Rural South Research Articles

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.

Ain’t Gonna Let Nobody Turn Me Around: A Principals Fight Against Traditional Educator Pathways to Staff an Underperforming School in the Rural South

Marcus, a young principal hired to turn around an underperforming school in the rural South, struggles to stabilize the school’s current staffing challenges. Throughout the case study, Marcus navigates recruiting and retaining teachers; however, he also creates an innovative partnership that enables him to train prospective teachers on his campus. The purpose of this case study is to encourage school leaders to pursue non-traditional solutions to staffing. This case also benefits graduate students in education policy, principalship preparation, and educational administration. Further, this case benefits leaders struggling to staff schools in under-resourced communities like the ones in the rural South.

Food Surrogates? County-Level Association Between Vegetable Production and Food Insecurity in the Rural South

ABSTRACT This study examines food insecurity in rural Georgia counties. Out of 159 counties in Georgia, 108 met the criterion of over 50% rurality. Despite their central role in U.S. food production, some counties face significant food security issues. We explored the link between food insecurity and harvested vegetable acreage, using regression analysis with county demographics. Results showed no significant correlation between vegetable acreage and food insecurity. We described these areas as possible “food surrogates” and found that factors like food access and poverty were correlated with food insecurity. Further research is needed to understand the challenges of “food surrogate” communities.

Prospects and Challenges to ICT Adoption in Teaching and Learning at Rural South African Universities: A Systematic Review

This study aimed to systematically review the prospects and challenges associated with adopting Information and Communication Technology (ICT) in teaching and learning at rural universities in South Africa. To achieve this aim, a systematic review methodology was employed. The systematic review findings revealed a multifaceted landscape wherein opportunities for enhancing education through ICT exist alongside significant challenges. Prospects include the potential for technology to bridge educational gaps, increase accessibility, and provide innovative learning experiences. However, challenges such as inadequate infrastructure, limited connectivity, and varying levels of digital literacy pose significant impediments. The study emphasizes the need for targeted interventions to address these challenges, including infrastructure development, capacity building, and localized content creation. Additionally, recommendations for flexible learning models and collaborative partnerships are outlined to facilitate effective ICT adoption in the unique context of rural South African universities. Continuous research and evaluation are advocated to inform future strategies and ensure sustainable improvements in rural education through ICT integration.

Aspirational Mexican American Parenting in the Rural South: Multilingualism, Hard Work, and the Middle Class

Aspirational Mexican American Parenting in the Rural South: Multilingualism, Hard Work, and the Middle Class

Developing an integrated HIV clinical and population database in rural south Africa

BackgroundHIV cohort data are crucial for understanding the effects of HIV infection and treatment. Linkage between HIV clinical and population records unlocks potential to understand the cause and consequences of social-economic factors on HIV-care seeking behaviors and mortality outcomes. We created HIV data infrastructure by linking HIV treatment records with routinely collected records. MethodsWe linked HIV cohort data(n=119,434) to Health and Demographic Surveillance(n=256,425), laboratory tests(n=617,314), clinic visits and hospital admissions(n=170,325) from KwaZulu-Natal, an HIV-endemic setting in rural South Africa. We used graph-based probabilistic record linkage algorithm to link the data for HIV patients accessing care at 17 clinics within the Hlabisa sub-district. Africa Health Research Institute (AHRI) has collected health and demographic surveillance data since 2000. AHRI has set up a hospital information system in the district to capture ICD-10 code admissions and discharges. ResultsFrom the 5% sample of 462,524 linkage clusters, the computed F-score was 0.88, sensitivity was 88% and positive predictive value was 91%. 38.5% of the patient ID clusters contained records linked across multiple databases. 36% of the HIV patient ID clusters contained records linked with laboratory tests. 19.5% of the HIV patient ID clusters contained data on demographic surveillance. 12.5% of the HIV patient ID clusters contained records linked with clinic visits and hospital admissions. 4% of patient IDs contained records across all four databases. ConclusionWe have successfully created a cross-sectorial HIV cohort through probabilistic record linkage methods. The cohort provides a platform to answer policy-relevant questions.

Faith and Intimate Partner Violence in Rural South Africa

Intimate partner violence (IPV) is the most common form of violence against women and is associated with risk factors at the individual, interpersonal and societal level. Women often resort to various coping mechanisms to manage their daily lives due to the complex nature by which these factors interact. We qualitatively interviewed a cohort of rural women participating in a microfinance “plus” program in South Africa where women received loans for small-scale business ventures and received training sessions on gender norms. Our findings detailed women’s experiences of IPV and the role of faith as a coping mechanism for navigating economic hardship and abuse. Belief in a higher power was predominant in almost every interview, offering a sense of purpose and optimism for the future amid precarious circumstances. Interventions for violence prevention need to consider the important role that faith can play in strengthening women’s sense of self and preventing IPV.

Do Y’all Say Gay or Trans?: The Impact of Gender and Sexuality on College Students’ Experiences in the Rural South

ABSTRACT While national trends indicate improvement in campus climates for LGBTQ+ students, these patterns may not exist on campuses in the Southeast region of the United States, particularly given conservative backlash in the region. Drawing from focus group and survey data, we investigated how students in a rural Southern location perceive campus and community space with regard to safety and support, and how the intersections of gender and sexual orientation affect those perceptions. We found LGBTQ+ students had a mostly positive perception of their campus experience, despite reports of harassment, perceptions of unsafe spaces, and some lack of awareness of resources. However, students rate the climate for queer-spectrum students more positively than that for trans-spectrum students. Cis-gender, heterosexual students were largely accepting of their LGBTQ+ peers and were mostly unaware of LGBTQ+ harassment in spaces on campus. Students’ positive assessments exist despite a lack of systematic, institutional-level programming to integrate them into the campus community but are influenced by the work of faculty and staff allies through classes, curriculum, and programs. Our analyses inform recommendations for policies and initiatives and illuminate unique challenges facing queer students on campuses in conservative, rural areas.

Differences and variations of drinking water quality between the northern and southern regions of a tropical island and the indicators influenced by meteorological factors

ABSTRACT Climate change poses a considerable threat to humanity. This study aims to explore the effects of meteorological factors on drinking water quality in urban and rural areas in the tropics. Drinking water was assessed by performing correlation and logistic regression analyses on South China from 2021 to 2023. Results showed that fluorine and chemical oxygen demand were low in the north countryside. The total bacterial count (TBC), sulfate, chloride, manganese, total dissolved solids, arsenic, ferrum, nitrate, total hardness, pH value, and turbidity in the north were higher than those in the rural south. Terminal tap water from northern rivers and southern lakes was significantly affected by meteorological factors (p < 0.05). In general, the microorganisms (r = 0.156–0.737) and trichloromethane (r > 0.633) increased with temperature, odds ratio (OR) > 1. Arsenic increased with temperature in the north rural areas (OR > 1). High levels of nitrate corresponded to increased frequency of extreme rainstorms. Furthermore, trichloromethane, aluminum, nitrate, and TBC were most susceptible to extreme meteorological factors in the tropics. Fluorine from different sources showed inconsistency. Chemical types and dosing or treatment adjustments in water treatment processes may help address deteriorated water quality during extreme weather events.

Pilot Study Assessing the Baseline Physical Activity and Knowledge of Heart Health of Elementary School-Aged Children in Rural South Carolina and the Impact of an Interactive Educational Program.

This study asked whether, if provided with education on heart-healthy habits, elementary school children in Abbeville, Greenwood, and Saluda counties in South Carolina would retain and desire to implement healthy nutrition and increased exercise. We hypothesized that teaching children about heart-healthy habits would increase their activity levels and improve their desire to be active. This was a longitudinal survey study. Children at local after-school programs were given a pre-survey, the Kids' Activity and Nutrition Questionnaire (KAN-Q), to assess their activity levels, diet, and knowledge of heart health. The children had a 15-minute educational period followed by an interactive program. Students completed the same survey at each of the three sessions. A total of 44 children answered the survey questions at the beginning of each session. Out of the 10 behavioral questions, six indicated a favorable shift towards adopting healthier habits. Whole grain consumption increased to 71% from 32% (p<0.01). Vegetable consumption increased from 39% to 88%, and fruit consumption increased from 68% to 92% (p<0.01). There was a 30% decrease in the consumption of sugary drinks (p<0.01), and a reduction in hours watching television (p=0.05). All four knowledge-based questions had an increase in correct responses across the three sessions (p<0.01). To augment behavior, a dual approach of education on nutrition and exercise leads to improved nutrition choices and exercise habits for primary prevention of cardiovascular risk factors in elementary school-aged children. These habits improve adherence to increased physical activity and better nutrition after school.

Applying Participatory Communication Principles in Covid-19 Health Message Dissemination in a Rural South African Municipality

Applying Participatory Communication Principles in Covid-19 Health Message Dissemination in a Rural South African Municipality

A RE-AIM Analysis of a Co-Designed Web-Based Cardiac Rehabilitation Program in Rural and Remote South Australia: An Implementation Study

A RE-AIM Analysis of a Co-Designed Web-Based Cardiac Rehabilitation Program in Rural and Remote South Australia: An Implementation Study

Indoor air pollution in rural south Indian kitchens from biomass-fuel usage and the predicted lung deposition in women

Indoor Air Quality (IAQ) encompasses the overall air quality conditions of a built environment related to the health of those who occupy it. The current study evaluates the indoor conditions in rural kitchens where the predominant cooking fuel is biomass. Monitoring of air quality parameters such as particulate matter (PM), carbon dioxide (CO2), carbon monoxide (CO), and bioaerosols, as well as thermal comfort parameters such as temperature, relative humidity, and air velocity, was carried out during the winter season. Instruments used for the campaign include an optical particle sizer - TSI OPS 3330 (PM), an IAQ meter - TSI IAQ Calc 7545 (CO & CO2), a bioaerosol sampler - MAS 100 NT, as well as a thermal comfort meter - DeltaOhm HD 32.3. Due to the constrained space and inadequate ventilation, indoor separate kitchens were found to have PM concentrations up to 3.5 times higher than open kitchens. Similarly, kitchens using improved cookstoves showed pollutant concentrations up to 1.8 times lower than the traditional mud or concrete cookstoves commonly used in rural areas. Further, deposition fractions were calculated using Multiple Particle Path Dosimetry (MPPD) to understand the deposition patterns in different parts of the human respiratory tract (HRT) for adult women. The model predicted twice as much PM deposition in the lungs of women using traditional cookstoves in indoor separate kitchens than those who use improved cookstoves in indoor open kitchens. This study not only establishes the IAQ characteristics but also quantifies the role of stove-type and kitchen-type in it. The study also indicates the foreseeable levels of human health impact in the form of PM deposition in the respiratory tract and its exposure characteristics.

Ophthalmic Artery Doppler as a Reliable Tool for Screening and Diagnosing Preeclampsia in a Rural South Indian Population

Ophthalmic Artery Doppler as a Reliable Tool for Screening and Diagnosing Preeclampsia in a Rural South Indian Population

Choosing to learn outside the classroom: Rural South African students’ motivation for and benefits of participating in voluntary international virtual exchanges

In recent years, universities have adopted virtual exchange programmes to promote intercultural competencies, language acquisition, and global citizenship among students. Virtual exchange is praised as a way to provide international experiences to students who do not have the means to study abroad. Current literature on virtual exchange programmes largely focuses on Western experiences, with little attention to the developing countries that participate in these programmes. The purpose of this study is to explore rural South African students’ motivations for participation and perceptions of their experiences in their virtual exchange with a midwestern university in the United States of America (USA). 47 students at the University of the Free State’s (UFS) Qwaqwa campus took part in four virtual online connections over the course of two months. Unlike most virtual exchange programmes represented in extant research, students participated in the programme voluntarily rather than as part of their prescriptive coursework. Through a focus group interview with 16 of the students at the conclusion of the interactions, we explored their motivations for taking part in the programme, as well as their perceived benefits of participation. Students were overwhelmingly positive about their experience and identified three types of advantages for participation: building relationships, building knowledge, and professional development.

Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management.

Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps. Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment. This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

Prevalance of PCOS in Teenagers (13 - 19 Years) in Rural South India - Screening and Early Detection by Anthropometric Method

Prevalance of PCOS in Teenagers (13 - 19 Years) in Rural South India - Screening and Early Detection by Anthropometric Method

Factors Effecting Adoption of Information and Communication Technology for Business Promotion by Micro Entrepreneurs of Rural South Odisha – The SEM Approach.

Factors Effecting Adoption of Information and Communication Technology for Business Promotion by Micro Entrepreneurs of Rural South Odisha – The SEM Approach.

Abstract P302: The Mississippi Rural Community Listening Project

Background: The Appalachia and Mississippi Delta regions have the lowest life expectancy in the United States. In response, Alabama, Mississippi, Kentucky, and Louisiana were selected for The Risks Underlying Rural Areas Longitudinal (RURAL) Study. The RURAL study is an observational population-based study focused on these at-risk communities in the rural south. During the planning phase, investigators identified the need to incorporate insights from the community in the proposal. Therefore, they initiated the “Rural Community Listening Project” in the four states to seek community members’ points of view on outreach research in their communities. The objectives of this research were to hear from members of the communities their concerns and ideas about health research, approaches that would promote their willingness to participate, and their willingness to have blood drawn and x-rays taken as a part of the research process. Method: Mississippi investigators conducted four focus group interviews with 10-12 participants in each focus group. They interviewed a total of 45 men and women between the ages of 35 to 65 in county-specific focus groups. The groups represented four rural Mississippi Counties: LeFlore, Oktibbeha, Panola, and Tishomingo. The investigators digitally recorded the interviews and had them transcribed, then analyzed the transcripts using thematic analysis. Results: Two themes arose: (1) Encouragement to Participate and (2) Barriers to Participation. Encouragement to Participate included (1) having trusted community stakeholders involved, (2) helping the community, (3) promoting one’s health, and (4) receiving feedback on one’s health. Barriers included lack of trust, time, location, and transportation. Overall, the focus group interviewees had not participated in health research but would be willing to do so. Participants had little to no experience in doing health surveys or tracking their health information using mobile or electronic devices but did not raise objections to doing so. Word-of-mouth, social media, newspaper, telephone, cell phone, and mail were recommended as modes of communicating with their communities. “Relevance to the individual” arose as a more prominent encourager than monetary incentives. Focus group interviewees reported trusting doctors, nurses, and health care providers in their respective communities to collect health information. Conclusion: The in-common barriers to participation in research were time, transportation, and location. Across all focus groups, trust emerged as a requisite for research participation. The model of listening to the community’s experiences, concerns, and recommendations can potentially inform future research practices in rural communities and changes to related state and/or local policies.

Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose&gt;200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p&lt;0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.