Journal of Rural Health最新文献

Background: The goal of this study was to gain an in-depth understanding about the lived experiences and unmet needs of rural male cancer survivors.

Methods: Focus groups were conducted with male survivors of prostate (N = 14) and colorectal cancers (N = 10), from rural Virginia. Demographic and clinical information were collected via surveys. A focus group guide contained questions about needs, lifestyles, and social networks of rural male cancer survivors. Focus group data were analyzed using Braun and Clarke's thematic analysis guidelines.

Results: Four primary themes emerged from the data: (1) contending with health problems, (2) quality and availability of health care services, (3) coping strategies to navigate survivorship, and (4) advocating for cancer prevention. Survivors had to contend with physical and emotional problems, which were a result of their cancer treatments. Due to their rural location, survivors had difficulty accessing health care services and had a limited understanding of the cancer-related resources that existed in their counties. Family support, religiosity and acceptance served as important coping strategies. Many felt strongly about promoting cancer-related education and awareness.

Conclusion: The lived experiences and unmet needs of rural male cancer survivors comprised several challenges, which included health problems and lack of health care access. Coping mechanisms comprised reliance on familial bonds and religion. Findings from this study reveal the need for tailored interventions to target the health care, psychosocial, and informational needs of rural male cancer survivors.

Purpose: This study investigates the experiences of one rural community in Central Pennsylvania following the closure of its singular pharmacy and primary health care facility. It aims to understand community members' responses and adaptations to declining health care accessibility and broader implications for rural health policy and practice.

Methods: Employing a qualitative case study design, researchers conducted 26 in-depth interviews from May to December 2022. Interviews were grounded in a phenomenological approach and focused on participants' perceptions of their community and experiences accessing health care. Data were analyzed thematically following a coding reliability approach.

Findings: The closure of the health care facilities resulted in significant social and economic impacts, particularly among vulnerable groups, such as older adults, people with disabilities, and working-class families. Participants reported increased reliance on their social support networks to access care, delays in seeking care due to the strain from longer travel distances, and loss of familiar and trusted care providers. We also found an over-reliance on local emergency medical services for routine care. Although the community demonstrated resilience through the use of social networks, some adaptations carried health risks, including delayed care and unmonitored use of alternative remedies.

Conclusions: This study highligths the need for health care policies that address the immediate loss of services and support the social networks and economic stability that rural communities rely on in the absence of local health care facilities. This research contributes insights for policymakers, health care providers, and community leaders working to support rural communities facing similar health care losses.

Purpose: As US hospital markets become increasingly consolidated, empirical evidence is needed on the clinical and financial impacts of mergers on care provided by rural hospitals. We identified characteristics of rural hospitals that underwent mergers or acquisitions and examined changes in profitability, clinical outcomes, and patient experience at acquired versus non-acquired rural hospitals.

Methods: We identified 145 rural US hospitals that underwent merger or acquisition between 2009 and 2014 and 906 rural non-acquired control hospitals. For each acquisition year, we used a difference-in-differences design to compare that year's acquired hospitals to a randomly chosen set of non-acquired controls. Adjusted linear regression models were used to assess the relationship between acquisition and changes in profitability, patient experience, and clinical outcomes.

Findings: Compared to non-acquired hospitals, acquired hospitals were more likely to be for-profit (18.6% vs. 4.6%, p<0.001) and tended to have lower total margins (-1.1% vs. 1.2%; p<0.05) despite higher average clinical volumes. Changes in acquired hospitals' total margins, patient satisfaction, and risk-adjusted 30-day mortality rates were not different than changes among control hospitals. However, acquisition was associated with lower improvement in 30-day risk-adjusted readmission rates (-0.58 percentage point [p.p.] difference-in-differences, 95% confidence interval -0.88 to -0.28 p.p., p<0.001).

Conclusions: Overall, mergers or acquisitions of rural hospitals were not associated with significant improvements in profitability, clinical outcomes, or patient experience. Policymakers may need to closely monitor rural hospital mergers in order to balance preserving access for rural patients with the consequences of health care consolidation.

Purpose: To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South.

Methods: An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self-reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi-square and binary logistic regressions were used for data analysis.

Findings: A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04).

Conclusions: Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South.

Background: Addressing social needs is a priority for many health systems, including the Veterans Health Administration (VA). Nearly a quarter of Veterans reside in rural areas and experience a high social need burden. The purpose of this study was to assess the prevalence and association with health outcomes of social needs in two distinct rural Veteran populations.

Methods: We conducted a survey (n = 1150) of Veterans at 2 rural VA sites, 1 in the Northeast and 1 in the Southeast (SE), assessing 11 social needs (social disconnection, employment, finance, food, transportation, housing, utilities, internet access, legal needs, activities of daily living [ADL], and discrimination). We ran weighted-logistic regression models to predict the probability of experiencing four outcomes (poor access to care, no-show visits, and self-rated physical and mental health) by individual social need.

Findings: More than 80% of Veterans at both sites reported ≥1 social need, with social disconnection the most common; Veterans at the SE site reported much higher rates. A total of 9 out of 11 needs were associated with higher probability of poor physical and mental health, particularly financial needs (average marginal effect [AME]: 0.21-0.32, p < 0.001) and ADL (AME: 0.27-0.34, p < 0.001). We found smaller associations between social needs and poor access to care and no-show visits.

Conclusion: High prevalence of social needs in rural Veteran population and significant associations with four health outcomes support the prioritization of addressing social determinants of health for health systems. Differences in the findings between sites support tailoring interventions to specific patient populations.

Purpose: Childhood obesity is more prevalent in rural compared to urban communities and may be related to urban-rural differences in environmental factors known to affect obesity. However, understanding of how environmental factors impact childhood obesity in rural settings remains limited. This study aimed to address this gap by exploring the relationship between obesogenic environments and childhood overweight/obesity rates, including variations across the urban-rural continuum.

Methods: This study analyzed data for counties in the United States (N = 3140). Linear regression models were employed to examine the relationship between the Childhood Obesogenic Environment Index, which consisted of ten variables from a variety of sources associated with physical activity and healthy eating, and childhood overweight/obesity rates estimates derived from the 2016 National Survey of Children's Health. County rurality was categorized using Rural-Urban Continuum Codes and a moderation analysis was conducted to identify potential variations by rurality.

Findings: There was a significant positive association between the COEI and childhood overweight/obesity rates nationally, with notable variations across the urban-rural continuum for specific index components. Neighborhood walkability showed a significant positive association across rurality, indicating that childhood overweight/obesity rates were higher in less walkable communities. Full-service restaurants exhibited an inverse relationship with childhood overweight/obesity rates across all RUCC levels.

Conclusions: These results underscore the obesogenic environmental factors associated with childhood overweight/obesity rates nationally and how they vary across the urban-rural continuum. This study highlights the importance of considering these variations when designing interventions to address childhood obesity.

Purpose: The CDC's Diabetes Prevention Program (DPP) is an effective lifestyle intervention to prevent type 2 diabetes (T2D). However, DPP implementation in rural areas is limited. This study sought to address this gap by implementing DPP in rural church settings through a community-academic partnership and identifying implementation facilitators and barriers.

Methods: This was a cross-sectional qualitative study. Semistructured interviews guided by the Consolidated Framework for Implementation Research (CFIR) assessed church leaders' and lifestyle coaches' perceptions of implementing DPP in rural churches. Thematic analysis was used to identify key themes through an inductive approach; then, these emergent themes were deductively linked to CFIR constructs. COREQ guidelines were used to report study findings.

Findings: Twenty-five stakeholders participated. Facilitators to implementing DPP included its evidence-based effectiveness in preventing T2D, as well as support from the academic partner in terms of funding, training, and communication. Additionally, DPP's alignment with community needs, along with the active engagement of pastors in participant recruitment, supported implementation. Several barriers hindered DPP implementation, including transportation and childcare issues, as well as program participants' medical conditions/disabilities limiting their participation. Furthermore, rural residents' reluctance to adopt lifestyle changes and loyalty to family churches posed challenges to their engagement in DPP.

Conclusions: This study identified contextual factors influencing DPP implementation in rural communities. Findings highlight the importance of tailored strategies that leverage facilitators while proactively addressing barriers, including rural residents' reluctance to attend programs outside their church, resistance to lifestyle changes, and transportation issues to ensure successful DPP implementation in rural areas.

Purpose: We examined the relationship between travel burden for surgical cancer care and rurality, geographic bypass of the nearest surgical facility, cancer type, and mortality outcomes.

Methods: Using Medicare claims and enrollment data (2016-2018) from beneficiaries with cancer of the colon, rectum, lung, or pancreas, we measured travel times to: the nearest surgical facility and facility used. For those who bypassed the nearest, we examined travel time and rurality in relation to surgical rates. Using multivariable regression modeling, we estimated associations of bypass with 90-day postoperative- and one-year mortality; rurality was examined as an effect modifier.

Findings: Among 211,025 beneficiaries with cancer, 25.5% resided in non-metropolitan areas. About 66% of metropolitan/micropolitan, and 78% of small town/rural patients bypassed their closest facility. Increasing rurality was significantly associated with increased likelihood of bypass (Referent = metropolitan, OR; 95%CI: micropolitan 1.10; 1.04-1.16, small town/rural 2.08; 1.96-2.20. Bypassing the nearest facility was associated with decreased likelihood of both 90-day postoperative mortality (OR = 0.79; 95%CI 0.74-0.85) and 1-year mortality (OR = 0.81; 95%CI 0.77-0.86). The greatest decrement in 1-year mortality was for pancreatic cancer across all rural-urban categories (OR; 95%CI: metropolitan 0.63; 0.53-0.76; micropolitan 0.53; 0.29-0.97); small town/rural 0.46; 0.25-0.86).

Conclusions: Most Medicare beneficiaries with lung, colon, rectal, or pancreatic cancer bypassed the closest facility providing surgical cancer care, especially rural patients. Bypassing was associated with a lower likelihood of 90-day postoperative, and 1-year mortality. Understanding determinants of bypassing, particularly among rural patients, may reveal potential mechanisms to improve cancer outcomes and reduce rural cancer disparities.

Purpose: Early sexual onset contributes to poor health outcomes through the life course. We use the social behavioral model to examine the behaviors and attitudes associated with early sexual onset and the intention to delay sex in middle school youth.

Methods: Youth in rural communities with high rates of hepatitis C and HIV filled out a survey prior to implementation of an evidence-based sex education program. Participants were asked if they had ever had sex and whether they planned to abstain from sex until the end of high school. We collected demographics, attitudes about abstinence, agency for sexual refusal, parent communication, sexual health knowledge, and history of system involvement. Logistic regression was utilized to examine factors associated with each outcome.

Findings: Our sample included 6,799 students, 12.7 years old ± 0.9 and 50.3% female. 5.1% had ever had sex and 73.9% planned to abstain until the end of high school. Early sexual onset was associated with older age, negative attitudes toward abstinence, lower agency for sexual refusal, more frequent parent communication about sex, history of child welfare, and history of juvenile involvement. Planning to abstain until the end of high school was associated with being younger, female, positive attitudes toward abstinence, higher agency for sexual refusal, less communication with parents about sex, more communication with parents about relationships, not having a history of foster involvement, and not having a history of juvenile involvement.

Conclusions: Age, agency, and parent communication were all associated with both outcomes. Our findings highlight the importance of early comprehensive, trauma-informed sex education.