Provision Of Services In Rural Areas Research Articles

Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study

BackgroundThe use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations.MethodsThis research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach.ResultsSixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments.ConclusionsThis research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.

Perspectives of Male Service Providers on Responding to Intimate Partner Violence in Rural Zimbabwe: Findings From Qualitative Interviews

Despite efforts made in Zimbabwe to address intimate partner violence (IPV), critical gaps still exist regarding the efficacy of IPV service provision in rural areas. This study examines male service providers’ perceptions of IPV in Chimanimani Rural District in Zimbabwe to provide guidance for policy and practice on IPV intervention in rural areas. A qualitative study was conducted with six male service providers using in-depth interviews and thematic analysis. Our findings revealed how the intersection of social norms and the geographical location of rural areas influence service providers’ perceptions of IPV and service provision. Most of the service providers interviewed had a general understanding of IPV and regarded it as unacceptable social behavior. However, constraints to service delivery typical in rural areas negatively impacted their IPV intervention, including having limited intervention resources, limited male participation, and conflicting identities (professional versus cultural identity). We conclude that service provision in rural areas is essential to respond to and prevent the occurrence of IPV, yet how service providers perceive IPV affects the quality of services rendered to victims.

Rehabilitation models for community integration of adults with acquired brain injury in rural areas: a scoping review.

Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas. A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion. Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level. The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.

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.

A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes

BackgroundAn emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions.ResultsA search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners.ConclusionsFuture studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.

The culturalisation of ‘honour’-based violence and its impact on service provision in rural communities

The ‘culturalisation of violence’ – a process through which culture is credited as being the sole or principal cause of violence – has resulted in ‘honour’-based violence/abuse being commonly (mis)understood and (mis)interpreted as being an imported cultural practice unique to particular black, Asian and minority ethnic communities living in the West. Addressing a vital gap in the literature, this article considers the conceptual shortcomings of these culturalised narratives on honour and ‘honour’-based violence/abuse, as well as the impact that they have upon service provision in rural areas of England and Wales – areas often conceptualised as ‘white spaces’ lacking in ethnic diversity. This article draws upon semi-structured interviews with both victims/survivors and rural front-line service providers. It is argued that under culturalised narratives, not only does ethnicity remain a key indicator for ‘honour’-based violence/abuse cases, but, as such, and given their perceived lack of ethnic diversity, rural regions are also increasingly identified as ‘safe spaces’ to relocate black, Asian and minority ethnic victims/survivors away from the reach of their ‘problematic’ culture. Ultimately, the core contention of this article is that by founding policy, legislative and support responses on culturalised understandings of violence, service providers are destined to fail to meet the intersectional needs of black, Asian and minority ethnic victims/survivors.

Making sense of sadness: eliciting illness meaning and experience of depression in rural Irish males

BackgroundTo analyse and understand the illness experience of depression in rural Irish males. Secondary objectives are to identify their explanatory models of depression, inform mental health service provision in rural areas, and identify suitable interventions for future research.AimIsolation and rural masculinities are thought to predispose rural Irish males to depression. Despite high levels of depressive symptoms among men in rural areas, lack of awareness and a different language around depression, coupled with stoicism, social isolation, and feminized mental health services, results in reduced help-seeking, under-reporting and under-treatment of depression in this population.MethodA purposive sample, selected through the West Cork and Galway/Roscommon Mental Health Services, and General Practitioners, of fourteen men, aged between 25 and 64 years of age, were interviewed in their homes. Data was collected through face-to-face interviews, using the McGill Illness Narrative Interview schedule. These interviews were recorded, transcribed to text, and analysed using a thematic content analysis. Results were integrated using the model of qualitative description.ResultsMost of the fourteen men reported alcohol and social isolation as precipitating factors of their depression. Suicidal intent and a stubborn attitude were common. Recovery-promoting behaviours included good social and family support, peer-support groups, religious practice and, universally, physical work.ConclusionRural Irish men view their depression as a disconnection from community, masculinity can be engaged in a positive way to improve mental health, and a sense of belonging is key to recovery. Future research should focus on the development of interventions incorporating these findings, such as community farming initiatives.

Changing Service Provision in Rural Areas and the Possible Impact on Older People: A Case Example of Compulsory Post Office Closures and Outreach Services in England

Rural post office provision is becoming increasingly reliant on alternative delivery models. The effect of change could fall disproportionately on older people as a key customer group of the Post Office, overrepresented in rural areas. There are only very limited polices in this area. The existing literature has not yet examined where compulsory changes have taken place alongside the impact on older people living in the community. This research uses a mixed methods approach, exploring the example of the 2007–9 Post Office Network Change Programme in England and a case study of older people in a community affected by this change. Very rural areas were vulnerable to post office changes; 70 per cent of changes to post office delivery models occurred in these areas. It is important to consider the impacts of changes more broadly, including both direct and indirect outcomes.

Citizens' participation and community orientation – indicators of social sustainability of rural welfare services

The article discusses the issues of social services in rural areas from a theoretical view point of sustainability paradigms of social work. The ecological crisis existing beyond the ongoing global economic crisis is not separated from the increasing urbanization and weakening perspectives in rural areas. The paper is based on results from a participatory action research project in Finland, which aims at strengthening social service provision in rural areas through citizens' participation and community-orientation. The neoliberal politics of centralization, marketization and privatization are heavily transforming rural regions also in the Nordic welfare states right now. The debates in the rural citizens' forums could be concluded in three tasks of the project's further agenda: a renewed democratic governance of social services, a radical turn towards the involvement of and respect for service users, and practical steps towards citizens as co-producers, especially in the form of village cooperatives. The results encourage participatory approaches in order to create practicable models for social services not only in rural areas. Conceptualizing sustainability can be especially productive in the rural contexts where interdependency of different life areas is more evident.

Could Self-Efficacy Relate to Workforce Issues for Rural Physiotherapists with a Specialist Paediatric Caseload? A Literature Review

Rural physiotherapists may need to extend their skills to address the lack of allied health service provision in rural areas but will do so based on their perceived self-efficacy. This narrative review aims to understand self-efficacy amongst rural physiotherapists and contributing factors to self-efficacy, especially in the specialised area of paediatrics.Method: A search of the literature was undertaken to understand the self-efficacy of rural physiotherapists who are expected to undertake specialist paediatric cases. Databases searched included CINAHL, PEDro, Informit, Proquest, PubMed, and Ovid. Articles were assessed for quality in accordance with the National Health and Medical Research Council (NHMRC) evidence ranking system. Using this search strategy and inclusion criteria, a total of forty five articles were found and included in the narrative review. Results: Self-efficacy, a person’s judgement of their capabilities, is a key component in performance, accomplishments, and positive well-being. If the rural physiotherapist has low self-efficacy in their work practices, then physiotherapy specialisation or advance practice may not be considered an achievable career option. However, the caseload of the rural physiotherapist is vast and demanding, spanning across many boundaries and scopes including paediatrics, which has been defined as an area of specialisation within physiotherapy. The work practices of the rural physiotherapist’s are often challenged by the complexities of rural area’s and an unstructured, poorly supportive workforce, thus giving cause for the recognition of rural physiotherapy as a specialist branch of physiotherapy practice. Yet, the majority of the evidence base surrounding this topic has been developed through opinion pieces and observational studies which were rated as level IV evidence. At present, the lack of higher level evidence allowed readers to make assumptions based on opinions and descriptive studies. Conclusion: If the current workforce and structure leads to low self-efficacy in the rural physiotherapy population, this in turn could lead to impaired confidence in the ability to practice as a physiotherapist as well as result in the development of poor coping strategies. Early identification of the self-efficacy beliefs within this cohort will allow the development and evaluation of strategies to help address those issues identified as challenges in rural areas. There is a definite need for stronger, higher levels of evidence on this topic in order to develop more accurate definitions of the work practices and working environments of the rural physiotherapists. Additional higher level research is needed to better understand the self-efficacy of rural physiotherapists and possible contributing factors for low self-efficacy. Higher level research will also establish true clinical implications of low self-efficacy amongst the rural physiotherapist population.

The Provision of Fire Services in Rural Areas

Fire services have been neglected in discussions of public service provision in rural areas. The way in which they are provided has a broader significance in terms of current debates about risk management. Fire service policy was transferred away from the Home Office, but the Bain Report provided the major stimulus to change. Early central government attempts to stimulate fire service provision in rural area were hampered by a lack of cooperation between local authorities. Rates of death from fire are influenced by attendance times and are particularly high in remote rural areas. The development of national standards of fire cover was focused on protecting property rather than saving lives with disproportionate funding being provided for urban areas. Social changes in rural areas have made it more difficult to secure sufficient numbers of retained fire fighters. It has proved particularly difficult to provide an adequate service in remote rural areas such as the Highlands and Islands of Scotland, despite recent policy initiatives there. Problems of providing fire cover are particularly acute on isolated islands. The development of integrated risk management plans should offer a more fine grained approach to providing fire cover. However, they may be too sophisticatedfor the task in rural areas and more traditional democratic mechanisms for expressing perceived community needs may have a greater relevance.

Fruitful Partnerships in a Rural African American Community

Rural African American congregations often have been pitted against their urban counterparts, with the urban churches viewed as superior social agents with a wider range of community services. An examination of social service provision in rural areas is necessary because both policy and programmatic responsibilities increasingly are delegated to state and local governance and ultimately to local communities. Legislation referred to as Charitable Choice encourages the government to contract with faith-based and community-based social service providers. This legislation also increases the importance of understanding the role that rural congregations play as the social service system favors private delivery of such services over public avenues. In this study, an in-depth examination of 17 congregations in an historically all-Black town revealed the distinct patterns of African American congregations providing a unified network of collaborative social services with secular organizations on behalf of their communities.

Family Planning Service Provision in Rural Areas: A Survey in Washington State

Women in rural areas are highly dependent on public clinics for family planning services, yet little information has been collected on rural family planning providers, especially on their funding and operation. All 31 family planning clinic sites in rural Washington State were surveyed about their sponsorship, staffing, service provision and population coverage. Clinic sites were located in 25 of the 53 discrete rural health service areas of Washington State. While the three wealthiest areas had clinics, eight of the poorest areas had no clinics. Eight clinics were Planned Parenthood affiliates, eight were private freestanding clinics and 15 were local health department sites. Clinic sites were small (with the equivalent of 2.4 full-time staff members, on average) and offered a mean of 18 of 43 potential reproductive and women's health care services; general primary care services were rarely provided. Only one clinic offered abortions. Family planning clinics in rural Washington State offer an important but limited number of services. Many rural areas have no local family planning clinic. Given these clinics' reliance on federal and state funding, decreased public support might seriously impair family planning provision in rural areas.

Changes in service provision in rural areas. Part 1: The use of GIS in analysing accessibility to services in rural deprivation research

Previous work has highlighted the importance of public service provision in rural areas particularly for potentially vulnerable groups such as the elderly, unemployed and single parents especially where this coincides with a lack of access to either private or public transport. Disadvantage can often be compounded by limited access to services for such groups with the superior resources of more affluent social groups enabling them to respond and adapt to the increasing centralisation and reduction of services. This paper reviews previous investigations of the implications of changing accessibility to services in rural areas and draws attention to the need for a new research agenda which uses spatial analytical techniques to gauge the current levels of (in)accessibility to key services at the community level. These techniques are illustrated in Part 2 of the paper with reference to changes in post office provision in mid Wales, and the policy significance of incorporating geographical information systems-based measures of provision into traditional area-based indicators of disadvantage is discussed.

Changes in service provision in rural areas. Part 2: Changes in post office provision in mid Wales: A GIS-based evaluation

This paper develops themes set out in Part 1 of this paper relating to the importance of public service provision in rural areas, particularly for potentially vulnerable members of the community such as the elderly, unemployed and single parents. Changes in a key service sector, post office services, in rural mid Wales over a 15-year period are assessed and analysed in relation to the developing sociodemographic profile of the underlying population. A Geographic Information System (GIS) approach is adopted to chart changing levels of post office provision in the study area, and the subsequent impacts on accessibility to those post offices. The policy significance of developing measures of accessibility to services with a view to incorporating these GIS-generated measures into traditional area-based indicators of disadvantage is highlighted.

An Empowerment-Oriented Mental Health Intervention with Elderly Appalachian Women: The Women's Club

ABSTRACT This article describes the application of an empowerment-oriented intervention to a home-based mental health program serving older women in the Appalachian region of Eastern Kentucky. The approach is designed to overcome the traditional transportation, social, and cultural barriers many older Appalachian women face in obtaining services. Through intervention on individual, group, and community levels the women learn the skills to empower themselves and others in their community to regain power over their lives. The article concludes with the implications of an empowerment approach to mental health and social service provision in rural areas.

Deregulation and Rural Bus Services: A Study in Rural Wales

The last decade has witnessed a significant realignment of the relationships between the public sector and the private, with privatisation and deregulation. There has been much speculation over the potential impact of privatisation on service provision in rural areas, which are thought to be potentially poor arenas of competition. In this paper, evidence is presented of the impact of the deregulation of bus services in rural Wales following the 1985 Transport Act. Although there has been relatively little change in the short term there are significant indications of worsening impacts in the medium and long term, particularly if financial contributions from the local state have to be reduced. The general lack of competition, initiative, and consumer benefits arising in remoter rural areas from deregulation of transport offers some pointers to the likely effects of privatisation in other sectors.

The role of the voluntary sector in the provision of rural services — the case of transport

The voluntary sector has become more fully involved in service provision in rural areas over the last 10 years and this paper attempts to assess its impact with respect to one particular group of services, namely transport. The importance of the initiatives which have taken place is outlined in a statement of recent policy changes, including the radical provisions in the 1985 Transport Act, and through a national review of the three principal kinds of voluntary transport services in rural areas — social car schemes, dial-a-ride and community buses. This review is followed by an in-depth analysis of the extent of the voluntary sector involvement in transport provision in Norfolk and Suffolk. Extensive tables are presented and the characteristics of the schemes outlined together with an assessment of the essential ingredients for success or failure. The conclusion reached is that the scope and scale of voluntary sector initiatives in rural areas is small, and they form no alternative to a more general and systematic provision of transport services. Further, voluntary sector activities may even increase the inequalities in service provision. Suggestions are made as to how the scattered developments could be brought together and developed through the parish councils, parish transport groups and the rural transport broker.

Demographic Changes and Service Provision in rural Areas in the Netherlands

With the economic measures of the government that concern important services like education and health, the question is to know if the rural population of the Netherlands will go on having access to all services. According to demographic patterns, the togetherness of these services' use can be deeply influenced by the ageing of the rural population, resulting from the decrease in birth rates and from selective migration. The customers for schools, hospitals and certain level of business will either increase or appreciably decrease. The differences will depend on the present location of these services and on the range of age they are directed to. In some areas of the country, the accessibility to some services might result in a big problem for the population.

Interpreting Patterns of Public Service Utilization in Rural Areas

Public service provision in rural areas is an important focus of research in geography and in related disciplines, but studies to date have been hampered by the paucity of theory on public service utilization. This paper synthesizes existing theory within a conceptual framework and evaluates its major components using a Canadian data set. The case study substantiates elements of both aggregate and behavioral conceptualizations. However, a fuller understanding of revealed relationships is forthcoming only when the two conceptualizations and the links between them (especially “action space”) are considered together. In addition, the results underline the importance of discriminating between critical and non-critical services and between use of service and use of facility.