Rural and remote health最新文献

{"title":"'I cut toenails with scissors and trim it with sand paper'. Patients' perspectives on diabetic foot complications.","authors":"Suliana Saverio, Masoud Mohammadnezhad, Filimone Maicau Raikanikoda","doi":"10.22605/RRH8614","DOIUrl":"https://doi.org/10.22605/RRH8614","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to explore type 2 diabetes mellitus patients' perspectives on diabetic foot complications and challenges of footcare management in Sigatoka, Fiji.</p><p><strong>Methods: </strong>This study applied a qualitative approach among persons with diabetes who attended diabetic foot clinics from August to September 2021. Participants were selected through purposive sampling and included any self-identified Fijian aged 18 years and over who had type 2 diabetes with a minimum diagnosis duration of 6 months and no experience of an amputation. Data were collected using semi-structured in-depth interviews, and the content of interviews was transcribed and analysed using thematic analysis to generate themes and subthemes outlined in the study.</p><p><strong>Results: </strong>The study included 30 participants. Three major themes were identified. The first was patient perceptions of diabetic foot complications, which showed that there was very limited patient knowledge of how diabetes caused foot complications. The second was practising foot care, which reflected that commonly practised recommendations were associated with daily activities like washing the feet. Third was patient perceptions of footcare services, whereby the majority were generally happy with the footcare services available to them.</p><p><strong>Conclusion: </strong>The study results indicated that patients lacked sufficient knowledge about the symptoms and prevention of type 2 diabetes mellitus, and healthy practices related to food complications. More effort needs to be invested into diabetes and footcare knowledge and practices for patients at the Sigatoka Hospital. This will help guide patients to make life-altering decisions that can help reduce the rate of diabetes related lower limb amputations, which are easily preventable.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"8614"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognition, physical function and life purpose in the rural elderly population: a systematic review.","authors":"Hércules Lázaro Morais Campos, Elisa Brosina De Leon, Ingred Merllin Batista de Souza, Anna Quialheiro, Elizabete Regina Araújo de Oliveira","doi":"10.22605/RRH8827","DOIUrl":"https://doi.org/10.22605/RRH8827","url":null,"abstract":"<p><strong>Introduction: </strong>Aging in rural areas is challenging and has very specific characteristics in the way these elderly people live their old age, from the perspectives of cognition, functionality and life purpose. There is a lack of information and data in the literature on how people age in rural areas around the world. The aim of this study was to identify and describe how people age in rural areas, focusing on the following domains: cognition, physical function/functionality and life purpose.</p><p><strong>Methods: </strong>We included cross-sectional studies published up to April 2023 found in six databases: PubMed, LILACS, PsycINFO, Scopus, SciELO and Web of Science. The Rayyan software was used for the first selection of studies and the Observational Study Quality Evaluation was used to assess methodological quality and risk of bias. For the primary analysis, the titles and abstracts available in the search engine were analyzed using the following MeSH descriptors: \"physical functioning\"; \"cognition\"; \"cognitive function\"; \"life purpose\"; 'personal satisfaction'; 'subjective well-being'; \"aged\"; \"elderly\"; \"old\"; \"rural aging\"; \"rural population\"; \"communities, rural\"; \"distribution, rural spatial\"; \"medium communities\"; \"rural settlement\"; \"small community\". In the secondary selection, the selected articles were fully read by two independent reviewers and confirmed by a third reviewer when necessary.</p><p><strong>Results: </strong>From 22 studies methodologically evaluated it was seen that rural aging in the world is female and mostly in elderly women farmers; mental evaluation together with activities of daily living and instrumental activities were the most evaluated; the studies did not mention the evaluation of life purpose.</p><p><strong>Conclusion: </strong>The world ages very differently in rural areas, and the way we age is directly linked to where this process takes place. Cognition, followed by functionality, are the most researched outcomes in cross-sectional studies with this population and the assessment of life purpose has not been investigated to date.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"8827"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation and assessment of encultured meaning of the Multi-Dimensional Scale of Perceived Social Support in Diné bizaad (Navajo) using community-based participatory action research methods.","authors":"Tapati Dutta, Jon Agley, Camille Keith, Gregory Zimet","doi":"10.22605/RRH9433","DOIUrl":"https://doi.org/10.22605/RRH9433","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Perceived social support is a psychological construct that is used to describe the 'perception of adequacy' of the support being provided by a person's social network. Higher perceived social support has been linked to multiple benefits across numerous studies over the past several decades and among multiple populations. The Multidimensional Scale of Perceived Social Support (MSPSS) is a 12-item scale to assess the construct of perceived social support. The instrument has been translated to approximately 35 languages and dialects, but it has rarely been translated into tribal languages, which may be commonly spoken in rural areas. Further, such translations have not always been accompanied by cultural adaptation. Assessment of the encultured meaning of terms from a validated instrument is important alongside translation because words and terms related to perceived social support can be culturally specific. As such, this article presents a community-engaged research approach to develop a translation of the MSPSS into Din&eacute; bizaad (Navajo), along with a qualitative assessment of the meaning and implications of key terminology from the instrument.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was led by a faculty member at a Native American-Serving Nontribal Institution (NASNTI) in south-western Colorado, US. Additional research collaborators included the original developer of the English MSPSS, a researcher with experience in methodology, and a member of the local Navajo community who was a student at the NASNTI. Using convenience and snowball sampling, a 2.5-hour focus group discussion was conducted and audio-recorded in May 2023 with eight Navajo community members who met eligibility criteria (including fluency in both Din&eacute; and English). All participants provided consent and received gratitude gifts for completion. Participants were four males and four females with an age range of 30-60 years. Since the discussion and recording were bilingual, a written English and Din&eacute; transcription was produced and anonymized, then reviewed by researchers. It was then backward-forward translated to English, then checked with discussion participants to validate accuracy. Using the general inductive method, key concepts and codes were separately identified and documented using NVivo 21 by two researchers. Full consensus as to coding was achieved over a sequence of six iterative consensus meetings among the coders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The project was able to produce a harmonized version of the MSPSS translated into Din&eacute; bizaad that accounted for variation in meaning and intent of multiple core concepts of perceived social support. For example, concepts of 'family' and 'friend' were often characterized by ethnic clan-based close-knit bonds. The concept of 'significant other' often meant 'spouse' but sometimes also meant someone who was highly trusted, especially among unmarried discussants. 'Soci","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"9433"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentorship in the mountains: lessons from a remote health center.","authors":"Kalimullah Jan","doi":"10.22605/RRH9504","DOIUrl":"https://doi.org/10.22605/RRH9504","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9504"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing multisystem parechovirus infection in a neonate - an experience from rural Australia.","authors":"Lorraine M Chung, Gopakumar Hariharan","doi":"10.22605/RRH9188","DOIUrl":"10.22605/RRH9188","url":null,"abstract":"<p><p>Human parechovirus (HPeV) infections in neonates and infants have been linked to outbreaks in regions including Australia, Northern Europe, and the US, resulting in long-term neurological complications. HPeV symptoms range from mild gastroenteritis and respiratory issues to severe systemic illness, including seizures and neurological damage. Human parechovirus type 3 (HPeV3) has emerged as a significant cause of sepsis-like illness in infants aged less than 3 months. We describe the case of a neonate aged 11 days with an acute abdomen and meningitis, treated at a rural hospital in Queensland, Australia. Early diagnosis of HPeV3 in this case facilitated supportive management of the neonate, and avoided unnecessary transfer to a tertiary centre.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9188"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of rural mental health and substance use nursing.","authors":"Sage Thomas, Nelly D Oelke, Dennis Jasper, Michelle Pavloff, Elizabeth Keys","doi":"10.22605/RRH9106","DOIUrl":"10.22605/RRH9106","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Globally, nearly 50% of the population live in rural areas, while just 36% of nurses serve in these locations. Rural nurses face distinct challenges such as limited resources and geographical isolation, and often work with an expanded scope of practice that includes mental health and substance use (MHSU) care. The extent to which rural nurses engage in MHSU care, care barriers, and facilitators has not been previously well described. Thus, this scoping review explored the international research on rural MHSU nursing. The aim was to synthesize the rural MHSU nursing evidence and consider it in relation to Knowing the Rural Community: A Framework for Nursing Practice in Rural and Remote Canada. The research question for this review was, 'What is known about rural nursing related to mental health and/or substance use considerations?'&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping review approach was used to guide a systematic exploration of the literature. CINAHL, Medline, and PsycINFO databases were searched for international qualitative, quantitative, and mixed-methods scholarly articles with rural MHSU nursing considerations, with no date limiters. Extracted data were mapped to the framework's categories: rural people, community, rural context, and larger society.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-seven articles were selected for this critical review of the literature, with most of the articles from Australia (n=15), the US (n=8), Canada (n=7), and South Africa (n=5), and representing rural nurses who worked in hospital (n=16), primary care (n=11), community mental health (n=7), and emergency department (n=6) practice settings. Rural MHSU nursing was described as a generalist and multifaceted role, with challenges such as workplace violence, practice setting and community isolation, and resource inadequacies. Results also indicated that rural MHSU nursing is influenced by a nurse's preparedness for their role, with a lack of preparedness complicated by multilayered resource deficits. Social determinants of health, mental health stigma, and health inequities also affected rural MHSU nursing practice. Despite facing significant barriers, rural nurses demonstrated resilience and commitment to providing quality MHSU care for their communities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Overall, there was congruence between the included studies and the framework. The framework provided a comprehensive foundation for this scoping review. However, based on the findings of this scoping review, minor amendments to the framework are recommended, such as including the rural nurse as an explicit part of the framework. Further, a rural-centric approach that is local, context-sensitive, and developed in collaboration with rural people, was identified as crucial for addressing the unique challenges faced by rural MHSU nurses and their communities. Future rural research should address nursing shortages, practice support, and under-resear","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9106"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long-term effects of different telerehabilitation programs on respiratory, exercise, and activity-related parameters in COVID-19 survivors: a randomized controlled trial in Türkiye.","authors":"Abdurrahman Tanhan, Aysel Yildiz Ozer, Eren Timurtaş, Ayşe Batirel, Mine Gülden Polat","doi":"10.22605/RRH8757","DOIUrl":"10.22605/RRH8757","url":null,"abstract":"<p><strong>Introduction: </strong>The long-term outcomes of different telerehabilitation gains for discharged COVID-19 patients are largely uncertain, and this point needs to be explored. This study aimed to research the effectiveness of telerehabilitation and compare the long-term results of videoconferencing-guided synchronous telerehabilitation and mobile application-guided asynchronous telerehabilitation programs, as well as determine the correlation between clinical and hemodynamic parameters.</p><p><strong>Methods: </strong>Exercise programs including aerobic exercises, strengthening exercises, and pulmonary exercises were given to COVID-19 patients discharged from the Kartal Dr. L&uuml;tfi Kirdar City Hospital in Istanbul, T&uuml;rkiye between August 2021 and January 2022, by videoconferencing or mobile application telerehabilitation. All patients underwent programs three times per week for 8 weeks. Lower extremity strength and functional status were assessed using a 30-second sit-to-stand test (30 s STS); physical activity level was assessed using the International Physical Activity Questionnaire short form (IPAQ); pulse oximetry was used to determine oxygen saturation and heart rate; and dyspnea and fatigue were assessed using a modified Borg Rating of Perceived Exertion Scale. Baseline, post-treatment, and long-term data were analyzed.</p><p><strong>Results: </strong>A total of 27 patients completed the study. Significant improvement was seen in all parameters in long-term results with telerehabilitation programs (p<0.05). Especially in the between-group effect at rest (p=0.031) and post-exertion oxygen saturation (p=0.004), there were significant differences in favor of videoconferencing. Oxygen saturation was negatively correlated with dyspnea and fatigue (p<0.05). Post-exercise, dyspnea showed a moderate positive correlation with fatigue (r=0.582, p=0.001) and heart rate (r=0.412, p=0.033), while it exhibited a moderate negative correlation with 30 s STS (r=-0.424, p=0.027) and IPAQ (r=-0.401, p=0.038).</p><p><strong>Conclusion: </strong>Both methods generally provide positive gains in clinical and hemodynamic parameters, but the videoconferencing results were slightly better. Saturation at rest and dyspnea after exertion can provide a brief prediction about the cardiopulmonary system. Our findings are important for individuals who have access problems to the clinic and city center, and can be used for follow-up and treatment approaches.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8757"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Politics, policy and action: lessons from rural GP advocacy in Ireland.","authors":"Shagun Tuli, Peter Hayes, Patrick O'Donoghue, Fergus Glynn, Robert Scully, Andrew W Murphy, Alan Bruce Chater, Liam Glynn","doi":"10.22605/RRH8700","DOIUrl":"10.22605/RRH8700","url":null,"abstract":"<p><strong>Context: </strong>Ireland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as problematic and in need of a structural fix. Structural urbanism where health care is viewed as a commodity for individuals, rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this article we present a brief account of advocacy led by rural GPs, their communities, and the political and policy implications of their efforts.</p><p><strong>Issues: </strong>In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports, distance coding and the Rural Practice Allowance, were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign, following which the Rural Practice Allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the Limerick Declaration, a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish rural general practice, which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.</p><p><strong>Lessons learned: </strong>Local voices have driven monumental change in the Irish healthcare context. For these communities, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learned is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8700"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Nations Peoples' perspectives on telehealth physiotherapy: a qualitative study focused on the therapeutic relationship.","authors":"Débora Petry Moecke, Travis Holyk, Stacy Maddocks, Kristin L Campbell, Kendall Ho, Pat G Camp","doi":"10.22605/RRH9022","DOIUrl":"10.22605/RRH9022","url":null,"abstract":"<p><strong>Introduction: </strong>Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship.</p><p><strong>Methods: </strong>A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis.</p><p><strong>Results: </strong>Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities.</p><p><strong>Conclusion: </strong>The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9022"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia.","authors":"Bunga A Paramashanti, Esti Nugraheny, Suparmi Suparmi, Tin Afifah, Wahyu Pudji Nugraheni, Yuni Purwatiningsih, Oktarina Oktarina, Muhammad Agus Mikrajab, Effatul Afifah, Yhona Paratmanitya","doi":"10.22605/RRH8722","DOIUrl":"10.22605/RRH8722","url":null,"abstract":"<p><strong>Introduction: </strong>Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve.</p><p><strong>Results: </strong>About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126).</p><p><strong>Conclusion: </strong>Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8722"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}