Rural Public Health Research Articles

Bibliometric Analysis of the Role of Nurses in Addressing Urban and Rural Public Health Disparities

This bibliometric analysis study explores the thematic and collaborative dynamics within the field of public health research, particularly focusing on the period from 2000 to 2024. Utilizing VOSviewer, we analyzed keyword occurrences and authorship data to identify central themes and the interconnections between researchers. The analysis reveals a strong emphasis on health disparities, with specific attention to access, quality, and policy issues. The emergence of COVID-19 as a significant research theme highlights the field's responsiveness to global health crises and its impact on existing inequalities. The study also maps out key contributors and their collaboration patterns, providing insights into the intellectual structure and potential gaps in the research community. Our findings emphasize the need for interdisciplinary approaches and greater collaboration to address the multifaceted challenges of global health disparities effectively.

The Toilet Revolution Empowers Rural Revitalization based on a Health Perspective

Since the reform and opening up, with the rapid development of the Chinese economy, public health problems have become increasingly serious. At the same time, due to the reality of imbalanced urban-rural development in China, improving the living environment in rural areas is the key and difficult point to achieve rural revitalization. Therefore, in 2015, the Chinese government officially began the "Toilet Revolution", a national public health movement aimed at improving urban and rural public health problems, enhancing people's quality of life, promoting rural economic development, and further promoting the implementation of the rural revitalization strategy. Based on a health perspective, this article analyzes the impact of the "toilet revolution" on rural health human capital by reviewing existing data and literature such as the "China Statistical Yearbook" on the level of health service expenditure and the number of sanitary toilet constructions. It further elucidates the mechanism by which the "toilet revolution" empowers rural revitalization, providing a theoretical basis for the government to deepen the "toilet revolution", narrow the urban-rural gap, and promote rural revitalization.

Determinants of the morbidity of the rural population in Russia during the COVID-19 pandemic: a regional aspect

MATERIAL AND METHODS: Data from the Federal State Statistics Service, as well as statistical materials from the digest “Rural Healthcare in Russia in 2021”, provided by the Federal State Budgetary Institution “Russian Research Institute of Health” of the Russian Ministry of Health were the main sources of information for this study. Analytical procedures included Pearson correlation analysis, factor analysis (principal component method), hierarchical cluster analysis, multiple linear regression with backward elimination method for selecting variables. RESULTS: Six typological groups of regions of the Russian Federation were identified based on the variations in the morbidity rates of the rural population across certain classes of diseases including infectious and parasitic diseases, neoplasms, diseases of the circulatory system, diseases of the respiratory system, digestive system, and external causes. It has been established that there was a differentiation in the regions of Russia in terms of factors influencing the morbidity rate of the rural population by the main classes of diseases during the COVID-19 pandemic in 2021. Healthcare system, medical and social factors had the greatest impact on the overall morbidity in the regions of the fourth and fifth classification groups, on the detection of some infectious and parasitic diseases in the regions of the second, fifth and sixth groups, and respiratory and digestive diseases in the third classification group. The housing quality in the regions of almost all groups was one of the most significant social factors. Economic conditions had a significant impact on the incidence of infectious and parasitic diseases in the regions of the third and sixth groups, as well as on the level of injuries and some consequences of external causes in the regions of the first and third groups. Environmental factors were significant determinants of morbidity in the regions of the fifth group. At the same time, regression analysis showed associations between selected factors for all classification groups of regions for some infectious and parasitic diseases. The smallest number of models has been defined for the incidence of neoplasms and circulatory organs. CONCLUSION: Contribution of socioeconomic, demographic, environmental and natural factors to rural public health should guide the development of policies aimed at development of rural healthcare taking into account regional characteristics.

Barriers and facilitators of cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda: a qualitative study using the integrated model of health literacy

BackgroundSeveral rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions.MethodsWe conducted ten Focus Group Discussions with rural women aged 25–49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women’s statements.ResultsLack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women’s ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women’s concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women’s ability to: understand information and access to cervical cancer screening services at individual level.ConclusionsThis study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions.

The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation.

Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Of the 9 participants, all were female and most worked at a local health department (7/9, 78%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting-89% (n=8) participants for task 1 and 67% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be "extremely useful" for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities.

Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America.

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.

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

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

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

Service quality: perspective of people with type 2 diabetes mellitus and hypertension in rural and urban public primary healthcare centers in Iran

ObjectiveThis study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran.MethodsThe Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17.ResultsAmong the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants’ anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers.ConclusionStudy reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.

Risk perceptions and behaviors concerning rural tourism and economic-political drivers of COVID-19 policy in 2020.

When COVID-19 was first introduced to the United States, state and local governments enacted a variety of policies intended to mitigate the virulence of the epidemic. At the time, the most effective measures to prevent the spread of COVID-19 included stay-at-home orders, closing of nonessential businesses, and mask mandates. Although it was well known that regions with high population density and cold climates were at the highest risk for disease spread, rural counties that are economically reliant on tourism were incentivized to enact fewer precautions against COVID-19. The uncertainty of the COVID-19 pandemic, the multiple policies to reduce transmission, and the changes in outdoor recreation behavior had a significant impact on rural tourism destinations and management of protected spaces. We utilize fine-scale incidence and demographic data to study the relationship between local economic and political concerns, COVID-19 mitigation measures, and the subsequent severity of outbreaks throughout the continental United States. We also present results from an online survey that measured travel behavior, health risk perceptions, knowledge and experience with COVID-19, and evaluation of destination attributes by 407 out-of-state visitors who traveled to Maine from 2020 to 2021. We synthesize this research to present a narrative on how perceptions of COVID-19 risk and public perceptions of rural tourism put certain communities at greater risk of illness throughout 2020. This research could inform future rural destination management and public health policies to help reduce negative socioeconomic, health and environmental impacts of pandemic-derived changes in travel and outdoor recreation behavior.

A training program for obstetrics point-of-care ultrasound to rural health care providers in Kenya

Background: Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to the increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low- and middle-income countries (LMICs) is limited. Despite the World Health Organization’s (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health has not been widely used in LMICs. We describe the implementation of obstetrics POCUS training for high-risk conditions in rural public health care facilities in Kenya. Methods: As part of the initiation of a large-scale implementation study of obstetrics-POCUS, clinician trainees were recruited from rural Kenyan hospitals to participate in a series of five-day POCUS workshops. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for five obstetrics POCUS applications. Instructor-observed assessments of students’ scanning and image interpretation were performed during the training period. Assessment of knowledge and confidence was performed via an online pretest and posttest and objective structured clinical examinations. Results: 514 midlevel health care providers were trained over three months, with a trainer: trainee ratio of 1:5. Of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. Obstetrics POCUS topics covered included malpresentation, multiple gestation, fetal cardiac activity, placenta, and amniotic fluid volume. There was a marked improvement in the posttraining test scores. Conclusion: Our implementation description serves as a guide for the successful rapid dissemination of obstetrics POCUS training for midlevel providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound during pregnancy through accessible obstetrics POCUS training programs.

The Burden of Cardiovascular Disease from Air Pollution in Rwanda.

Rwanda, like many countries in sub-Saharan Africa, is still relatively early in development. Industrialization and urbanization are major drivers of the county's economic growth. Rwanda is also undergoing an epidemiological transition, from a pattern of morbidity and mortality dominated by infectious diseases to a pattern shaped by non-communicable diseases (NCDs). The rise in NCDs is due, in part, to increasing exposures to environmental hazards. These include emissions from the growing number of motor vehicles and toxic occupational exposures. Cardiovascular disease (CVD) is now an increasingly important cause of death in Rwanda, and ambient air pollution is a CVD risk factor of growing importance. To quantify the burden of CVD attributable to air pollution in Rwanda and identify opportunities for prevention and control of air pollution and pollution-related disease. We relied on the 2019 Global Burden of Disease (GBD) study for information on levels, sources, and trends in household and ambient air pollution and the burden of pollution-related disease in Rwanda. Information on pollution sources was obtained from the Health Effects Institute State of Global Air 2019 report. An estimated 3,477 deaths (95% Uncertainty Interval [UI]: 2,500-4,600) in Rwanda in 2019 were attributable to air pollution-related CVD. Of these, 689 (UI: 283-1,300) deaths were from ambient air pollution-related CVD, while 2,788 (UI: 1,800-3,800) deaths were from household air pollution-related CVD. Rwanda is experiencing increased rates of disease and premature death from NCDs, including CVD, as the country grows economically. While household air pollution is still the top pollution-related cause of disease and premature death, rising levels of ambient air pollution are an increasingly important CVD risk factor. Actions taken now to curb rising levels of ambient air pollution will improve health, reduce CVD, increase longevity, and produce great economic benefit for Rwanda. The single most effective intervention against air pollution will be a rapid nationwide transition to renewable energy. We recommend additionally that Rwanda prioritize air pollution prevention and control, establish a robust, nationwide air monitoring network, support research on the health effects of air pollutants, and build national research capacity. The allocation of increased resources for rural and urban public health and health care will complement air pollution control measures and further reduce CVD. To incentivize a rapid transition to renewable energy in Rwanda and other nations, we recommend the creation of a new Global Green Development Fund.

Making waves: The benefits and challenges of responsibly implementing wastewater-based surveillance for rural communities

The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri‑urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial – though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed.

Research on Improving the Quality of Rural Medical Services in Shandong Province Based on the SERVQUAL Model

Rural healthcare is an essential aspect to consider in rural revitalization. Using the SERVQUAL model to examine the present state and challenges of healthcare service quality in Shandong Province, it was observed that rural people's perception of actual value falls short of their expectations in five different areas: tangibility, reliability, responsiveness, assurance, and empathy. The primary challenges entail inadequate public health consciousness among particular villagers, deficient modernization of rural healthcare facilities, and illogical regional health strategizing. Hence, to enhance the standard of living in rural regions and foster the building of a rural public health network, it is imperative to take initiatives to enhance villagers' hygiene awareness, promote the modernization of rural medical aid, and enhance practitioners' expertise via various means.

Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study

BackgroundHealth worker retention in remote and hard-to-reach areas remains a threat in most low- and middle-income countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda.MethodsA descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical officers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information.ResultsMost of the respondents were females (62.90%), married (84.62%), with certificate level (55.74%), and nurses as qualification (36.60%) as well as attached to Health Center 3 level (61.28%). Significant individual factors associated with retention included having a certificate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staff, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship.ConclusionThe study established that indeed several individual and social demographics, health system and career-related factors are significantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.

Conformity assessment of Pharmaceutical Storage on the Rural Public Health Center of West Kalimantan Indonesia

The storage condition of pharmaceutical drugs and medical disposables in the primary healthcare providers (e.g., public health centers) should meet the required quality standard to maximize financial profit and avoid loss. In order to ensure this matter, a conformity assessment is required. This study aimed to examine the conformity of the storage condition in the rural public health center of Dalam Kaum village, West Kalimantan, Indonesia, with the Regulation of the Minister of Health of the Republic of Indonesia Number 74 of 2016 and the indicators for the storage of pharmaceutical drugs and medical disposables. This study was a descriptive non-experimental method applying quantitative and qualitative approaches by observation using a checklist and interviews. Overviews of the conditions were compared with guidelines sourced from the Regulation, including storage method, storage stability, flammable and explosive material storage, narcotic and psychotropic drug storage, and storage with risk of contamination. In addition, the indicators included the percentage of damaged or expired drugs, dead stock of drugs, and turnover ratio (TOR). The study's findings reported that the conformity of the storage condition based on the Regulation was 100% for storage method, storagestability,narcotic and psychotropic drug storage, and storage with risk of contamination, while 0% was for flammable and explosive material storage. In terms of the indicators, this study found 10.8% for damaged or expired drugs, 53.4% for dead stock of drugs, and 8.53 times per year for TOR. Based on the findings, it could be concluded that almost all aspects of the public health center of Dalam Kaum village conformed to the Regulation of the Minister of Health of the Republic of Indonesia. Unfortunately, only one aspect showed conformity regarding the indicators for the storage of pharmaceutical drugs and medical disposables.

Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis.

Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.

Overweight children in rural Norway - public health nurses' possibilities and limitations within national guidelines.

Globally, overweight and obesity are more prevalent in rural areas than in urban areas. The purpose of this study was to determine to what extent public health nurses in rural areas in Norway feel equipped to tackle the overweight and obesity epidemic within two sets of national guidelines: The National Guidelines for the Standardized Measurement of Height and Weight and The National Guidelines for the Prevention, Identification, and Treatment of Overweight and Obesity in Children and Adolescents. These guidelines are inspired by New Public Management (NPM) logic, which emphasises more market orientation within the public sector to obtain a more cost-effective supply of public goods. The focus is on the weighing of schoolchildren, available resources, inter-agency cooperation and the rural context. The data were collected using a structured questionnaire among 40 public health nurses working with children in rural areas, as well as qualitative interviews with 25 informants involved in the prevention and treatment of overweight and obesity among rural children. The study shows that rural public health nurses worry about the lack of resources for follow-up with children with a body mass index greater than what is characterised as 'normal'. The public health nurses suggested better cooperation between different stakeholders to work around the lack of resources and at the same time be able to see the whole picture, considering that overweight and obesity are complex problems connected to different challenges. They believed that it is an advantage to see the individuals in their local surroundings, to know their family history, their leisure activities and so on. This might be easier in rural areas than in urban areas, as these areas are often more transparent. There was consensus among the public health nurses involved in this study that national guidelines for treating overweight and obesity in children with the principles of NPM, and simplifying and standardising services, adds challenges instead of solutions. Such practices also hinder the use of experience-based knowledge about both the individual and the local context. There is a need for more flexible guidelines that can easily be adapted to the local (rural) context.

Opportunities and Challenges of Using Carve-Outs to Fund Rural Public Health Initiatives: Evidence From the COVID-19 Pandemic.

Opportunities and Challenges of Using Carve-Outs to Fund Rural Public Health Initiatives: Evidence From the COVID-19 Pandemic.

Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey.

Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).