Rural Settings Research Articles

Reverse Career Fairs in Rural Areas for Postsecondary Transitions for Students With Disabilities

For students with disabilities in rural locations, there can be unique barriers related to postsecondary transition. Reverse Career Fairs (RCFs), wherein employers take the role of attendees and students with disabilities focus on showcasing their skills and talents, are one way to provide students with experiences that support evidence-based predictors of post-school outcomes. An option for navigating these barriers is described through a framework used to foster postsecondary transitions for students with disabilities in rural settings through the implementation of RCFs. RCFs provide inclusive postsecondary opportunities by restructuring traditional approaches to career exploration and promoting meaningful connections between students with disabilities and prospective employers. A framework identifying key role groups and phases in facilitating an RCF and pilot results of one Special Education Regional Technical Assistance Center are provided.

Variations in health literacy and influential factors affecting the categories of social support among rural patients with diabetes mellitus.

The aim of this study is to explore the inherent classification of social support among individuals residing in rural areas of China. Additionally, we aim to examine the attributes and variations in health literacy scores among patients with diabetes mellitus (DM) within diverse social support categories. Cross-sectional study. Employing the multi-stage stratified sampling technique, we enrolled 2,178 patients diagnosed with DM residing in the rural regions of Guangxi Province. We utilized the General Information Questionnaire, Social Support Rating Scale (SSRS), and Functional, Communicative and Critical Health Literacy Instrument. The rural patients with DM were categorized into four distinct groups based on the types and levels of their underlying social support. These groups included a low-level social support utilization group (43%), a low-level objective social support group (17%), a moderate-level social support group (20%), and a high-level social support and high-level utilization group (20%). Statistical analysis revealed significant differences among the four groups in terms of age, disease duration, and blood sugar control level (p < 0.05). Furthermore, health literacy scores and scores across various dimensions for rural patients with DM demonstrated variability in accordance with latent profiles of social support, with statistically significant differences observed (p < 0.05). A positive correlation was identified between the level of social support and all dimensions of health literacy among rural patients with DM (p < 0.05). The social support available to individuals with DM in rural settings can be categorized into four distinct types, and its manifestation is influenced by demographic factors. The health literacy of rural patients with DM is intricately linked to the extent of social support they receive. For enhanced outcomes, interventions targeted at enhancing health literacy and quality of life among rural patients with DM should be tailored to address the heterogeneity observed in latent profiles of social support.

Managing an adolescent with Type 1 Diabetes and socioeconomic deprivation in a remote primary care setting — Ethical challenges

This case study discusses the ethical challenges encountered by a primary care team in managing a 17-year-old girl with Type 1 diabetes in a socio-economically deprived tribal area. The case highlights critical issues such as justice in access to essential medicines, ethical dilemmas arising from complex family dynamics, and systemic failures within the public health system. By examining these challenges, this case study underscores the importance of addressing broader social determinants of health to ensure just and effective healthcare delivery in rural and tribal settings.

Kicking Newcastle Disease in Poultry: The Therapeutic Potential of a Herbal Blend of Christmas Melon, Aloe Vera, Chili, and Ash Extract

Newcastle Disease (ND) is a highly contagious viral infection that causes substantial mortality and economic losses in poultry, particularly in resource-limited settings like rural Uganda. This study explores the therapeutic potential of a herbal blend composed of Christmas melon, aloe vera, chili, and ash extract as an alternative or adjunct treatment for ND in poultry. Grounded in Integrative Medicine Theory (IMT), which emphasizes the synergy between conventional and traditional medical approaches, the study investigates the effectiveness of this herbal remedy in both treating and preventing ND. The results, based on personal case studies and a larger preventive trial, demonstrate a high recovery rate in affected birds and successful prevention in exposed flocks. Notably, six out of seven birds treated for ND showed full recovery, and no new ND cases emerged in the preventive trial involving 1,654 layers. However, a slight decrease in egg production was observed in treated layers, signaling a potential side effect that warrants further research. This study underscores the viability of herbal remedies in managing ND in areas where conventional treatments may be limited or inaccessible, providing a holistic, farmer-centered, and cost-effective solution to poultry health management in rural African settings. While promising, further research is needed to optimize dosage, assess long-term safety, and minimize adverse effects.

The impact of language variation on educational outcomes in African rural settings

The present research discusses how language variation may influence educational outcomes within African rural settings concerning indigenous languages, colonial languages, and dialectal diversity. From the critical literature review, it has been determined that mother-tongue education advances academic performance as well as social cohesion and engagement since students find learning more accessible and relevant to their culture. Conversely, the range of dialects, along with other issues such as a lack of resources and proper teacher training, complicates the implementation of mother-tongue education. On the other hand, the use as medium of instruction of a few colonial languages causes inequalities to worsen, alienating rural learners and causing underachievement. This study has strengthened calls for more flexible and localized language policies, with further research on the longer-term impacts of indigenous language education in rural classrooms and the role of dialects. The resolution of at least these linguistic problems would allow the countries of Africa to come closer to equitable and more inclusive education systems. Keywords: Language Variation, Educational Outcomes, Rural Africa, Indigenous Languages, Colonial Languages, Dialectal Diversity.

Integration of renewable energy-powered cold storage solutions for reducing post-harvest food waste in rural agricultural areas

Post-harvest food loss remains a critical challenge in rural agricultural areas, exacerbated by inadequate storage facilities and unreliable energy access. This study develops and optimizes an advanced renewable energy-powered cold storage system tailored for rural settings, integrating solar and wind energy with phase change materials (PCMs) for efficient energy storage. The system incorporates Internet of Things (IoT)-based sensors and artificial intelligence (AI)-driven energy management to maintain optimal storage conditions and enhance energy efficiency. Field trials conducted in Lincolnshire, UK, and Appalachian regions of the US demonstrated significant reductions in post-harvest food loss by an average of 43.5%, extensions in produce shelf-life by up to 300%, and increased income for smallholder farmers by approximately 43%. The system also achieved an 80% reduction in greenhouse gas emissions compared to conventional diesel-powered systems. Economic analyses revealed a shorter payback period and higher return on investment, confirming the system's viability. High user satisfaction and adoption rates indicate the system's practicality and potential for widespread implementation. The findings suggest that integrating renewable energy with smart technologies in cold storage solutions offers a scalable and sustainable approach to enhancing food security, promoting economic growth in rural areas, and supporting environmental objectives globally.

Occurrence and diversity of Campylobacter species in diarrheic children and their exposure environments in Ethiopia

Campylobacter is a major zoonotic foodborne pathogen that poses a significant public health threat, particularly among children and immunocompromised individuals. However, data on the occurrence and sources of Campylobacter infection remain scarce in Ethiopia. This study assessed the occurrence, diversity, and relationships between Campylobacter from diarrheic children and potential exposure sources using whole-genome sequencing. Through case-based tracing, animal, food, and environmental samples were collected from Harar town and Kersa district between November 2021 and January 2023. Campylobacter was identified using selective media, and DNA was extracted and sequenced with the Illumina NextSeq 550 instrument. Sequence reads were analysed using bioinformatics tools. The overall Campylobacter prevalence in the exposure sources was 5.5%, with 6.0% in urban and 5.0% in rural settings. Campylobacter detection was 1.8 times more likely in household samples (8.7%; OR = 1.8; 95% CI: 0.7–4.5) than in samples from marketplaces. The occurrence of Campylobacter in food was 4.2%, with no significant differences across the meat, milk, and other food categories. The likelihood of Campylobacter contamination in the environment was 5.8 times higher in the presence of poultry (17.7%; OR = 5.8; CI: 1.1–30.6) compared to shoats. Sequence analysis identified a low Campylobacter spp. diversity comprising only C. jejuni and C. coli, which were characterized by 8 distinct sequence types (STs). Phylogenetically, the majority of the sequenced case isolates were clustered with isolates from either caretakers, environmental exposures, or both. In conclusion, Campylobacter was detected in various exposure sources of diarrheic children, and its occurrence did not differ significantly between Kersa and Harar or among food items. The majority of isolates shared MLST profiles and clustered together, demonstrating the involvement of multiple vectors in the transmission of the pathogen. Genome-based integrated studies supported by an attribution model are recommended to determine the relative contribution of each source.

Level of burnout and associated factors among healthcare workers in central Uganda: A facility-based cross-sectional study.

Burnout among healthcare workers is a global concern with significant implications for both the well-being of the workforce and the quality of patient care. This facility-based cross-sectional study aimed to identify factors associated with burnout among healthcare workers in central Uganda. The study, conducted between June and July 2023, utilized a cross-sectional design involving physicians, nurses, and technicians. The study covered both public and private hospitals in central Uganda, incorporating urban and rural settings. A sample size of 550 healthcare workers was selected using a simple random sampling. Data collection involved a socio-demographic survey, the Professional Quality of Life (ProQOL-5). Descriptive statistics, Pearson Chi-square test, and ordinal regression models were employed to analyze demographic factors associated with burnout. Of 548 participants, 218(39.8%) experienced high burnout levels. Factors significantly associated with high burnout levels included having over 10 years of work experience (OR: 2.04, 95% CI: 1.12-3.73), working more than 40 hours per week (AOR: 4.46, 95% CI: 1.20-16.62), lack of management support (AOR: 14.45, 95% CI: 3.83-54.56), not experiencing workplace violence (AOR: 2.22, 95% CI: 1.31-3.76), and reporting inadequate sleep (AOR: 6.96, 95% CI: 3.86-12.57). Addressing burnout among healthcare workers in central Uganda requires targeted interventions tailored to the specific challenges faced in the region, including workload distribution, managerial support enhancement, violence prevention strategies, and promotion of adequate sleep. Urgent attention to these factors is essential for enhancing the well-being of healthcare professionals and maintaining quality patient care.

An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women’s menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

A Review of Wastewater-Based Epidemiology for the SARS-CoV-2 Virus in Rural, Remote, and Resource-Constrained Settings Internationally: Insights for Implementation, Research, and Policy for First Nations in Canada

Wastewater-based epidemiology (WBE) is regarded as a support tool for detecting and assessing the prevalence of infectious diseases at a population level. For rural, remote, and resource-constrained communities with little access to other public health monitoring tools, WBE can be a low-cost approach to filling gaps in population health knowledge to inform public health risk assessment and decision-making. This rapid review explores and discusses unique considerations of WBE in key settings, with a focus on the detection of the SARS-CoV-2 virus, which has rapidly expanded WBE infrastructure globally. To frame our understanding of possibilities for WBE with First Nations in Alberta, we address the following questions: What are the unique considerations and challenges for WBE under similar contexts in rural, remote, or resource-constrained settings? What are the resources and expertise required to support WBE? This review identifies several unique considerations for WBE in rural, remote, and resource-constrained communities, including costs, accessibility, operator capacity, wastewater infrastructure, and data mobilization—highlighting the need for equity in WBE. In summary, most resource-constrained communities require additional support from external research and/or governmental bodies to undertake WBE.

The impact of a rural school-based oral health intervention among primary schoolchildren in Armenia

Abstract Objectives Oral health (OH) interventions are shown to be effective in improving children’s OH status and behavior. This study evaluated the effectiveness of a school-based OH intervention combined with OH educational activities on rural schoolchildren’s OH status and behavior in a rural setting in Armenia. Methods The study population were primary schoolchildren of Mrgashat village, Armavir province, Armenia, and their parents. The intervention included sealant application to eligible permanent molars of children and fluoridization of their teeth twice a year over a two-year period. Educational activities included a training session for children and their parents, and distribution of educational materials among them. Baseline (BL) and follow-up (FU) assessments were conducted before and after the intervention (in 2022 and 2024) to evaluate its impact. Both assessments included clinical examination of children’s OH status by calculating their DMFT/dmft index, and telephone survey among parents on OH knowledge and behavior. The changes in DMFT/dmft index and OH knowledge and behavior scores were measured using paired t-test. Results Overall, 94 children and their parents participated in both BL and FU assessments. There was no significant change in the parental OH knowledge score: 77.4% (SD 14.0) at the BL and 78.7% (SD 13.2) at the FU. Yet, children’s OH behavior score increased significantly: from 44.9% (SD 18.2) at the BL to 60.0% (SD 15.4) at the FU (p &amp;lt; 0.001). Children’s DMFT/dmft index also improved significantly: from 7.31 at the BL to 5.09 at the FU assessment (p &amp;lt; 0.001). Conclusions The study demonstrated the effectiveness of the OH intervention in improving children’s OH status and behavior. Therefore, we recommend expansion of the intervention with inclusion of more rural sites in Armenia, and targeting primary schoolchildren, considering the importance of timely preventive interventions and early development of healthy habits for better OH later in life. Key messages • Oral health interventions among primary schoolchildren covering awareness raising and carries prevention activities result in positive changes in children’s oral health habits and teeth health. • Expansion of this type of interventions with inclusion of new rural sites and conduction of further assessments to explore the long-term effects of such interventions are recommended.

Thermal Performance of Novel Eco-Friendly Prefabricated Walls for Thermal Comfort in Temperate Climates

The global threat of climate change has become increasingly severe, with the efficiency of buildings and the environment being significantly impacted. It is necessary to develop bioclimatic architectural systems that can effectively reduce energy consumption while bringing thermal comfort, reducing the impact of external temperatures. This study presents the results of a real-scale experimental house prototype, MHTITCA, using a unique design composed of novel eco-friendly prefabricated channel walls filled with a blend of soil, sawdust, and cement for walls and roofs. The experimental analysis performed in this study was based on dynamic climatology. A solar orientation chart of the place was constructed to identify the solar radiation intensity acting on the house. Measurements of roof surface temperatures were conducted to determine temperature damping and temperature wave lag. Monthly average temperature and direct solar radiation data of the site were considered. Compared to other alternative house prototypes, the system maximizes thermal comfort in high-oscillation temperate climates. Temperature measurements were taken inside and outside to evaluate the thermal performance. A thermal insulating layer was added outside the wall and the envelope to improve the prototype’s thermal comfort and reduce the decrement factor even more. This MHTITCA house prototype had 85% thermal comfort, 0% overheating, and 15% low heating. This eco-friendly prototype design had the best thermal performance, achieving a thermal lag of twelve hours, a reduced decrement factor of 0.109, and preventing overheating in areas with high thermal fluctuations. Comparatively, the other prototypes examined provided inferior thermal comfort. The suggested MHTITCA system can be an energy-saving and passive cooling option for thermal comfort in low-cost houses in temperate climates with high thermal oscillations in urban or rural settings.

Assessing cyberchondria and eHealth literacy differences in urban and rural China

Abstract Background and Objectives This study aimed to explore the association between cyberchondria and eHealth literacy in the general Chinese population, and to assess how this relationship changes between urban and rural residents. Methods Data obtained from a web-based, cross-sectional survey that evaluate cyberchondria and its impact on health in February 2024. The Cyberchondria Severity Scale - 12 item was used to measure the cyberchondria, while the eHealth Literacy Scale was used to evaluate eHealth literacy. Descriptive analysis was used to describe the background characteristics of the participants. Then, a multivariable linear regression model was then performed for urban and rural subsample to examine the relationship between cyberchondria and eHealth literacy, respectively, providing a comparative analysis between the urban and rural populations. Results A total of 634 individuals completed the questionnaire. The average age was 33.2 years (SD = 7.4), with approximately 50.3% (n = 319) being female. Urban residents made up 71.4% (n = 451) of the participants. The mean eHEALS scores for urban and rural residents were 31.9 (SD = 4.3) and 30.4 (SD = 4.2), respectively. The CSS-12 scores for urban residents were 40.3 (SD = 7.58) and for rural residents were 39.1 (SD = 7.2). Linear regression analyses showed a significant association between eHealth literacy and cyberchondria for urban residents (Beta = 0.30, p &amp;lt; 0.001), but age and education level had no significant impact. For rural residents, a statistically significant association between eHealth literacy and cyberchondria was also observed (Beta = 0.40, p = 0.002). Conclusions Overall, eHealth literacy consistently predicts cyberchondria severity in both urban and rural samples. Higher eHealth literacy is linked to greater cyberchondria, especially in rural areas. Future research should explore other potential mediators, including psychological factors, internet usage patterns, and access to healthcare services. Key messages • eHealth literacy strongly predicts cyberchondria severity in both urban and rural populations, with a notably stronger impact observed in rural settings. • Urban and rural differences highlight the need for customized digital health literacy programs to effectively address region-specific challenges and behaviors.

Did the COVID-19 Pandemic Affect Suicide Rates Differently in Urban and Rural South Korea?

Abstract Background The influence of the COVID-19 pandemic on suicide rates remains a subject of debate. Despite increases in suicidal ideation and attempts reported during the pandemic, several recent meta-analyses have not demonstrated corresponding rises in suicide rates. Given the potential for substantial regional and demographic variability in the psychological consequences of COVID-19-related restrictions, this study explores differential suicide rates in urban versus rural contexts within South Korea subsequent to the pandemic outbreak. Methods This investigation employed age-standardized suicide rates from two periods, 2015-2019 and 2020-2022, across 234 administrative divisions (152 urban, 82 rural). A difference-in-differences approach was utilized to evaluate the pandemic’s impact on suicide rates, segmented by urban and rural classifications. A linear regression model was developed to examine the interaction between location (urban/rural) and time period, controlled for annual variations, perceived stress, and health status within each locale. Results Analysis revealed higher suicide rates in rural areas compared to urban counterparts (β = 1.247, p = 0.003), although no significant changes were observed during the pandemic period itself (β=-0.425, p = 0.682). Furthermore, the interaction between urban/rural status and the pandemic period did not reach statistical significance (p = 0.367). Conclusions The findings indicate no significant contribution of the COVID-19 pandemic to increased suicide rates, irrespective of the urban or rural setting. Further research is warranted to dissect the impact of more direct socioeconomic factors on this dynamic. Key messages • There in no evidence of increased suicide rates during the COVID-19 pandemic in South Korea. • The impact of the COVID-19 pandemic on suicide rates did not significantly different between urban and rural areas.

Exploring Type 2 Diabetes Self-Management Practices Among African Americans in Rural Counties: A Qualitative Study.

The purpose of the study was to understand diabetes self-management practices among African American individuals living with type 2 diabetes (T2D) in rural communities. This qualitative descriptive study, undergirded by the theory of integration, purposively sampled African Americans (N = 34) diagnosed with T2D living in rural communities. Thematic analysis employed both a priori and inductive coding to identify salient themes. Participants' mean age was 65.9 (SD 12.3) years, with an average T2D diagnosis duration of 14 (SE 11.2) years. Two major themes emerged: deciphering the cues and body sensing, which the participants used to monitor their glucose level using a personalized feedback loop. Those with longer diabetes duration demonstrated an ability to recognize hypoglycemic or hyperglycemic symptoms (deciphering the cues), informing their decision-making and self-management strategies (body sensing). The decision-making involved in glycemic level management emerges as a complex developmental process influenced by disease trajectory and cultural and environmental factors. These findings may inform a conceptual framework to guide future inquiries and provide insights for primary care clinicians and diabetes educators to better understand the complexities of T2D management among African American individuals in rural settings.

Creating opportunities for community voices to be heard

Abstract This presentation will showcase the importance of community based participatory research in developing health literacy in Ireland. Purposeful sampling (n = 105: 71% female) in two contrasting Sláintecare Healthy Community areas in Ireland (Finglas &amp; Cabra and Mayo), recruited participants to take part in semi-structured focus groups, or individual interviews. Using reflective thematic analysis, and a critical friend approach, five key themes were identified that demonstrated the strengths, needs and challenges in health literacy in urban and rural communities in Ireland. This included: i) Accessing and understanding health information; ii) Health literacy changing over time; iii) Perceiving health literacy as an individual responsibility; iv) Interpersonal and community influences on health literacy; and v) Health access through a rural or urban infrastructure. There were many similarities between rural and urban, young and old. Equally, there were unique challenges that required local solutions. As such, the next phase of this project utilised a co-design process to check, challenge, collaborate and create recommendations for health literacy solutions in each case study area. A specific method of experience-based co-design, the Double Diamond Design Approach (DDDA) was used. With DDDA, stakeholders progress through a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Two Co-design Workshops took place in March 2024 aiming to revise the strengths, barriers, needs, and propose potential recommendations for health literacy in each Sláintecare Healthy Community, using an adapted DDDA. Within the rural setting, solutions to promote health literacy spanned across transport, health access, and community based needs. Within an urban context specific suggestions around community engagement, information sharing, and earlier educational intervention were called for.

The profile and aberrant driving behavior of juvenile traffic law violators in Greece

Abstract The majority of juvenile offenses in Greece are related to road traffic violations. Juveniles in Crete region are required to attend an educational program offered by LaHeRS lab (HMU), in collaboration with the Prosecutor’s Office as part of reformative measures. The current presentation reports on the profile and aberrant driving behavior of juvenile offenders who attended the program between 2023-2024. The Driver Behavior Questionnaire (DBQ) was administered to 181 juvenile offenders. Participants were males (97.8), with a mean age 18.6 (SD = 1.2), resided in rural settings (51.8%) and secondary students 60.7%. The mean age of the first offence was 15.8 (SD = 1.1, min 13 - max 18). Participants scored low in all DBQ scales (covered violations mean=6.1, sd = 7.5; unintentional violations mean=0.9, sd = 1.6; lapses mean=8.9, sd = 10.5). No statistically significant difference was found in DBQ scores between those who had and did not have a driver’s license, as well as between those from urban or rural areas. The three DBQ subscales significant correlated (p &amp;lt; .001). Among other risky behaviors, 54.9% reported exceeding the legal speed limit, 66.3% reported aggression feelings when driving behind a slow vehicle, 34.5% used mobile phones while driving, 17.7% reported alcohol use while driving. Surprisingly, 85.5% stated high confidence addressing risks on the roads. Key messages • Early interventions on aberrant driving behavior among adolescents is crucial. • Educational programs should be tailored to address the unique needs of juvenile traffic law violators.

Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador

Abstract Background The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context. Methods Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals. Results Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia. Conclusions The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations. Key messages • The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities. • Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.

Development and validation of a training course on proton pump inhibitor deprescription for general practitioners in a rural continuing medical education program: a pilot study

BackgroundDespite being cornerstone medications for managing gastrointestinal disorders, proton pump inhibitors (PPI) have raised concerns due to inappropriate prescribing and overutilization, their potential side effects, and interactions with other medications. General practitioners (GPs) provide long-term patient follow-up and are targets to promote PPI deprescribing to reach the widest possible population. GPs practicing in rural settings encounter unique challenges as their numbers dwindle and their workload increases. Hence, targeted educational interventions are crucial to promote appropriate prescribing practices in such underserved areas.MethodsWe developed a continuing medical education (CME) program focused on PPI deprescribing for GPs in rural settings. The program comprised of an interactive training session featuring clinical cases, an open discussion, and distribution of educational materials. We assessed the program’s effectiveness using a two-level Kirkpatrick model, evaluating participant satisfaction and knowledge levels through pre- and post-course questionnaires.ResultsThirty-three GPs participated, with 61.9% working in semi-rural and 38.1% in rural areas (21 responded to the 1st questionnaire, 14 to the 2nd ). Median medical experience was 6 years, with 61.9% serving as internship supervisors. Despite 95.2% acknowledging PPI overprescription, none had previously participated in dedicated PPI CME programs. The open discussion session provided valuable insights into various topics related to PPI use and gastrointestinal health. Participants expressed high satisfaction with the program (average rating of 9.1/10) and 92.9% reported changes in practice, including increased awareness of inappropriate PPI prescriptions. Indeed, 92.9% of GPs identified inappropriate PPI use following the course. 57.1% of participants utilized the provided educational materials. The main practice changes observed included an increased reassessment rate of PPI indications (71.4% at each renewal after vs. 19% before, 28.6% non-systematically after vs. 66.8% before, 0% rarely after vs. 14.3% before; p = 0.006), the necessity for more than one consultation to deprescribe (64.3% after vs. 23.8% before; p = 0.021), systematic utilization of gradual cessation of PPI (100% vs. 61.9%; p = 0.039) and more frequent use of additional medication (92.9% vs. 57.1%; p = 0.022), primarily antiacids (92.3%).ConclusionsOur study underscores the effectiveness of targeted CME programs in promoting appropriate prescribing practices and enhancing knowledge among GPs in rural settings. Despite the challenges encountered in deprescribing PPI, the program facilitated proactive approaches in managing treatment discontinuation failures. Tailored educational interventions are essential for mitigating medication prescribing challenges and improving patient outcomes in rural primary care settings.Trial registrationsNot applicable.

The Impact of a Dialogic Intervention on a Chinese Rural Teacher and Students' Stances Towards Texts

ABSTRACTIn language arts classrooms, dialogic teaching encourages diverse text interpretations, fostering discussions that enhance students' literacy skills like reasoning. However, adopting a dialogic stance poses challenges for both teachers and students. The study investigated the impact of a tailor‐made dialogic intervention on a Chinese rural teacher and students' stances towards texts. Chinese rural students shifted from efferent and instrumental stances to a more critical‐analytical stance, indicating a profound change in how rural students interacted with texts through exploratory talk, highlighting the potential of dialogic teaching practices to foster deep engagement with reading materials. However, after the intervention ended, the teacher reverted to a monologic approach due to limited dialogic texts and time constraints. The findings underscore the potential of dialogic teaching for engaging rural students, yet highlight the need for sustained teacher training and suitable texts. Future research should focus on cultivating and maintaining students' growth mindset effectively in rural settings.