Rural and remote health最新文献

Introduction: Scotland faces persistent challenges in addressing medical workforce shortages, particularly in remote and rural areas. The Scottish Graduate Entry Medicine (ScotGEM) program was established to address these challenges by training adaptable and resilient medical practitioners with a focus on rural and underserved healthcare settings. Evaluating the preparedness of ScotGEM graduates as they transition into clinical practice is essential for assessing the program's effectiveness.

Methods: This study utilised data from the General Medical Council Foundation Year 1 Preparedness Survey, which evaluates newly qualified doctors' self-reported perceptions of preparedness in key domains: overall preparedness, clinical practical procedures, prescribing and managing acutely unwell patients. Preparedness perceptions of the inaugural ScotGEM cohort were compared to national and Dundee University cohorts using Z-tests for proportions and Cohen's h to quantify effect sizes.

Results: ScotGEM graduates reported levels of preparedness comparable to the national average across all surveyed domains. Specifically, 57.5% of ScotGEM graduates felt adequately prepared for practice (57.9% nationally), 84.6% felt adequately skilled in clinical practical procedures (80.3% nationally), 75.0% reported adequate prescribing skills (79.3% nationally) and 75.0% felt prepared to manage acutely unwell patients (68.4% nationally). Statistical analysis revealed no significant differences between ScotGEM and other cohorts (p>0.05), with small effect sizes (h<0.2) indicating minimal practical differences.

Conclusion: ScotGEM graduates demonstrate preparedness levels comparable to their peers nationally and from traditional-entry programs, underscoring the effectiveness of Scotland's first graduate-entry and rurally delivered medical program. Future evaluations with larger sample sizes will be essential to detect subtle differences and further refine ScotGEM's contributions to Scotland's medical workforce, particularly in underserved areas.

Introduction: Australians in rural and remote areas have poorer health and welfare outcomes than urban populations. Rural people are reliant on a consistent workforce to service the population. Attracting and maintaining a health professional workforce in rural Australia has been well documented as an ongoing issue. However, there is a need for research that explicitly investigates the unique factors that impact the recruitment and retention of allied health workers.

Methods: A scoping review methodology was utilised to investigate the research question: How does the current literature identify, describe and address workforce recruitment and retention issues for allied health professionals in rural and remote Australia? Utilising the PRISMA-ScR guidelines for conducting a scoping review, 14 databases (Ovid Medline, Ovid Embase, Ovid EmCare, AMED, APA PsycInfo, Ovid Medline ALL, Scopus, CINAHL Complete, Dissertations & Theses Global, Nursing & Allied Health, Rural & Remote Health database, Health Collection, ATSI-Health and Open Access Theses and Dissertations) and the grey literature were systematically searched for sources published between 2013 and 2024, with four key concepts utilised as search terms. The Crowe Critical Appraisal Tool was used to review the quality of the literature, and a narrative synthesis approach was utilised to collate and summarise the data.

Results: In total, 11,165 sources were extracted from the database search, with title and abstract screening completed on 4,441 sources. Following full-text review, 60 sources were included in the review, 45 of which were peer-reviewed. Sources included research articles (n=27), reports (n=9), review articles (n=5), conference documents (n=3), web pages and online magazine pieces (n=8) and other sources (n=8). Many studies used a qualitative study design (n=11) and 22 sources generally referred to allied health professions without specifying which discipline. Of the specified allied health profession across sources, physiotherapy was the most studied (n=16), with occupational therapy (n=11) and psychology (n=9) following. The narrative synthesis yielded five key themes: Workforce: opportunities, facilitators and challenges; Rural health career: professional and personal identity; Workplace and professional role: demands, benefits and opportunities; Community and family: support, care and connectedness; and Connection, commitment and collaboration.

Conclusion: This scoping review highlights the opportunities, facilitators and challenges that affect the allied health workforce. It informs recommendations for professionals, organisations, communities and policymakers to build on the sector's strengths, and resources and presents a range of innovative strategies being trialled and implemented by the allied health workforce.

Introduction: We analyze a 2014 policy that increased physician supply in rural Bangladesh and assess its impact on access to care and health outcomes for rural residents.

Methods: We use data from the Household Income and Expenditure Survey for 2005-2016 and employ a difference-in-differences model. Our analysis focuses on five key outcome categories: access to providers, access to medicine, cost of care, health status, and travel time to reach healthcare providers.

Results: Rural residents' likelihood of visiting a government doctor increased by 14 percentage points, while visits to private doctors decreased by 15 percentage points. Rural residents are more likely to receive medication from public facilities, and their total monthly cost of care has decreased. We found a rise in reported cases of chronic conditions like heart disease and arthritis among rural residents.

Conclusion: Our findings indicate that increasing physician availability in rural Bangladesh positively impacted healthcare access and utilization.

Context: In Australia, rural clinical schools (RCSs) were developed to address the maldistribution of the rural medical workforce. Evidence demonstrates that medical students who attend an RCS, or have a rural background, are more likely to become rural doctors. To enhance the likelihood of our graduates from Deakin University becoming rural doctors, we strategically combined these two independent factors and created a dedicated rural training stream (RTS), which commenced in 2022. To support the introduction of the RTS and provide students with an authentic RCS experience, we developed a 3-day RCS immersion program for year 1 students. The broad aim was to provide students with experience and knowledge that would allow them to make an informed clinical school preferencing decision. Despite delivering the same curriculum, each of Deakin University's three RCS campuses are shaped by their distinct clinical setting, community and approach to program delivery. To showcase these individual aspects, each RCS designed a bespoke 3-day immersion program centred around three themes: connecting students to the local Indigenous Country, the community and the clinical school.

Issue: Historically, our students' clinical school preferences have fluctuated annually, with the majority of students generally electing to remain at the years 1 and 2 urban training location. This phenomenon was unsurprising as the majority of students, with metropolitan backgrounds, had little understanding of what living and learning in a rural community would be like. Clinical school promotional activities, before the introduction of the RTS, were held at the preclinical urban campus. Only a small number of students would visit one or more of Deakin University's five clinical schools on an ad-hoc basis. The available research on how medical students make their clinical school preferencing decisions highlights that both personal and learning needs are considerations. However, we lacked evidence on factors influencing our own students' clinical school decisions. Information provided to prospective students focused solely on the clinical schools, with an absence of practical information about the rural community or Country. The introduction of the RTS and immersion program provided an opportunity to explore medical students' decisions when preferencing clinical schools, offering learnings to enhance the associated policies and procedures.

Lessons learned: The program achieved its overarching aim of providing students with realistic exposure to the RCS environment, with 86.9% agreeing the experience helped them to make informed decisions about their clinical school preferences. The program, initially a pilot, has become embedded in the year 1 curriculum. Participation in the immersion program reduced student hesitancy towards attending an RCS, with over a quarter of initially hesitant students ultimately ranking an RCS a

Introduction: Suicidal behavior has increased in the past decade, particularly among Indigenous children and adolescents. This study explores variables associated with spiritual harmony - understood by Indigenous Peoples of Colombia as holistic mental health - among displaced Embera Dobidá youth, focusing on food security, general health, and connection to the land. It also evaluates outcomes of community-led and interculturally coordinated strategies implemented between 2023 and 2025.

Methods: A descriptive longitudinal study was conducted with all children aged 6 to 17 years (mean 14.97 years) from an Embera Dobidá community displaced by armed conflict. Data were collected at two time points (January 2023 and January 2025) using culturally validated instruments (Parenting, Behavior, Emotions, and Suicide Risk scale, Brief Solastalgia Scale and food security scale) and pediatric assessments. Interventions included traditional ceremonies, sanitation improvements, intercultural mental health support, and psychological first aid adapted to local cosmovision. Bivariate analyses were performed.

Results: In 2023, 57.4% of participants had nutritional problems and 30% were at suicide risk. Strong associations (p<0.001) were found between suicide risk and variables such as access to clean water and to food, environmental distress, and physical health. By 2025, significant improvements were observed in mental health (r=0.86), food security (r=0.84), environmental distress (r=0.61), and family dynamics (attachment r=0.58).

Discussion: Suicidal behavior is closely linked to ecological, cultural, and nutritional factors rather than only psychiatric disorders. Forced displacement, disconnection from ancestral territory, and spiritual disharmony are central elements.

Conclusion: Restoring mental health in Indigenous communities requires culturally grounded interventions that integrate nutrition, land-based practices, and intercultural collaboration. These strategies demonstrate potential for addressing pediatric suicide risk through culturally grounded, collective healing.

Introduction: Considering socioeconomic aspects, this study aimed to analyze the relationship between quality of life and family health in residents of a rural area of Peru.

Methods: In a cross-sectional design study, the sample comprised 288 residents chosen through simple random probabilistic sampling. It included male and female Peruvian residents aged 18 years or more who lived with their families and agreed to participate in the study. The SALUFAM (family health) scale and the Quality of Life Index are used for data collection.

Results: The results revealed that residents with basic education (adjusted odds ratio (aOR): 2.44, 95%CI: 1.33-4.49, p=0.004) who did not have a job (aOR: 1.66, 95%CI: 1.23-2.23, p=0.001) and who received an income less than the minimum wage (aOR: 1.45, 95%CI: 1.03-2.03, p=0.03) presented a greater probability of perceiving inadequate quality of life. Furthermore, residents with more vulnerable family health (aOR: 1.79, 95%CI: 1.34-2.38, p=0.000) were more likely to perceive an inadequate of their quality of life than those in families with less vulnerability.

Conclusion: Socioeconomic factors and vulnerability in family health are significantly associated with a worse quality of life in these rural communities.

Introduction: A sustainable rural and remote healthcare workforce is critical for addressing healthcare access disparities globally. Attracting recent healthcare graduates to rural and remote areas is one proposed solution. The objective of rural placements is to expose healthcare students to the unique challenges and rewards of working in these areas, thereby encouraging them to consider long-term employment in such settings. It is essential to understand the events and experiences that significantly influence healthcare students' sense of belonging to these communities, as this sense of belonging is crucial for their commitment to future employment in rural areas. This scoping review aimed to investigate the events and experiences that influence medical, nursing and allied health students' sense of belonging to a rural and remote community when on clinical placement. Understanding these outcomes helps in designing placements that effectively foster a sense of community and commitment among students, ultimately contributing to a more suitable rural healthcare workforce.

Methods: The scoping review followed the Joanna Briggs Institute methodology. Literature from 1995 to 2024 was systemically identified and mapped using five databases: CINAHL (via EBSCOhost), APA (American Psychological Association) PsycInfo, PubMed (via Ovid), ProQuest and Informit Health Collection. Peer-reviewed primary research with quantitative, qualitative or mixed-methods designs were included. A narrative analysis approach was adopted to identify and synthesise themes.

Results: From the 3316 reports found, 13 were analysed. Three themes were generated encompassing rural environment and rural identity formation, social isolation and community activity engagement. Key findings highlight the positive impact of welcoming community environments in fostering belonging and mitigating social isolation among students.

Conclusion: While clinical training among healthcare students remains pivotal, social integration for enhancing students' experiences and potentially bolstering future rural healthcare workforce retention is underscored. Gaps in the literature remain, particularly in understanding the intricate relationships between community involvement, social activities and student retention. Future research should explore student belonging to inform placement programs that address clinical and social integration.

Introduction: Allied health workforce challenges in Australian rural areas have negative implications for employers, due to high staff turnovers, and consumers, who receive suboptimal care. Rural health services cannot provide the range of specialised allied health providers available in urban areas, resulting in disparity in access and outcomes for rural people. Rural allied health professionals are required to work across the full scope of professional skills to meet the needs of their local communities, which is particularly challenging for early-career professionals. The allied health rural generalist pathway was introduced as a workforce strategy in South Australia's regional areas to develop and recognise the specific skills and knowledge required for rural practice. This research retrospectively explored the contextual factors impacting on the success of the pathway, including personal and organisational factors, to support generalisability.

Methods: A pragmatic qualitative study was undertaken over four research phases. In-depth interviews were conducted with trainees, supervisors, line managers, profession leads and the project team throughout the pathway. Qualitative and quantitative results were analysed separately and reported together to comprehensively explore research findings.

Results: Community integration, personal attributes, availability of support, timing of commencement and a generalist caseload were found to be important factors for success. Trainees who elected to participate in the generalist pathway were also more likely to complete. Location and profession were not found to predict success in the pathway.

Conclusion: A range of contextual factors was analysed to explore who, where and what circumstances were better suited to the allied health rural generalist pathway as it was introduced in South Australia. It is recommended that organisations consider the selection process, support available, caseload breadth and opportunities for participation in service development projects to promote successful completion of the pathway.