Rural and remote health最新文献

Introduction: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction: Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access.

Methods: GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic.

Results: The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31).

Conclusion: Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

Purpose: Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice.

Method: To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework.

Results: An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills.

Conclusion: The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.