ijerph-logo

Journal Browser

Journal Browser

Special Issue "Rural and Remote Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 30 September 2022 | Viewed by 39148

Special Issue Editor

Dr. Rohan Rasiah
E-Mail Website
Guest Editor
Western Australian Centre for Rural, University of Western Australia, PO Box 62, Karratha 6714, WA, Australia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organising a Special Issue on “Rural and Remote Health” in the International Journal of Environmental Research and Public Health, a peer-reviewed journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph. 

The provision of healthcare to rural and remote communities across the globe is challenging. Approximately half of the global population (45% in 2018) lives in rural areas and this proportion is expected to drop to 32% by 2050. Currently the global rural population is close to 3.4 billion, with Africa and Asia home to 90% of the world’s rural population. While the rural population is expected to peak in the coming years, the provision of adequate healthcare to these people is of paramount importance. The cost of providing healthcare to rural and remote communities is significant in both economic, social and environmental terms. It is important to consider the linkages with urban areas, to assist in providing integrated health services to rural communities.

To help reduce the health inequities of people living in rural and remote locations, governments, policy makers, health professionals and communities need to work together to provide innovative solutions to developing a sustainable rural health workforce and healthcare. The advancement of telehealth and other technologies to increase the reach of health care to these communities has been beneficial, but there is still a requirement to ensure equitable access to health workers in rural areas.

At the 71st World Health Assembly held in May 2018, the ‘triple billion’ targets were approved as part of the World Health Organisation’s new five year strategic plan. By 2023, the targets aims to achieve:

  • 1 billion more people benefitting from universal health coverage;
  • 1 billion more people better protected from health emergencies; and
  • 1 billion more people enjoying better health and wellbeing.

To achieve these targets, it is important to consider the WHO Sustainable Developmental Goals (SDG) and Universal Health Coverage to help “ensure that everyone, everywhere can access essential quality health services without financial hardship” [World Health Organisation].

This Special Issue will explore the many different approaches to the provision of healthcare in rural and remote communities globally, including health workforce development, integrated healthcare, telehealth, technological advancements in health, environmental health, education and training, capacity building in rural communities, health policy, universal health coverage, and Indigenous health. The issue is open to any topic related to rural and remote health. The listed keywords suggest just a few of the many possibilities.

Assoc. Prof. Rohan Rasiah
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Rural and remote health
  • Health workforce
  • Participation and social inclusion
  • Health education and training
  • Telehealth, information communication technology (ICT)
  • Integrated care
  • Multidisciplinary healthcare
  • Interprofessional
  • Quality of life
  • Social participation
  • Holistic approaches
  • Resilience
  • Health literacy
  • Self-management
  • Health behaviour and health seeking
  • Health knowledge, attitudes, practice
  • Community participation
  • Indigenous, Aboriginal, First Nations
  • Health policy
  • Primary healthcare
  • Universal health coverage
  • Environmental health

Published Papers (25 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review, Other

Article
Commitments, Conditions and Corruption: An Interpretative Phenomenological Analysis of Physician Recruitment and Retention Experiences in Indonesia
Int. J. Environ. Res. Public Health 2022, 19(9), 5518; https://doi.org/10.3390/ijerph19095518 - 02 May 2022
Viewed by 574
Abstract
Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians’ decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the [...] Read more.
Complex factors influence physicians’ decisions to remain in rural and remote (RR) practice. Indonesia, particularly, has various degrees of poor governance contributing to physicians’ decisions to stay or leave RR practice. However, there is a paucity of literature exploring the phenomenon from the perspective of Indonesian RR physicians. This study explores physicians’ lived experiences working and living in Indonesian RR areas and the motivations that underpin their decisions to remain in the RR settings. An interpretative phenomenological analysis was utilised to explore the experiences of 26 consenting voluntary participants currently working in the RR areas of Maluku Province. A focus group discussion was undertaken with post-interns (n = 7), and semi-structured interviews were undertaken with junior (n = 9) and senior physicians (n = 10) working in district hospitals and RR health centres. Corruption was identified as an overarching theme that was referred to in all of the derived themes. Corruption adversely affected physicians’ lives, work and careers and influenced their motivation to remain working in Indonesia’s RR districts. Addressing the RR workforce shortage requires political action to reduce corruptive practice in the districts’ governance. Establishing a partnership with regional medical schools could assist in implementing evidence-based strategies to improve workforce recruitment, development, and retention of the RR medical workforce. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
How Does Public Health Investment Affect Subjective Well-Being? Empirical Evidence from China
Int. J. Environ. Res. Public Health 2022, 19(9), 5035; https://doi.org/10.3390/ijerph19095035 - 21 Apr 2022
Cited by 1 | Viewed by 493
Abstract
Maximizing or improving residents’ subjective well-being is one of the basic purposes of public expenditure. As an important component of public expenditure, the impact of public health investment on residents’ subjective well-being receives considerable attention. Regarding the empirical evidence, this paper measures residents’ [...] Read more.
Maximizing or improving residents’ subjective well-being is one of the basic purposes of public expenditure. As an important component of public expenditure, the impact of public health investment on residents’ subjective well-being receives considerable attention. Regarding the empirical evidence, this paper measures residents’ subjective well-being from the perspectives of overall cognitive happiness, life satisfaction, positive emotions and negative emotions, on the basis of a multi-level structural model of subjective well-being. Factor analysis is used to estimate the subjective well-being of residents at the province level in China, based on the China Family Panel Studies of 2018. In addition, structural equation modeling is employed to explore the impact of public health investment and its regional disparity on the subjective well-being of residents. The empirical results show that public health investment has a significant positive effect on residents’ subjective well-being. Moreover, there is an inverted U-shaped relationship between the regional disparity of public health investment and residents’ subjective well-being. Further study illustrates that the effects of public health investment and its regional disparity on residents’ subjective well-being are heterogeneous by group. Public health investment has a greater impact on the well-being of low- and middle-income, eastern and urban residents than high-income, midwest and rural residents. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Comparison of Study Quality as Determined by Standard Research and Community Engagement Metrics: A Pilot Study on Breast Cancer Research in Urban, Rural, and Remote Indigenous Communities
Int. J. Environ. Res. Public Health 2022, 19(9), 5008; https://doi.org/10.3390/ijerph19095008 - 20 Apr 2022
Viewed by 501
Abstract
The purpose of this review is to compare research evaluation tools to determine whether the tools typically used for assessing the quality of research adequately address issues of Indigenous health and culture, particularly when the studies are intended to benefit Indigenous peoples in [...] Read more.
The purpose of this review is to compare research evaluation tools to determine whether the tools typically used for assessing the quality of research adequately address issues of Indigenous health and culture, particularly when the studies are intended to benefit Indigenous peoples in urban, regional, rural, and remote settings. Our previously published systematic review evaluated studies about breast cancer using a modified Indigenous community engagement tool (CET). In this study, we evaluated the same studies using two commonly used tools: the Critical Appraisal Skills Programme (CASP) for qualitative research; and the Effective Public Health Practice Project (EPHPP) for quantitative research. The results were then compared to ascertain whether there was alignment between performances in terms of engagement and the CASP/EPHPP metrics. Of the 15 papers, 3 papers scored weakly on both metrics, and are therefore the least likely to offer reliable findings, while 2 papers scored strongly on both metrics, and are therefore the most likely to offer reliable findings. Beyond this summation, it was clear that the results did not align and, therefore, could not be used interchangeably when applied to research findings intended to benefit Indigenous peoples. There does not appear to be a pattern in the relationship between the reliability of the studies and the study settings. In order to address disparities in health outcomes, we must assess research through a typical research quality and cultural engagement and settings lens, ensuring that there is rigour in all aspects of the studies. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Children’s Filial Piety Changes Life Satisfaction of the Left-Behind Elderly in Rural Areas in China?
Int. J. Environ. Res. Public Health 2022, 19(8), 4658; https://doi.org/10.3390/ijerph19084658 - 12 Apr 2022
Viewed by 555
Abstract
Along with the aging of the population and miniaturization of family structure, the problem of the left-behind elderly has become more and more prominent in China. According to the Report on the family development in China (2015) released by the National Health Commission [...] Read more.
Along with the aging of the population and miniaturization of family structure, the problem of the left-behind elderly has become more and more prominent in China. According to the Report on the family development in China (2015) released by the National Health Commission of the People’s Republic of China, left-behind elderly people account for half of the total number of the elderly, of whom 10% live alone. The left-behind elderly not only suffer physiological obstacles such as body function decline, but also face a lack of support at the material level and loneliness at the spiritual level, which greatly affects their quality of life, accounting for their lower life satisfaction than that of the ordinary elderly. The rural areas of Sichuan Province are relatively backwards in terms of economic level and have limited pension security. Therefore, the left-behind elderly in rural areas are confronted with more complicated and severe pension problems compared with those in urban areas. Meanwhile, limited by economic and regional factors, a large number of rural labor forces in Sichuan Province have transferred to cities. These long-time migrant workers cannot provide material, spiritual and life care support for their left-behind parents in rural areas in a timely fashion, which changes their filial piety behaviors, and this affects the life satisfaction of the rural left-behind elderly. Therefore, it is necessary to understand the living conditions of empty-nest elderly and their children’s filial piety in rural areas of Sichuan province in order to verify the influence mechanism of filial piety on the life satisfaction of the elderly, and to explore how to improve the rural empty-nest elderly’s life satisfaction, enabling the elderly to live a healthy and happy life. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon
Int. J. Environ. Res. Public Health 2022, 19(7), 4193; https://doi.org/10.3390/ijerph19074193 - 01 Apr 2022
Cited by 1 | Viewed by 459
Abstract
Cervical cancer is a major public health problem, especially in the north region of Brazil. The aim of the study was to identify the factors associated with not undergoing the cervical cancer screening test in rural riverside populations in the Amazon. A cross-sectional [...] Read more.
Cervical cancer is a major public health problem, especially in the north region of Brazil. The aim of the study was to identify the factors associated with not undergoing the cervical cancer screening test in rural riverside populations in the Amazon. A cross-sectional home-based survey was carried out in 38 locations covered by a fluvial primary healthcare team, and the administrative records of the screening tests from January 2016 to May 2019 were analyzed. After the descriptive analysis, logistic regression was performed considering the outcome of having undergone cervical cancer screening within the past three years. Of the 221 women assessed, 8.1% had never undergone the test, and 7.7% had undergone it more than three years ago. Multiparity (OR = 0.76 (95%CI = 0.64–0.90)), occupation in domestic activities (OR = 0.31 (95%CI = 0.11–0.89)), and lack of knowledge of the healthcare unit responsible for the service (OR = 0.18 (95%CI = 0.04–0.97)) were associated with not undergoing the cervical cancer screening test. The administrative records revealed that the screening test was performed outside the recommended age range (24%), performed needlessly (9.6%) with undue repetitions (3.2%), and a high percentage of the samples collected were unsatisfactory (23.5%). The findings revealed the existence of barriers for riverside women to access cervical cancer screening tests. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Liver Disease Screening and Hepatitis C Virus Elimination in Taiwan Rural Indigenous Townships: Village-By-Village Screening and Linking to Outreach Hepatology Care
Int. J. Environ. Res. Public Health 2022, 19(6), 3269; https://doi.org/10.3390/ijerph19063269 - 10 Mar 2022
Viewed by 524
Abstract
Medical resources are limited for hepatitis C virus (HCV) elimination in rural indigenous areas of Taiwan. This study aimed to investigate liver disease risk and conduct a HCV elimination program in two rural indigenous townships. A program of village-by-village screening tests was conducted [...] Read more.
Medical resources are limited for hepatitis C virus (HCV) elimination in rural indigenous areas of Taiwan. This study aimed to investigate liver disease risk and conduct a HCV elimination program in two rural indigenous townships. A program of village-by-village screening tests was conducted including hepatitis B virus surface antigen (HBsAg), antibody to HCV (anti-HCV) and gamma-glutamyl transferase (GGT), linking to outreach hepatology care at two indigenous townships (Laiyi and Mudan). Adult residents were invited to join this program. One hepatology specialist assessed liver disease risk, provided HCV treatment counselling and initiated direct acting antivirals (DAA) at an outreach hepatology clinic in primary health centers. A total of 3503 residents attended this program with a screening coverage of 73.5%. The prevalence of HBsAg, anti-HCV, and high GGT level was 8.2%, 10.0% and 19.5%, respectively. Laiyi had significantly higher prevalence of anti-HCV than Mudan. While males had significantly higher prevalence of HBsAg and high GGT in both townships, females in Laiyi had higher anti-HCV prevalence. HBsAg and high GGT prevalence peaked at 40–59 years of age and anti-HCV prevalence increased significantly with age. Two hundred and sixty-three residents visited the outreach hepatology clinic for HCV treatment evaluation, with 121 (46%) residents having active HCV, while 116 received DAA, with 111 (95.7%) achieving HCV elimination. For rural indigenous townships in southern Taiwan, HCV infection and alcohol consumption were two major liver disease risks. While HCV infection was predominant in old females, chronic hepatitis B virus infection and habitual alcohol consumptions predominated in middle-aged males. HCV elimination was achieved by the village-by-village screening model and linked to outreach hepatology care. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
“No One Manages It; We Just Sign Them Up and Do It”: A Whole System Analysis of Access to Healthcare in One Remote Australian Community
Int. J. Environ. Res. Public Health 2022, 19(5), 2939; https://doi.org/10.3390/ijerph19052939 - 03 Mar 2022
Cited by 1 | Viewed by 964
Abstract
Objective: To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. Setting: A remote community in New South Wales, Australia. Participants: Aboriginal [...] Read more.
Objective: To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. Setting: A remote community in New South Wales, Australia. Participants: Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. Design: Case study. Methodology: The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. Results: Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. Conclusion: The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study
Int. J. Environ. Res. Public Health 2021, 18(23), 12767; https://doi.org/10.3390/ijerph182312767 - 03 Dec 2021
Cited by 1 | Viewed by 707
Abstract
Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs [...] Read more.
Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Fostering Health Literacy Responsiveness in a Remote Primary Health Care Setting: A Pilot Study
Int. J. Environ. Res. Public Health 2020, 17(8), 2730; https://doi.org/10.3390/ijerph17082730 - 16 Apr 2020
Cited by 3 | Viewed by 1488
Abstract
Primary healthcare organisations have an important role in addressing health literacy as this is a barrier to accessing and utilising health care. Until recently, no organisational development tool operationalising health literacy in an Australian context existed. This research evaluated the efficacy of the [...] Read more.
Primary healthcare organisations have an important role in addressing health literacy as this is a barrier to accessing and utilising health care. Until recently, no organisational development tool operationalising health literacy in an Australian context existed. This research evaluated the efficacy of the Organisational Health Literacy Responsiveness (Org-HLR) tool and associated assessment process in a primary healthcare organisation in the Pilbara region of Western Australia. This study utilised a sequential explanatory mixed methods research design incorporating the collection and analysis of data in two phases: (1) Pre- and post-survey data and; (2) seven semi-structured interviews. Survey results showed that participants’ confidence in core health literacy concepts improved from baseline following the intervention. Analysis of the interview data revealed participants’ initial understanding of health literacy was limited, and this impeded organisational responsiveness to health literacy needs. Participants reported the workshop and tool content were relevant to their organisation; they valued involving members from all parts of the organisation and having an external facilitator to ensure the impartiality of the process. External barriers to improving their internal organisational health literacy responsiveness were identified, with participants acknowledging the management style and culture of open communication within the organisation as enablers of change. Participants identified actionable changes to improve their organisational health literacy responsiveness using the process of organisational assessment and change. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context
Int. J. Environ. Res. Public Health 2020, 17(8), 2698; https://doi.org/10.3390/ijerph17082698 - 14 Apr 2020
Cited by 26 | Viewed by 3498
Abstract
People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor [...] Read more.
People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia
Int. J. Environ. Res. Public Health 2020, 17(6), 2031; https://doi.org/10.3390/ijerph17062031 - 19 Mar 2020
Cited by 6 | Viewed by 2501
Abstract
Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. [...] Read more.
Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion program. Data from self-report questionnaires (n = 245), including items of Communities Advancing Resilience Toolkit (CART) assessment, and qualitative (focus group and interview) data from key local stakeholders (n = 24), were pooled to explore the factors perceived to be influencing program implementation. Survey results indicate the primary community resilience strengths across the four sites were related to the ‘Connection and Caring’ domain. The primary community resilience challenges related to resources. Qualitative findings suggested lack of communication and leadership are key barriers to effective program delivery and identified a need to provide ongoing support for program staff. Assessment of perceived community resilience may be helpful in informing the implementation of mental health promotion programs in rural areas and, in turn, improve the likelihood of their success and sustainability. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Extending a Conceptual Framework for Junior Doctors’ Career Decision Making and Rural Careers: Explorers versus Planners and Finding the ‘Right Fit’
Int. J. Environ. Res. Public Health 2020, 17(4), 1352; https://doi.org/10.3390/ijerph17041352 - 20 Feb 2020
Cited by 3 | Viewed by 1118
Abstract
This study uses data from a Rural Clinical School of Western Australia (RCSWA) and WA Country Health (WACHS) study on rural work intentions among junior doctors to explore their internal decision-making processes and gain a better understanding of how junior doctors make decisions [...] Read more.
This study uses data from a Rural Clinical School of Western Australia (RCSWA) and WA Country Health (WACHS) study on rural work intentions among junior doctors to explore their internal decision-making processes and gain a better understanding of how junior doctors make decisions along their career pathway. This was a qualitative study involving junior doctor participants in postgraduate years (PGY) 1 to 5 undergoing training in Western Australia (WA). Data was collected through semi-structured telephone interviews. Two main themes were identified: career decision-making as an on-going process; and early career doctors’ internal decision-making process, which fell broadly into two groups (‘explorers’ and ‘planners’). Both groups of junior doctors require ongoing personalised career advice, training pathways, and career development opportunities that best “fit” their internal decision-making processes for the purposes of enhancing rural workforce outcomes. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Can Age-Friendly Planning Promote Equity in Community Health Across the Rural-Urban Divide in the US?
Int. J. Environ. Res. Public Health 2020, 17(4), 1275; https://doi.org/10.3390/ijerph17041275 - 17 Feb 2020
Cited by 11 | Viewed by 2355
Abstract
In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index [...] Read more.
In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index based on the World Health Organization’s (WHO) domains of age-friendly communities: health, housing, neighborhood, transportation, environment, engagement, and opportunity. This study links the 2018 AARP Livability Index categories with demographic structure and socio-economic factors from the American Community Survey at the county level in the US to examine if the physical, built and social environment differentiate communities with better community health across the rural–urban divide. Results show that the neighborhood built environment has the largest impact on community health for all county types. Although rural areas lag in community health, those which give more attention to engagement and opportunity rank higher. Rural communities with more African Americans, children, and poor Whites, rank lower on community health. While neighborhood characteristics have the strongest link to community health, a broader approach with attention to age, race, poverty and engagement and opportunity is needed for rural areas. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia
Int. J. Environ. Res. Public Health 2020, 17(3), 808; https://doi.org/10.3390/ijerph17030808 - 28 Jan 2020
Cited by 3 | Viewed by 1939
Abstract
In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the [...] Read more.
In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen’s health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Social Participation and Functional Decline: A Comparative Study of Rural and Urban Older People, Using Japan Gerontological Evaluation Study Longitudinal Data
Int. J. Environ. Res. Public Health 2020, 17(2), 617; https://doi.org/10.3390/ijerph17020617 - 18 Jan 2020
Cited by 24 | Viewed by 2309
Abstract
This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological [...] Read more.
This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Understanding the Factors Influencing Junior Doctors’ Career Decision-Making to Address Rural Workforce Issues: Testing a Conceptual Framework
Int. J. Environ. Res. Public Health 2020, 17(2), 537; https://doi.org/10.3390/ijerph17020537 - 15 Jan 2020
Cited by 10 | Viewed by 1435
Abstract
Medical graduates’ early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown [...] Read more.
Medical graduates’ early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown to influence workplace location, but the interaction between interest, training availability, and other work-relevant factors has not yet been fully explored. A qualitative study conducted by the Rural Clinical School of Western Australia (RCSWA) and WA Country Health Service (WACHS) explored factors influencing the decision to pursue rural work among junior doctors. Data collection and analysis was iterative. In total, 21 junior doctors were recruited to participate in semi-structured telephone interviews. Two main themes relating to the systems of influence on career decision-making emerged: (1) The importance of place and people, and (2) the broader context. We found that career decision-making among junior doctors is influenced by a complex web of factors operating at different levels. As Australia faces the challenge of developing a sustainable rural health workforce, developing innovative, flexible strategies that are responsive to the individual aspirations of its workforce whilst still meeting its healthcare service delivery needs will provide a way forward. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
‘It Shouldn’t Be This Hard’: Exploring the Challenges of Rural Health Research
Int. J. Environ. Res. Public Health 2019, 16(23), 4643; https://doi.org/10.3390/ijerph16234643 - 22 Nov 2019
Cited by 9 | Viewed by 1724
Abstract
Health research is important for innovation and assessment of health status and health interventions, and maintaining a strong, engaged cohort of rural health researchers is essential for the ongoing improvement of the health of rural populations. Ethical guidelines and processes ensure research is [...] Read more.
Health research is important for innovation and assessment of health status and health interventions, and maintaining a strong, engaged cohort of rural health researchers is essential for the ongoing improvement of the health of rural populations. Ethical guidelines and processes ensure research is undertaken in a way that protects and, where possible, empowers participants. We set out to systematically examine and document the challenges posed by ethics and governance processes for rural health researchers in Western Australia (WA) and the impact on the research undertaken. In this qualitative study, fifteen WA-based rural health researchers were interviewed. The identified challenges included inefficient systems, gatekeeping, apparent resistance to research and the lack of research experience of those involved in approval processes. For researchers seeking to conduct studies to improve rural and Aboriginal health, extended delays in approvals can hold up and impede research, ultimately changing the nature of the research undertaken and constraining the willingness of practitioners and researchers to undertake health research. Unwieldy ethics processes were seen to have a particularly onerous impact on rural research pertaining to service delivery, multiple sites, and research involving Aboriginal people, impeding innovation and inquiry in areas where it is much needed. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Article
Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia
Int. J. Environ. Res. Public Health 2019, 16(22), 4488; https://doi.org/10.3390/ijerph16224488 - 14 Nov 2019
Cited by 11 | Viewed by 3337
Abstract
Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote [...] Read more.
Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
Exploring Readiness for Change: Knowledge and Attitudes towards Family Violence among Community Members and Service Providers Engaged in Primary Prevention in Regional Australia
Int. J. Environ. Res. Public Health 2019, 16(21), 4215; https://doi.org/10.3390/ijerph16214215 - 30 Oct 2019
Cited by 1 | Viewed by 2099
Abstract
Community efforts at the primary prevention of family violence (FV) involve changing values, structures and norms that support gender inequality. This study examines the attitudes of a group of highly engaged community leaders and service providers involved in FV primary prevention in Geraldton, [...] Read more.
Community efforts at the primary prevention of family violence (FV) involve changing values, structures and norms that support gender inequality. This study examines the attitudes of a group of highly engaged community leaders and service providers involved in FV primary prevention in Geraldton, a small city in regional Western Australia. The outcomes of focus group discussions were mapped against a readiness for change model. Despite considerable involvement in discussions of FV prevention over time, the readiness level of these engaged community members for taking leadership roles in the prevention strategy were between pre-planning and preparation stages, although some individuals’ understanding of the drivers of FV and readiness for implementing change was higher. Key areas for further education are the role of gender inequality as the primary driver of FV, particularly rigid gender roles and men’s control of decision making, and the role of alcohol and drugs as reinforcers but not primary drivers of FV. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Article
‘It’s Important to Make Changes.’ Insights about Motivators and Enablers of Healthy Lifestyle Modification from Young Aboriginal Men in Western Australia
Int. J. Environ. Res. Public Health 2019, 16(6), 1063; https://doi.org/10.3390/ijerph16061063 - 24 Mar 2019
Cited by 7 | Viewed by 3752
Abstract
Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were [...] Read more.
Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were sought out to explore how they achieved this success. Four Aboriginal men aged 20–35 years were identified and consented to participate. Their perceptions of motivation for change, strategies, and facilitators and barriers were explored through in-depth interviews. Themes developed from the interviews included self-efficacy, self-reliance, and increased knowledge and altered health beliefs underpinning change. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. In a setting with high levels of disadvantage, participants had relatively favourable socioeconomic circumstances with solid social supports. These findings highlight that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed. Increasing diabetes awareness among at-risk young people is important, emphasising the largely preventable and potentially reversible nature of the condition. Broad health improvements and individual changes will be facilitated by equitable socioeconomic circumstances and environments that support health. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Review

Jump to: Research, Other

Review
Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress
Int. J. Environ. Res. Public Health 2022, 19(13), 7705; https://doi.org/10.3390/ijerph19137705 - 23 Jun 2022
Viewed by 309
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and [...] Read more.
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Review
Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review
Int. J. Environ. Res. Public Health 2019, 16(24), 5126; https://doi.org/10.3390/ijerph16245126 - 15 Dec 2019
Cited by 12 | Viewed by 2643
Abstract
This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban [...] Read more.
This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts. Full article
(This article belongs to the Special Issue Rural and Remote Health)

Other

Jump to: Research, Review

Systematic Review
Effect of Rural Clinical Placements on Intention to Practice and Employment in Rural Australia: A Systematic Review
Int. J. Environ. Res. Public Health 2022, 19(9), 5363; https://doi.org/10.3390/ijerph19095363 - 28 Apr 2022
Viewed by 503
Abstract
Background: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP [...] Read more.
Background: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP for nursing, midwifery, allied health, and dentistry health professions in Australia, which have received substantial federal investment. This review examined the relationship between rural CP and non-medicine health students’ future rural practice intentions and workforce outcomes. Methods: Four databases were systematically searched; papers were screened using defined criteria and appraised using the mixed-methods appraisal tool (MMAT). Findings were synthesized using a critical narrative approach. Results: The methodological quality of the 29 eligible studies (13 quantitative non-randomized, 10 mixed method, 4 qualitative, 2 quantitative description) was appraised. Ten high-quality studies were identified. The review found that positive CP experiences may influence intention to practice rurally amongst undecided students and serve as a reinforcing experience for those students already interested in rural practice. There were mixed findings regarding the influence of CP length. The review also found that there is currently only evidence for the short-term effects of CP on students’ future practice outcomes in rural areas with focus thus far on early practice outcomes. Conclusions: Those looking to use rural CP to promote the rural health workforce should focus on supporting the quality of a large number of CP experiences that are undertaken in rural areas, as there are currently differing findings on the role of rural CP length. Future studies of rural CP should consider greater use of social and educational theories to guide them. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Systematic Review
Telecardiology in Rural Practice: Global Trends
Int. J. Environ. Res. Public Health 2022, 19(7), 4335; https://doi.org/10.3390/ijerph19074335 - 04 Apr 2022
Viewed by 546
Abstract
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of [...] Read more.
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Show Figures

Figure 1

Brief Report
Predictors of At-Home Death for Cancer Patients in Rural Clinics in Japan
Int. J. Environ. Res. Public Health 2021, 18(23), 12703; https://doi.org/10.3390/ijerph182312703 - 02 Dec 2021
Viewed by 564
Abstract
Background: The prediction of at-home deaths has become an important topic in rural areas of Japan with an advanced aging society. However, there are no well-established predictors to explain how these factors influence intention. This study aims to investigate the possible predictors of [...] Read more.
Background: The prediction of at-home deaths has become an important topic in rural areas of Japan with an advanced aging society. However, there are no well-established predictors to explain how these factors influence intention. This study aims to investigate the possible predictors of at-home death for cancer patients in rural clinics in Japan. Methods: This is a nationwide cross-sectional survey. A self-administered questionnaire was sent to 493 rural clinics in Japan. The main outcome was the realization of at-home deaths for cancer patients. Results: Among the 264 clinics (54%) that responded to the survey, there were 194 clinics with the realization of at-home death. The use of a clinical pathway (adjusted odds ratio 4.19; 95% confidence interval 1.57–11.19) and the provision of organized palliative care (adjusted odds ratio 19.16; 95% confidence interval 7.56–48.52) were associated with the prediction of at-home death, irrespective of island geography or the number of doctors and nurses. Conclusions: Having a clinical pathway and systematizing palliative care could be important to determine the possibility of at-home deaths for cancer patients in rural clinics in Japan. Full article
(This article belongs to the Special Issue Rural and Remote Health)
Back to TopTop