Rural and remote health最新文献

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.

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.

Introduction: Pharmacies and pharmacists play an integral role in primary health care. This role is particularly important in regional and rural settings where workforce is scarce. There are many challenges in recruiting and retaining a pharmacist workforce in regional and rural Australia. The literature on rural pharmacy workforce is largely based on employees' perspectives, with little emphasis on employers' experiences. This study aims to explore employers' perspectives of (1) recruitment and retention of staff pharmacists in their regional or rural practices and (2) strategies to mitigate recruitment and retention challenges of regional rural staff pharmacists.

Methods: This study was a qualitative, cross-sectional study of a randomised group of employers. A database of 151 unique employers was created using publicly available sources, and a randomised sample of 20 was identified using the Statistical Package for the Social Sciences. Semi-structured interviews were conducted individually with each selected employer. As part of a content analysis, responses pertaining to recruitment and retention were coded.

Results: A total of 473 basic responses were discovered using the inductive coding process. These codes were then condensed into 72 codes, based on their interpretive meaning and similarity. The codes were then sorted and categorised, by their logical and natural epistemology, into three separate but related topic areas: remuneration, work conditions and policy aspects (161 responses, 28 codes); workplace and role satisfaction (231 responses, 31 codes); and social factors (81 responses, 13 codes). The most significant findings included that pay and remuneration are highly inadequate, flexibility both in terms of working hours and scope of practice are perceived to be key factors for recruiting and retaining employee pharmacists, and geographical distance and social aspects persist and were reported as difficult to overcome. Various strategies to address these issues were discussed with mixed outcomes.

Discussion: Like employee pharmacists, employers emphasised that contemporary pay and remuneration, as outlined in industry awards and agreements, were inadequate. In addition, flexibility both in terms of scope and working hours, as well as a harmonious work environment, are key factors to recruiting and retaining employee pharmacists from an employers' perspective.

Conclusion: This study identified that remuneration, work conditions and policy aspects, as well as workplace and role satisfaction and social factors, are the major challenges for employers in recruiting and retaining pharmacists in regional or rural Victoria. More needs to done to attract and retain a workforce for rural Victoria.

Introduction: Indonesia comprises 16,771 islands, including 111 small islands and atolls. The Indonesian government has established community health centres, known as puskesmas in Indonesian, to provide health services to the entire populations of the country, including those in remote areas. In 2014, the Indonesian government introduced a national health insurance system with the goal of providing equitable access to health care for all citizens. However, not all health issues can be managed by these community health centres, necessitating a referral system to more advanced healthcare facilities. This study aims to evaluate the implementation of the referral system by community health centres in small island areas, with a view to addressing a research gap on this topic.

Methods: This implementation research explores the challenges associated with the referral system using the intervention mapping approach. This approach involves six stages: (1) needs assessment, (2) change matrix development, (3) devising strategies to optimise referrals based on practical theories, (4) program preparation, (5) adoption and implementation planning, and (6) evaluation planning. The target population will comprise patients, healthcare workers at community health centres and various other stakeholders. The study is to be conducted on three small islands in Sangihe Islands Regency, North Sulawesi Province: Nusa Tabukan, Marore and Kahakitang.

Results: The evaluation of the referral program addresses the gap in the implementation of referrals from community health centres on small islands, providing valuable information for the government and policymakers regarding healthcare delivery in hard-to-reach and remote areas.

Conclusion: The study's results are expected to offer valuable insights into systematic research processes and provide recommendations for interventions designed to improve the referral system from community health centres to regional hospitals.

Introduction: Recruitment and retention of the healthcare workforce are crucial to maintaining access to services and provision of care, but these are ongoing challenges for health services both in the UK National Health Service (NHS) and globally. We know from systematic reviews of the international literature that many recruitment and retention strategies are based on little definitive evidence. As part of a wider study of place-based community-led initiatives to attract healthcare staff to remote and rural areas, we decided to examine how NHS job advertisements represent the community to which they are recruiting, drawing on the concept of asset-based community development (ABCD) to focus on which social and professional community assets are given prominence and how.

Methods: In total, 270 job advertisements for posts in remote and rural areas of the UK were collected between July and December 2022, from a monthly search of three sources: the British Medical Journal job advertisement site; the NHS Scotland GP job site, and the NHS Scotland jobs site. We then contacted named recruitment contacts from all the advertisements collected where possible, to ask how many applications were received and whether an appointment had been made. Informed by the ABCD lens, job advertisements were analysed using a thematic framework analysis approach to identify the different assets that advertisements highlighted. Responses from advertisers contacted were added to the framework, including free text about their experiences of trying to recruit.

Results: Advertisements ranged from a couple of short paragraphs of text describing the post, with perhaps (although not always) a few details about the location, to lengthy and elaborate descriptions of both the post and the local community, sometimes with photographs, links to further information and videos about the community. We found that while many advertisements included plenty of detailed information about the community and the lifestyle, other places may not be realising the full potential of local assets. One simple change would be to provide more visual information, either in the advertisement itself or - if that is too costly - in a linked website or document. Emails were sent to 189 advertisers, and we received 45 responses. Of the 45 responses received, only 18 stated that an appointment had been made as a direct result of the advert. Feedback from advertisers has also suggested that those recruiting to rural and remote posts may need to proactively seek connections with potential applicants rather than hoping that the advertisement alone will be enough to find them.

Conclusion: There is evidence from our results that local place-based assets are not always featured as strongly or as visually as they could be in advertisements for remote and rural healthcare jobs. To our knowledge, there has not been a cost-effectivene