldwide. QRISK is a well-established cardiovascular disease (CVD) risk score, in use across the NHS since 2009, which is designed to identify people at high risk of developing CVD who need to be recalled and assessed in more detail to reduce their risk of developing CVD. Methods: This was a cross-sectional study conducted under the department of community medicine in rural and urban health training centre of JNMC AMU, Aligarh, India, during 2019 to 2020 with a sample size of 204. Results: A total of 204 males in the age group of 25 to 84 years were study participants. Among all, 32.8% participants were physically active, 52.0% participants were current smokers, 27.0% participants were overweight, and 5.4% were found to be obese. The prevalence of raised blood sugar was 21.1% and raised blood pressure in 23% participants. According to the QRISK2 score developed in 2017, participants at high risk (≥20%) were 26.5%. Conclusions: Cardiovascular disease risk factors, smoking, lack of physical activity, diabetes, raised blood pressure, overweight and obesity by BMI, and abdominal obesity and also 10-year cardiovascular risk are higher than the studies conducted for these risk factors in India. Health education, early diagnosis should be imparted to the general population.

The Family Adoption Program (FAP) is an initiative under the competency-based medical education (CBME) in which each medical student is assigned to families in a rural community from the beginning of the curriculum. Community engagement in medical education gives the students an insight into the living conditions of the public and how they influence their health, along with improving their communication skills. This program provides preventive and primary care services to resource limited rural population.The objective of this study was to recognize perceived challenges and benefits of the FAP to the medical students and to the adopted families, and to gather suggestions for the improvement of the FAP. This observational qualitative study was conducted using a purposive sampling technique. Faculty members, medical social workers (MSWs) of the community medicine department, along with first, second, and third year medical undergraduate students, and heads of allotted familieswere our study subjects. Key informant interviews (KIIs) and the focus group discussion (FGD) technique were the study tools. A total of 38 KIIs (18 faculty members, 5 MSWs/field staff, and 15 community members) and three FGD sessions were conducted. The participants felt that the FAP provides a good opportunity for rural people to improve their health through health education activities and health camps. The undergraduate students realize that the FAP will have a good and positive impact on medical education.The most important challenge expressed by participants was the shortage of human resources. The FAP has a good scope to improve rural health due to long-lasting bonding between students and rural people and health-promoting activities. The FAP improves communication skills and develops empathy among students. There is a need to strengthen these activities through improving infrastructure and increasing manpower.

This study aims to examine the relationships among perceived burdensomeness, technology use habits, and activities of daily living (ADL) in older adults residing in rural areas. This descriptive correlational study was conducted with 384 older adults living in rural areas in two different regions of Turkey. Data were collected using an Information Form, the Geriatric Perceived Burdensomeness Scale, the Barthel Index for Activities of Daily Living, and the Technology Use Habits Scale. Perceived burdensomeness was moderately and negatively correlated with ADL (r = - 0.484, p < 0.001), whereas technology use habits were weakly but positively correlated with BADL (r = 0.192, p < 0.001). In the hierarchical regression analysis, technology use habits showed a positive and statistically significant association with ADL in the initial model (β = 0.189, p < 0.001). When perceived burdensomeness was added to the model, it emerged as a strong negative predictor of ADL (β = -0.497, p < 0.001), substantially increasing the explained variance. In the fully adjusted model, perceived burdensomeness, age, digital device use, and duration of digital device use were significantly associated with ADL, whereas age did not significantly affect the relationship between perceived burdensomeness and ADL. Overall, perceived burdensomeness and technology use habits were identified as key factors related to functional independence among rural older adults. The findings of this study indicate that perceived burdensomeness and technology use habits are closely associated with independence in activities of daily living among older adults living in rural areas. These findings indicate an association between technology use and perceived burdensomeness and provide a foundation for future research in nursing practice and rural health services. Future research is recommended to focus on evaluating technology-based and psychosocial interventions that support independence and psychosocial well-being in rural older populations. Not applicable.

Background: Globally, cervical cancer is the fourth leading cause of cancer deaths. In Kenya, it is ranked as the second cause of cancer-related deaths among females. Men’s knowledge of cervical cancer is essential in reducing cervical cancer burden. This study was conducted in Makueni County, Kenya, to establish knowledge and health facility-related determinants of men’s support for spousal cervical cancer screening in Kenya. Methods: Quantitative and qualitative data were collected using structured questionnaires from married men aged 18–64 years attending three rural Health facilities in Makueni County, Kenya. Participants were recruited via simple random sampling from purposively selected hospitals. Quantitative data were analysed using descriptive and inferential methods, while qualitative data employed thematic coding. Key informant interviews with nurses heading Maternal and Child Health services provided qualitative insights. Ethical approval was obtained and participants consented. Results: Male support for spousal cervical cancer screening was low, with 82% showing minimal involvement. Knowledge factors such as knowledge of cervical cancer signs or symptoms, causative agent, risk factors, prevention, screening frequency, and screening duration was strongly associated with male involvement (p&lt;0.001). Awareness that men can transmit the causative agent to women also showed a significant relationship with involvement (p=0.019). The level of male support was significantly associated with service availability, presence of signage, and cost (p&lt;0.005). Conclusions: Male support for their spouses cervical cancer screening was low, calling for increased health education and awareness among men to boost support for cervical cancer screening initiatives. Health facilities should ensure continuous access to free services and promote their awareness.

Abstract With the rapid advancement of Internet of things (IoT) technologies, smart and connected healthcare systems have emerge as a promising solution for continuous and remote patient monitoring. This is particularly critical for elderly populations and patients with chronic conditions, where frequent hospital visits are costly and hectic. In this paper, we propose an experimentally validated Low-cost, low-power IoT-based remote health monitoring system designed for continuous acquisition of vital physiological parameters, including electrocardiogram (ECG), heart rate, blood Oxygen saturation (Sp ), and body temperature. The proposed architecture integrates wearable wireless sensors, energy-efficient clustering mechanisms, secure data transmission, and cloud-based storage and analytics. To address the limitations of existing systems, our methodology combines a hardware prototype with network-level simulations conducted using NS-3 and MATLAB to evaluate latency, energy consumption, packet delivery ratio, and scalability. Security and privacy of patient data are guaranteed through a lightweight encryption framework suitable for resource-constrained IoT devices, with comparative analysis against computationally expensive homomorphic encryption schemes. Experimental results demonstrates that the proposed systems achieve reduced latency, improved energy efficiency and reliable data confidentiality. The findings confirm the suitability of the architecture for real-time remote healthcare monitoring in smart city and rural healthcare environments. Keywords: Internet of Things, Remote Healthcare Monitoring, Wireless Sensor Networks, security, Energy Efficiency, Wearable sensors.

To determine if the establishment of a multidisciplinary allied health training demonstration site, as one part of the expanded Rural Health Multidisciplinary Training (RHMT) programme in the Lachlan region, had a positive social return on investment (SROI). This SROI only reflects the incremental impact of the expanded RHMT programme delivered by one University Department of Rural Health (UDRH), to one additional training demonstration site in the Lachlan region. Scope does not include the well-established ongoing RHMT programme, nor the complete body of work being delivered by the UDRH. This SROI investment referred to the grant to fund the incremental expansion of the RHMT programme to training demonstration sites in more remote settings, in addition to the in-kind and/or cash resources provided by the UDRH. The SROI was based largely on actual data (evaluative) and some future data (forecast). Operational and qualitative data were collected to determine the investment and return of the programme. The SROI was conducted over a 3-year time horizon, took a societal perspective, and included consumer feedback in both the design and interpretation of results. A 25% discount to the value of future rural employment was applied for attribution. There was no comparative group. Rural New South Wales, Australia. Multidisciplinary health students who completed a placement at the training demonstration site and their supervisors, host organisations and members of the rural community, including First Nations peoples. Value of the 'investment' required to implement the expanded RHMT programme. Value of the 'social return' generated from the expanded RHMT programme, including the value of the students' intended future rural allied health employment. The expanded RHMT programme included 99 students across 422 weeks of placement. For every $1 spent on the expanded RHMT programme, the SROI was $1.60. The intended future rural health employment attributed 65% of the SROI value. This study supports ongoing federal government funding into quality rural health student placements, with benefits of value observed for students and their supervisors, host organisations and members of the rural community.