Rural Health Research Articles

Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China

BackgroundThe public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement.MethodsWe used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences.ResultsThe total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones.ConclusionsThe public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.

Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns

AimCustomer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program.MethodsThe customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed.ResultsThe BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability.ConclusionsEngaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning.

Factors affecting the extent of medication compliance among clients with type 2 diabetes in Sulu rural health units

This study evaluated the degree to which patient, healthcare provider, and family factors influenced type 2 diabetes patients' medication compliance in Sulu Rural Health Units during the fiscal year 2022. The following findings are presented in this study, which used 100 samples obtained through the non-probability sampling method via purposive sampling, along with weighted mean, standard deviation, t-test for independent samples, One-way ANOVA, and Pearson's r. Of the 100 respondents, the majority are married females between the ages of 36 and 55; 2) On average, medication compliance among clients with type 2 diabetes in Sulu Rural Health Units is thought to be highly affected by the attitudes of the patients, nurses 3) In general, the variables of age, gender, and civil status do not significantly mediate in ways that determine the extent of medication compliance among type 2 diabetes clients in Sulu Rural Health Units; 4) In general, the respondents who evaluated the degree to which factors affected the medication compliance among type 2 diabetes clients in Sulu Rural Health Units in terms of Patient Factor as Agree or with High Extent are likely the same respondents who evaluated the degree to which factors affected the medication compliance among type 2 diabetes clients in Sulu Rural Health Units in terms of Healthcare Provider Factor and Family Factor, respectively.

Technical efficiency and its convergence among village clinics in rural China: evidence from Shanxi Province.

Village clinics (VCs) are the foundation of the three-tiered health service system in China, delivering basic and routine outpatient services to citizens in rural China. VC technical efficiency and its convergence play a critical role in policy decisions regarding the distribution of health service resources in rural China. This study measured VC technical efficiency (using the slacks-based measure model), its convergence (using the convergence model), and the factors that influence the convergence in Shanxi Province, China. Data were obtained from the Shanxi Rural Health Institute 2014-2018 Health Statistics Report, which involved 3,543 VCs. The results showed that VC technical efficiency was low and differed by region. There was no α convergence in VC technical efficiency, but evidence of β convergence was found in Shanxi. The main factors that influence convergence were the building area of each VC (BA), proportion of government subsidies (PGS), and ratio of total expenditure to total income of each VC (RTETI). The government should increase investments in VCs and improve VC technical efficiency. Meanwhile, the government should be aware of and take measures to curb the inequity in VC technical efficiency among different regions and take suitable measures to curb this disparity.

Effectiveness of hierarchical medical system and economic growth: based on China's urban vs. rural health perspectives.

The hierarchical medical system is an important measure to promote equitable healthcare and sustain economic development. As the population's consumption level rises, the demand for healthcare services also increases. Based on urban and rural perspectives in China, this study aims to investigate the effectiveness of the hierarchical medical system and its relationship with economic development in China. The study analyses panel data collected from Chinese government authorities, covering the period from 2009 to 2022. According to China's regional development policy, China is divided into the following regions: Eastern, Middle, Western, and Northeastern. Urban and rural component factors were downscaled using principal component analysis (PCA). The factor score formula combined with Urban-rural disparity rate (ΔD) were utilized to construct models for evaluating the effectiveness of the hierarchical medical system from an urban-rural perspective. A Vector Autoregression model is then constructed to analyze the dynamic relationship between the effects of the hierarchical medical system and economic growth, and to predict potential future changes. Three principal factors were extracted. The contributions of the three principal factors were 38.132, 27.662, and 23.028%. In 2021, the hierarchical medical systems worked well in Henan (F = 47245.887), Shandong (F = 45999.640), and Guangdong (F = 42856.163). The Northeast (ΔDmax = 18.77%) and Eastern region (ΔDmax = 26.04%) had smaller disparities than the Middle (ΔDmax = 49.25%) and Western region (ΔDmax = 56.70%). Vector autoregression model reveals a long-term cointegration relationship between economic development and the healthcare burden for both urban and rural residents (βurban = 3.09, βrural = 3.66), as well as the number of individuals receiving health education (β = -0.3492). Both the Granger causality test and impulse response analysis validate the existence of a substantial time lag between the impact of the hierarchical medical system and economic growth. Residents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. The urban rural disparity in the hierarchical medical system is associated with the level of economic development of the region. When formulating policies for economically relevant hierarchical medical systems, it is important to consider the impact of longer lags.

The role of clinical associates in South Africa as a health workforce: A scoping review.

South Africa's health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers. This study mapped Clin-As' history and practice in South Africa, assessing their roles in the health workforce and offering recommendations. Following the framework outlined by Arksey and O'Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening. Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As' perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation. As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa's health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution:This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

Perceptions and outcomes of an embedded Alzheimer Society First Link Coordinator in rural primary health care memory clinics

BackgroundPrimary health care has a central role in dementia detection, diagnosis, and management, especially in low-resource rural areas. Care navigation is a strategy to improve integration and access to care, but little is known about how navigators can collaborate with rural primary care teams to support dementia care. In Saskatchewan, Canada, the RaDAR (Rural Dementia Action Research) team partnered with rural primary health care teams to implement interprofessional memory clinics that included an Alzheimer Society First Link Coordinator (FLC) in a navigator role. Study objectives were to examine FLC and clinic team member perspectives of the impact of FLC involvement, and analysis of Alzheimer Society data comparing outcomes associated with three types of navigator-client contacts.MethodsThis study used a mixed-method design. Individual semi-structured interviews were conducted with FLC (n = 3) and clinic team members (n = 6) involved in five clinics. Data were analyzed using thematic inductive analysis. A longitudinal retrospective analysis was conducted with previously collected Alzheimer Society First Link database records. Memory clinic clients were compared to self- and direct-referred clients in the geographic area of the clinics on time to first contact, duration, and number of contacts.ResultsThree key themes were identified in both FLC and team interviews: perceived benefits to patients and families of FLC involvement, benefits to memory clinic team members, and impact of rural location. Whereas other team members assessed the patient, only FLC focused on caregivers, providing emotional and psychological support, connection to services, and symptom management. Face-to-face contact helped FLC establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients with dementia. Although challenges of rural location included fewer available services and travel challenges in winter, the FLC role was even more important because it may be the only support available.ConclusionsFLC and team members identified perceived benefits of an embedded FLC for patients, caregivers, and themselves, many of which were linked to the FLC being in person.

Human papillomavirus circulating tumor DNA assays as a mechanism for head and neck cancer equity in rural regions of the United States.

The rates of human papillomavirus-positive oropharyngeal cancer (HPV-OPC) are rising worldwide and in the United States, particularly in rural regions including Appalachia. Rural areas face unique health challenges resulting in higher cancer incidence and mortality rates, and this includes HPV-OPC. The recent advent of highly sensitive liquid biopsies for the non-invasive detection of HPV-OPC recurrence (circulating tumor HPV DNA, HPV ctDNA) has been swiftly adopted as part of surveillance paradigms. Though knowledge gaps persist regarding its use and clinical trials are ongoing, the ease of collection and cost-effectiveness of HPV ctDNA make it more accessible for HPV-OPC survivors than usual surveillance methods of frequent exams and imaging. Herein, we discuss how implementing HPV ctDNA assays in rural regions of the United States provide one poignant example of how liquid biopsies can improve cancer care equity.

Building the workforce of tomorrow: The weighting of rural exposure in standardised curriculum vitae scoring criteria for entrance into Australian specialty training programs.

To determine the weighting of rural exposure within publicly available standardised curriculum vitae (CV) scoring criteria for trainee medical officer's applying into medical and surgical specialty training programs in Australia and New Zealand. An observational analysis of rural exposure point allocations within publicly available standardised CV scoring criteria for entrance into specialty training programs. All Australian and New Zealand medical and surgical specialties training programs outlined by the Australian Health Practitioner Regulation Agency (AHPRA) who publish publicly available standardised CV scoring criteria for entrance into specialty training were included. Of the 14 specialty training programs that publish publicly available standardised CV scoring criteria, 8/14 allocate points towards rural exposure. While the allocation of points within this scoring domain varies between the eight training programs, the mean weighting of rural exposure is 13.7%. The relative weighting of rural exposure varies between the eight specialty training programs who include rural exposure as a CV scoring criteria. The deliberate and strategic construction of CV scoring criteria and inclusion of rural exposure points is important to continue developing the Australian rural specialist workforce. Future development of standardised CV scoring criteria should continue to consider point allocation towards rural exposure and related activities to ensure that the requirements of rural Australian healthcare needs are met across medical and surgical specialties.

Revealing rural motivations in pharmacy students pursuing a graduate certificate program

IntroductionTo assist recruitment and retention efforts and influence the need for an increased supply of future rural pharmacists, this study examines perceptions and key motivators of pharmacy students who chose to participate in the Rural Pharmacy Health Certificate (RPHC) program and pursue pathways to rural practice. MethodsWe interviewed six RPHC students prior to or shortly after beginning their first semester in the RPHC program. Interview questions assessed applicants' reasons for pursuing the RPHC, perceptions of living in and providing healthcare in rural and small communities, awareness of barriers and health disparities in rural areas, and qualities needed to be a successful rural pharmacist. We analyzed data with the Sort and Sift, Think and Shift method, a common approach to qualitative data analysis. ResultsInterest in pursuing rural pharmacy grew out of growing up in a rural area, as well as a desire to serve and help others. Students expected that completing the RPHC would strengthen their skillsets to provide the best care by addressing barriers such as difficulty accessing care and health literacy. Being a learner of one's community was the primary quality identified as necessary to be a successful rural pharmacist. ConclusionThis study identified primary motivators and perceptions that led students to pursue a rural health program at one US pharmacy school. The results can be used to identify and train good candidates for rural pharmacy practice, strengthening the rural pharmacy workforce to better meet communities' needs.

Impact of the Use of Street Play Mode of Education on the Self-care Capacity of Village Women for Lifestyle Modification for Prevention of Hypertension

Objectives: The objectives of this study were as follows: (1) To ascertain the prevalence of hypertension (HTN) among village women. (2) To determine the impact of an intervention strategy of Behavior Change Communication utilizing a camp approach supplemented with nukkad natak on the self-care capacity of village women for lifestyle modification for prevention of HTN. Materials and Methods: The study was conducted during June–July 2023 in the field practice area of Community Medicine of a medical college. Sample size was arbitrary (n = 200) out of all willing women attending outpatient departments during the study period. First, a baseline assessment of the study population was done. Street plays were held for the study population on HTN-related healthy lifestyle. Changes in their knowledge were documented. Appropriate statistical analysis was done using Excel sheets. Results: Most (79%) of the women in the village had normal blood pressure, with 19% of them having mild and 2% had moderate HTN. Most hypertensive women (72%) were not taking medications. Out of 12 hypertensive women who were taking antihypertensive medications, half of them were regular. There was a significant improvement in the score of self-care capacity, treatment HTN diet-related knowledge of the women after the intervention. Respondents liked the idea of organizing drama to propagate health-related messages. Conclusion: One in every five persons in the study population of rural health training centre (RHTC) had HTN. Most hypertensive women (72%) were not taking medications. Those who were taking antihypertensive medications, only half were regular in it. After Nukkad Natak based intervention, there was a significant improvement in the scores of HTN diet and treatment-related knowledge and self-care capacity of the respondents for prevention of HTN. Our respondents liked the idea of organizing drama to propagate health-related messages.

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.

The Rural Interprofessional Health Initiative.

Innovative models that prepare students for careers in rural health are of increasing interest. The UNC Rural Interprofessional Health Initiative (RIPHI) is an intentional interprofessional model that has been in existence since 2017. This article provides an overview of this work, lessons learned, and opportunities for future partnerships.

Evaluating rural health outcomes: A methodological approach using population-level data.

The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care, which are difficult to measure in a rural context. In an evaluation of rural practice, it is often the case that the only comparators are larger referral facilities, for which facility-level comparisons are difficult due to differences in population demographics, acuity of patients, and services offered. This publication outlines these limitations and highlights a best-practice approach to making facility-level comparisons using population-level data, risk stratification, tests of noninferiority, and Firth logistic regression analysis. This includes an investigation of minimum sample-size requirements through Monte Carlo power analysis in the context of low-acuity rural surgical care. Monte Carlo power analysis was used to estimate the minimum sample size required to achieve a power of 0.8 for both logistic regression and Firth logistic regression models that compare the proportion of surgical adverse events against facility type, among other confounders. We provide guidelines for the implementation of a recommended methodology that uses risk stratification, Firth penalized logistic regression, and tests of noninferiority. We illustrate limitations in facility-level comparison of surgical quality among patients undergoing one of four index procedures including hernia repair, colonoscopy, appendectomy, and cesarean delivery. We identified minimum sample sizes for comparison of each index procedure that fluctuate depending on the level of risk stratification used. The availability of administrative data can provide an adequate sample size to allow for facility-level comparisons in surgical quality, at the rural level and elsewhere. When they are made appropriately, these comparisons can be used to evaluate the efficacy of general practitioners and nurse practitioners in performing low-acuity procedures.

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...

Learning from COVID equity measures to increase community resilience: Case study of a rural local public health unit

Learning from COVID equity measures to increase community resilience: Case study of a rural local public health unit

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

The Impact of Telerehabilitation on Physical Therapy Services in Rural Communities

Telerehabilitation is a transformative approach to physical therapy, revolutionizing the accessibility of healthcare in rural communities through the strategic use of Telecommunications technology. This novel approach has the potential to significantly enhance the efficacy of healthcare delivery, particularly considering the critical challenges posed by geographical isolation and resource scarcity. This paper explores the multifaceted benefits of Telerehabilitation, including increased access to care and reduced costs, alongside the challenges of technological barriers and privacy considerations. It provides a comprehensive overview of Telerehabilitation’s impact on rural healthcare, emphasizing its capacity to optimize patient outcomes and proposing strategies for effective implementation. The findings of this study suggest that the use of technology to deliver telecare is a key means of delivering equitable healthcare to underserved populations, a promising way to improve access to rural physiotherapy services address the challenge of telehealth resources, and promote the long-term sustainability of rural Telerehabilitation practices.

Treatment adherence among patients with pulmonary tuberculosis in Jolo

This study assessed the level of treatment adherence among pulmonary tuberculosis patients at the Rural Health Unit-Jolo in terms of disease awareness, health care support, and family support. With 33 samples taken through non-probability sampling method via purposive sampling, and with the use of weighted mean, standard deviation, t-test for independent samples, One-way ANOVA, and Pearson’s r, this study reveals the following findings:1) Of the 100 respondents, mostly are male, married within the age range of 30 years old &amp; below, and with high school of education; 2) On the average, patients at Rural Health Unit-Jolo are perceived to have moderate adherence to treatment of Pulmonary Tuberculosis; 3) Generally, unlike age and civil status, variables such as gender and educational attainment do not significantly mediate in ways how respondents assessed the levels of treatment adherence of Pulmonary Tuberculosis patient at Rural Health Unit-Jolo; 4) Generally, the group of respondents who assessed the level of treatment adherence of Pulmonary Tuberculosis patient at Rural Health Unit-Jolo, in the context of disease awareness as Moderate Adherent is mostly probably the same group of respondents who assessed the level of treatment adherence of Pulmonary Tuberculosis patient at Rural Health Unit-Jolo, in the context of disease awareness in contexts of Family Support and Healthcare Support as Moderate Adherent, respectively; and 5) This study seems to support Health Belief Model (HBM) by Edward C. Green and Elaine Murphy (2020) elucidates the cognitive processes influencing nurses’ behaviors in the context of infection control.

Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

M&#257;ori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural M&#257;ori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-M&#257;ori and M&#257;ori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural M&#257;ori and other Indigenous Peoples in nations impacted by colonisation. The review was underpinned by Kaupapa M&#257;ori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.