Services In Rural Areas Research Articles

Knowledge, attitudes and practices related to dog bite and its management among adults in rural Maharashtra with reference to their literacy status: a cross sectional study

Background: In India, 97% of human rabies is transmitted by dogs. Rabies is 100% fatal but 100% preventable by vaccination. In rural community, there exists a considerable gap in knowledge, attitudes and practices (KAP) related to dog bite and its management. So, study was planned to assess same with reference to literacy status among adults. Methods: A cross-sectional study was conducted in rural field practice area of Rajiv Gandhi medical college in Maharashtra during April to June 2023. Sample size was estimated. Simple random sampling technique was used to select the subjects. Data was collected by personal interview using pretested questionnaire. Descriptive and inferential statistics were applied. The statistical level of significance was fixed at p<0.05. Results: Of the 254 subjects interviewed, 208 (81.89%) were literate and 46 (18.11%) were illiterate, 224 (88.19%) subjects knew about rabies disease of which 190 (91.35%) were literate (p<0.05), 208 (81.89%) subjects mentioned that the dog bite leads to rabies of which 178 (85.58%) were literate (p<0.05), 172 (67.72%) said rabies can be prevented through vaccination of which 151 (72.60%) were literate (p<0.05), 179 (70.47%) said washing dog bite wound can reduce chance of rabies of which 158 (75.96%) were literate (p<0.05), 88 (34.65%) subjects have given history of dog bite. Literate subjects were having better knowledge, positive attitudes and healthy practices related to dog bite and its management. Conclusions: The gap in knowledge, attitude and practices about dog bite and its management among the subjects can be reduced by increasing literacy status, health education and focusing on communication services in rural area.

Regional energy transition governance for the co-transformation of sustainable energy infrastructure as a public service in rural areas

Die dringende Transformation unseres Energiesystems hin zu einer nachhaltigen Infrastruktur der Daseinsvorsorge scheitert in der regionalen Umsetzung regelmäßig an raumbezogenen und gesellschaftlichen Anforderungen des ländlichen Raums. In diesem Beitrag werden am Beispiel eines transdisziplinären Projektes Dilemmata in der partizipativen Umsetzung der regionalen Energiewende identifiziert und Gelingensbedingungen einer raumsensiblen Energiewende-Governance formuliert. Wie mit dem entwickelten Governance-Ansatz zur „Co-Transformation“ gezeigt wird, können kontextsensitive Partizipationsformen der Co-Regulierung, Co-Allokation und Co-Visionierung zur Verfahrens‑, Verteilungs- sowie Zukunftsgerechtigkeit und damit zur Akzeptabilität der regionalen Energiewende als Daseinsvorsorgeinfrastruktur im ländlichen Raum beitragen. Zentrale Maßnahmenfelder sind dabei ergebnisoffene und regional angepasste Formen der Mitwirkung durch die Co-Regulierung im Planungsprozess, Ansätze zur räumlichen Co-Allokation energiewendebezogener Belastungen und lokaler Mehrwerte sowie die Co-Visionierung regionaler Energiezukünfte und daraus abzuleitender regionaler Energievisionen.

Contribution of mobile health technologies to public health in rural areas: Accessibility and education methods

In today's rapidly advancing world, mobile health services have become influential in various aspects of our lives. It is anticipated that mobile applications, especially in rural areas, can play a significant role in the delivery of healthcare services. In this context, it is essential to examine the applications of mobile health services in rural areas and the education methods employed in these applications. The main objective of this study is to explore the contributions of mobile health services applications in rural areas to public health and to examine the education methods used in these services in light of current literature. The focus of this study is on how mobile health applications can be utilized in rural areas, the impact of this usage on public health, and the effectiveness of the education methods employed. The research was conducted through searches using key terms such as "mobile health" and "public health nursing" or "mobile health technologies" and "nursing" or "telehealth" on important academic databases like Google Scholar, PubMed free fulltext, Science Direct, Ebscohost, Sage, Scopus, and CINAHL. The information obtained from literature searches was analyzed to understand the impact of mobile health applications on public health in rural areas and the education methods employed. The study results indicate that the use of mobile health applications in rural areas can contribute significantly to public health. Advantages such as rapid diagnosis and treatment, effective monitoring of chronic diseases, and quick access to emergency services stand out among the potential impacts of mobile health applications. Mobile health applications can contribute significantly to public health in rural areas and increase their usage, particularly in primary healthcare services.

Research on the Innovation and Development of the Internet of Things Forestry Carbon Sink Model from the Perspective of Digital Village

The integrated development of forest carbon sinks and the digital economy can enhance both the rural industrial system and the level of economic development, ensuring the construction of digital villages. However, several challenges arise in actual development. The shortage of financial services in rural areas makes it arduous to meet the demand for industrial upgrading. The forestry carbon sink sector of the Internet of Things is in its initial phase and requires further improvement and support. Hence, it is imperative to enhance the appropriate policies and institutional framework to reinforce the construction of digital villages. This involves strengthening the management proficiency of the digital village and improving the financial channels of the Internet of Things forestry carbon sink industry. It is also crucial to guide the development of the rural digital economy industry through proper policy formulation.

Integrating Spatial and Non-Spatial Dimensions to Evaluate Access to Rural Primary Healthcare Service: A Case Study of Songzi, China

Access to rural primary healthcare services has been broadly studied in the past few decades. However, most earlier studies that focused on examining access to rural healthcare services have conventionally treated spatial and non-spatial access as separate factors. This research aims to measure access to primary healthcare services in rural areas with the consideration of both spatial and non-spatial dimensions. The methodology of study is threefold. First, the Gaussian two-step floating catchment area (G-2SFCA) method was adopted to measure spatial access to primary healthcare services. Then, a questionnaire survey was conducted to investigate non-spatial access factors, including demographic condition, patient’s household income, healthcare insurance, education level, and patient satisfaction level with the services. After that, a comprehensive evaluation index system was employed to integrate both spatial and non-spatial access. The empirical study showed a remarkable disparity in spatial access to primary healthcare services. In total, 78 villages with 185,137 local people had a “low” or “very low” level of spatial access to both clinics and hospitals. For the non-spatial dimension, the results depicted that Songzi had significant inequalities in socioeconomic status (e.g., income, education) and patient satisfaction level for medical service. When integrating both spatial and non-spatial factors, the disadvantaged areas were mainly located in the eastern and middle parts. In addition, this study found that comprehensively considering the spatial and non-spatial access had a significant impact on results in healthcare access. In conclusion, this study calls for policymakers to pay more attention to primary healthcare inequalities within rural areas. The spatial and non-spatial access should be considered comprehensively when the long-term rural medical support policy is designated.

Working as a Healthcare Professional at Island Primary Care: An Exploratory Qualitative Study on the Cyclades Islands, Greece.

Improving the quality of and access to healthcare services in rural areas is fundamental to developing sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary-care units that lack direct hospital or hospital-health centre access. The research was conducted specifically in the rural islands of the Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors, and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, an unstable working environment, educational and organisational aspects, and an insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy

Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.

Mental Health Research Among Tribal Population in India

Tribals are the most marginalized social category in the country. There is little and scattered information on the actual burden and pattern of illnesses they suffer from. Tribal communities in general and primitive tribal groups are prone to disease. Also, they do not have required access to basic health facilities. They are most exploited, neglected, and highly vulnerable to diseases with a high degree of malnutrition, morbidity, and mortality. Research on the mental health of tribal people is not much in numbers. Few studies made on them have produced inconsistent results. This study aims to assess the mental health status of tribal communities. It was found that due to a lack of appropriate mental health services in rural areas, the tribal population is unable to access the needful services and treatment. There is a need to develop a psychosocial care program for tribal to promote positive social, physical, psychological, and emotional well-being. This study is the first of its kind to review research on mental health among STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.

Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

The reliability of remote diagnostic hearing assessment in school-entry-aged children

Objective To explore the feasibility of remote diagnostic hearing testing within schools, for school-entry aged children (4–7 years). Design A prospective cross-sectional comparative study design was used to establish the reliability of remote hearing assessment by comparing traditional face-to-face pure tone audiometry (PTA) with remote PTA, traditional otoscopy with remote video otoscopy and interpretation of tympanograms in-person with remote analysis. Study Sample 464 school-entry year level children from 18 schools. Results Air conduction thresholds established by remote testing were within a clinically acceptable range of ±10 dB HL from traditional thresholds in 98% of cases at 1 kHz and 97.8% at 4 kHz. Bone conduction thresholds varied by ≤10 dB HL in 100% of cases at 1 kHz and 95.7% at 4 kHz. Remote otoscopy and tympanometry interpretation had 78.6% agreement (moderate; κ = 0.6) and 92.2% agreement (almost perfect; κ = 0.9), respectively. Conclusions We found there to be good reliability between face-to-face PTA and remote PTA performed within the school environment. Furthermore, assessment of the outer and middle ear via video otoscopy and remote tympanometry classification were both viable. Remote diagnostic hearing tests in schools can extend reach of paediatric services in rural areas.

Doula-Supported Births and Outcomes Among DONA International Doulas, 2000-2012

Introduction: Doula care has been shown to decrease maternal morbidity and mortality given the physical, emotional, and informational support that doulas provide during pregnancy and birth. Although usage of doulas and coverage of doula services have been increasing, several people are still unaware of the benefits doulas provide. In this study, we sought to describe characteristics related to doulas and doula-supported women on a national scale, including location, method of referral, childbirth settings and providers, and obstetric outcomes. Methods: We examined doula-supported births by year, state, urban/rural location, maternal age, and characteristics related to doulas, doula-supported birthing women, childbirth settings, providers, and obstetric outcomes. The sample population consisted of doula-assisted births (n=12,675) from 2000 to 2012 based on records from Doulas of North America (DONA) International. We used t tests or Pearson’s chi-squared test (X2) for continuous and categorical variables. Results: Doulas reported that the vast majority (73.2%) of all doula-supported women birthed by spontaneous vaginal birth and fewer than 1 in 5 (18.2%) women birthed by unplanned cesarean. Nearly 3 out of 4 (73.2%) women had some form of childbirth preparation instruction. Information regarding the source of referrals to doulas suggests that over half (52.9%) of birthing women found a DONA-member doula from a source other than a hospital system or DONA International. About half (49.7%) of birthing women supported by doulas were self-pay clients. Overall, few doulas (1.3%) received third-party reimbursements for their paraprofessional services. The vast majority (95.3%) of doula-supported births in the sample occurred in urban areas of the United States. Conclusions: This is the largest analysis of doula-supported births from the largest US doula certifying organization, which is critical for understanding how widespread access to doula services has the potential to significantly improve health outcomes for women and their infants during birth. Additionally, the data suggest there is a need for increased referrals and increased insurance coverage and potentially a heightened need for doula services in rural areas.

Legitimacy of community-based social enterprises (CBSE) in service provision in rural areas

PurposeMunicipalities seek new opportunities for co-producing services in rural areas. One potential partner is community-based social enterprises (CBSEs). However, whilst service co-production through CBSEs obscures the traditional roles of actors, it may lead to a legitimation crisis in local service provision. In this paper, the ways CBSEs are legitimised as service providers in rural areas are addressed from the CBSE and municipality perspectives.Design/methodology/approachEmpirical data combine interviews with CBSE representatives and open-ended national survey responses from municipality decision-makers. The data analysis is based on a qualitative content analysis to examine legitimation arguments.FindingsResults show that unestablished legitimacy and un-institutionalised support structures for co-production models build mistrust between CBSEs and municipalities, which prevents the parties from seeing the benefits of cooperation in service production.Research limitations/implicationsThe research focusses on the legitimation of CBSEs in service co-production in rural areas. As legitimation seems to be a context-specific process, future research is needed regarding other contexts.Practical implicationsMunicipalities interested in the co-production of services might benefit from establishing a collaborative and responsive (rural) service policy forum that would institutionalise new models of co-production and enable better design and governance of service provision.Originality/valueResults will give new theoretical and practical insights into the importance of legitimacy in the development of service co-production relationships.

Healthcare Laboratories: a venture to ramp up health of rural India

Learning outcomes The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis). Case overview/synopsis HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties. Complexity academic level The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas. Supplementary materials Teaching notes are available for educators only. Subject code CSS3: Entrepreneurship.

A cooperative vehicle routing problem with delivery options for simultaneous pickup and delivery services in rural areas

The booming e-commerce is challenging express companies by requiring higher logistics service efficiency in rural China. This study investigates a cooperative vehicle routing problem for simultaneous pickup and delivery requests, in which the delivery orders can be fulfilled either by home delivery or customer pickup. The delivery option for each order is complex due to the optional cooperative relationships among express companies, the inter-dependence between self-pickup site selection and the overall online vehicle routing scheme, and the distance-dependent compensation to self-pickup customers. The problem is formulated as a mixed integer linear programming model and solved by a tailored adaptive large neighborhood search algorithm. A cost-saving allocation mechanism based on the core guaranteed Shapley value is applied to carrier collaboration. The numerical results show that the newly introduced cooperative distribution system can significantly reduce operational costs. Such improvements are robust even if the total demand changes or under different rural logistics network topologies.

Positive change in intent to practice rurally is strongly associated with nursing and allied health students of metropolitan origin after rural clinical placement.

To: (1) assess whether rural clinical placements influence change in intention to practice rurally for nursing and allied health students, (2) to assess whether residential origin (metropolitan or rural) or university location (metropolitan or non-metropolitan) influence this change, and (3) assess residential origin of health professionals practicing rurally after graduation. Cross-sectional survey (2014-2022) conducted in Northern/Northeastern Victoria and Grampians region by nursing and allied health students completing rural clinical placements. Survey explored student placement satisfaction, intention to practice rurally and demographic information, with a follow-up two years' post-placement. Experience of a rural placement increased students' intention of practicing rurally. Importantly, 57% of metropolitan origin students studying at metropolitan campuses exhibited positive change. Logistic regression analysis suggested that after controlling for age, gender and satisfaction with placement and supervision, students of metropolitan origin at metropolitan campuses were 6.4 times more likely to report positive change in intent to practice rurally after placement than students of rural origin studying at non-metropolitan campuses.Follow-up data suggested that a substantial proportion of health professionals providing services in rural areas were of metropolitan origin. These findings concur that rural origin and rural training are important predictors of working rurally. Additionally, metropolitan students can change their intention to practice rurally after a rural placement. This study supports strategies to enhance intention to practice rurally that are not restricted to rural origin students to build rural workforce.

Does county financial marketization promote high-quality development of agricultural economy?: Analysis of the mechanism of county urbanization.

China's agricultural economy has been hindered by insufficient accumulation of agricultural capital and credit constraints. It is worth investigating whether China's county financial marketization reform policy can alleviate these constraints and promote high-quality development of the agricultural economy (HQDAE). This paper presents an empirical analysis of the impact of county financial marketization reform on the HQDAE, based on county panel data. The focus is on the mechanism of county urbanization in the above relationship. The results show that county financial marketization has a significant non-linear impact on the HQDAE. Specifically, it has a 'U-shaped' impact on the overall growth of the agricultural economy and an inverted 'N-shaped' impact on the quality improvement of the agricultural economy. Secondly, the relationship between county financial marketization and the HQDAE is influenced by a threshold effect based on the level of county urbanization. As the level of county urbanization increases, the promoting effect of county financial marketization on HQDAE also increases significantly. Additionally, county financial marketization helps to promote county urbanization and accelerate urban-rural integration, which in turn leads to HQDAE. The research in this paper suggests that county-level local governments should promote a differentiated county financial system. In the early stages of financial market-oriented reform, the government should enhance the capacity of financial services in rural areas through tax breaks, policy incentives, and other measures to prevent financial leakage from agriculture. In the later stages of financial marketization reform, the government should strengthen financial supervision to prevent financial resources from being diverted from industry to capital. Moreover, to achieve the HQDAE, it is necessary to promote county financial market-oriented reform and accelerate the construction of county urbanization. This will help break the dual economic structure of urban and rural areas and promote the flow of financial capital, technology, and human capital from county cities to rural areas.

Corneal blindness in the developing world: The role of prevention strategies.

Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and to improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.

Advancing rural healthcare: A novel approach to designing blockchain-enabled IoB devices and integrating fuzzy intelligence systems for patient monitoring and record management

This research paper presents a novel approach to improving healthcare services in rural areas by leveraging the potential of Fuzzy Intelligence Systems, Internet of Bodies (IoB) devices, and Blockchain technology. It begins by exploring the design and development of a Blockchain-based Patients Record System (BPRS), which ensures secure, transparent, and tamper-proof storage of patient medical records. The paper then delves into the fabrication of advanced IoB devices, specifically designed to study and monitor the health of rural populations. These devices, integrated with Fuzzy Intelligence Systems, provide efficient and reliable data capture, interpretation, and decision-making support. The highlight of the study is the innovative integration of the IoB enabled Patient Monitoring System with the BPRS, which ensures real-time data synchronization and secure access to patient data for authorized personnel. The system collectively promotes efficient healthcare delivery, data privacy, and patient safety in rural areas.

Barriers to financial access of disabled people to health services in rural areas: A case study of Iran.

People with disabilities (PWDs) account for a significant percentage of the world's population, with a higher prevalence in less developed countries. Access to healthcare services is the main component of health systems performance, with lower access for PWDs living in rural areas. The current study aimed to investigate PWD's access to healthcare services in rural areas of Iran and, secondly, factors that contribute to this issue. Following a cross-sectional design, the current descriptive-analytical study is performed in the north of Iran. Using the quota sampling technique, 471 PWDs were recruited. Data were collected using a valid and reliable questionnaire, covering three dimensions of access, by face-to-face interview. Data analysis was administered using central tendency indicators and multiple regression by SPSS version 17. Statistical significance was considered when the P value <0.05. The mean score of PWD's access to healthcare services for dimensions of utilization, availability, and affordability was 8.91 (±6.86), 14.54 (±2.3), and 51.91 (±8.78), indicating very low, low, and moderate levels of access. All three regression models were significant (P < 0.05), and variables of gender, age, marital status, education level, residence status, the income of the household head, receiving financial aid, and house area showed a significant effect (P < 0.05). This study demonstrated the seriousness of paying attention to PWD's financial access to healthcare services, particularly in rural areas of Iran. Hence, policymakers should better focus on this problem, mainly regarding accessibility and utilization and factors that result in inequalities.

Bridging the Gap. Policies to Accelerate Social Change for an Inclusive Rural Digital Transformation in Sweden

Abstract This study explores officials’ perspectives on Swedish policies for rural digital transformation (RDT). Through the lens of Social Acceleration and systems thinking, employing Critical Systems Heuristics collecting empirical data, we explore how officials perceive that Swedish digitalisation policies impacts inclusive RDT. We investigate whether the possibility to implement Swedish digitalisation policies support or hinder inclusive RDT. Our results emphasize the importance of Social Acceleration based on the aspirations of rural residents, encompassing technical acceleration, social change, and the pace of life. The rapid societal acceleration driven by digitalisation impacts the implementation of digital services in rural areas. Policies do not address the needs of tailored digital services; officials strive to manage this through creative methods despite inherent challenges.