Rural North Research Articles

Community health worker outreach to farmworkers in rural North Carolina: Learning from adaptations to the SARS-CoV-2 pandemic.

Community health workers represent a critical part of the health outreach and services for migrant and seasonal farmworkers ('farmworkers') in rural areas of the United States. We sought to identify adaptations to farmworker patient engagement and health outreach made by community health workers during the first 18 months of the COVID-19 pandemic. In this qualitative study, we used semi-structured interviews with community health workers from August 2020 to February 2022 (n = 21). Two coders used thematic analysis to identify three themes related to the experiences of community health workers in conducting health education and outreach to farmworkers prior to and following the onset of the pandemic. We found themes related to pre-pandemic outreach efforts to provide health education resource sharing with farmworkers and pandemic-related outreach efforts that included adoption of porch drops and distanced delivery of health education, adaptation of modes of health education and communication through technology and the internet, and taking on new roles related to COVID-19. Finally, we identified changes that reverted after the pandemic or will continue as adaptations. Community health workers created practice-based innovations in outreach in response to the COVID-19 pandemic. These innovations included new COVID-19 related roles and new modes of health education and outreach, including the use of digital resources. The changes developed for emergency use in COVID-19, particularly related to internet and technology, have likely altered how community health workers conduct outreach in North Carolina going forward. Funders, community health worker training programs, and researchers should take note of these innovations. Community health workers who typically come from patient populations and provide critical navigation and connection with the health care system advised on the design and creation of this research project, including serving on an advisory board. Two authors have experience working as community health workers.

“Just Did The Best That I Could Do”: CPS Social Workers’ Perceptions of Self-Efficacy in Legal Aspects

AbstractChild protective services (CPS) social workers assess safety and risk needs during abuse and neglect investigations to determine if legal interventions are needed. However, only 60% of abuse and neglect cases have safety and risk assessed during the investigatory process in North Carolina. This study aimed to explore the perceptions of self-efficacy among rural North Carolina CPS social workers in child abuse and neglect investigations. Understanding CPS social workers’ perceptions of self-efficacy and factors that may influence their self-efficacy is vital to improving job satisfaction, retention, and the legal and investigative processes relating to child abuse and neglect. A purposive sampling approach was used to recruit nine CPS social workers in rural counties in North Carolina. Through a process of open, axial, and selective coding, we conclude that a CPS social worker’s self-efficacy is impacted by factors relating to leadership and legal teams, longevity, previous social work experience, and paperwork and caseload demands.

Power & Moral Capital - A “Theory of Access” for People Receiving Public Assistance in Rural USA

ABSTRACT In-depth interviews with people using public assistance in a rural place in the United States demonstrated barriers to accessing resources through formal work and self-provisioning and the ability to benefit from use of public assistance—low income means-tested medical, nutritional, financial, or other services from state, federal, or non-governmental agencies. The Theory of Access (TOA) was used as a framework to organize participant narratives and an intersectional perspective to a multidimensional theory of power was used to demonstrate how moral capital is levied and reproduced. Findings from the TOA revealed intersectionalities in barriers to accessing resources across structural, relational, physical, and psychosocial access mechanisms for women, particularly women of color with dependent children, pregnant women of color, and women with disabilities. While TOA demonstrated need for public assistance, the double power of moral capital demonstrated how the benefits of public assistance to human dignity and welfare were reduced by (1) disciplinary tactics to reject public assistance and (2) reproduction of broader moral imperatives. The connections between TOA and moral capital contribute an intersectionality approach for understanding the multiple disadvantages of people with the lowest incomes, which helps to explain low rates of self-provisioning and public assistance use despite high need across the rural Global North.

What to make of a Sultan's tear: Phaticity, praise poetry, and social infrastructures in the Sultanate of Oman

AbstractThe distributive political economy of contemporary Arab Oman yields a status‐differentiated social infrastructure composed of elites who distribute and non‐elites who, in many ways, rely on those distributions. The construction of communicative links within social infrastructures via the performance of sung poetry depends on the phaticity of the link being activated. For Omani poets, different linguistic performance genres telescope the vast social distance between elites who listen and non‐elites who sing in different ways and with different results. Omani poets from the rural north of the country conduct cross‐class social contact—conceptually “vertical” social infrastructural movement—by way of two contrasting genres of Arabic praise poetry: a one‐off request or statement, the solo qasida, and a recognitive, addressive choral form that reciprocally establishes and evaluates such vertical relationships, the 'āzī. I argue that the metapragmatic distinctions that Omani poets draw between these two genres reveal a subtle phatic ideology that allows certain modes of communicative contact to index deeper, cross‐class social ties within grand public performances, while simultaneously reinforcing tacit norms of elite avoidance of non‐elites in everyday social intercourse.

Seasonal variations in social contact patterns in a rural population in north India: Implications for pandemic control.

Social contact mixing patterns are critical to model the transmission of communicable diseases, and have been employed to model disease outbreaks including COVID-19. Nonetheless, there is a paucity of studies on contact mixing in low and middle-income countries such as India. Furthermore, mathematical models of disease outbreaks do not account for the temporal nature of social contacts. We conducted a longitudinal study of social contacts in rural north India across three seasons and analysed the temporal differences in contact patterns. A contact diary survey was performed across three seasons from October 2015-16, in which participants were queried on the number, duration, and characteristics of contacts that occurred on the previous day. A total of 8,421 responses from 3,052 respondents (49% females) recorded characteristics of 180,073 contacts. Respondents reported a significantly higher number and duration of contacts in the winter, followed by the summer and the monsoon season (Nemenyi post-hoc, p<0.001). Participants aged 0-9 years and 10-19 years of age reported the highest median number of contacts (16 (IQR 12-21), 17 (IQR 13-24) respectively) and were found to have the highest node centrality in the social network of the region (pageranks = 0.20, 0.17). A large proportion (>80%) of contacts that were reported in schools or on public transport involved physical contact. To the best of our knowledge, our study is the first from India to show that contact mixing patterns vary by the time of the year and provides useful implications for pandemic control. We compared the differences in the number, duration and location of contacts by age-group and gender, and studied the impact of the season, age-group, employment and day of the week on the number and duration of contacts using multivariate negative binomial regression. We created a social network to further understand the age and gender-specific contact patterns, and used the contact matrices in each season to parameterise a nine-compartment agent-based model for simulating a COVID-19 epidemic in each season. Our results can be used to parameterize more accurate mathematical models for prediction of epidemiological trends of infections in rural India.

An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

An Exploratory Study of the Perceived Need for and Acceptability of a Healthy Frozen Meal Product Among Rural Corner Store Customers in North Carolina

ABSTRACT This pilot study assesses barriers to obtaining healthy affordable food and the early-stage acceptability of a novel subsidized healthy frozen meal product designed to address food insecurity and nutritional status among corner store customers in rural North Carolina. A convenience sample of 50 customers were surveyed to examine the perceived availability of healthy food options, barriers to maintaining healthy diets, food shopping and consumption habits, and reception of the product. Findings confirmed barriers to obtaining healthy foods that the product seeks to address, the validity of corner stores as the intervention site, and approval of the product’s taste and concept.

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

Assessing a Community-Based Maternal Self-Efficacy Intervention in Rural India using a Quasi-Experimental Design

More than 175 million people in India live below the poverty line and are concentrated in rural areas. Families in rural Indian communities may benefit from interventions that support long-term well-being. Maternal self-efficacy (MSE) may be an important target for interventions given prior associations with positive maternal and child outcomes. The present study examined MSE in a pilot community-based group intervention delivered in rural North India. Using convenience sampling recruitment and a quasi-experimental design, 97 mothers (79 self-identified as low-caste) with at least one child between 0–24 months who engaged in the intervention were compared with a matched control group ( n = 219; 114 low-caste). Findings suggest that participation in the intervention was associated with higher MSE (ß = .294, p = .020) and the positive association was stronger amongst mothers from low-caste groups who participated in the intervention (ß = .390, p = .008). MSE may be malleable with the right approach and could be an important target for public health interventions, particularly for low-caste groups in rural India.

Provider perspectives on delivering telemental health services in rural North Carolina: Field report.

Provider perspectives on delivering telemental health services in rural North Carolina: Field report.

Maternal understanding and practices of breastfeeding and infant feeding in rural North Karnataka: a cross sectional study

Background: Child-malnutrition is a critical global concern supported by substantial evidence. Recognizing optimal infant and young child-feeding practices as pivotal in combating malnutrition is crucial. Methods: This was a cross-sectional study conducted through house-to-house survey in Ukkali and Shivanagi villages for period of 6 months from February 2018 to July 2018. A pretested-questionnaire was administered to 133mothers of 6 to 12-month-old children, collecting socio-demographic data, knowledge, attitudes, and practices regarding prelacteal, breastfeeding, and complementary-feeding. Results: Knowledge gaps emerged, with only 50% understanding colostrum's importance. Limited awareness of exclusive breastfeeding (65%) and extended breastfeeding (31.57%) was observed. Prelacteal-feeding was widespread (52.63%), with sugar-water being a prevalent choice (21.8%). Most mothers (over 90%) opted for breastfeeding, yet timely initiation (27.6%) and exclusive-breastfeeding (30%) were suboptimal. Complementary-feeding initiation (15%) and minimum-meal-frequency adherence (13.3%) were low. Meal-diversity was deficient in over 60%. Conclusions: Bridging knowledge gaps and promoting optimal-feeding-practices through targeted nutritional education is essential. This study underscores the importance of addressing misconceptions, enhancing early-breastfeeding, and ensuring proper complementary-feeding to improve child-health outcomes. Socio-demographic-factors must be considered when designing educational material and interventions in rural-settings.

WORKING TOGETHER TO PROVIDE GERIATRIC CARE: INTERDISCIPLINARY TEAM CREATION AND EVALUATION IN CANADA

Abstract Prince Edward Island is Canada’s smallest province (pop. 160,000) and has one of the oldest populations in Canada. While there is a robust and growing geriatrics program through provincial healthcare, it consists exclusively of medical providers (i.e., geriatricians and nurse practitioners). An opportunity for formal interprofessional collaboration presented itself when the University of Prince Edward Island began a Doctor of Psychology (PsyD) program in 2019. Soon thereafter, we established an interdisciplinary team between the PsyD and the provincial geriatrics programs. The goals of the team included: 1) enhancing care for older adults on the island, 2) providing training for PsyD students, and 3) increasing interprofessional collaboration and learning. In an evaluation of the first year of the collaboration, we collected data on the types of referrals and characteristics of the patients referred (e.g., number of medications), and asked all providers on the team (N=4 geriatricians, N=9 nurse practitioners, and N=4 psychology student clinicians) to answer open ended questions on the highlights and challenges of establishing the team, the organization of formal team meetings, and provision of patient care. Of the 74 patients seen by psychology, reasons included cognitive or psychodiagnostic assessment (N=22, 30%), psychotherapy (N=20, 27%), caregiver support (N= 25, 34%), or multiple services (i.e., both assessment and intervention; n=7, 10%). Additional patient characteristics will be shared, as well as themes from provider survey responses. Our program has implications for other areas in rural North America, particularly training opportunities built into our team functioning.

Multilevel and subnational analysis of the predictors of maternity continuum of care completion in Nigeria: a cross-sectional survey

Understanding population discrepancy in maternity continuum of care (CoC) completion, particularly in sub-Saharan Africa is significant for interventional plan to achieve optimal pregnancy outcome and child survival. This study thus investigated the magnitudes, distribution, and drivers of maternity CoC completion in Nigeria. A secondary analysis of 19,474 reproductive age (15–49 years) women with at least a birth (level 1) in 1400 communities (level 2) across 37 states covered in the 2018 cross-sectional survey. Stepwise regression initially identified important variables at 10% cutoff point. Multilevel analysis was performed to determine the likelihood and significance of individual and community factors. Intra-cluster correlation assessed the degree of clustering and deviance statistics identified the optimal model. Only 6.5% of the women completed the CoC. Completion rate is significantly different between communities “4.3% in urban and 2.2% in rural” (χ2 = 392.42, p < 0.001) and was higher in southern subnational than the north. Education (AOR = 1.61, 95% CI 1.20–2.16), wealth (AOR = 1.73, 95% CI 1.35–2.46), media exposure (AOR = 1.22, 95% CI 1.06–1.40), women deciding own health (AOR = 1.37, 95% CI 1.13–1.66), taking iron drug (AOR = 1.84, 95% CI 1.43–2.35) and at least 2 dose of tetanus-toxoid vaccine during pregnancy (AOR = 1.35, 95% CI 1.02–1.78) are associated individual factors. Rural residency (AOR = 1.84, 95% CI = 1.43–2.35), region (AOR = 1.84, 95% CI 1.43–2.35) and rural population proportion (AOR = 1.84, 95% CI 1.43–2.35) are community predictors of the CoC completion. About 63.2% of the total variation in CoC completion was explained by the community predictors. Magnitude of maternity CoC completion is generally low and below the recommended level in Nigeria. Completion rate in urban is twice rural and more likely in the southern than northern subnational. Women residence and region are harmful and beneficial community drivers respectively. Strengthening women health autonomy, sensitization, and education programs particularly in the rural north are essential to curtail the community disparity and optimize maternity CoC practice.

The burden of head trauma in rural and remote North Queensland, Australia

BackgroundHead trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma. MethodsWe conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality. ResultsA total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67–3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die. ConclusionsIn North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "Rainbow model” is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited.1 An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.

Implementation of an academic-community partnership model for equitable access to precision oncology decision support in rural community cancer centers.

141 Background: Comprehensive genomic profiling (CGP) is an essential tool for selecting cancer therapies and matching patients to clinical trials, however patients in rural community cancer centers are less likely to receive CGP. We developed an academic-community partnership model to expand Duke’s Molecular Tumor Board (MTB) clinical decision-making and trial-matching services to Duke Cancer Network (DCN), a series of affiliated community cancer centers across rural North Carolina. Methods: The Duke Precision Cancer Medicine Initiative created a Molecular Registry of Tumors database to aggregate CGP results from multiple vendors and enable review by a multidisciplinary MTB. Patients treated at DCN sites had their CGP results and relevant clinical data reviewed by the Duke MTB. After review, clinical recommendations were communicated in a standardized note and returned to DCN providers within one week. One year into implementation, DCN providers were anonymously surveyed to identify persistent barriers to utilization of CGP. Results: Between Jan 2022 and June 2023, 96 patients were consented, enrolled, and reviewed by Duke MTB. 29.2% were Black, 19.8% were Native American, and 5 .2% were of Hispanic ethnicity. 57.3% patients were found to have an actionable genomic biomarker. Of these, 14 of 22 (63.6%) received matched FDA-approved therapies and 0 of 17 (0%) with molecular criteria for a clinical trial at Duke successfully enrolled at time of submission. 85% DCN providers reported comfort ordering CGP and 45% reported comfort interpreting the results. Most frequently reported major barriers to clinical trial participation included distance (70%), lack of transportation (55%), and lack of local trials (50%). Conclusions: Our implementation of a novel academic-community partnership serves as a sustainable and reproducible model to expand access to MTB services. Further research and interventions are necessary to mitigate persistent urban versus rural barriers to utilizing CGP, especially those in clinical trial enrollment. By providing MTB support to historically underserved communities and a framework to identify salient barriers in the process, our model can be adopted by academic cancer centers nationally, contributing to improved and equitable outcomes in oncology.[Table: see text]

Grassroots Leviathan: Agricultural Reform and the Rural North in the Slaveholding Republic

Grassroots Leviathan: Agricultural Reform and the Rural North in the Slaveholding Republic

Study of ocular manifestations of COVID-19 patients in a tertiary care hospital of Rural North Maharashtra

Objectives: The purpose of the study is to understand profile of ocular manifestations in recovered post COVID 19 patients and to suggest recommendations based on observations. Materials and Methods: It was a prospective hospital-based case analysis study done at tertiary care hospital of rural North Maharashtra from April 2020 to June2021 and included 104 patients with recent history of COVID 19 infection and various ocular symptom Results: Diabetes mellitus is most common associated factor observed. Viral conjunctivitis was observed in 52 cases .2 cases reported subconjunctival hemorrhage. Retinal vein occlusions were seen in 3 cases. Total ophthalmoplegia was seen in 23 cases. Orbital cellulitis with mucormycosis was documented in 12 cases. Orbital apex syndrome with an impending intracranial spread in 4 case required orbital exenteration. Peribulbar Amphotericin B was given in 3 cases and intravenous and oral antifungals also given simultaneously Conclusion: COVID 19 infection can lead to various ocular symptoms even in the recovery period. Early diagnosis by high degree of suspicion and prompt treatment with multidisciplinary approach is required for prevention of visual disability.

School-to-work transitions in rural North Sweden: staying on in a reviving local labor market

ABSTRACT This article addresses young people’s school-to-work transitions. The analysis draws on data from a Swedish ongoing qualitative longitudinal project spanning over 10 years. In this article, we focus on eight young people who grew up and still live in a small rural inland town in North Sweden where the regional labor market is going through a process of rapid reindustrialization after decades of industrial decline and welfare state retrenchment. The aim of the study is to explore the young rural ‘stayers’ transitions in a region characterized by strong economic growth, yet with long-standing challenges in terms of social reproduction, focusing on what kind of work they end up with and their speed of establishment on the labor market. At the time of the latest interview all but one of the 8 participants in this study had employment in local or regional industries, however, how fast they had managed to establish themselves on the labor market varied between them. Further, their staying on locally depended largely on regional mobility. We discuss their transitions in relation to the ongoing re-industrialization process in North Sweden but also what implications young stayers’ school-to-work transitions might have in relation to the wider social reproduction in the region.

“We grew up in the church”: A critical discourse analysis of Black and White rural residents’ perceptions of mental health

RationaleKnown as the “Black-White mental health paradox,” Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. ObjectiveThe purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. MethodsWe conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. ResultsWhite rural residents’ condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. ConclusionsOur findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations.