Rural Service Providers Research Articles

Perception And Attitude Of Undergraduate Medical Students Towards Rural Health Services – A Cross Sectional Study

Introduction: Medical students are under immense pressure and competition to advance in their career. 65% of Indian population resides in rural area and their health care needs are to taken care of. Understanding perception and attitude of undergraduate medical students towards rural health service will help in better provision of rural healthcare services. Objectives: 1) To assess the perception and attitude of medical students towards rural health services 2) To understand the factors influencing willingness and unwillingness of medical students towards serving in rural areas Material and methods: A cross-sectional study was conducted among 600 students of first, second and final MBBS studying in a private medical college in Andhra Pradesh. A predesigned semi-structured, self-administered questionnaire was used for data collection and the data was analyzed in Epi Info 7 Results: A total of 467 completed questionnaires were returned with participation rate of 78% out of which 67.9% were females and 32.1% were males. 44.3% of the respondents had a family member working in rural area. 81.4% of respondents believed that rural services should be made compulsory for doctors. 79.9% of respondents expressed willingness to work in rural areas. The commonest reason for willingness to work in rural areas was to gain experience (62.2%) while the commonest reason for unwillingness to work in rural areas was limited infrastructure (57.5%).Conclusions: Rural health services can be improved by employing young medical graduates.

Social practices, gender, and materiality: Women's agency in bioenergy-dependent households and communities in the central Ethiopian Rift Valley

Current energy-related practices in bioenergy-dependent households and communities regularly reinforce social inequality and exacerbate environmental challenges. By investigating women's influence on rural energy service provision, this study sheds light on gendered practices and women's agency in a case study of three villages in central Ethiopia.Women's lives in these communities revolve around practices such as collecting wood and using fire for cooking, hygiene, or space heating. Energy-efficient technologies like cookstoves are peddled as solutions to the day-to-day challenges women face. While these can enhance health and well-being, a one-sided focus on technology overlooks the deep-seated social meanings that limit the agency of women. Energy research urgently needs to improve its understanding of how women may alter energy-related social practices, to avoid that technocratic approaches entrench the provision of energy services as a gendered female chore.This interdisciplinary research employs a Stock-Flow-Practice nexus perspective to analyse interlinkages between agency, practices, meanings, and the use of materials. Study results reveal that the agency of women to change their engagement in energy-related practices is curtailed by social prescriptions within the investigated households and communities. However, in households where women can garner higher levels of agency, they are able to shift how their households engage in practices.Our findings highlight the importance of understanding women's agency as unfolding through their engagement in social practices and reflecting negotiated social prescriptions. Policies and programmatic interventions towards sustainable and equitable energy transitions in bioenergy-dependent communities need to incorporate a practice-centred concept of agency to reach their goals.

Shared decision making in rural general practices: a qualitative exploration of older rural South Australians’ perceived involvement in clinical consultations with doctors

BackgroundShared decision-making (SDM) implementation is a priority for Australian health systems, including general practices but it remains complex for specific groups like older rural Australians. We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices. MethodsWe conducted a patient-oriented research, partnering with older rural Australians, families, and health service providers in research design. Participants who visited general practices were purposively sampled from five small rural towns in South Australia. A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted. ResultsTelephone interviews were held with 27 participants. Four themes were identified around older rural adults’ involvement in SDM: (1) Understanding of “patient involvement”; (2) Positive and negative outcomes; (3) Barriers to SDM; and (4) Facilitators to SDM. Understanding of patient involvement in SDM considerably varied among participants, with some reporting their involvement was contingent on the “opportunity to ask questions” and the “treatment choices” offered to them. Alongside the opportunity for involvement, barriers such as avoidance of cultural care and a lack of continuity of care are new findings. Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices. Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers. ConclusionAdequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia. Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians’ involvement in general.

IN PRAISE AND SEARCH OF MIDWIFERY WELL-SUITED To RURAL WOMEN

In order to investigate rural maternity care from the perspective of women, narrative interviews were conducted with 36 mothers and 36 health care workers in three small community case study sites in south central Ontario in 2000. Based on the resulting data, this article suggests numerous ways that living rurally affects maternal health. It goes on to explore ways in which midwifery is particularly well-suited to addressing the needs of women living in rural places and identifies sites of resistance to rural midwifery. The research findings indicate that a commitment to the sustained provision of rural midwifery services is well worth the effort and investment required, and this article discusses implications of such a commitment for both practitioners and policy makers.

Activating Co-production of Rural Service Delivery: Examining the Role of Nonprofit Organizations Using a Case Study in China

AbstractAlthough co-production between the government and society can improve service outcomes, the two parties may lack the willingness and the capacity to cooperate. Can nonprofit organizations play an active role in facilitating government–citizen co-production? If so, how? The role of nonprofits in social services co-production has received increasing attention, but studies on developing countries are limited. Therefore, this study conducts an in-depth case study of a rural social work institute in Z village, Beijing, China. Using on-site observations, semi-structured interviews, and secondhand materials, we found that social workers adopted four strategies to engage community officials and rural residents in service co-production. They established trustworthy relationships, facilitated effective communication, fostered shared motivation, and built co-productive capacity. The results showed that nonprofit organizations use third-party roles and professional skills to shape government-citizen interactions through service co-production. These findings can improve rural service provision in developing countries.

Community Service Workers’ Experiences Following Australia’s Black Summer: Contextualising Rural Service Provision

ABSTRACT The Australian Black Summer season of 2019–2020 caused widespread social, economic, and environmental impacts for affected rural communities. In this article, the authors report on a small study exploring postdisaster service provision from the perspectives of community service workers following the Australian Black Summer season. Using a qualitative, semistructured design, six community service workers were interviewed about their experiences delivering postdisaster services to affected rural communities. Three themes emerged from a thematic analysis. These themes were impacts of rurality, accounting for diversity, and the influencing policy context. The Findings underscore rurality as a context-specific characteristic intersecting with social identities in a broader sociopolitical system. Implications suggest the need to address persisting rural inequities that cause cumulative disadvantage and advocate for policy change to address service system gaps. IMPLICATIONS Structural inequities in rural communities continue to shape the experiences of residents impacted by disasters causing cumulative disadvantage. Diversity within and between neighbouring communities and population groups requires consideration of the heterogeneity of rural contexts. The policy context constrains aspects of rural service provision causing adverse impacts on affected residents’ experiences.

A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country

BackgroundHealthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of people from refugee or refugee-like backgrounds. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healthcare needs of refugees, this creates challenges for healthcare service providers. Identifying barriers to accessing healthcare in rural areas is therefore important to better inform policy settings and programmes that will provide culturally appropriate patient-centred care to the refugee community.MethodsThis review scoped 22 papers written in English between 2018 and July 2023 from five countries (Australia, New Zealand, Germany, Bangladesh, and Lebanon) in order to provide an overview of the barriers and possible solutions to facilitate refugees’ access to healthcare.ResultsThe reviewed literature summarised the perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators and identified major challenges. These include communication (illiteracy in the resettlement country language and lack of a suitable interpreter), lack of cultural awareness of health services, discrimination, and access difficulties (transportation, availability of health specialist services, cost). As a consequence, it was identified that improving access to affordable housing, employment through credential recognition, competence-level education for children, facilitating language training, and adapting health information would increase resettlement and encourage access to healthcare.ConclusionsRefugees face significant barriers to accessing and engaging with healthcare services. This impacts their integration into rural communities and increases the prevalence of psychosocial issues like feelings of loneliness, low self-esteem, a lack of autonomy, and a lack of empowerment over informed decision-making, especially for women, jobless men, and the elderly. These findings support the need for additional support for refugees and healthcare providers to improve language proficiency and cultural competency. Policymakers need to improve the availability and accessibility of employment, housing accessibility, and service mobility. Additionally, more research is needed to assess the efficacy of emerging innovative programmes that aim to close the gap by delivering culturally appropriate patient-centred care to refugee communities in rural areas.

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists’ experiences across continents

IntroductionMany health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC.MethodsThe study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed ‘Secrets to success’. The session was recorded with the participants’ consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified.ResultsThirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed.DiscussionThis PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.

Exploring Public Satisfaction in Rural Public Services: 2022 Case Study

This study investigates public satisfaction with service provision in Desa Larangan, Kecamatan Candi, Kabupaten Sidoarjo, focusing on nine key elements outlined in the Ministry of Administrative and Bureaucratic Reform's guidelines. Evaluating citizen satisfaction in areas ranging from requirements to infrastructure, the research surveys Organisasi Perangkat Daerah (OPD) and the Village Government as service recipients. Findings reveal an overall favorable assessment, showcasing a commendable service quality and performance with a Satisfaction Index of 79.02. Notably, infrastructure facilities garnered the highest average score (3.28), while requirements scored the lowest (3.02). This study highlights the positive quality of rural public service provision and underscores areas for potential enhancement, serving as a benchmark for governance optimization.
 Highlights:
 
 Comprehensive Assessment: Evaluated nine dimensions of service satisfaction.
 Favorable Findings: Overall positive performance with notable room for improvement.
 Governance Benchmark: Offers insights for optimizing rural service delivery.
 
 Keywords: Public Satisfaction, Service Quality, Rural Governance, Citizen Feedback, Administrative Performance

“Just trying to adjust to the new reality that seems to be changing every hour”: Lessons learned from nation-wide peer meetings on COVID-19 with rural disability service providers

ABSTRACT At the onset of the COVID-19 pandemic, providers of independent living services for rural disabled people were forced to adapt how they conducted their operations. This study is a primary analysis of data based on transcripts from eight meetings of a nationwide network of service providers (n = 40-150 participants per meeting), who met virtually to provide peer support during the unfolding pandemic. We used qualitative thematic analysis to understand the ways these service providers adapted to address the needs of rural disabled people during the pandemic. We identified four main themes describing organizational adaptations. Although this was a predominantly challenging time, service providers identified ways their adaptations were beneficial. These included creating new ways to connect, reaching more people with disabilities, and reducing commuting time to provide services. Service providers intended to continue using their adapted strategies and platforms for providing services, and thus projected these benefits would be long-lasting.

Synergy between rural and smart tourism: is it possible and necessary?

PurposeThe study aims to identify the opinions of rural tourism service providers on synergy between rural and smart tourism in Latvia, Zemgale region.Design/methodology/approachThe research is of a qualitative nature and it profiles possibilities for and the necessity of synergy between rural and smart tourism. As part of the study, a survey was conducted to identify the opinions of 63 rural tourism service providers from the Zemgale region.FindingsThe study found that rural tourism service providers use digital tools mainly for payment, communication with customers as well as marketing activities, which revealed that the level of digitalization of rural tourism in Latvia is low. The survey data indicates the respondents' dual vision of synergy between rural and smart tourism, recognizing that IT progress was rapid and its influence was inevitable, while at the same time emphasizing an argument for maintaining the basic value and nature of rural tourism.Originality/valueThe paper is an original study of the opinions of rural tourism service providers on synergy between rural and smart tourism in Latvia and specifically, the Zemgale region.

Social Organizations in Rural China: From Autonomy to Governance

AbstractThis article examines the government purchase of social services in China as a window by which to investigate the evolving relations between the party-state and social organizations. Going beyond the conventional focus on state–non-governmental organization (NGO) dynamics in urban areas, we explore the expanded role of social organizations in rural service provision under state-led campaigns of rural modernization. Engaging with institutional theory and the consultative authoritarianism thesis, we argue that NGOs initially operated in an emerging organizational field where they exercised considerable autonomy in setting agendas and designing services. As the party-state's incentives to utilize and co-opt the social work profession grow, however, we observe a trend towards incorporation, wherein social workers now play a bigger role alongside the strengthening of state control over the sector. Through tracing the inception and eventual termination of a decade-long social service project in Guangdong, this article shows how state incorporation might undermine the future role of NGOs in rural development.

Sexual and reproductive health services access and provision in Cambodia during the COVID-19 pandemic: a mixed-method study of urban–rural differences

BackgroundThe COVID-19 pandemic pushed governments worldwide to implement unprecedented mitigation measures, including safe-distancing, lockdowns, disruption of non-essential services, border closures and travel restrictions, with both potential to affect rural and urban service-users differently and unintended consequences including reductions in sexual and reproductive health (SRH) services. We aimed to explore rural–urban differences in progress and challenges in SRH services provision in Cambodia, particularly during initial months of the COVID-19 pandemic.MethodsWe used a mixed-methods study design, including a household survey of 423 adolescents and women aged 18–49 and semi-structured interviews with 21 healthcare providers. We analysed survey data using multivariable logistic regression to identify associations between rural–urban setting and contraceptive perceptions or access. We analysed interview data thematically.ResultsRural–urban residence was significantly associated with reported perceptions about and access to contraceptives. Rural participants had higher odds of stating it was possible to change contraceptive methods early in the COVID-19 pandemic, compared with urban participants. Qualitative data showed that although SRH services continued, health-workers faced differential challenges in rural and urban areas, e.g. service-users not attending due to job losses in urban areas and not complying with safe-distancing and mask-wearing requests in rural areas.ConclusionsCOVID-19 and inadequate mitigation responses differentially affected rural and urban SRH service providers and service-users, exacerbating existing socioeconomic stressors while adding new fears of infection, transport constraints, and reduced livelihoods. Added financial support could help mitigate challenges in both rural and urban areas.

Empowering rural service providers to improve nutrition in mountain regions

Improved agroecological practices tend to lead to production diversity but often fall short of achieving optimal dietary diversity in rural contexts. Thus, multi-prong interventions involving knowledge and skill development for production and consumption are needed. This study assesses nutrition and production-related interventions implemented in the East African Highlands, Pamir-Tian Shan, Hindukush and the Andes. Overall, 601 rural service providers were trained and supported to implement various nutrition-sensitive agroecological interventions. Study results show that these interventions significantly increased the intake of flesh food, eggs, vitamin A-rich leafy greens, and vitamin-A-rich vegetables and fruits. The increase in production diversity was correlated with the increase in dietary diversity. Thus this study highlights the crucial role of rural service providers in catalyzing nutrition-related changes in mountain contexts.

A mountain of health benefits? Impacts of ecological restoration activities on human wellbeing

Just as ecological degradation contributes to many public health problems, restoration of these areas can be health-enabling not only for the environment but also for people. However, despite growing recognition of the positive relationships between ecological restoration and human health, knowledge gaps persist. Rural areas are most closely affected by ecological degradation from industries such as forestry, farming and mining and rural populations suffer the poorest health outcomes. Nevertheless, the wellbeing benefits of ecological restoration for participants and communities in these areas are under-researched. Rural wellbeing is impacted by factors of geographic isolation, poverty and limited health services which generate rural health inequities. Place-based ecological restoration activities have the potential to address individual and community-level wellbeing issues. In this paper we report on a qualitative study from the Break O'Day municipality in Tasmania, Australia, the site of over 20 years of ecological restoration by local people. The organisation leading the restoration work, the Northeast Bioregional Network, observed that well-organised holistic ecological restoration projects could cultivate ecological ethics and improve human health. Using interview data, we explored the lived impacts of ecological restoration on various aspects of participant health and wellbeing, as well as the observed community-wide benefits. Our analysis identified certain characteristics of place-based ecological restoration participation that are supportive of wellbeing, and the opportunities for improved synergies between ecological restoration and mainstream rural health service provision. We conclude that participation in well-designed, holistic ecological restoration programs can contribute to ameliorating complex health problems affecting rural communities.

Rural hospitality: Problems of legal regulation of guest safety

This study investigates the problems of legal regulation of the safety of visitors – guests of rural estates during the provision of rural hospitality services. The relevance of this study is conditioned upon the urgent need to develop special legislation that would reflect the specifics of such a new area of agricultural diversification for Ukraine as rural hospitality, specifically one of the defining aspects for the development of this sphere – the safety of guests of rural estates. The purpose of this study was to characterize the state of legal support for the outlined area and formulate proposals for improving the legal regulation of the safety of visitors/guests of rural estates. The methodological framework of this paper included a set of general scientific and special legal methods of scientific cognition, namely dialectical, system-structural, formal logical, system analysis, and formal legal methods. As a result of the conducted study, the term “safety of rural hospitality” was defined in broad and narrow meanings, and the external and internal levels of safety in rural hospitality were also distinguished. The possibility of applying tourism legislation to regulate external security relations in rural hospitality was substantiated. The need to regulate internal security relations in rural hospitality in a special regulation on rural hospitality in the form of a law was proved. It is proposed to establish in this prospective regulation an imperative rule regarding the conclusion of a written agreement on rural hospitality services, and the substantial terms and conditions of such a contract were defined. A proposal was put forward to develop a model agreement for the provision of rural hospitality services. To streamline the safe rendering of services within rural hospitality to attract guests of a rural estate to perform agricultural work, it was proposed to develop safety instructions for attracting guests of rural estates to perform agricultural work. The obtained conclusions will help in the development of legislation on rural hospitality and can also be used in theoretical and applied scientific research on the specific features of legal regulation of relations concerning rural hospitality.

The Concept of a Regional Maintenance Center

Key contributors to address maintenance concerns for rural transit systems are an aging fleet, poor maintenance practices, and a lack of technical expertise. This lack of local maintenance expertise is especially severe in rural areas. This paper examines the general requirements and maintenance service approach for a Regional Maintenance Center model in rural transportation systems. Among other findings of this study, it was determined that Regional Maintenance Centers, with a training center for mechanics and drivers, could improve vehicle reliability, increase vehicle longevity, and improve service to transit clientele. Also determined was that a generalized “one-size-fits-all” regional maintenance program could actually be counter-productive. Regional Maintenance Centers must be designed and located so potential use by rural transit service providers is maximized in order to provide superior serviceability and quality customer service.

Conclusion: how could rural tourism provide better support for well-being and socioeconomic development?

PurposeThis concluding paper summarizes the articles presented in this issue and the significant themes that emerged from the authors' contributions. The main objective of this theme issue on rural tourism is to examine different facets of rural tourism that are critical to short-term recovery as well as long-term sustainable development.Design/methodology/approachThis article draws on the findings of the papers and revisits the question: how could rural tourism provide better support for well-being and socioeconomic development?FindingsThe papers in this issue can be classified into one of three clusters: (1) cultural traditions; (2) support for rural tourism service providers and (3) embracing new technologies. In addition to classifying these papers, the authors propose a conceptual framework to achieve sustainable rural tourism and development comprising four critical success factors for sustainable rural tourism and development.Originality/valueThe main objective of this theme issue is to examine different facets of rural tourism that are critical to short-term recovery as well as long-term sustainable development. Here the authors summarize the findings and propose a conceptual model for the benefit of managers. The authors think that the model could be helpful in designing a strategy for developing sustainable rural tourism projects. It includes reference to (1) stakeholder engagement and support for capacity-building, (2) gradual and organic growth processes, (3) valorization of sociocultural traditions and preservation of cultural heritage and (4) leveraging digital technology in marketing strategy.

Can coproduction change the perceived outcome of rural public services? Evidence from the “New Socialist Countryside” initiative in China

The recent research on citizen participation in the provision of public services represented by coproduction has become a hot topic in public management. Coproduction studies propose that citizens can directly or indirectly participate in the process of public services to help improve the quality and legitimacy of public services. Very little, however, has been written in the existing coproduction literature on the outcome of public services provision. Based on the “One-Hundred Villages” Survey in 2020, this article analyzes and evaluates the impact of coproduction on the perceived outcome of public service in rural China. A series of statistical analysis results show that both co-planning and co-delivery have significant and positive impacts on how one views the outcome of rural public service provision. This research provides new evidence in rural China that citizen participation plays a crucial role in the state-led “New Socialist Countryside” campaign.

Characterization of Rural Tourism Marketing to Strengthen Skills in Indigenous Communities of Chimborazo, Ecuador

The sustainability of tourism management in indigenous communities that adopt tourism as a way of life is an issue that contributes to local and national development. The general objective of the study was to characterise tourism marketing in order to dynamise and strengthen the competencies of indigenous communities in the province of Chimborazo in Ecuador, and it was a descriptive-explanatory field study. As a result, evidence was obtained of the absence of marketing principles, strategies and tools to generate impact results in rural tourism service providers and, consequently, in the province and its cantons. It is concluded that the characterisation can, through educational interventions in communities, and accompaniment until the final implementation, incorporate these principles for social, community and tourism benefit.