Rural and remote health最新文献

{"title":"Learning environments in decentralized and urban medical curricula in Norway: a comparative study.","authors":"Ida Sara Johnsen, Hilde Grimstad, Borge Lillebo","doi":"10.22605/RRH8745","DOIUrl":"10.22605/RRH8745","url":null,"abstract":"<p><strong>Introduction: </strong>As the numbers of, and interest for, decentralized medical curricula increase, the need for knowledge about enrolled students' experiences becomes increasingly urgent. Concerns have been raised that the learning environment may be impaired when educational programs are moved from urban to less central locations. Previous research investigating this issue has revealed discrepant findings, and no such studies have been conducted in Scandinavia.</p><p><strong>Methods: </strong>In this cross-sectional study, the 50-item Dundee Ready Education Environment Measure (DREEM) was used to compare learning environment perceptions of students in a decentralized medical program in Norway to that of their urban peers. DREEM includes statements about different aspects of a learning environment. Three student cohorts were included, and students responded to the questionnaire during the final 2 months of year 4. The original English DREEM was translated to Norwegian as a part of the study. Independent t-test was used for comparison of DREEM overall scores and subscale scores.</p><p><strong>Results: </strong>Both student groups perceived the learning environment as good, and the educational atmosphere was seen as particularly positive. The decentralized group obtained a significantly higher overall DREEM score, as well as significantly higher scores for all subscales. The largest intersite difference was found for students' perception of learning, while students' academic and social self-perceptions were subject to less score differences.</p><p><strong>Conclusion: </strong>Despite concerns about suboptimal learning environment conditions in decentralized curricula, this study indicated the opposite. Plausible explanations include integration of students in a clinical community, development of continuous longitudinal relations between students and teachers, and the use of flipped classroom activities in small student groups. Considering the learning environment's importance for student learning and wellbeing, these findings are valuable in the further establishment and development of decentralized medical education.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"8745"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483976","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":"Rural proofing: lessons from OECD countries and potential application to health.","authors":"Betty-Ann Bryce","doi":"10.22605/RRH9096","DOIUrl":"10.22605/RRH9096","url":null,"abstract":"<p><strong>Context: </strong>Promoting rural development can pose numerous policy and governance challenges. However, rural proofing offers a vital solution. It helps policymakers create strategies that cater to rural needs, which is particularly relevant to health care. It involves making policy decisions based on evidence on rural dynamics available in a timely fashion to enable changes and adjustments.</p><p><strong>Issues: </strong>Governments should consider rural proofing health sector policies and strategies because making health policies rural-friendly encourages innovation and ensures access to services in rural and remote communities.</p><p><strong>Lessons learned: </strong>Effective rural proofing mechanisms give policymakers the necessary information and data to assess how policies affect rural areas, allowing for timely adjustments early in the policy design phase. The key to this process is timing, evidence and flexibility - one size does not fit all. The rural proofing requires experimentation to find the best solutions and modalities that fit a country's context.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"9096"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433750","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":"Creating a centre of excellence in rural health care: strategy, tactics and initial outcomes of the Riverland Academy of Clinical Excellence.","authors":"Wayne Champion, Paul Worley, Caroline Phegan, Sharon Frahn, Hamish Eske, Lambert W T Schuwirth, Amy E Mendham","doi":"10.22605/RRH9233","DOIUrl":"10.22605/RRH9233","url":null,"abstract":"","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"9233"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053312","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":"'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":"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":"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":"Unveiling the rural dichotomy: the dual impact of rurality on youth mental health.","authors":"Sarah A Youngson, Beatriz Cuesta-Briand, Mathew Coleman","doi":"10.22605/RRH8692","DOIUrl":"https://doi.org/10.22605/RRH8692","url":null,"abstract":"<p><strong>Introduction: </strong>The geographic, cultural, social and economic milieu that impacts mental health in rural communities globally has been well documented. However, few studies have addressed how rural ecosystems impact specifically upon the mental health and wellbeing of young people. Furthermore, the limited explorations of factors contributing to poorer mental health outcomes in rural youth have primarily included adult voices. The study aimed to give a youth voice to the vexed problem of high rates of youth mental illness and suicide in rural and remote areas, exploring young people's experiences in a deeply contextual manner.</p><p><strong>Methods: </strong>This study followed a phenomenological qualitative design underpinned by the principles of participatory action research. A youth-led reference group provided guidance on the study design and recruitment. A total of 29 young people aged 12-19 years were recruited from a small rural community in southern Western Australia. Individual and focus group semi-structured interviews were conducted. The interviews were transcribed and subjected to thematic analysis informed by ecological systems theory.</p><p><strong>Results: </strong>The findings demonstrate the impact of a rural address on youth mental health through the influence of three overarching spheres of influence, as described by ecological systems theory: 'everyone knows everyone', 'small school and beyond' and 'the place'. Most themes included both positive and negative components, as well as ambivalence, demonstrating a double-edged sword.</p><p><strong>Conclusion: </strong>The study findings support the view that mental health in rural young people is best viewed through an ecosystem lens, acknowledging the complex and dynamic interplay between interpersonal, community and environmental factors on young people. The paradoxes and contradictions present in almost every interview are informative, instructive and of great value in considering the needs and desires of rural young people. Rural communities should be supported to build upon their intrinsic strengths to ameliorate the impact of rurality on mental health risk factors for young people. Building on the assets inherent in rural communities, could rural young people have better outcomes than urban youth?</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"8692"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151631","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":"Rural and remote health care: the case for spatial justice.","authors":"Karen Hayes, Kristy Coxon, Rosalind A Bye","doi":"10.22605/RRH8580","DOIUrl":"10.22605/RRH8580","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Almost universally, people living in rural and remote places die younger, poorer, and sicker than urban-dwelling citizens of the same country. Despite clear need, health services are commonly less available, and more costly and challenging to access, for rural and remote people. Rural geography is commonly cited as a reason for these disparities, that is, rural people are said to live in places too distant, too underpopulated, and too difficult to access. However, all these descriptions tacitly compare rural places with urban spaces. That is, rural places are perceived as too distant from cities, less populated than cities, and too difficult to access from cities. This relative framing situates urban geography as normal, and non-urban geography as abnormal and blames people who live outside of normalised urban spaces for their own disadvantage. It suggests rural people should expect less service, higher costs, and increased awkwardness in using healthcare services due to the 'abnormality' of living in rural spaces. The concept of spatial justice provides an alternative way of considering geography that we propose could effectively reframe understanding of and approaches to rural and remote health care to improve health outcomes. Spatial justice refers to the experience of justice relative to location and requires opportunities, including access to health care, to be distributed equally across geographic spaces as well as among people. To critical geographers, places are not static; humans both respond to geography and shape it based on decisions influenced by contemporary social ideologies. As a society we decide where we build housing, roads, and healthcare facilities, based on what and who we value. Rural health outcomes could therefore be conceived as resulting from social ideology regarding locational investment, social worth, and urbanormativity, rather than challenges of topography. In this critical narrative review, we apply geographical concepts to suggest how rural and remote geography may have been shaped by ideologies of capitalism and neoliberalism to result in spatial injustice. Our analysis suggests that, rather than rural geography being a neutral issue, society shaped geographies to limit health opportunities for people who live in rural and remote places. We suggest reframing to allow rural and remote geography to be conceived as a social factor able to be shaped, rather than as an insurmountable barrier to equity. We consider how application of French philosopher and geographer Lefebvre's tripartite model of conceived, perceived, and lived space could be used to examine and guide social policy to reshape rural and remote geography to increase health opportunities. This application of spatial justice to rural and remote health care suggests opportunities to reframe assumptions that rural and remote people should necessarily experience greater cost, inconvenience, and difficulty accessing health care due to geography. If soc","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"8580"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053326","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 comparison of gambling behaviors and beliefs in rural and urban populations in Pennsylvania.","authors":"Gillian Eh Russell, Glenn E Sterner, Kayla M Lopez, Amanda M Ferrara, Miranda P Kaye","doi":"10.22605/RRH9077","DOIUrl":"https://doi.org/10.22605/RRH9077","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the differences between rural and urban gamblers and potential vulnerabilities that may be unique to either population. This exploratory study aimed to evaluate differences between rural and urban Pennsylvanians' gambling behaviors and beliefs.</p><p><strong>Methods: </strong>A dual-frame random digit dial survey was conducted in the US state of Pennsylvania. The analyses included a final sample of 1934 Pennsylvanian adults, with nearly three-quarters of the sample residing in rural counties. The survey was designed to assess online and offline gambling prevalence, engagement in different gambling formats, risk for problem gambling, motivations to gamble online, beliefs about gambling, and demographic characteristics.</p><p><strong>Results: </strong>Prevalence rates were higher in urban populations for both online and offline gambling. However, those living in rural areas tended to gamble on more gambling formats. Motivations were largely the same in both regions, and there were no differences in risk for problem gambling. Beliefs about gambling harms and benefits were similar in urban and rural populations, but those in rural areas were less likely to believe all forms of gambling should be legal. In addition, there were several demographic differences, which largely reflected existing differences between those living in rural and urban areas.</p><p><strong>Conclusion: </strong>Findings suggest a need for provision of policies, treatment, and prevention targeting those living in rural areas, where individuals may be at a greater risk of developing a gambling problem due to less access to relevant service.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 1","pages":"9077"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151615","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":"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":"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}