Wider Rural Community Research Articles

Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management

Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly.

Prevalence of antimicrobial resistance in urine, blood, and wound pathogens among rural patients in Karnataka, India

Antimicrobial resistance (AMR) is increasing in tertiary-care hospitals across India, which consumes more antibiotics than any other country. Microorganisms with novel resistance mechanisms, initially isolated in India, are now recognized worldwide. Until now, most efforts to stem AMR in India have focused on the inpatient setting. Ministry of Health data now suggest that rural areas are playing a more significant role in the pathogenesis of AMR than was previously appreciated. Thus, we conducted this pilot study to ascertain whether AMR is common in pathogens causing infections acquired in the wider rural community. We performed a retrospective prevalence survey of 100 urine, 102 wound, and 102 blood cultures obtained from patients who were admitted to a tertiary-care facility in Karnataka, India, with infections acquired in the community. The study population included patients >18 years of age who (1) were referred to the hospital by primary care doctors, (2) had a positive blood, urine, or wound culture, and (3) were not previously hospitalized. Bacterial identification and antimicrobial susceptibility testing (AST) were carried out on all isolates. Enterobacteriaceae were the most common pathogens isolated from urine and blood cultures. Significant resistance to quinolones, aminoglycosides, carbapenems, and cephalosporins was noted among pathogens isolated from all cultures. Specifically, high resistance rates (>45%) to quinolones, penicillin, and cephalosporins were evident among all 3 types of culture. Among blood and urinary pathogens, there were high resistance rates (>25%) to both aminoglycosides and carbapenems. Efforts to stem AMR rates in India need to focus on rural populations. Such efforts will need to characterize antimicrobial overprescribing practices, healthcare-seeking behaviors, and antimicrobial use in agriculture in rural settings.

Raw milk collection in Ireland: insights into the challenges facing the industry

PurposeThis paper provides insights into national practices used to schedule, collect and manage the transportation infrastructure of raw milk by Irish processors.Design/methodology/approachA survey was designed and distributed to 14 processors, collecting details regarding suppliers, seasonality, costs per litre, planning, processing sites and emissions related to milk collection.FindingsIrish raw milk transportation costs €95 million per annum, with an average weighted cost of 1.1 cents per litre. Primary route clustering of suppliers is based on farm location. Typically, collections employ forty-eight-hour rotas. Just three of the processors reported transportation emissions data. A disjointed approach to the adoption of scheduling and transportation technology was revealed.Research limitations/implicationsGiven the broad scope of the survey covering financial, operational and environmental aspects of milk collection, it was challenging to find a single representative such as a transport manager who could be tasked with responding to the entire survey. Future research may consider a more focused interview-based approach with the various stakeholders to provide a more in-depth analysis.Practical implicationsProcessors can gain an improved understanding of diversified milk collection methods. The research supports policymakers in considering environmental issues related to milk transportation. Costs could be reduced if transportation was better managed collectively with benefits accruing to the industry, suppliers and wider rural community. Stakeholders will need to address aspects of responsibility concerning environmental issues going forward.Social implicationsIn this paper the authors recognise the environmental cost of milk collection. By improving the transportation infrastructure, this will have a positive impact on society in general.Originality/valueThe paper highlights the unique challenges and extends present knowledge in relation to milk collection; thus, this paves the way for new approaches to raw milk transportation.

Working for a Sustainable Surfing Community: Becoming a Local Surfer at a New Home Destination

South Korea used to be a non-surfing region until it experienced a remarkable realization of the surfing phenomenon, the so-called “surfing boom”, during the past couple of decades. The nonexistence of surfing communities or cultures offers a unique context that surfers have to deal with to become local surfers. The migration status of surfers further complicates the process of local surfer identity construction. This particular context provided migrant surfers with unique socio-spatial challenges and tasks that led them to a certain desire for sustainable surfing milieu. This paper aims to explore the experiences of early migrant surfers when constructing their local surfer identity. Data were collected through fieldwork, in-depth interviews, and document analysis. The early migrant surfers perceived becoming local surfers to be a process of making a new life while they were settling on their new “home”. Thus, they desired a sustainable surfing environment not only with the surf breaks but also with the whole regional community they live in. Hence, becoming a local surfer was becoming a local villager at the same time. They put forth multilateral community endeavors to construct and maintain social and emotional bonds with local authorities, local native residents, and the community environment. Through their interactions with the wider rural community, it was hoped that they would also actually contribute to the formation and maintenance of that rural community for sustainable surfing.

Concerns about climate change among rural residents in Australia

Abstract Climate change impacts human health and there is growing recognition of the explicit consequences for mental health and wellbeing. Rural communities are recognised as one of the most vulnerable populations to climate change. The majority of research to date is quantitative and has a focus on farmers specifically, with the impacts of climate change on the wider rural community considered to a lesser extent. Our study addresses this gap by analyzing qualitative data from the Australian Rural Mental Health Study (ARMHS), a longitudinal study conducted in non-metropolitan New South Wales (NSW), Australia, during the Millennium Drought. Free text responses from 823 participants to the open-ended question “What is your biggest concern about climate change?” were analysed to determine what the qualitative data from ARMHS reveals about the mental health and wellbeing of rural communities. Four themes were identified: (i) suffering under climate change; (ii) causes of climate change; (iii) extremes of climate change; and (iv) leadership and action to address climate change. The environmental, financial, health and social impacts of climate change were of greatest concern to rural residents. Many participants also had concerns relating to climate change attribution, with many believing climate change was a natural, cyclical process not caused by human actions. Other major concerns were the financial consequences of extreme events and the adequate communication of climate change information. Analysis of qualitative data such as that presented here gives context and breadth of understanding to issues identified via quantitative analysis. Importantly, insights emerging from qualitative data, and the personal/community context that is not always available from quantitative data, can lead to more informed community-based approaches to addressing climate change issues experienced by vulnerable populations.

Experiences of rural life among community-dwelling older men with dementia and their implications for social inclusion.

Current international dementia care policies focus on creating 'dementia-friendly' communities that aim to support the social inclusion of people with dementia. Although it is known that the geo-socio-cultural rural environment can impact on the experiences of people living with dementia, this can be overlooked when exploring and implementing social inclusion policies. This paper addresses an important gap in the literature by exploring the perceptions of daily life for older men (65+ years) living with dementia in three rural areas of England. Open interviews were conducted with 17 rural-dwelling older men with dementia and the data elicited were analysed thematically to construct two higher order themes. The first focussed on 'Cracking on with life in a rural idyll' and highlighted the benefits of rural living including the pleasant, natural environment, supportive informal networks and some accessible formal dementia support. The second presented 'A challenge to the idyll' and outlined difficulties the men faced including a lack of dementia awareness amongst their family and the wider rural community as well as the physical and internal motivational barriers associated with the rural landscape and their dementia. The findings were interpreted through a lens of social inclusion and demonstrated how the geo-socio-cultural rural environment both enabled and inhibited facets of the men's experiences of life in their communities. Based on these findings, the paper offers recommendations for practitioners, researchers and policy makers wishing to promote social inclusion in rural-dwelling older men living with dementia.

‘It's the sea and the beach more than anything for me’: Local surfer's and the construction of community and communitas in a rural Cornish seaside village

This paper reports on a qualitative ethnographic study undertaken on a small rural village community in Cornwall, UK with a significant population of local surfers. It focuses on these local surfers' interactions with the wider rural community they co-exist with, and in which ways this group might contribute to the formation, maintenance and identity of that broader rural community. The analysis presented draws together a range of broadly agreed conceptual notions of community with Victor Turner's (1969) notion of spontaneous, normative and ideological communitas as dynamic emergent elements in what Whol (2015) refers to as a process of developing community sense through experiencing and communicating aesthetic judgments. Findings illustrate that notions of community were not restricted to a static and bounded geographical location. Rather, the village focused upon in this study was seen as a hub of a close and a wider de-territorialised community. Despite their obvious differences, there was a strong sense of communitas, community sense and aesthetic judgement between surfing locals and non-surfing locals, expressed through the sharing of experience of the inspired feelings of native place configured around relationships with the sea, the local beach, surf break and village life.

Management and control of invasive brown hares (Lepus europaeus): contrasting attitudes of selected environmental stakeholders and the wider rural community

Management of wildlife is often a contentious issue in which stakeholders are increasingly influential. The European hare (Lepus europaeus) is a non-native invasive species, now established in Northern Ireland. The European hare impacts the endemic Irish hare (L. timidus hibernicus), a priority species of conservation concern, via competition and hybridisation to the extent that control of European hares is a priority. We conducted a questionnaire survey among members of Countryside Alliance Ireland (CAI)—an organisation that promotes rural interests, including field sports—and non-members, to ascertain the contrasting attitudes to the lethal control of European hares in Northern Ireland; a total of 342 (20%) questionnaires were returned. We hypothesised that: (i) CAI members would exhibit greater support for intervention than non-members; and (ii) respondents in the core invasive range will differ in their outlook when compared to respondents from other zones. CAI members were more likely to be aware of the presence of the non-native species and to support lethal management. Both groups considered the threat posed to biodiversity by the European hare to be important. We conclude that members of rural interest groups may be important advocates of intervention, whilst non-members of field sports organisations may be more reluctant to support any proposed management plan involving lethal control. Active engagement to develop a mutual understanding, prior to developing management options, is crucial in ensuring long-term success.

Management and control of invasive brown hares (<em>Lepus europaeus</em>): contrasting attitudes of selected environmental stakeholders and the wider rural community

Management and control of invasive brown hares (<em>Lepus europaeus</em>): contrasting attitudes of selected environmental stakeholders and the wider rural community

Rural residents' perspectives on the rural 'good death': a scoping review.

The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives.

The impact of gambling on rural communities worldwide: A narrative literature review.

Gambling has become a popular activity in both urban and rural settings. Although the prevalence and participation of gambling is well known, little has been reported regarding the impacts of gambling on rural communities. Therefore, a narrative literature review approach was adopted to examine what is known regarding gambling in rural communities. This article describes the prevalence and types of gambling that are popular in rural communities around the world. It identifies the benefits and highlights the potential harm caused by a person’s gambling and the impact this has on families and the wider rural community. There are both benefits and risks associated with increased availability of gambling opportunities. Specific vulnerable groups within rural populations are identified within this context and how different countries respond to rural gambling is explored. A number of strategies based on a public health approach are recommended to ensure that gambling remains as harmless an activity as possible in rural communities. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Rethinking e-Agriculture Innovation Using a Human Centred Systems Lens

Historically, farmers have been some of the most innovative people in the world. However, agriculture lags behind other sectors in its uptake of new information technologies for the control and automation of farming systems. In spite of decades of research into innovation, generally we still do not have a good understanding as to why this is the case. This paper reviews two theories of innovation and offers a new approach to thinking about agricultural ICT (e-Agriculture). It firstly explores the problem of ICT adoption in agriculture. It also proposes new dimensions of a theory of e-Agriculture adoption and innovation. The paper thereby opens up an avenue of research for control and automation systems theory and practice, which informs policy in respect of e-readiness of farmers and the wider rural community both at a national level and an international level.

Scaling Up Malaria Control in Zambia: Progress and Impact 2005–2008

Dear Sir: Your publication of the assessment of Zambia's National Malaria Control Program by Elizabeth Chizema-Kaweshia and others1 documents successful outcomes using evidence-based Integrated Vector Management in Zambia. World Health Organization (WHO) recommendations and goals of the Global Roll Back Malaria Partnership contributed a proven framework for implementing Zambia's national malaria control strategies. There is agreement regarding Integrated Vector Management as an important strategy for the national prevention and control of malaria in Zambia and other African Countries with endemic malaria.2 An integrated approach to vector management is critical to maintaining and improving Zambia's extensive collaborative efforts with multilateral and bilateral agencies and stakeholders globally and nationally. Between 2005 and 2008, Zambia applied Integrated Vector Management to malaria prevention and control. The results showed measurable improvements in the successful prevention and advancement of malaria control in Zambia. However, the authors did not acknowledge achievements and compare lessons learned from other African countries recording similar success with malaria control programs. There is a lack of data regarding capacity building for health communication among indigenous people in Zambia.3 Health communication tools and strategies in Zambia's Strategic Plan would support advocacy for wider rural community participation, coverage, and leadership.

Planning for Rural Housing in the Republic of Ireland: From National Spatial Strategies to Development Plans

This paper examines the role of spatial planning as a policy framework for managing rural housing within an integrated territorial development strategy. The paper focuses on the Republic of Ireland, which provides a useful case for analysing spatial planning and rural housing relationships, due to the State's recent shift towards spatial planning (formalized with the publication of the Irish National Spatial Strategy), as well as the level of housing construction that has been observed in an increasingly post-productivist countryside (triggered by counter-urbanization flows, increased affluence and demands for second holiday homes, etc.). The paper reviews all policy instruments that have been used to manage rural housing at various scales (from national strategies to local level development plans). It is argued that while spatial planning adopts an integrative vocabulary, as policy moves down the spatial scale hierarchy, multi-dimensional spatial goals are implemented through traditional, narrow land-use regulation. This often leads to rural housing being addressed in isolation from its wider social and economic context, disconnecting housing from wider rural community issues and ultimately failing to deliver a coordinated and coherent spatial policy for managing rural settlements.

‘Putting Animals into Politics’: The Labour Party and Hunting in the First Half of the Twentieth Century

This article will discuss the background to opposition to hunting within the Labour Party before the Second World War, and in particular the role of the Humanitarian League and its successor the League Against Cruel Sports. It will highlight internal tensions of class and ideology that are still current today. It will examine the fate of two private members bills introduced in 1949 designed to prohibit hunting and coursing. Both bills were heavily defeated after the intervention of the Labour Government. This article will examine the reasons the post-war Labour Government used to oppose the bills before drawing some general conclusions about the Labour movement and blood sports. It will be argued that the primary reason why the bills were defeated was the strong desire of the Government to preserve its relationship with the farmers and the wider rural community.

Across the divide (?): Reconciling farm and town views of agriculture–community linkages

In North America and elsewhere it is frequently asserted that changes in rural society have led to an economic and social ‘decoupling’ of agriculture from the wider rural community. Casual analysis of contemporary media reporting and popular discourse would suggest that interactions between the two spheres are as often characterized by neglect or conflict as by complementarity and collaboration. However, scholarly interpretation of evolving relations between farming and the wider rural community, and whether these constitute a trend to relinking or decoupling, has remained elusive and problematic. This paper advocates for and articulates a case study approach to the analysis of ‘ambiguous interdependency’ at the local level. Specifically, it is argued that much can be learned from a comparative analysis of farm and town views of sector-specific development trajectories and of implications for agriculture–community linkages. Insights obtained from in-depth interviews with 68 farm and town residents of South Huron County, Ontario, suggest a strong tendency for farmers to undervalue their importance and influence within the local community, but also highlight certain consequences of ongoing agricultural change and recent municipal restructuring that point toward the continued reshaping of agricultural community linkages. The research suggests both points of convergence and divergence that may be valuable in understanding, and perhaps managing, future development at the local scale and beyond.

Death in the wrong place? Emotional geographies of the UK 2001 foot and mouth disease epidemic

In this paper, we draw on the concept of ‘lifescape’ (Somé and McSweeney, ILEIA Newsletter, ETC Leusden, The Netherlands, 1996; Howorth, Rebuilding the Local Landscape, Ashgate, Aldershot, 1999) to capture the spatial, emotional and ethical dimensions of the relationship between landscape, livestock and farming community and to elucidate the heterogeneity of agricultural emotional landscapes. In so doing, we illustrate complex and contradictory spatial, emotional and ethical relations between humans and non-humans. Farm animals may exist simultaneously as ‘friends’ and sources of food, leading to a blurring of socially constructed categories such as ‘livestock’ and ‘pet’ (Holloway, J. Rural Stud. 17 (2001) 293). Livestock as ‘economic machines’ for converting roughage to meat, milk and by-products (Briggs and Briggs, Modern Breeds of Livestock, fourth ed., Macmillan Publishing Co. Inc., New York, 1980) represents one strand of these relations; the sight of farmers crying and farm animals being blessed during the 2001 Cumbrian foot and mouth outbreak, yet another. As (Franklin, Anthropology Today 17 (3) (2001) 3) indicates, ‘the farmer weeping beside the blazing pyre of dead sheep is a complex portrait of a breach in the relationships between animals and humans’. By drawing on experiences of the 2001 foot and mouth epidemic, for farmers and the wider rural community in North Cumbria, we try to articulate the ambiguities of this breach.

It's More Than the Money: The Relationship Between Social Values and Demographic Change in Sustaining a Rural General Practitioner Workforce

Historically, rural General Practitioners (GPs) in Australia tended to be male, Anglo, middle-class and in nuclear family structures, whereas the contemporary workforce demographic is increasingly female and of diverse ethnicity. Demographic trends and changing social values of university-educated professionals directly affect services in rural communities. GPs are key providers of primary health care in rural Australia. Despite the dedication of significant resources to recruiting and retaining rural GPs, a significant problem remains. This research project focused on identifying and addressing the family and personal support needs of two cohorts of rural female GPs and rural registrars, as a means of increasing retention in rural areas. In response to the complex and diverse needs articulated by rural GPs and their spouses during the project, the research team worked collaboratively with the participants to implement and evaluate a number of strategies. The project found that the strategies to address family and personal needs could be grouped into three areas: individualised strategies; strategies to do with practice restructure (predominantly aimed at achieving increased family time); and rural development strategies aimed at broader level change in the community. We argue that strategies addressing wider rural community needs (for example, recreation or children’s education) are essential and require cross-sectoral approaches; to date, these have received little attention.

Sustainable feeding systems based on the use of local resources

Sustainability is a socially constructed concept whose meaning often depends on the context. After defining the feeding system and the meaning that can be attached to the concept of sustainability, its application to existing systems is examined. The attributes of sustainability are derived from an analysis of time-tested systems in Mediterranean and tropical regions. Farm organisation, animal intake and product quality are considered to mean more than mere correspondence between feed requirements and crop production patterns. The rational management of rangeland and forestry systems was taken as an example of organisation and planning of the use of renewable local resources. The multiple use of a specific feed resource and the development of mixed pasture-cropping systems, with possible inclusion of fodder trees and shrubs, were considered as examples of diversification and exploitation of local resources. The integration and fractioning of diverse feed resources and the combination of different activities in a given area, are intended to constitute a global approach to land use aimed at reducing off-farm inputs whilst enhancing natural resources and nutrient recycling. This approach should facilitate the development of mixed and diversified systems, with alternative yield objectives, low environmental impact and reduced economic hazards. Examples are reported on the intercropping of forage, food and fuel sources in the tropics, and for cereal and livestock production in the Mediterranean basin. Flexibility of ruminant production and complementarity between animal species are also described as examples of integration and multiple use of local feed resources. The discussion deals with the possible roles of fodder species and the need to combine several activities into dynamic agricultural systems. Attention is also drawn to the vital links between farmers and the wider rural community through coordinated actions that are appropriate to a mosaic of local conditions.