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Background: Several rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions., Methods: We conducted ten Focus Group Discussions with rural women aged 25-49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women's statements., Results: Lack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women's ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women's concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women's ability to: understand information and access to cervical cancer screening services at individual level., Conclusions: This study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions., (© 2024. The Author(s).)

Early screening for cervical cancer has substantially reduced the morbidity and mortality attributed to it. This study aimed to assess factors that affect the intention to undergo cervical cancer screening among rural women attending primary healthcare facilities in south-central Ethiopia. A health-facility-based, cross-sectional study design was employed for which the calculated required sample size was 427. An interviewer-administered structured questionnaire was adapted from previously published research and used to collect data. Statistical Package for Social Sciences (SPSS) version 27 was used for the statistical analysis. A logistic regression model was used to determine the factors that influenced the women's intention to undergo cervical cancer screening. A total of 420 women participated in this study, with a response rate of 98%. The mean score from the questionnaire that was used to assess the women's intention to undergo cervical cancer screening was 10.25 (SD ± 2.34; min 3, max 15). The absence of previous screening experience (AOR: 0.498; 95% CI 0.27-0.92) and high degree of perceived behavioural control (AOR, 0.823; 95% CI 0.728-0.930) were significantly negatively associated with women's intention to undergo cervical cancer screening. Previous screening experience and perceived behavioural control significantly influenced the intention to undergo cervical cancer screening. Women in rural areas could, therefore, benefit from awareness-creation programmes that focus on these factors.

Background: Intensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes., Methods: A three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions., Discussion: The CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings., Trial Registration: Registered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022., (© 2024. The Author(s).)

Background: Oral cancer is becoming a primary concern for non-communicable illnesses and global health care initiatives. Low-income people, people with disabilities, the elderly, residents of detached and rural regions, and people belonging to minority groups bear a greater burden of oral diseases. The purpose of this research is to identify rural women's oral cancer prevention activities using the theory of planned behavior (TPB)., Methods: The current research is a cross-sectional analysis of 700 female hookah users who were referred to rural health facilities in Fasa and Shiraz, Fars, Iran in 2019-2020. The participants were selected by random sampling method. The TPB questionnaire and a demographic information questionnaires were the data gathering instruments used in this study to assess oral cancer prevention practices among participants. Data were analyzed by SPSS 22 using frequency, mean, and standard deviation as descriptive statistics, and Pearson correlation coefficients and linear regression as inferential statistics at a significance level of P  < 0.05. The Kolmogorov-Smirnov test was used to determine whether the data were normal., Results: The average age of the participants was 44.54 ± 8.72 years, and the average age at which they started hookah was 23.8 ± 28.68 years. The average history of hookah use was 15.8 ± 6.65 years, and the average size of the household in the test group was 4.73 ± 1.16. The average scores of the constructs of the TPB and oral cancer prevention behaviors were average or at a low level, while nicotine addiction was relatively high. The constructs of knowledge, attitude, subjective norms, and behavioral intention are significantly correlated with oral cancer prevention behaviors in hookah-user women. There was a significant inverse relationship between nicotine dependence and oral cancer prevention behaviors, and there was a strong link between perceived behavioral control and behavioral intention ( P  < 0.05)., Conclusion: Based on the results of this study, the average scores of the structures of the TPB and oral cancer prevention behaviors were average or at a low level among rural hookah-user women, which indicates the necessity of an educational program based on this theory for rural women to adopt and maintain oral cancer prevention behaviors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Mohammadkhah, Kamyab and Khani Jeihooni.)

Introduction: Cervical cancer is an important public health issue in Bangladesh. Despite government efforts, the awareness and healthcare utilization in rural areas are inadequate., Methodology: This cross-sectional study was conducted in six districts of Barishal division over 997 respondents aged 15-64 years. The demographic variables, accessibility to healthcare, vaccination status, awareness of HPV causing cervical cancer, and knowledge of the HPV vaccine were recorded through a structured questionnaire. T-test for univariate and chi-square test for bi-variate analysis were used. Logistic regression was used to determine factors associated with awareness., Results: Most of the participants were SSC passed (45.3%), unemployed (54.4%), and married (74.4%). While 83.5% were aware of cervical cancer, only 3.3% knew about HPV's role. The majority (96.2%) had never been tested for HPV, albeit 79.5% knew about the vaccine, and only 2.45% were vaccinated. Knowledge levels were low, with only 1.4% demonstrating sound knowledge, mostly associating with higher income, residing closer to healthcare facilities, and being married. Bhola district participants had highest level of awareness, and the lowest was in Pirojpur. Education level was positively correlated with knowledge, with graduates being most aware. Logistic regression showed education, marital status, willingness to vaccinate daughters, and district were significantly related with better awareness, while income, distance, and age did not., Conclusion: Mass education and awareness campaigns may improve the awareness level in rural community., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Sexual health literacy (SHL) is a set of skills related to sexual behaviors that can affect sexual behavior and empower individuals to maintain as well as improve their sexual health. This study aimed to investigate the rural women's sexual health literacy and its related factors in Iran. This cross-sectional study was conducted on 200 married women of reproductive ages referring to health center in Benaroyeh region along with six sub-villages in the South of Fars, Iran. Using convenience sampling method, we collected data via demographic-reproductive characteristics questionnaire and sexual health literacy for adult's questionnaire. We analyzed data using SPSS-16. Approximately 33.5% of the women obtained their sexual information online. The mean total SHL score was 75.64 ± 12.81. The SHL level was considered desirable in 82.5% of the participants. Among the four domains of SHL, the scores of most subjects on access skills and analysis-evaluation skills were unfavorable, 24.5% and 35.5%, respectively. The results show that the SHL level was correlated with education (P = 0.021) and inversely related to the gravidity (P = 0.04). There was also a statistically significant relationship between SHL level and women's career (P = 0.026), spouse's career (P = 0.01), and parity (P = 0.05). Most rural women had desirable levels of SHL. Given the lower levels of SHL in access and analysis-evaluation skills, and given the prevalence of Internet use, the provision of high quality and accessible online sexual health content within social and cultural norms is recommended., (© 2024. The Author(s).)

Objectives: To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services., Methods: Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022., Results: The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics., Discussion: Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. RE [ER] department: Department of Veterans Affairs, Boston, United States; and the authors are from different locations., (© 2024 Cohen, Monteith, Stacker, McCarthy, Bomsztyk, Wilson, Childers, Hussain and Kohlwes.)

Background: Chinese rural women aged 35-64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women's preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS., Methods: A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women's BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women's preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated., Results: A total of 451 rural women, aged 35-64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named "process driven" and "efficiency driven" were identified by the preference heterogeneity analysis of the LCM., Conclusion: There is a higher uptake of breast cancer screening when services are tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: The purpose of this study was to examine how rural women cancer survivors experience and manage financial toxicity., Methods: A qualitative descriptive design was used to explore experiences of financial toxicity among rural women who received cancer treatment. We conducted qualitative interviews with 36 socioeconomically diverse rural women cancer survivors., Results: Participants were categorized into three groups: (1) survivors who struggled to afford basic living expenses but did not take on medical debt; (2) survivors who took on medical debt but were able to meet their basic needs; and (3) survivors who reported no financial toxicity. The groups differed by financial and job security and insurance type. We describe each group and, for the first two groups, the strategies they used to manage financial toxicity., Conclusions: Financial toxicity related to cancer treatment is experienced differently by rural women cancer survivors depending on financial and job security and insurance type. Financial assistance and navigation programs should be tailored to support rural patients experiencing different forms of financial toxicity., Implications for Cancer Survivors: Rural cancer survivors with financial security and private insurance may benefit from policies aimed at limiting patient cost-sharing and financial navigation to help patients understand and maximize their insurance benefits. Rural cancer survivors who are financially and/or job insecure and have public insurance may benefit from financial navigation services tailored to rural patients that can assist with living expenses and social needs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women., Methods: This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed., Results: The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001)., Conclusion: The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience., (© 2024. The Author(s).)

Women's empowerment and health literacy are essential for fostering community well-being. Empowering women through education and diverse training plays a crucial role in ensuring their prosperity and overall health. This study investigates the satisfaction and experiences of underprivileged rural mothers participating in a functional literacy education program in the Kailali district, Nepal. We assess participants' perceptions of program effectiveness, examining training content, facilities, and trainers while exploring menstrual hygiene practices and maternal health awareness. Through convenience sampling, 141 underprivileged women from five rural villages near Tikapur were selected from literacy centers run by Mahima Group. Utilizing structured questionnaires and statistical analyses, including descriptive analyses, Spearman's rho correlation, and Pearson's chi-square test, we found that 65.2% of participants expressed high satisfaction levels. Moreover, 96.5% found the program highly effective, with 97.9% reporting improved literacy skills and 96.5% demonstrating increased awareness of menstrual hygiene practices. Additionally, 97.2% agreed that the program enhanced maternal and child health knowledge. Significant correlations were observed among the training course, facilities, trainers, and overall training perception. In line with this, significant associations were found between age groups ( p = 0.003) and geographical areas ( p = 0.023) with satisfaction levels with the literacy program. These results underscore the satisfaction of participants within the literacy program and its impact on their lives, and advocates for its broader implementation to empower marginalized communities for sustainable development.

Problem: Training programs aimed at empowering rural women in Kurdistan, Iran, have fallen short of their goals. This study offers a unique understanding of how contextual factors and cultural nuances impact the effectiveness of market-driven training programs for rural women in Kurdistan., Objectives: This study explored factors affecting the effectiveness of market-driven training programs for rural women in Kurdistan., Methods: A qualitative approach using grounded theory methodology was employed. Interviews were conducted with 23 key informants, including rural women and experts. Data analysis with MAXQDA software identified seven categories and a core category related to market-driven training., Findings: The study revealed that successful implementation of market-driven training hinges on various external and internal factors. These include access to markets, facilities, and funding, along with effective monitoring of business activities. Additionally, rural community culture and the purchasing power of women were identified as key intervening conditions impacting program success. When implemented effectively, market-driven training programs have the potential to empower women, reduce rural migration, and improve product quality., Recommendations: The research suggests that future training programs should adopt a multi-dimensional approach that addresses the identified factors to achieve sustainable positive outcomes for rural women in Kurdistan., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Allahmoradi, Hosseini, Lashgarara and Moghaddasi.)

Introduction: The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women., Methods: A household survey was conducted by using a multi-stage sample with 407 married women aged 18-45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services., Results: Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth., Conclusion: This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth., (© 2024. The Author(s).)

Rural women veterans are less likely than men and nonrural veterans to access Veterans Health Administration (VHA) care. This qualitative study describes rural women veterans' barriers to accessing care and explores whether participants viewed a peer specialist intervention as having the potential to facilitate access to care. We recruited rural veterans who identified as women with psychological distress and social needs, women peer specialists, and VHA primary care professionals working with rural veterans. We conducted two veteran focus groups, two peer specialist focus groups, and 11 individual Patient Aligned Care Team professional interviews using semistructured interview questions. One of the veteran focus groups was exclusive to veterans of color. We used a rapid qualitative data analysis approach to analyze the results. Data analysis revealed barriers affecting perceived access to services for rural women veterans, especially veterans of color, including transportation, finances, childcare, long travel distance to clinics, lack of access to gender-specific services, ineligibility for services, and lacking information about available resources. Participants also reported challenges accessing community services outside of the VHA. The rural women veterans reported a strong preference for gender-specific services. Leveraging existing VHA resources with rural women veterans may mitigate some of the identified barriers. In particular, participants agreed that increasing availability of peer specialists who are both women and veterans could bridge some perceived barriers to accessing care among rural women veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States., Methods: This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse., Results: During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women ( P  < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics., Conclusions: Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: We compared differences in perinatal outcomes among rural and nonrural women, stratified by maternal race/ethnicity. We also examined differences between majority minority rural counties with majority White rural counties., Study Design: We conducted a retrospective cohort study with 2015 national vital statistics birth certificate data. Maternal county of residence was identified, and counties with <50,000 people were designated as rural. We compared adverse perinatal outcomes between rural and nonrural residents, stratified by race/ethnicity. Adverse perinatal outcomes included primary term cesarean, preterm birth (PTB) <37 and <32 weeks, neonatal intensive care unit (NICU) admissions, infant death, small for gestational age, and Apgar's scores <7 and <3 at 5minutes. Majority-minority rural counties were defined as counties having <50% White women. We compared perinatal outcomes among this cohort to those of women from majority White rural counties. Bivariate analysis and multivariable logistic regression were performed., Results: Within the entire cohort, rural residents were more likely to be younger (age ≥35 years, 10.1 vs. 16.8%; p <0.001), Medicaid beneficiaries (50.3 vs. 44.1%; p <0.001), and uninsured (6.6 vs. 4.2%; p <0.001), and less likely to be married (57.4 vs. 60.20%; p <0.001). Rural residence was associated with Apgar's score <7 (adjusted odds ratio [aOR]=2.04; 95% confidence interval [CI]: 1.64-2.54) and <3 (aOR=1.90; 95% CI: 1.04-3.48) among Asian women. Rural residence was also associated with PTB <37 weeks among Black (aOR=1.09; 95% CI: 1.06-1.13) and Asian women (aOR=1.16; 95% CI: 1.03-1.31). When compared with majority White rural county of residence, majority-minority rural county of residence was associated with the adverse perinatal outcomes studied., Conclusion: We observed increased rates of adverse perinatal outcomes among rural women. These trends persisted in majority-minority rural. Additional study is needed to find actionable targets for improving outcomes for rural women., Key Points: · Rural county of residence was associated with lower socioeconomic markers.. · Perinatal outcomes were worse among women from rural counties.. · Differences in perinatal outcomes exist among rural women by race/ethnicity.., Competing Interests: None declared., (Thieme. All rights reserved.)

Context: Breast self-examination (BSE) is a simple and cost-effective screening procedure in downstaging breast tumors., Aim: To assess the BSE practices and its associated knowledge and attitudes of rural women from Tirunelveli District, Tamil Nadu during the COVID-19 pandemic., Settings and Design: A descriptive cross-sectional survey design was employed, and snowball sampling was used to recruit the sample of rural women from Tirunelveli., Materials and Methods: Women ages 18-60 willing to take part were included. Data were collected online through a self-developed questionnaire., Statistical Analysis: Responses were analyzed using SPSS Version 20. Descriptive statistical analysis was used to present the general details and responses of the rural women through percentages. Using the appropriate tests, the mean differences of the BSE attitudes based on the personal variables were computed using one-way ANOVA., Results: A total of 433 rural women (Mean age: 29.20 ± 9.35 years) from Tirunelveli responded to the online Knowledge, Attitude and Practice (KAP) questionnaire. Regular health checkups were undergone by 27.48% of women and 9.24% underwent breast cancer (BC) screening in the past. While 68.36% had heard of BC, 61% knew it could be detected in the early stages. Insufficient knowledge regarding BSE techniques was evident among the women. Knowledge about BC was highest among those earning more than 20,001 INR, women aged 36-45, widowed/separated/divorced women, and diploma graduates. Overall, BSE and BC knowledge score was low, with correspondingly low attitudes and practices., Conclusion: Findings showed the KAP among rural Tirunelveli women to be low., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)

Access to justice is a fundamental principal of the rule of law. With this in mind, this research aims to analyze the mechanisms and barriers that women from rural areas in the province of Chimborazo, Ecuador, face when seeking justice. This investigation adopted a qualitative method approach, and was comprised of exploratory fieldwork as well as descriptive documentary analysis. The findings indicate that in this province, rural women's access to justice is facilitated through various government institutions and university legal clinics. These entities collaborate to spread awareness and offer direct legal assistance. However, despite these efforts, challenges persist, including the lack of specific data on the affected women's localities and the need for broader dissemination of available legal pathways. The study concludes that addressing these shortcomings is essential to further bolster the province's legal infrastructure and better address the intricate needs of its female population, particularly those from rural backgrounds., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The menopausal experiences of women in selected rural areas of Visnagar, addressing a research gap within cultural and socio-economic landscapes is of interest. The global aging trend was reflected in the 26% representation of women aged 50 and over in the study. Employing a cross-sectional design, 200 menopausal women were sampled through stratified random sampling, emphasizing demographic diversity. Results from a structured Knowledge Questionnaire and a Likert Scale for Attitude revealed that women generally possessed commendable knowledge (mean score 10.94) and positive attitudes (mean score 28.66) toward menopause. Significant associations between age, education, occupation, and income with knowledge and attitudes were uncovered through chi-square tests. This study underscored the need for tailored interventions in rural settings, considering the influence of cultural, regional, and demographic factors on menopausal experiences. The findings contributed to bridging the research gap and emphasized the importance of individualized approaches for promoting the well-being of menopausal women in rural communities., (© 2024 Biomedical Informatics.)

Rural women are important agents of development and they are the backbone of achieving sustainable development in any society. However, rural women in Nigeria, like in most developing countries, disproportionately bear the burden of poverty due to poor access to productive resources, information and services. There is growing evidence that prioritizing measures for ending poverty among rural women represents an important gateway to the achievement of other global goals. This study therefore seeks to determine the extent of multidimensional poverty among rural women in Nigeria and to also identify its critical risk factors. Using secondary data obtained from 2018/2019 Harmonized Nigeria Living Standard Survey (HNLSS), findings from the study reveal that more than three-quarters of the rural women in Nigeria are multidimensionally poor and they experience multiple deprivations in the weighted indicators across the poverty dimensions. The living standard dimension accounted for the largest share of deprivation suffered by rural women while health dimension contributed the least. However, further analysis across the sub-indicators of poverty dimensions revealed security shocks, unemployment and time to health care services as the biggest contributors to multidimensional poverty of rural women in Nigeria. Results also show that age, household size, years of education, household expenditure, ownership of cropland, credit access and access to safety nets are the main determinants of multidimensional poverty among rural women. The study recommends the need to focus on policy options that provide more primary health care services, increase employment opportunities and strengthen shock-preventive or shock-responsive social protection systems of rural women., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author.)

Open defecation continuously remains a major global sanitation challenge, contributing to an estimated 1.6 million deaths per year. Ghana ranks second in Africa for open defecation and had the fourth-lowest sanitation coverage in 2010. Evidence indicates that about 32% of the rural Ghanaian population still practice open defecation due to lack of access to basic sanitation facilities, drifting the country from achieving universal access to sanitation by 2030. Women, particularly those in rural areas, are disproportionately affected by open defecation, facing heightened health risks, harassment, and a loss of dignity. Even though previous studies on open defecation in Ghana exist, they lack national representation and neglect women in rural residents who are disproportionally affected by the repercussions of open defecation. Examining that rural women will contribute to heightening their own vulnerability to health risks by practising open defecation is essential to bridging the literature gap on open defecation practices among rural women. The study investigated determinants of open defecation among rural women in Ghana using data from the female files of the 2003, 2008 and 2014 Demographic and Health Surveys (DHS). A total of 4,284 rural women with complete information on variables of interest were included in the study. The outcome variable was 'open defecation', whilst 14 key explanatory variables (e.g., age, education, wealth status, among others) were used. Two logistic regression models were built, and the outputs were reported in odds ratio. Descriptively, 42 in every 100 women aged 15 to 49 practiced open defecation (n = 1811, 95% CI = 49-52). Open defecation (OD) significantly correlated with educational attainment, wealth status, religion, access to mass media, partner's education, and zone of residence. The likelihood of practicing open defecation reduced among those with formal education [aOR = 0.69, CI = 0.56-0.85], those whose partners had formal education [aOR = 0.64, CI = 0.52-0.80], women in the rich wealth quintile [aOR = 0.12, CI = 0.07-0.20], the traditionalist [aOR = 0.33, CI = 0.19-0.57], and those who had access to mass media [aOR = 0.70, CI = 0.57-0.85]. Residents in the Savannah zone had higher odds of openly defecating [aOR = 21.06, CI = 15.97-27.77]. The prevalence of open defecation is disproportionately pro-poor, which indicates that impoverished rural women are more likely to perform it. Public health initiatives should aim to close the rich-poor divide in OD practice among rural women., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: The Veterans Health Administration (VA) Office of Rural Health (ORH) and Office of Women's Health Services (OWH) in FY21 launched a three-year Enterprise-Wide Initiative (EWI) to expand access to preventive care for rural, women Veterans. Through this program, women's health care coordinators (WHCC) were funded to coordinate mammography, cervical cancer screening and maternity care for women Veterans at selected VA facilities. We conducted a mixed-methods evaluation using the RE-AIM framework to assess the program implementation., Materials and Methods: We collected quantitative data from the 14 program facilities on reach (i.e., Veterans served by the program), effectiveness (e.g., cancer screening compliance, communication), adoption, and maintenance of women's health care coordinators (WHCC) in FY2022. Implementation of the program was examined through semi-structured interviews with the facility WHCC funding initiator (e.g., the point of contact at facility who initiated the request for WHCC funding), WHCCs, and providers., Results: Reach . The number of women Veterans and rural women Veterans served by the WHCC program grew (by 50% and 117% respectively). The program demonstrated effectiveness as screening rates increased for cervical and breast cancer screening (+0.9% and +.01%, respectively). Also, maternity care coordination phone encounters with Veterans grew 36%. Adoption : All facilities implemented care coordinators by quarter two of FY22. Implementation . Qualitative findings revealed facilitators and barriers to successful program implementation and care coordination. Maintenance : The EWI facilitated the recruitment and retention of WHCCs at respective VA facilities over time., Implications: In rural areas, WHCCs can play a critical role in increasing Reach and effectiveness. The EWI demonstrated to be a successful care coordination model that can be feasibly Adopted , Implemented , and Maintained at rural VA facilities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Relyea, Kinney, DeRycke, Haskell, Mattocks and Bastian.)

Process evaluation is essential to understanding and interpreting the results of randomized trials testing the effects of behavioral interventions. A process evaluation was conducted as part of a comparative effectiveness trial testing a mailed, tailored interactive digital video disc (DVD) with and without telephone-based patient navigation (PN) to promote breast, cervical and colorectal cancer screening among rural women who were not up-to-date (UTD) for at least one screening test. Data on receipt, uptake, and satisfaction with the interventions were collected via telephone interviews from 542 participants who received the tailored interactive DVD (n = 266) or the DVD plus telephone-based PN (n = 276). All participants reported receiving the DVD and 93.0% viewed it. The most viewed sections of the DVD were about colorectal, followed by breast, then cervical cancer screening. Most participants agreed the DVD was easy to understand, helpful, provided trustworthy information, and gave information needed to make a decision about screening. Most women in the DVD+PN group, 98.2% (n = 268), reported talking with the navigator. The most frequently discussed cancer screenings were colorectal (86.8%) and breast (71.3%); 57.5% discussed cervical cancer screening. The average combined length of PN encounters was 22.2 minutes with 21.7 additional minutes spent on coordinating activities. Barriers were similar across screening tests with the common ones related to the provider/health care system, lack of knowledge, forgetfulness/too much bother, and personal issues. This evaluation provided information about the implementation and delivery of behavioral interventions as well as challenges encountered that may impact trial results., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: Gender and geographic access to care play a large role in health disparities in esophageal cancer care. The aim of our study was to evaluate disparities in peri-operative outcomes for patients undergoing esophagectomy based on gender and geographic location., Methods: A retrospective cohort of prospectively collected data from patients who underwent esophagectomy from 2003 to 2022 was identified and analyzed based on gender and county, which were aggregated into existing state-level "metropolitan" versus "rural" designations. The demographics, pre-operative treatment, surgical complications, post-operative outcomes, and length of stay (LOS) of each group were analyzed using chi-squared, paired t -tests and single-factor ANOVA., Results: Of the 1545 patients, men (83.6%) and women (16.4%) experienced similar rates of post-operative complications, but women experienced significantly longer hospital ( p = 0.002) and ICU ( p = 0.03) LOSs as compared with their male counterparts, with no differences in 30-day mortality. When separated by geographic criteria, rural women were further outliers, with significantly longer hospital LOSs ( p < 0.001) and higher rates of ICU admission ( p < 0.001)., Conclusions: Rural female patients undergoing esophagectomy were more likely to have a longer inpatient recovery process compared with their female metropolitan or male counterparts, suggesting a need for more targeted interventions in this population.

Introduction and Background: It is claimed that very little research has been done in Africa on breast cancer screening to identify the best method that can be adopted to have early detection of the malignancy. Breast cancer is a growing burden globally and in Sub-Saharan Africa (SSA). There is a rise in breast cancer mortality in SSA. This is caused by limited breast cancer screening or early detection practices due to limited resources which makes mammography unaffordable by the majority of women. This problem is more prevalent in elderly women living in rural areas where limited or no breast cancer screening is taking place. Downstaging which is context-specific is recommended for African countries but more studies are required to confirm its effectiveness., Objectives: This review aims to identify the gaps in the literature focusing on strategies to enhance breast cancer screening among elderly women aged 40-75 years who reside in rural areas., Inclusion Criteria: The articles to be reviewed should focus on screening for the elderly women population that reside in rural areas and should fall within the age range of 40-75 years. Other phrases that can be included instead of breast cancer screening could be early detection measures, early diagnosis, or downstaging., Methodology: The methodology was guided by the published manual for Joana Briggs Institute for scoping reviews. A search of the relevant studies was conducted on 4 October 2022 across PubMed, SCOPUS, Embase, and EBSCO Host databases. The systematic literature search strategy was developed and carried out using the Medical Subject Heading (MeSH) database. The eligibility criteria were developed using the Participants, Concept, and Context framework. Only articles written in English and published between 2010 and 2022 were considered. Removal of duplications was done first, followed by screening using the article title and abstract and then using full-text articles. The results of the search were profiled on the PRISMAScR flow chart diagram. Themes were identified from the conclusions of the reviewed studies., Results: After searching 78 citations were identified. These were screened and only 8 were left after the different stages of screening. The reviewed articles were published between 2010 and 2020. The majority (75%) of the studies were surveys except for two which were qualitative and all done in Kenya. No mixed methodology study was done. No study focused on developing a model to enhance breast cancer screening among rural women aged 40-75 years although there are very few countries in Africa with established nationwide breast cancer screening guidelines., Conclusion: There are limited studies done on breast cancer screening of elderly rural women in SSA. No study was done to identify a model to enhance breast cancer screening among the rural elderly women population. None of the reviewed studies utilized the mixed methodology design to have an in-depth context-specific understanding to pave the way for the implementation of downstaging which is recommended for countries with limited resources., Contribution: The scoping review indicated the gap in research in terms of breast cancer screening among women aged 40-75 years who reside in rural areas and highlighted the future need for such studies to make downstaging effective., (Copyright © 2023. Published by Elsevier Inc.)

The purpose of this cross-sectional study was to identify the current awareness about cervical cancer prevention among rural women in Luohe City as well as its potential influencing factors. Meanwhile, these data were expected to provide a theoretical basis for Luohe future cervical cancer prevention and therapy. Based on geographical distribution, 40 villages in Luohe City were randomly selected, and questionnaires were given to women in each village. In this study, a total of 4665 questionnaires were distributed, and 4561 valid questionnaires were returned, with a recovery rate of 97.98%. The average score was 4.06 ± 2.46 out of 10. It was found that women had a high awareness rate of cervical cancer screening (55.25%) but a low awareness rate of human papillomavirus (HPV) and HPV vaccine (10.17%). Moreover, univariate and multivariable analyses showed that age > 45 years, low household income, low education level, being a farmer, spouse unemployment, no pregnancy or birth delivery history, no family or personal history of cervical disease, and no previous complimentary 2-cancer screening (i.e., breast cancer and cervical cancer) were all factors influencing the cognitive level of rural women in Luohe City (P < .05). However, ethnicity, marital status, and spouse education level were not correlated with cognitive level (P > .05). In conclusion, low awareness of cervical cancer prevention among rural women in Luohe was correlated with individual, family, and social factors. So it was recommended to cultivate the rural population knowledge, optimize screening strategies, and conduct targeted cervical cancer prevention and treatment in rural regions., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Rising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care-typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by comparatively assessing hospital use in rural SSA by wealth and parity., Methods: Countries in SSA with a Demographic and Health Survey since 2015 were included. We assessed rural hospital childbirth stratifying by wealth (wealthier/poorer) and parity (nulliparity/high parity≥5), and their combination. We computed percentages, 95% CIs and percentage-point differences, by stratifier level. To compare hospital use across countries, we produced a composite index, including six utilisation and equality indicators., Results: This cross-sectional study included 18 countries. In all, a minority of rural women used hospitals for childbirth (2%-29%). There were disparities by wealth and parity, and poorer, high-parity women used hospitals least. The poorer/wealthier difference in utilisation among high-parity women ranged between 1.3% (Mali) and 13.2% (Rwanda). We found use and equality of hospitals in rural settings were greater in Malawi and Liberia, followed by Zimbabwe, the Gambia and Rwanda., Discussion: Inequalities identified across 18 countries in rural SSA indicate poor, higher-risk women of high parity had lower use of hospitals for childbirth. Specific policy attention is urgently needed for this group where disadvantage accumulates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province., Methods: The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software., Results: The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05)., Conclusion: Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program., (© 2024. The Author(s).)

Gastric cancer is a common cause of cancer death in the world. This study examined 120 rural women. The educational program included four sessions for each group based on the health belief model. The mean age of the women was 34.51 ± 9.16. The mean score of the perceived barriers significantly decreased in the experimental group (11.08 ± 0.37) compared to the control group (14.92 ± 0.42) ( P  < .001), and the mean score of knowledge, performance and HBM constructs, increased significantly 2 months after the education ( P  < .001).It is recommended that educational interventions be designed by HBM to improve nutritional behaviors related to GC in the female population.

Background: Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women., Methods: In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4 months after the intervention., Results: The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs ( P < 0.05) was observed in the control group., Conclusion: This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Despite women accounting for an increasing proportion of impaired drivers and higher rates of impaired driving and road fatalities in rural areas, little is known about rural women who drive impaired and their other risky behavior. Objective: The present study assessed the association between impaired driving history, risky substance use, and other drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. Methods: Four hundred women from three rural jails provided information about their impaired driving, drug use, injection drug use practices, and sex risk behaviors. Groups were stratified on whether they self-reported impaired driving in the year prior to incarceration. Impaired drivers ( n  = 260, M  = 31.90 years old) were compared to women who did not drive impaired ( n  = 131, M  = 34.42 years old) using MANCOVA and logistic regression analyses. Results: Impaired drivers had significantly ( p < .05) higher substance use severity scores for cannabis, sedatives, and prescription opioids. Furthermore, impaired drivers were significantly ( p < .05) more likely to have been the passenger of an impaired driver (78.08% vs. 53.44%), been an injection drug user (69.62% vs. 41.98%), had a casual sex partner (47.31% vs. 25.95%), and traded sex for drugs or money (31.15% vs. 15.27%) in the year prior to incarceration. Conclusions: This study found a consistent association between past year impaired driving and a range of drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. These findings highlight an opportunity to intervene in criminal justice settings to reduce multiple health risk behaviors.

Background: Worldwide exclusive breastfeeding is still recommended as a successful strategy even during the COVID -19 pandemic to lower infant morbidity and mortality. This study aimed to assess the knowledge and practices of exclusive breastfeeding among rural women during the COVID-19 pandemic., Methods: A descriptive cross-sectional study was conducted at EL-Morabeen Family Medicine Center in rural Damietta, Egypt among 178 lactating women who were chosen by using the purposive sampling technique. A developed structured questionnaire consisting of four parts was used to gather data from March to May 2022. Univariate analysis for descriptive data and bivariate analysis through the chi-square test were performed., Results: The current study revealed that 73% of the studied rural women did not receive any breastfeeding counseling during antenatal visits and 61.2% of them believed that coronavirus was transmitted through breastmilk. Only 15.2% of them breastfed their infant exclusively for 6 months, 88.2% of mothers delayed breastfeeding initiation after delivery and 48.3% administered the prelacteal feeds. A total of 98.3% of rural women had never made skin-to-skin contact, and 79.2% of them had not been vaccinated against COVID-19. Additionally, a statistically significant association between good knowledge and practice with highly educated women aged 26-30 years, with a monthly income of 4000-6000 L.E was found. Furthermore, only 26.4% and 26.1% of rural women had good knowledge and practice scores respectively., Conclusion: Suboptimal breastfeeding practices, such as delayed onset of breastfeeding, low percentages of exclusivity, early weaning, prelacteal feeding administration, and lack of skin-to-skin contact during the COVID -19 pandemic were prevalent among the studied rural mothers. Breastfeeding counseling for all pregnant women and implementation of evidence-based practices in the health care system, such as the early initiation of breastfeeding and skin-to-skin contact, are recommended., (© 2023. The Author(s).)

Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field., (© 2023 The Authors. Research in Nursing & Health published by Wiley Periodicals LLC.)

Rural women suffer greater vulnerability to food insecurity (FI) compared to their urban or male counterparts. We analyzed the association between food security (FS) status and dietary diversity (DD) in rural women through data from the Mexican National Health and Nutrition Survey (ENSANUT) 2018 from 2,099 rural women. DD was measured using a semi-quantitative food frequency questionnaire. FS was measured using the Latin America and Caribbean Food Security Scale (ELCSA). The prevalence of any level of FI was 70.1%. Mean DD score was 3.8. Mild FI was associated with low DD (OR 1.49, 95% CI 1.06, 2.10). Results highlight the need for government strategies targeted to this population sector to improve their diet quality.

Worldwide, unintended pregnancies remain a critical public health challenge, with 74 million women in low- and middle-income countries getting these pregnancies yearly. The African continent alone contributes about 25% of all unintended pregnancies globally. Even though not all unintended pregnancies are unwanted, they can lead to many health problems for mothers and children, like malnutrition, sickness, neglect, or abuse, as well as maternal and infant morbidities and mortalities. Globally, many women die due to complications related to childbirth, either during or after pregnancy. Contraceptives, especially for long-acting reversible Contraceptive methods (LARCs), are among the best interventions to reduce maternal death. LARCs help the mother delay pregnancy and allow for longer intervals in childbirth spacing. However, utilising LARCs globally and in Uganda remains low because of limited male partner support.The purpose of this phenomenological qualitative research study was to elicit an understanding of the perceptions and beliefs of rural indigenous Ugandan men towards the use of LARCs by rural women. Ultimately the study designed strategies to enhance the uptake of those methods. Purposive sampling was used to identify 65 participants for focus group interviews and 30 for individual interviews comprising married men aged 20 to 49 years. The study was conducted in the Rubanda and Kiboga Districts of Uganda. The researcher used semi-structured questions for individual and focus group interviews.The data analysis was done by transcribing the interviews, sorting the field notes, organising, and storing the data, listening to recordings, and reading field notes and interviews to look for patterns related to the perceptions and belief systems. Using the identified patterns, the researcher coded and categorised the data to build themes emerging on the phenomenon.The study established negative perceptions and belief systems among rural indigenous Ugandan men regarding the use of LARCs by their rural women, which acted as barriers to utilisation. These perceptions included side effects, fears, desires, and cultural and religious beliefs. The study recommends strengthening social and behavioural change communication, strengthening service provision for LARCs, and monitoring and evaluation systems for LARCs. Additionally, policymakers should provide a conducive environment for LARC services provision, and the Ministry of Education and Sports, through health training institutions and universities, should prepare pre-service and in-service healthcare workers to provide LARC services., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Mobile phones have emerged as the predominant technology in developing countries, especially within agricultural enterprises. This research investigates the influence of mobile phone utilization on the empowerment of female entrepreneurs in rural farming communities. Data were gathered from 150 female agricultural entrepreneurs in the rural regions of Bangladesh. The empowerment of these women was assessed across five dimensions: economic, social, technological, psychological, and political. The findings indicate that the composite empowerment index was notably higher at 61.92% post-mobile phone adoption, in contrast to 37.47% prior to its use. This underscores the positive impact of mobile phone utilization on the empowerment of rural female farmers. The research highlighted significant enhancements in all five empowerment dimensions, with these augmentations being statistically meaningful. The most pronounced improvement was observed in economic empowerment, while political empowerment witnessed the least growth. Furthermore, the shifts were profoundly correlated with the other three dimensions: social, technological, and psychological. The evidence establishes a link between mobile phone adoption by rural female farmers and their subsequent empowerment, with empowerment metrics showing a steady rise from the low-usage to the high-usage categories. Consequently, the correlation is positive. The results advocate that mobile phone utilization assists rural female farmers in augmenting their empowerment. It is thus recommended that policymakers and developmental organizations prioritize mobile technology as a tool to empower rural women in Bangladesh. This can be realized by enhancing accessibility, confronting socio-cultural barriers, and fostering digital literacy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

The study was conducted to examine the implications of the Common Interest Group (CIG) scheme for rural livelihood change in the selected areas of the Wara-Jarso woreda, Central Ethiopia. The study focuses on the activities of the CIGs, their effectiveness, Strengths, Weaknesses, Opportunities, and Threats, along with the changes in the livelihood status of CIG members. Four CIGs that fits into the aim of the study were purposively selected from the CIGs operating in the woreda. Among a qualitative research approach, a case study was employed. The data were collected from January 1, 2021 to February 28, 2021. Primary data were gathered using Focus Group Discussions and Key Informant Interviews. A thorough desk review of official documents and other secondary sources was made as an auxiliary method to capture sets of relevant information. The data organization was performed by the MAXQDA 2020 qualitative data analysis package program. The data were analyzed using thematic analysis, relational analysis, and content analysis methods. It was found that the CIGs have encouraged strong social capital among members and becomes an important alternative financial source. It was also found that the CIGs operation has encountered problems related to lack of entrepreneurial education and skill training, monitoring and evaluation, workplace, coordination among stakeholders, inadequate and improper financial use, and non-existence of market linkage. Their strengths, weaknesses, and opportunities were also indicated. For successful rural women and youth livelihood change through the CIGs scheme, the study recommends access to entrepreneurial skill training, coordination among relevant stakeholders, strong monitoring and evaluation, access to market linkage and workplace, and adequate funding., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Leul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Limited research exists on the employment experiences of rural women cancer survivors, yet this population may face unique barriers to employment following a cancer diagnosis. This study aims to identify facilitators and barriers to employment for rural women cancer survivors., Methods: We used a qualitative descriptive design to examine facilitators and barriers to employment for rural women cancer survivors. We conducted interviews with 33 rural women with cancer histories., Results: Facilitators of employment included paid time off, flexible work arrangements, and supportive workplace social networks, while barriers to employment included compromised immunity, long-term treatment effects, stigma and discrimination, and limited rural job markets. Rural women with secure employment histories generally experienced facilitators of employment, while rural women with insecure (e.g., temporary, informal, non-standard) employment histories generally faced barriers to retaining jobs and finding employment., Conclusions: Formal and informal workplace support helped rural women retain their jobs during and following cancer treatment, especially those with secure employment. However, women with insecure employment histories generally faced multiple barriers to retaining and finding employment. More inclusive policies to support workers facing disabling illnesses, such as paid medical leave, are needed to ensure cancer survivors can maintain employment and/or financial security during and following their cancer treatment., Implications for Cancer Survivors: Cancer survivors with secure employment may benefit from formal and informal workplace support in retaining their employment. Those with insecure employment histories may benefit from access to job placement services and inclusive policies protecting employment for all workers experiencing disabling illness., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Breast cancer is a serious public health threat. Mammography is the most reliable screening method that detects breast cancer early, enabling early onset of treatment which improves the prognosis of the disease., Objectives: To determine women's knowledge of breast cancer, as well as barriers and willingness of women to participate in mammography screening., Methods: Using the cross-sectional survey design, we sampled and studied two rural communities of Enugu State, Nigeria. Two researcher-made questionnaires were used for the study. Frequencies, percentages, chi-square and regression analysis were employed in data analysis., Results: Only 11.4 percent of study participants had good knowledge of breast cancer. There were significant differences in knowledge of breast cancer based on level of education (χ 2 = 15.670; p =.001), monthly income (χ 2 =6.954; p = .021) and ever screened (χ 2 =5.242; p =.015). Lack of money (48.0%) and lack of knowledge (30.4%) were the most reported barriers to breast cancer screening. Women that had ever screened were 92.3% less likely willing to be screened than those never screened (aOR: .077, 95%CI .011-.522, p=.009)., Conclusion: Health Education should be combined with improving women's economic status and subsidizing the cost of screening to increase breast cancer screening practice., (© 2023 Abugu LI et al.)

Objectives: to analyze the social representations of rural women about being a woman in the rural context and its implications for sexual and reproductive health., Methods: this is a descriptive qualitative study with data triangulation, based on the Theory of Social Representations, developed with 31 women who live in the rural context of Minas Gerais (MG/BR). An in-depth interview with a semi-structured script was conducted. A lexical analysis was performed with the help of the ALCESTE 2012 software., Results: the family relationship, especially the couple's, demonstrated subjectivities and was permeated by violence and normalized sexual practice. The imagery dimension of the ideal family seems to be responsible for exerting domination over rural women., Final Considerations: rural women are subject to the norms and prescriptions of a patriarchal society. It is urgent to increase attention to sexual and reproductive health in an egalitarian and liberating way in order to minimize the consequences of machismo and conservatism.

Background: In recent times, cervical dysbiosis which mostly causes and aggravates infections is highlighted for its role in immune modulation in cervical dysplasia, which promotes the shifting of Th1 phenotype immunity to Th2 phenotype immunity. This study therefore estimated and compared the levels of circulatory IL-4, IL-6, IL-10, TNF- α , and IFN- γ cytokines among adult women identified to have different grades of cervical intraepithelial neoplasia (CIN) and with cervicovaginal infection., Methods: A total of 157 participants were recruited from the Akyemansa District of Ghana, and cervical swabs and blood samples were taken. The Pap smear test, microbiological culture, and ELISA were employed for cytology analysis, bacteria isolation, and identification and estimation of IL-4, IL-6, IL-10, TNF- α , and IFN- γ cytokines, respectively., Results: Overall, 14/157 (8.9%) had CIN with 7.6% having CIN 1 and 1.3% having CIN 2. The main predictor for CIN was age above 46 years (OR 11.16, 95% CI: 2.4-51.8). Bacterial vaginosis ( p = 0.003) and Candida infection ( p = 0.012) were significantly higher in CIN. Again, Staphylococcus aureus (60% vs. 17.6%, p = 0.005) , Citrobacter sp. (40.0% vs. 13.2%, p = 0.017), and Morganella morganii (40.0% vs. 4.4%, p = 0.002) isolates were significantly higher in CIN-positive participants. IL-10 and TNF- α concentrations were elevated in participants with CIN 1+ (TNF- α NIL vs. CIN 1+ only, p < 0.05) while IL-6 was decreased among participants with CIN 1+. In the presence of vaginal infection, TNF- α decreased among CIN 1+ participants while IL-10 remained elevated., Conclusion: The findings of this study suggest that cervical dysbiosis causes immune suppression, which creates a suitable microenvironment for the development of CIN., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2023 Loretta Betty Blay Mensah et al.)

Purpose: Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services., Methods: Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts., Findings: Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities., Conclusion: Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

According to this study., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Persistent high-risk human papillomavirus (hrHPV) infection is associated with most cervical cancers. This study aims to investigate the prevalence of and independent risk factors for hrHPV infection among women residing in rural areas of Shanxi Province, China., Methods: Data from the records of the cervical cancer screening programs for rural women in Shanxi Province were retrospectively collected. Women receiving primary HPV screening between January 2014 and December 2019 were included. The detection rate of hrHPV was calculated, and the independent risk factors for hrHPV infection were analyzed by multivariate logistic regression., Results: Among the women included, the overall infection rate of hrHPV was 14.01% (15,605/111,353), with the top five subtypes being HPV16 (24.79%), HPV52 (14.04%), HPV58 (10.26%), HPV18 (7.25%), and HPV53 (5.00%). The independent risk factors for hrHPV infection were specific geographical regions, testing years, older age, lower education level, inadequate previous screening, bacterial vaginosis, trichomonas vaginitis, and cervical polyps., Conclusion: Rural women over 40 years of age, especially those who had never received screening, have a significantly increased risk for hrHPV infection and should be the target population with priority in cervical cancer screening., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.

Purpose: The present study aimed to evaluate the implementation of a civic engagement curriculum (HEART Club) designed to catalyze positive environmental change in rural communities., Design: The HEART Club curriculum was integrated into a six-month community-based health behavior intervention to reduce cardiovascular disease risk., Setting: Participants were recruited from eight rural towns in Montana and New York., Subjects: 101 midlife and older women., Intervention: Participants worked to address an issue related to their local food or physical activity environment and establish progress monitoring benchmarks., Method: Evaluation components included after-class surveys, program leader interviews ( n = 15), participant focus groups ( n = 8), and post-intervention surveys., Results: Intervention sites reported high fidelity (78%) to the curriculum. Average attendance was 69% and program classes were rated as highly effective (4.1 out of 5). Despite positive participant feedback, low readiness for civic engagement and insufficient time were implementation challenges. The majority of HEART Club groups had accomplished two or more benchmarks post-intervention. Facilitators of progress included community support, effective leadership, and collective effort. Participants also indicated that trying to affect community change while simultaneously making personal health improvements likely stalled initial progress., Conclusion: These findings highlight the potential and challenges associated with civic engagement within the context of rural lifestyle interventions. Future implementation efforts should focus on reframing civic engagement as an approach to support and maintain behavior change.

Background: This study aimed to identify factors affecting the behavioral intention of Iranian rural women to use medicinal herbs. The research model was developed by integrating "dissatisfaction with modern medicine" into the "theory of planned behavior"., Methods: Data were collected through questionnaire from a sample of 260 Iranian rural women, which were randomly selected. The validity and reliability of the scale were confirmed using expert opinions and Cronbach's alpha method, respectively., Results: Based on the results of structural equation modeling, attitude (β = 0.44; p < 0.01), subjective norms (β = 0.27; p < 0.01) and dissatisfaction with modern medicine (β = 0.11; p < 0.05) had significant positive effects on rural women's intention to use medicinal herbs. In addition, subjective norms indirectly affected rural women's intention to use medicinal herbs through attitude (β = 0.23; p < 0.01)., Conclusions: Subjective norms was a key factor in determining the intention of Iranian rural women to use medicinal herbs, followed by attitude and dissatisfaction with modern medicine. Therefore, this study could contribute to our understanding on how the intention of Iranian rural women to use medicinal herbs was influenced by different factors., (© 2023. The Author(s).)

Background: Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM)., Methods: We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model., Results: The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05)., Conclusions: Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide., Trial Registration: Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569., (© 2023. The Author(s).)

The metalloid arsenic (As) induces oxidative stress is a well-known fact. However, the extent of variation of oxidative stress according to different exposure levels of As in groundwater and the mechanism responsible for As mediated oxidative stress is yet to be elucidated in a human population of West Bengal. In the present study, we have investigated the impact of low level (> 10 ≤ 50 µg/L) and high-level groundwater As (> 50 µg/L) on cellular redox status, DNA damage, and repair mechanisms in chronically exposed rural women of West Bengal. Prediction models of ordinary least square regression of nail As, forced vital capacity (FVC) %, and that of forced expiratory volume during the first one second (FEV1) % deciphered that accumulation of As in nails may predict hemoglobin deficiency. Moreover, consumption of As-laced water tends to decrease FEV1% and FVC%. A strong positive correlation was observed between water and nail As level and reactive oxygen species (ROS) generation. ROS, perturbed nuclear factor erythroid 2-related factor 2(Nrf2)/ Kelch-like ECH-associated protein 1 (Keap1) redox regulation, compromised antioxidant defense machinery-superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione transferase (GST), induced DNA damage, and suppressed DNA repair proteins-poly ADP ribose polymerase1(PARP1)/ X-ray repair cross-complementing protein 1(XRCC1)/ 8-oxoguanine glycosylase (OGG1) in a dose-dependent manner. All the low and high As areas had very high cancer risk values for the exposed population. It has been predicted that if the As level in the drinking water of a 40-year adult increases by 2 ug/L, the likelihood of the cancer risk will increase by 10%, keeping the body weight and amount of water intake constant. Thus, long-term exposure to either low or high As is seriously affecting the lives of asymptomatic women who are vulnerable to developing carcinogenic changes after a period of latency., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status., Methods: We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects., Results: Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status., Conclusions: Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance., Trial Registration: ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019., (© 2023. The Author(s).)