Rural and remote health最新文献

{"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":"<p><strong>Introduction: </strong>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?'</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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":"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}

{"title":"Barriers and facilitators to continuous quality improvement engagement among rural physicians in British Columbia, Canada: a mixed-methods study.","authors":"Dawson Born, Brenna M Lynn, Bob Bluman, Ray Markham, Vernon Curran","doi":"10.22605/RRH9144","DOIUrl":"10.22605/RRH9144","url":null,"abstract":"<p><strong>Introduction: </strong>Rural physician engagement in continuous quality improvement (CQI) activities is vital to improving quality of care, patient safety, and healthcare delivery efficiencies. However, there is a lack of evidence surrounding the barriers and facilitators to CQI uptake across rural medical practices. This study aimed to explore enablers and barriers to CQI implementation and identify ways to foster greater engagement of rural physicians.</p><p><strong>Methods: </strong>A mixed-methods triangulation study design was undertaken encompassing a survey and focus group interviews with physicians practising in rural communities of British Columbia, Canada.</p><p><strong>Results: </strong>The survey was distributed to 1584 rural physicians, and 299 responses were received (response rate of 19%). Seven focus groups were conducted with 33 participants. Survey respondents indicated strong support towards CQI and the benefits of improved patient outcomes and practice quality. Less than half (47%) of respondents had participated in a CQI initiative within the previous 2 years. Key barriers to CQI engagement included time constraints, limited knowledge of CQI principles, and a lack of understanding of accessing and using relevant data. Key motivators for CQI engagement were opportunities for peer collaboration and receiving practice improvement feedback. Key enablers included more usable and accessible data and appropriate staffing resources to assist with undertaking CQI activities.</p><p><strong>Conclusion: </strong>Given rural physicians' time demands, better support systems are required to enhance rural physician engagement in systematic CQI activities. Specific support areas include dedicated CQI staff resources and better practice data systems and processes to support CQI initiatives.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9144"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751504","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":"'Imagine if we had an actual service ...': a qualitative exploration of abortion access challenges in Australian rural primary care.","authors":"Anna Noonan, Erica Millar, Jane Elizabeth Tomnay, Georgina M Luscombe, Kirsten I Black","doi":"10.22605/RRH9229","DOIUrl":"10.22605/RRH9229","url":null,"abstract":"<p><strong>Introduction: </strong>Rural populations in Australia rely upon local primary health care for medication abortion access. Yet little is known about how individual primary healthcare providers themselves negotiate the unique complexities of the rural health system to provide local abortion services.</p><p><strong>Methods: </strong>To address this gap, we conducted qualitative, semi-structured interviews with primary healthcare providers in rural New South Wales (NSW). Recruitment strategies included sending invitations to all GP clinics in Western NSW, distribution of flyers via professional networks and social media posts as well as snowballing. The Framework Method was used to conduct an inductive thematic analysis.</p><p><strong>Results: </strong>We interviewed 16 rural GPs, nurses, midwives and women's health clinic operational staff. Four themes were identified: (1) scarce abortion services place overreliance on availability and goodwill of local prescribers; (2) lack of back-up support, financial incentives and training deters providers; (3) there is interprofessional stigma, secrecy and obstruction; and (4) local abortion access requires workarounds through informal rural networks. Participants described abortion exceptionalism within Australia's health system and chronic rural workforce shortages in rural settings as unique and compounding challenges to local provision. Conversely, strong rural community networks were identified as important enablers of informal pathways to abortion within or around systemic barriers.</p><p><strong>Conclusion: </strong>Improving rural abortion access in Australia requires attention to the numerous intersecting barriers that local primary care providers themselves face when providing services at the periphery of an unaccommodating health system.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9229"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576850","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 Murtupuni Statement on rural generalist professional practice in Australia.","authors":"Richard B Hays, Ruth N Barker, Alice Cairns, Vanessa L Sparke, Ruth A Stewart, Sharon Varela, Bonnie E Collins, Catherine Maloney, Rodney Omond, Tarun Sen Gupta, Sarah Chalmers, Hwee Sin Chong, Kylie McKenna, Kristie Forrest, Erica West, Jennie Matthews, Rosalie Ballard, Gabrielle Sabatino, Jodie Turvey, Jo Symons, Andrew Quabba, Jodi Brown","doi":"10.22605/RRH9308","DOIUrl":"https://doi.org/10.22605/RRH9308","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9308"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584267","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":"Wolastoqiyik adaptation of the Aaniish Naa Gegii: the Children's Health and Well-Being Measure.","authors":"Isabelle Bernard, Joline Guitard, Annie Roy-Charland, Diane Pelletier, Nancy L Young","doi":"10.22605/RRH8796","DOIUrl":"10.22605/RRH8796","url":null,"abstract":"<p><strong>Introduction: </strong>Indigenous children in Canada represent one of the fastest-growing pediatric populations and experience severe health inequities. There is an ongoing need for new research on relevant methods to measure the health and wellbeing of Indigenous children that considers the cultural differences between communities. The Aaniish Naa Gegii: the Children's Health and Well-Being Measure (ACHWM) is a self-reported questionnaire that was developed to meet this need and to include the voices of Indigenous children. The purpose of this study was to assess the cultural relevance of the ACHWM for Wolastoqiyik children and to determine what revisions may be needed to ensure that the questions are well understood and culturally appropriate.</p><p><strong>Methods: </strong>We recruited a community-based sample of nine Wolastoqiyik children (ages 8 to 16 years), two caregivers, and a community Elder within the Madawaska Maliseet First Nation community in New Brunswick. Through a process of cognitive debriefing, we probed children's comprehension of the 62 questions of the First Nation French version of the ACHWM. We analyzed the information reported to determine the participants' understandings relative to the other participants and to the original intent of the ACHWM content.</p><p><strong>Results: </strong>Each of the nine children identified at least one item they recommended for revision during the interview. We observed similarities in the suggestions offered by several respondents. A total of 23 questions were considered, and 14 questions (22.6%) were modified, taking into consideration all participants' suggestions.</p><p><strong>Conclusion: </strong>While measures like the ACHWM offer useful information, relying solely on a 'one size fits all' Indigenous questionnaire is insufficient. Our findings underline the importance of having methods that are easily accessible, adaptable, and culturally appropriate for assessing and addressing Indigenous children's unique health and wellbeing. Such information allows clinicians to develop interventions that are culturally relevant, addressing children's individual needs within the context of their distinct cultural identity.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8796"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717037","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":"Therapeutic resources used by traditional communities of the Brazilian Amazon: a scoping review.","authors":"Altair Seabra De Farias, Fabíola Guimarães de Carvalho, Franciane Ribeiro Farias, Joseir Saturnino Cristino, Alicia Patrine Cacau Dos Santos, Vinícius Azevedo Machado, Sediel Andrade Ambrosio, Wuelton Marcelo Monteiro, Jacqueline Sachett","doi":"10.22605/RRH8269","DOIUrl":"10.22605/RRH8269","url":null,"abstract":"<p><strong>Introduction: </strong>The traditional communities of the Brazilian Amazon possess significant knowledge regarding the huge therapeutic arsenal available from natural sources that can be used to care for their health problems. This study aimed to identify, map and synthesize the scientific evidence on the use of traditional medicine as a therapeutic resource when used by traditional communities of the Brazilian Amazon.</p><p><strong>Methods: </strong>This is a scoping review, which is a method used to map the main concepts of a research area, the available evidence and its sources. It is developed in five steps: (1) identification of the research question; (2) identification of relevant studies; (3) selection of studies; (4) data analysis; and (5) grouping, synthesis and presentation of data.</p><p><strong>Results: </strong>Medicinal plants, vertebrates and invertebrates, among other medicinal products, are elements that are widely used by traditional populations. Plant stems, bark, leaves, flowers, fruits, seeds, roots, tubers and even the whole plant are prepared in various forms, such as teas, infusions, smoke for rituals, baths, macerations, oils, ointments, concoctions, dressings, incenses and exfoliants, among others. The main structures and forms used from animals are lards, fats, viscera, horns, cocoons, nests, feathers and beaks of birds, eggs and roes. These therapeutic practices are often carried out using endogenous, wild and domesticated natural resources present in the biodiverse environments of traditional populations. They involve magical-religious beliefs to treat all types of illnesses, including cultural syndromes that affect children, young people, adults and the elderly.</p><p><strong>Conclusion: </strong>This scoping review has an important role to disseminate and expand the discussion of traditional medicine practices, inviting readers - whether they are health professionals, community members, managers or decision-makers - to a continuing debate using an intercultural dialogue necessary to improve approaches. From this perspective, it is essential to consider the comprehensive legal and legal framework that guides the public policies of national health systems.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8269"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590943","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":"It's more than just a rural GP shortage: challenging a dominant construction of the rural health workforce 'problem'.","authors":"Christina Malatzky, Catherine Cosgrave, Anna Moran, Susan Waller, Hazel Dalton","doi":"10.22605/RRH8734","DOIUrl":"10.22605/RRH8734","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"8734"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473746","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 burden of HPV-associated cancer in rural America beyond 2020.","authors":"Jason Semprini","doi":"10.22605/RRH9281","DOIUrl":"https://doi.org/10.22605/RRH9281","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"24 4","pages":"9281"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473747","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}