Rural Practitioners Research Articles

Using Complex Adaptive Systems Theory to Understand the Complexities of Hospital Social Work Practice in Rural and Remote South Australia

Abstract Working with complexity is a growing concern and challenge for social workers in contemporary practice. This study explored how rural social work practitioners experience complexity in their professional judgement and decision-making, giving voice to the unique understandings and perspectives of rural health social workers (RHSWs). Complex adaptive systems (CAS) theory is used to conceptualise participants’ experiences. An interpretive critical research paradigm valued the unique viewpoint of rural social workers whilst also disrupting the urban-centric focus of social work practice. The participants were recruited via their involvement in the Country Health South Australia social work leadership group. Data collected using a living lab approach, consisted of ten phone interviews sandwiched by two focus groups (n = 14). The data were analysed using both hand-coding and computer-assisted analysis (NVivo). The results demonstrated that RHSW encounter complexity within and across three main systems: client, organisational and rural systems. Importantly, the rural system plays an equally significant role in understanding complexity in this context, with each system overlapping and influencing one another. RHSW understanding of complexity was consistent with CAS, suggesting the advantage of using this theory to underpin understandings of complexity in social work practice and specifically in the rural practice domain.

Understanding help-seeking in rural counties: A serial mediation analysis.

Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self-stigma, followed by greater self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists. Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online. Mediation analyses supported a direct association between general self-reliance and attitudes toward help-seeking that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.

VP31.12: Trends in fetal ultrasound referrals and case severity throughout the first and second waves of the COVID‐19 pandemic

To determine the combined and differential impact of individual waves of the COVID-19 pandemic on fetal ultrasound referral patterns and antenatal case severity. This was a cross-sectional study evaluating temporal trends in fetal ultrasound referral patterns and case severity at a regional fetal assessment unit. Fetal assessment scans performed during the first and second ‘waves’ of the pandemic (March to May 2020 and November to March 2021) were compared head-to-head and to baseline pre-COVID-19 patterns. Clinic lists and stored ultrasound reports were reviewed to collate maternal demographics and medical history, referral details, daily scan volumes, ultrasound findings, and level of case severity, in order to compare outcomes across the pandemic. 9,451 fetal ultrasounds were performed during the first and second waves of the pandemic, and represent a significant reduction from baseline volumes in the unit (p = 0.008). In the first wave, there was a significant decrease in referrals for early pregnancy complications, genetic ultrasounds, and diabetes surveillance (p < 0.01): there were also fewer referrals from rural communities and general practitioners. The second-wave of the pandemic represented a further decline in referrals from remote locations, but less disruption in number of scans for maternal medical complications. The level of high-acuity cases increased significantly throughout the pandemic compared to baseline (4.9% vs 3.3%; p = 0.0031), but was higher in the first as compared to the second-waves. Also, there was an almost 10% increase in the relative proportion of stillbirths diagnosed during the pandemic, although the absolute numbers remain small. Fetal ultrasound volumes decreased and case severity increased throughout the pandemic, as well as an increase in stillbirths. Enhanced understanding of the impact of access to prenatal care and utilisation of services on the direct and indirect risks for pregnant women is critical for improving care and outcomes during future pandemic planning.

Retrospective Study of the Round Radiopaque Foreign Bodies in the Oesophagus

Introduction Ingested foreign bodies (FBs) of the digestive tract can be divided into radiolucent and radiopaque, based on their appearance in Roentgenogram. Coins and button-batteries (BBs) constitute majority of the radiopaque FBs that are round in shape. Materials and Methods Medical records of children admitted with foreign bodies in the GI tract during the last 5 years have been reviewed. We have taken into our study, round radio-opaque FBs and analyzed the results. Results Out of 120 radiopaque FBs, in 112 cases they are lodged in cricopharyngeal sphincter (CPS), which were removed. Of these, 103 were coins and 9 were BBs. Five coins, which had crossed the CPS, ultimately passed out naturally with faeces. Three BBs, impacted in the oesophagus, distal to the CPS, were removed via esophagoscopy, on emergency basis. One child with impacted BB developed mediastinitis and died. Conclusion A round opaque disc shaped FB which is impacted or seen below CPS should not be treated as coin every time. High index of suspicion is needed to rule out BB ingestion as it is associated with high morbidity and mortality. Aim of this study is to stress on the need for educating primary care physicians and rural medical practitioners to avoid wait and watch policy, thus reducing misdiagnosis of coins for BBs.

Electronic Commerce for Sustainable Rural Development: Exploring the Factors Influencing BoPs’ Entrepreneurial Intention

Rural e-commerce entrepreneurship is an effective and credible means to alleviate poverty and promote sustainable social development, particularly in the Base of the Pyramid (BoP). Understanding how to encourage BoPs’ entrepreneurial intention in the rural e-commerce market has become a key issue for private enterprises and local governments. Based on the entrepreneurial event model, we constructed a research framework to evaluate the factors influencing BoPs’ entrepreneurial intention in rural e-commerce. We conducted an online survey of rural e-commerce practitioners from Jieyang and Chaozhou in Guangdong Province, China, and empirically analyzed the survey results using SmartPLS software. The results show that professional knowledge, resource endowment, information and communication technology, and logistics infrastructure have a significant positive impact on BoP entrepreneurship in rural e-commerce, while previous market channels had a significant negative impact. Based on the findings, we recommend that BoPs should focus more on cultivating professional knowledge in e-commerce entrepreneurship and capitalize on local resource advantage. E-commerce enterprises and local governments should strengthen and improve information communication technology and logistics infrastructure among BoP communities. Policymakers should support BoP entrepreneurship in rural e-commerce by creating a favorable environment.

The pros and cons of the implementation of a chronic care model in European rural primary care: the points of view of European rural general practitioners.

This article describes the views of European rural general practitioners regarding the strengths, weaknesses, opportunities and threats (SWOT) of the implementation of a chronic care model (CCM) in European rural primary care. This was a mixed-methods online survey. Data were collected from 227 general practitioners between May and December 2017. Categorical data were analysed using descriptive methods while free-text responses were analysed using qualitative methods. The setting was rural primary care in nine European countries (including Central and Eastern Europe). Main outcomes measures were respondents' evaluations of a chronic care model in their rural healthcare settings in terms of SWOT. The SWOT analysis showed that the expertise of healthcare professionals and the strength of relationships and communications between professionals, caregivers and patients are positive components of the CCM system. However, ensuring adequate staffing levels and staff competency are issues that would need to be addressed. Opportunities included the need to enable patients to participate in decision making by ensuring adequate health literacy. The CCM could certainly have benefits for health care in rural settings but staffing levels and staff competency would need to be addressed before implementation of CCM in such settings. Improving health literacy among patients and their carers will be essential to ensure their full participation in the implementation of a successful CCM.

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated. To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area. This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020. Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine. The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients' travel distance to treatment. A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients' data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients. These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.

'The word that comes to mind is polymath': medical students' perceptions of rural postgraduate careers.

Physician shortages in rural and remote areas challenge accessibility and delivery of care to rural and remote communities, including within Scotland. Medical education is a reform priority to establish a sustainable medical workforce. Although there is evidence to support aspects of medical education that enhance the likelihood of practising rurally, the mechanism by which these educational initiatives work is not clearly understood. This study aimed to examine medical students' perceptions of rural and remote practice, how these perceptions motivate their interest to practise rurally, and what aspects of education are thought to influence these perceptions. This cross-sectional study utilised semistructured interviews with 10 University of St Andrews medical students enrolled in undergraduate or graduate-entry medical education programs. Feldman and Ng's theoretical framework was deductively applied. Interviews informed additional subthemes, which were integrated into the original framework. The final framework helped examine medical students' perceptions of rural medicine and mechanisms that shape these perceptions. Structural (countrywide) themes included geographical barriers affecting patients and physicians. Organisational themes included perceptions of inequitable allocation of resources between urban and rural areas, as well as limited staff and support in rural practices. Occupational themes included the perception of rural clinical generalists. Personal life themes included the perception of community in rural areas. Mechanisms shaping medical students' perceptions most profoundly were their experiences (educational, personal experience or working). Medical students' perceptions align with other professionals' reasons for staying in a particular job. Perceptions regarding rural careers included challenges due to geographical proximity to patients, resource allocation in rural areas, and the potential to subspecialise as a general rural practitioner. Identified mechanisms, which shape perceptions, can be addressed and strengthened by educators, policy-makers and governments to optimise medical education that promotes rural recruitment and retention.

Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions

BackgroundThe challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre.MethodsThis qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data.ResultsFour themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context.ConclusionsThis study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

A measure of local uniqueness to identify linchpins in a social network with node attributes

Network centrality measures assign importance to influential or key nodes in a network based on the topological structure of the underlying adjacency matrix. In this work, we define the importance of a node in a network as being dependent on whether it is the only one of its kind among its neighbors’ ties. We introduce linchpin score, a measure of local uniqueness used to identify important nodes by assessing both network structure and a node attribute. We explore linchpin score by attribute type and examine relationships between linchpin score and other established network centrality measures (degree, betweenness, closeness, and eigenvector centrality). To assess the utility of this measure in a real-world application, we measured the linchpin score of physicians in patient-sharing networks to identify and characterize important physicians based on being locally unique for their specialty. We hypothesized that linchpin score would identify indispensable physicians who would not be easily replaced by another physician of their specialty type if they were to be removed from the network. We explored differences in rural and urban physicians by linchpin score compared with other network centrality measures in patient-sharing networks representing the 306 hospital referral regions in the United States. We show that linchpin score is uniquely able to make the distinction that rural specialists, but not rural general practitioners, are indispensable for rural patient care. Linchpin score reveals a novel aspect of network importance that can provide important insight into the vulnerability of health care provider networks. More broadly, applications of linchpin score may be relevant for the analysis of social networks where interdisciplinary collaboration is important.

The effect of rural placements on future rural general practice

Background: Providing health care to rural populations is a major issue in Australia. Disease burdenand health risk factorsincrease with remoteness, but the access to appropriate service decrease. The introduction of Rural Clinical Schools, rural locations for internship and residency, and decentralisation of the Australian General Practitioner Training Programaim to address this disparity. This systematic review aimed at determining if rural placements throughout medical training are associated with future rural general practice in Australia.Methods: Medline (Ovid), Pubmed, CINAHL and Science Direct were searched for the period January 2000 to July 2019. Included studies related specifically to rural general practitioners in Australia and studies were excluded if they reported only on intention to practice rurally. Evidence was assessed using the Standards for Quality Improvement Reporting Excellence Guidelines.Results: Eleven articles met the inclusion criteria. Three studies examined the effect of rural placements in medical school on future rural general practice. Three studies looked at placements as a junior doctor on future rural general practice. Four studies looked at the effect of rural general practitioner training on future rural general practice. One study reported on the effect of rural placements during both medical school and junior doctor years on future rural general practice. The studies supported an association between rural placements and future rural general practice, particularly for Australian born doctors, Australian graduates and individuals from rural backgrounds.Discussion: This review suggests that rural placements during medical training increase the likelihood of future rural general practice. The interplay of personal and professional life influence whether rural intention is sufficient to result in rural practice. Addressing human factors that influence rural practice will contribute to achieving equitable rural health care.

A case for mandatory ultrasound training for rural general practitioners: a commentary.

Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient's bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients' lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five. Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling and quality assurance programs prevent physicians from feeling confident when utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use. Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance.

Developing and Validating a Scale of Tourism Gentrification in Rural Areas

In recent years, tourism gentrification has made great progress in rural areas and has had significant impacts on these areas’ development, specifically in the domains of the economy, living standards, community, culture, and environment. Tourists play a key role in developing tourism gentrification in rural areas, but research investigating tourism gentrification in rural areas from the tourist perspective is scarce. To fill this gap, we focus on tourism gentrification and develop a measurement scale from the tourist perspective through multiple qualitative and quantitative steps. Our findings confirm that tourism gentrification in rural areas from the tourist perspective comprises eight dimensions: economic growth, enhanced environment, enhanced living standards, individual civilization, improved communication, promoted social environment, cultural appreciation, and improved individual quality. Through development and validation of the scale, we hope to offer a comprehensive referencing index of tourism gentrification in rural areas to policy makers and rural tourism practitioners.

A Reflection on the Role of Communal Resource Mobilization on Project Performance for Rural Development, Evidence from Kalungu District

The study was conducted to establish the relationship between communal resource mobilization and rural development in Kalungu district. It adopted a case study research design which was both quantitative and qualitative to describe data and its characteristics: 332 respondents were selected for research using simple random sampling and purposive sampling techniques. Close ended questionnaires were further used to harvest information from respondents and data was analyzed using frequencies, percentages, bar graphs (SPSS) and Pearson linear correlation coefficient. The study found out that the triumph or failure of any development project depended largely on the rate at which the community was involved thus understanding techniques through which community participation can spearhead rural development is essential both for scholars and rural development practitioners. The study recommended government and all rural development practitioners to embrace communal resource mobilization as an effective community participation strategy. Conclusively, the purpose of this paper is to provide an overview of the working community participation strategies for rural development.

Hand of generalism.

![Figure][1]</img> When I am not practising medicine, I enjoy drawing. It takes me a while to complete a piece, but I do not mind. I normally put music on in the background, sit back, and relax. It is a nice break from my work as a rural general practitioner. We all need breaks. The multiple

Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles.

Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non-clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships. Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships. PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well-being and patient welfare. While off-duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on-duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal-professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions. Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.

The seroprevalence of SARS-CoV-2 in a rural southwest community.

The true prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has been difficult to determine due to limited testing, inconsistent symptom severity, and asymptomatic infections. Systematic investigation of the prevalence of SARS-CoV-2 has been limited to urban environments and large academic centers. Limited data on the seroprevalence of SARS-CoV-2 is available for those who live in a rural community setting, leaving rural practitioners to extrapolate the epidemiology of COVID-19 to a nonhomogeneous population. To determine the seroprevalence of SARS-CoV-2 in a community setting. The secondary objective of this study was to describe the difference in infection rate and reverse transcription polymerase chain reaction (RT-PCR) testing in the same rural community. A prospective convenience sample of community members and healthcare workers from the Kingman, Arizona area were tested for SARS-CoV-2-specific antibodies using a lateral flow immunoassay with theVITROS Anti-SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, Inc.) from September 28, 2020 to October 09, 2020. Upon recruitment, participants were asked to complete a demographic survey assessing socioeconomic status, comorbidities, and COVID-19 symptoms in the preceding twomonths. Following enrollment, a retrospective chart review was completed to determine the percentage of patients who had undergone previous SARS-CoV-RT-PCR testing. A total of 566 participants were included in the final analysis: 380 (67.1%) were women, 186 (32.9%) were men, a majority (458; 80.9%) self-identified as White, and 303 (53.5%) were employed as healthcare professionals. Seroprevalence of SARS-CoV-2 was found to be 8.0% (45 of 566) across the sample and 9.9% (30 of 303) in healthcare workers. No statistical difference in seroprevalence was found between men and women, healthcare workers andother participants, amongst racial groups, by socioeconomic status, by comorbid conditions, or by education level. Among the participants, 108 (19.1%) underwent previous RT-PCR testing. Of the 45 patients who were antibody positive, 27 (60%) had received a previous RT-PCR test, with 20 (44.4%) testing positive for SARS-CoV-2. Participants with symptoms of anosmia/ageusia (p<0.001), chest congestion (p=0.047), fever (p=0.007), and shortness of breath (p=0.002) within the past twomonths were more likely to have antibodies to SARS-CoV-2. Only 8% of 566 participants in this rural community setting were found to have antibodies for SARS-CoV-2. A large minority (18; 40%) of patients testing seropositive for SARs-CoV-2 had never received a prior test, suggesting that the actual rates of infection are higher than publicly available data suggest. Further large-scale antibody testing is needed to determine the true prevalence of SARS-CoV-2 in the rural setting.

Dismantling the hub and spoke: Social accountability and rural medical education.

Originally advocated for by the World Health Organization in the 1990s, there has been a renewed call for focus on social accountability in the medical education community. Intrinsic to this mandate is the need to train physicians to practice in rural, often underserviced, communities. To this end, social accountability language has been incorporated into medical school mission and vision statements1 , but the reality is that, despite improvement, the end goal of supplying rural areas with an adequate number of physicians has remained unfulfilled. The problem, in large part, is driven by the movement of populations from rural to urban areas and the attractiveness of cities for work and leisure. However, medical school policies, curriculum and the legacies of a centralized medical education system also play a significant role in the challenge of developing a sustainable community of rural practitioners.

Study on the coupling mechanism of social interaction and rural tourism practitioners sustainable participation

As a green industry, tourism provides a new path for the green development of rural areas and plays an important role in the development of rural economy and the construction of ecological civilization, the sustainable participation willingness of the practitioners is the primary factor that affects the sustainable development of rural tourism. This paper studies the effect of Social Interaction on sustainable participation of practitioners. Through the empirical analysis, it is found that the interaction between practitioners and tourists, government and neighbours has a significant positive impact on the willingness of practitioners to continue to participate in rural tourism. Practitioners’ satisfaction with local tourism development plays an intermediary role in social interaction behaviour and willingness to participate continuously.

The psychosocial experiences and supportive care preferences of organ transplant recipients and their carers who live in regional Australia

There is no evidence that being a rural or regional organ transplant recipient has adverse physical health outcomes post-surgery compared with those experienced by people living in cities, but the impact of living remotely from transplant centres on psychosocial outcomes has not been explored. To identify the social, emotional, psychological, spiritual, informational and practical issues associated with being a regionally based organ transplant recipient or carer and determine how support services could be improved for this group. Twenty-two purposively sampled adult Australians who lived outside metropolitan centres and had received an organ transplant (n=15) or were the primary carer of someone who had received one (n=7), participated in semi-structured, telephone interviews. Qualitative data were collected until data saturation was reached and were analysed using thematic analysis. Five key themes (plus subthemes) were identified: (a) travelling for specialist transplant care takes a toll, (b) unique transplant-related psychological and emotional issues experienced before and after transplants, (c) caring for transplant recipients is a demanding role, (d) lay, peer and professional support, including rural general practitioners and accommodation facilities, help ease the burden, but (e) significant barriers to accessing transplant-focused psychosocial support exist. Novel methods of delivering targeted, transplant-specific information and psychosocial care to rural transplant recipients and their carers, employers and rural health professionals require development and evaluation. Strategies might be delivered by peers or professionals via telehealth, telephone, social media or websites for example, depending on preferences and level of need.