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Background: Almost half the world's population lives in rural areas. How best to provide palliative care to rural populations is unclear. Privileging rural patient and family voices about their experiences of receiving care delivered via rural palliative care models is necessary. Aim: To identify the key palliative care elements that rural patients with palliative care needs and their families perceive to be critical to receiving the care and support they need to live well. Design and Data Sources: A systematic review and meta-synthesis registered with Prospero (CRD42020154273). Three databases were searched in June 2024. Raw qualitative data were extracted and analysed using Thomas and Harden's three-stage thematic synthesis methodology. Findings reported according to the PRISMA statement. Results: Of the 10,834 identified papers, 11 met the inclusion criteria. Meta-synthesis of extracted, raw quotes (n = 209) revealed three major themes: (1) Honouring the patient's existing relationship with their General Practitioner (GP); (2) strategically timed access to specialist services, clinicians and equipment is critical; and (3) a need to feel safe, prepared and supported. Conclusion: The strategic inclusion of specialists alongside primary care providers is integral to optimising rural palliative care models. General Practioners are central to these models, through being embedded in their communities and as the conduit to specialist palliative care services. Rural palliative care patients and families value responsive care, trajectory signposting, effective communication, 24/7 support and recognise the value of virtual health. Globally, positive public policy and funding is critical to ensuring access to GP-led, specialist-supported, rural palliative care models. [ABSTRACT FROM AUTHOR]

Background: Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner. Objectives: To examine the menstrual hygiene practices of adolescent girls schooling in rural Anambra communities. Study design: Cross-sectional descriptive study. Method: Participants were selected using multistage stratified random sampling technique and interviewed using self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22.0. Results: Mean age of all, pre-menarche and post-menarche girls were 14.7 ± 1.84, 12.8 ± 1.09 and 15.1 ± 1.73 years, respectively. About 46% of the pre-menarche girls had not received any information on menstruation. Common sources of initial menstruation information were mother (87.3%), school (52.2%) and peers (20.0%). Among the 1091 (85.0% (1091/1283)) post-menarche girls, last menstrual period, last menstrual period duration and cycle length could not be recalled by 53.9%, 34.4% and 39.3%, respectively. Majority (98.3%) who could recall last menstrual period had a cycle length of ⩽30 days and the mean duration of menses was 4.4 ± 0.84 days. Disposable sanitary pad was mostly (60%) cited as recommended product, but cloth/rags (40.6%) or tissue paper (32. 3%) were predominantly used. Majority (88.6%) took their bath ⩾twice/day, 50.9% changed sanitary product ⩽twice/day while 72.5% exhibited poor hand washing. Sanitary products were mostly discarded by burning (45.4%). Fifty-one percent could not change in school predominantly due to lack of functional toilets/changing rooms (84.2%) while 72.5% of those who changed did so in bushes or unused spaces. Challenges faced during menstruation include restriction from holy places (38.9%), waist pain (74.9%), blood stains (36.1%) and lack of money to buy pad (27.0%). Factors significantly associated with using commercial pads were age (p = 0.047), class (p = 0.006), mother's educational status (p < 0.001), social class (p < 0.001), ability to recall last menstrual period date (p = 0.029) or duration (p = 0.001). Conclusion: Menstrual hygiene management was unsatisfactory among studied adolescents. Continuous education of adolescent girls on menstrual hygiene management and advocacy for adequate menstrual hygiene management support are imperative. [ABSTRACT FROM AUTHOR]

Bridging literature that addresses the work–family interface and the changing nature ofcareers, this article examines, from a life course perspective, the extent to which, andwhy, young people anticipate careers as ‘flexible'. Drawing on 123 interviews with menand women engaged in different post-secondary education pathways in Australia, thestudy draws attention to the role of gender and to some extent class in shaping careersin a network of social relations. Three dimensions of flexible careers are examined:temporal, that is, through imagined possibilities in various stages of early adulthood;structural, including opportunities and constraints afforded by different industry sectorsand workplaces; and relational, in terms of household-level role negotiations. Thefindings revealed that women continue to adapt their career goals to accommodatecare, but that both men's and women's careers are shaped by contingencies includinghousehold income, home ownership, access to flexible work and ideological expectationsof market/family work roles. These contextual dynamics directly impact on decisions inthe present. The article underscores the need for an expanded research focus on workand care from a life course perspective in order to promote career flexibility in waysthat align with young people's broader aspirations for gender equality. [ABSTRACT FROM AUTHOR]

Background: Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. Its goals are to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services and is grounded in equal partnerships between civic life, community members, patients and carers, and service providers. This takes many forms, including what we have termed the 'citizen organization'. Objectives: This paper reports on an evaluation of Little Haven's model of care and explores the organization's place as a 'citizen' of the community it services. Design: A co-designed evaluation approach utilizing mixed-method design is used. Methods: Multiple data sources obtained a broad perspective of the model of care including primary qualitative data from current patients, current carers, staff, volunteers and organizational stakeholders (interviews and focus groups); and secondary quantitative survey data from bereaved carers. Thematic analysis and descriptive statistics were generated. Results: This model of care demonstrates common service elements including early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users, with strong community engagement. These elements enable high-quality care for patients and carers who describe the support as 'over and above', enabling good quality of life and care at home. Staff and volunteers perceive the built-in flexibility of the model as critical to its outcomes; the interface between the service and the community is similarly stressed as a key service element. Organizational stakeholders observed the model as a product of local activism and accountability to the community. Conclusion: All participant groups agree the service model enables the delivery of excellent care. The construction of a community palliative care service as a citizen organization emerged as a new concept. Plain language summary: 'Citizen organization': an Australian community-based palliative care service model Little Haven is a rural, community-based specialist palliative care service in Gympie, Australia. It aims to provide highest quality of care, support and education for those experiencing or anticipating serious illness and loss. Families and communities work alongside clinical services, with community engagement influencing compassionate care and support of dying people, their families and communities. Public Health Palliative Care promotes community engagement by community-based palliative care services in equal partnerships between civic organizations, community members, patients and carers, and service providers. We undertook an evaluation of Little Haven's model of care by speaking with current patients, current and past carers, staff, volunteers and stakeholders about their experiences of Little Haven. We found that Little Haven's model contains the essential elements of a palliative care service and provides early access to holistic, patient/family-centred, specialized palliative care at little or no cost to users. They have strong community engagement with a strong background in community activism. We identified that Little Haven's 'being in the community' goes beyond service provision or even sentiment. We observed a symbiotic relationship between the organization and the community it supports in what we have termed the 'citizen organization'. The distinctive characteristic of the citizen organization is its inseparability from the community in which it dwells. [ABSTRACT FROM AUTHOR]

Literature widely acknowledges that women who experience Child Sex Abuse (CSA) have a higher risk of experiencing sexual revictimisation later in life, yet less is known about experiences of revictimisation in non-urban areas. The aim of this review is to examine what is known internationally regarding revictimisation of non-urban women, and to provide future research, practice and policy recommendations. A total of 2414 articles were identified through a comprehensive search across five broad health sciences and humanities databases; 11 articles met inclusion criteria and were included in this review. This review found a general lack of qualitative revictimisation studies, and limited research focusing on non-urban women. While existing studies included non-urban research samples, few articles (n = 3) explored how non-urban location contextualises revictimisation experiences. Most peer-reviewed articles identified within this paper (n = 7) examined intimate partner violence (IPV) revictimisation, highlighting a significant lack of research on sexual revictimisation within non-urban settings. Findings from the review indicate that experiences of violence in childhood and adulthood are frequent among non-urban women, and that experiencing child abuse is associated with a heightened likelihood of poor mental health and IPV in adulthood. The review also found that non-urban women faced significant structural disadvantage including low levels of employment and income, limited-service sector resources, unsafe family environments and exposure to community violence. Additional qualitative research is needed to better understand the experiences and needs of non-urban revictimised women, particularly within an Australian context. [ABSTRACT FROM AUTHOR]

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This project employed community researchers as a means of improving community engagement around their Private Water Supplies (PWS) in rural Scotland. In this paper, we reflect on working with community researchers in terms of the benefits and challenges of the approach for future rural research that seeks to improve community engagement. The paper (1) critiques the involvement of community researchers for rural community engagement, drawing on the experiences in this project and (2) provides suggestions for good practice for working with community researchers in rural communities' research. We offer some context in terms of the role of community members in research, the importance of PWS, our approach to community researchers, followed by the methodological approach and findings and our conclusions to highlight that community researchers can be beneficial for enhancing community engagement, employability, and social capital. Future community researcher approaches need to be fully funded to ensure core researchers can fulfil their duty of care, which should not stop when data collection is finished. Community researchers need to be supported in two main ways: as continuing faces of the project after the official project end date and to transfer their newly acquired skills to future employment opportunities. [ABSTRACT FROM AUTHOR]

Background: Issues of the aging population and disability of older persons have been rapidly developing in China over the past 20 years. Since 2016, the Chinese government has been exploring remedies to alleviate social and family burdens and ensure the dignity of the disabled old persons by implementing long-term care insurance systems in a few pilot cities across the country. Purpose: The purpose of this study is to present the current challenges faced by China's long-term care insurance system and put forth suggestions for the future, based on literature research and the feedback obtained from its implementation in pilot areas. Research Design: This paper conducts a theoretical study based on the principles of public health ethics. Study Sample: Since 2016, China has launched two batches of pilot cities for long-term care insurance. The analysis object of this study is the feedback on the policy implementation of the existing 29 pilot cities that participated. The relevant data involved in the analysis are from the authors' field research and published literature on the analysis of pilot cities. Analysis: The ethical value and importance of long-term care insurance policies in China are evaluated from the perspectives of policy philosophy and social individual interests. Results: The results of this evaluation show that the core ethical values were not met in the development of China's current long-term care insurance system. Moreover, distributive justice norms were neglected, and access to the system between different social groups and within the groups covered by it was unequal. Conclusions: This paper argues that long-term care insurance should not differentiate between urban and rural areas in allocating nursing resources. Additionally, it would be essential to build democratic supervision and manage public opinions by adopting open and transparent information-sharing policies. Standards of disability assessments and treatment payment should be at par to ensure a balance between the rights and obligations of policyholders. [ABSTRACT FROM AUTHOR]

Aims: This paper focuses on how social inequality is associated with overweight and obesity in children. There is a lack of research with a focus on an important distinction in social inequality, namely geography. The aim of this study was to reduce this knowledge gap by looking closely at the links between rurality and overweight. Methods: The findings in this paper are based on in-depth interviews with school nurses and teachers in rural Norway. The focus was on their experiences with and knowledge about overweight and obesity numbers in rural versus urban areas. Results: We used Bourdieu's terminology to address the challenges related to urban–rural differences, and found that cultural factors connected to tradition, identity and courtesy play an important role in the rural overweight and obesity discourse. Conclusions: Actors and 'experts' working with overweight and obesity and national guidelines need to understand rural contexts and customs and address problems of the countryside on rural, not exclusively urban, premises. Different contexts imply different needs when it comes to reducing the inequalities between rural and urban areas regarding overweight and obesity. [ABSTRACT FROM AUTHOR]

Background: Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. Aim: To identify the key care elements that optimise palliative care for people in rural communities. Design and data sources: A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. Results: Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. Conclusions: A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs. Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273 [ABSTRACT FROM AUTHOR]

Women's disproportionate engagement in housework and its determinants has been relatively well studied for developed countries, but such research is absent for less developed countries. Unless barriers to women's participation in development efforts are addressed, poverty reduction programs may not succeed. Using data from a household survey of 502 women and employing a multivariate linear regression model, this paper analyzed determinants of women's hours of housework. Results show that, in line with theory and past research, time availability and resources or bargaining power have statistically significant negative associations with a woman's housework time. Similarly, traditional gender perception/practice has the expected positive association with a woman's housework time. National strategies aiming at poverty reduction may need to pay more attention to educate women, help them overcome shortage of working capital, and improve employment opportunities since these may increase resources available to women, empower them, and thereby minimize gendered housework. [ABSTRACT FROM AUTHOR]

The effect of marriage pairings on fertility intentions is specific and has attracted increasing scholarly attention in recent years. Using data from the China Family Panel Studies (CFPS), this study explored the impact of couples' educational pairings, age pairings, and income pairings on women's desired number of children and their preference for sons. The results showed that marital-educational pairing had a greater effect on women's fertility intentions than age and income pairing. The effect of marital pairing on women's fertility intentions is also influenced by women's age and urban–rural differences. The study helps to understand the changes in women's fertility intentions and the factors influencing them after the fertility policy transition in China and inspires scholars to pay more attention to the interaction process between couples in the study of fertility intentions. [ABSTRACT FROM AUTHOR]

Background: E-learning has shown to be an effective intervention in helping informal caregivers of people living with dementia. It has the potential to reach people living in remote areas, increasing service coverage. As a response to the demographic context in Spain associated with a higher percentage of ageing, depopulation, and the complexities of health service delivery in rural areas, this paper describes the cultural adaptation and co-design of the iSupport online training and support programme for Castilla y León, Spain, as a potential e-health intervention to mitigate these constraints. Methods: The translation and cultural adaptation were performed following the WHO guidelines, with some adaptation due to the cultural context of Spain. Three focus groups were conducted with informal caregivers, health professionals, and a group of experts on cognitive impairment and dementia. The co-design process was performed as a Patient and Public Involvement activity with three groups consisting of people living with dementia, informal caregivers, rural population and experts on technology and dementia. Results: A total of 435 suggestions were proposed for adaptation associated with erroneous terminology, rewording text/writing, grammatical or punctuation marks errors, and repeated information or need for additional content. Several recommendations were exposed during the co-design process: preference for interactive material such as videos or images, a forum to receive feedback from health care professionals and to leave satisfaction comments, availability in multiple platforms (e.g., tablet, laptop, mobile), slide format for information presentation, and availability to edit letter size and background colours. Conclusions: A culturally adapted version of the iSupport was developed for Castilla y León, Spain. The need for modification of words and expressions, information links to local resources websites, adjustments of characters' names and caregivers' scenarios, and additional content to some sections were recommended. Suggestions for the design should be taken into account for further adapted versions and platform developments. [ABSTRACT FROM AUTHOR]

This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the COVID-19 pandemic. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this investigation was to understand the dynamics among dementia caregiving, vigilance, and home and community-based service use. Methods: This paper is derived from a larger, mixed-methods study on caregiving. We used a descriptive qualitative approach to analyze interview data of 30 family caregivers of relatives with dementia. Results: We found five domains of vigilance in which caregivers felt "on duty": ensuring attentiveness, ensuring safety, ensuring resources, ensuring healthcare, and ensuring closeness. Formal service use did not necessarily give caregivers relief from vigilance, with the language of risk often employed by caregivers. Conclusion: Because service use could contribute to feelings of vigilance, rather than give caregivers a break from a sense of watchfulness, these findings support calls for dementia-specific training for service providers. In future caregiving research, the relationship between vigilance, caregiver distress, and role captivity should be explored. [ABSTRACT FROM AUTHOR]

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally. [ABSTRACT FROM AUTHOR]

In Latin America, approximately 70 million individuals live with a disability. Although global evidence suggests that people with disabilities are one of the poorest groups and present lower employment rates, the evidence for Latin America is still weak. This article aims to contribute to the literature by estimating and analysing the levels of employment opportunity for persons with disabilities in six countries in Latin America (Chile, Bolivia, Mexico, Peru, Colombia, and Costa Rica). Using household survey data, we measure inequality of opportunities using the Paes de Barros approach and compare the probability distributions of being employed for people with disabilities according to different individual characteristics. This research makes several contributions to the literature. First, it analyses and compares the characteristics of persons with disabilities in six countries of the region. Second, it is the first paper in the region that computes and compares the levels of employment opportunities for persons with disabilities, using the Human Opportunity Index. Third, it analyses which are the main aspects contributing to the levels of employment opportunities for persons with disabilities in each of the countries. The main results of the study reveal that people with disabilities face high levels of inequality of employment opportunity compared with people without disabilities in the six countries. Peru shows the lowest disadvantage, with higher coverage of opportunities for people with disabilities. Colombia and Costa Rica were the countries where this group presents the largest disadvantages to be employed. In addition, women with disabilities and people with disabilities living in rural areas have a lower probability of being employed compared with people without disabilities. These findings reveal that policies in the region aiming to include this group in the labour market have not been effective, and there is a necessity to guarantee the proper labour inclusion of this group. [ABSTRACT FROM AUTHOR]

Background: The concept of stigma has been widely used to understand patterns of discrimination and negative ideas surrounding people with mental health problems, yet we know little of the specific nuances of how this might operate beyond the 'Global North'. Aim: This paper aims to explore the notion of stigma in an Indian context by considering the lived experience of patients, carers and community members. Methods: A sample of 204 participants, representing mental health patients, informal carers and community members was recruited from urban and rural areas in Kerala, India. Participants took part in interviews where they were encouraged to talk about their experiences of mental ill health, attitudes towards these problems, barriers encountered and sources of support. Results: Experiences akin to the experience of stigma in Europe and the United States were elicited but there were important local dimensions specific to the Indian context. The difficulties faced by people with diagnoses of mental disorders in finding marriage partners was seen as an important problem, leading to marriage proposals being refused in some cases, and secrecy on the part of those with mental health problems. Rather than the 'self-stigma' identified in the US, participants were more likely to see this as a collective problem in that it could reflect badly on the family group as a whole rather than just the sufferer. Conclusions: In the Indian context, the idioms of stigma emphasised impairments in marriage eligibility and the implications for the family group rather than just the self. [ABSTRACT FROM AUTHOR]

Background: Eating disorders are as common in Māori, the Indigenous people of Aotearoa-New Zealand, as they are in non-Māori; however, research has focused on the experiences of non-Māori. This paper will describe explanatory factors, treatment experiences and what helps with recovery for Māori. Methods: Kaupapa Māori research methodology informed the methods and analysis. Fifteen semi-structured interviews comprised thirteen Māori participants with eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorder) and two whānau (support network) members. A thematic analysis was undertaken by a first cycle of coding that used deductive structural coding to identify data describing participants' perceived causes of eating disorders, their experience of treatment and recovery. A second cycle of coding used inductive analysis with descriptive and pattern coding. Results: Three overarching themes were antecedents (cumulative exposure), treatment (a system of complexities) and recovery (resource empowerment). Antecedents comprised cumulative exposure to body and sporting ideals and adversity as causal factors of eating disorders. In the treatment theme, a system of complexities critiqued rural settings for generalised mental health services, allocation of Māori cultural support, the economic burden of treatment, culturally incongruent treatment (methods, values) and a weight-focused discharge criterion. Recovery (resource empowerment) found appropriate health information, self-determination and connection to Māori culture and whānau aspirations helped with recovery. Conclusion: The diversity of birdcalls reminds us of the individuality of eating disorders. Health practitioners are reminded that just as the Tūī, Kākā and Kererū possess their own unique birdcalls, so do Māori with eating disorders and their whānau have their own experiences, needs and required treatment responses. [ABSTRACT FROM AUTHOR]

Background: The use of methamphetamine or amphetamine stimulant drugs has been identified by authoritative public health bodies as a global health issue, with a worrying trend towards production and consumption of a higher purity crystalline form methamphetamine (ice) over the past decade. This trend has been well documented within Australia, resulting in a public perception of there being an 'ice' epidemic in regional/rural areas. Considering the illicit nature of ice, monitoring it is challenging and as such little information is available regarding the actual extent of methamphetamine use, harms and patterns in regional/remote Australia. Aim: To collate the available literature regarding methamphetamine use in regional/rural Australia and identify gaps in the literature. Methods: A literature search was conducted by searching 6 databases (PUBMED, Medline, CINAHL, EMBASE, PsycINFO and SCOPUS) following which exclusion/inclusion criteria were applied. Included papers were appraised with the Joanna Briggs Institute Critical appraisal tools and synthesised in light of the sociocultural, ethnic and geographic differences in methamphetamine use in Australia. Results: Regarding rural/regional Australia there is a significant lack of research into methamphetamine use, patterns and epidemiology since the rise of crystalline methamphetamine in 2013. The existing literature available suggests great variability in methamphetamine harms in rural communities. This can be a double-edged sword however, as the introduction of ice into a remote/rural community may result in greater harms if it becomes ingrained in local customs. Similarly, there is a lack of research into the specific factors within Indigenous communities leading to an increased rate of methamphetamine use amongst members. Recommendation: Future research should address the causes of variance in methamphetamine harms in rural/remote regions. Although the scope of this paper was the Australian context, a wider international approach may yield useful information. [ABSTRACT FROM AUTHOR]

The use of audio recordings has become a taken-for-granted approach to generating transcripts of in-depth interviewing and group discussions. In this paper we begin by describing circumstances where the use of a recorder is not, or may not be, possible, before sharing our comparative analysis of audio-recorded transcriptions and interview scripts made from notes taken during the interview (by experienced, well-trained interviewers). Our comparison shows that the data quality between audio-recorded transcripts and interview scripts written directly after the interview were comparable in the detail captured. The structures of the transcript and script were usually different because in the interview scripts, topics and ideas were grouped, rather than being in the more scattered order of the conversation in the transcripts. We suggest that in some circumstances not recording is the best approach, not 'second best'. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic increased the use of remote service delivery in early childhood intervention (EI), and this increased use is promising for young children with disabilities living in rural communities. However, the increase in remote service delivery requires a greater understanding of using evidence-based practices (EBP) delivered by EI providers via this mode. Remote service delivery adds a new context to EI services requiring study to identify (a) what works for whom and under what conditions, (b) how an evidence-based practice delivered remotely results in positive outcomes for young children and caregivers, and (c) the independent variables that influence those outcomes. This position paper explains the importance of remote service delivery for improving access to EBP for young children with disabilities and their families in rural communities using a conceptual framework. The conceptual framework includes three essential factors described in depth in this article. First, the conceptual framework can support researchers in designing rigorous studies to deliver evidence-based practices remotely. Second, the conceptual framework can support EI programs and providers in identifying EBP for service delivery for young children and families in rural communities. [ABSTRACT FROM AUTHOR]

Purpose: An individual's lack of social connections and social isolation is often associated with feelings of loneliness which is regarded as having a negative effect on health. This paper describes the development and assessment of a 10 item 'Personal Sociability and Connections Scale' (PeSCS) to measure individual's disposition and accompanying skills to seek out companionship and engage in interpersonal relations. Methods: The study was conducted at a rural primary care unit in Northern Greece. A total of 199 attenders were recruited over a 6-week period in 2020 and questionnaires completed. This informed the 10-items PeSCS that comprises Social, Behavioral, and Emotional components focusing on the expression of social comfort, willingness to share experiences, stories and concepts, and feelings of similarity at first contact. Reliability of the PeSC scale was assessed and the relationship with scale scores examined as an indicator of convergent validity. A multivariate linear regression analysis was performed to examine the relationship of PeSC scale score with the characteristics of participants. Results: Assessment of reliability of PeSC scale produced a Cronbach's alpha of 0.809. The relationship between components and the total PeSCS scores identified significant correlations (p <.001). At a multivariate level, male gender was the sample characteristic with a significant association with scale levels (p <.05) and higher annual income with Social component (p <.05). Otherwise the distribution of sociability dispositions was similar across population groups. Conclusion: The 10-item PeSC scale forms a simple and quick to complete measure whose overall reliability was rated as 'meritorious'. The PeSC instrument may be a useful tool for assessing the causes and appropriate responses to the negative health effects of loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Introduction: While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions. Methods: Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences. Results: Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences. Conclusions: Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients' lack of interest and fear in the medical encounter. [ABSTRACT FROM AUTHOR]

This paper illustrates how systems theory can be used in social work research design to understand the systemic issues associated with spousal care in rural Australia. Spousal caregiving is embedded within multiple formal and informal systems, including family, community, health and aged care practice, social policy, and social and cultural norms. It is therefore a complex phenomenon to explore in social research, with each of these systems interacting with and influencing other aspects of the care system. The purpose of this paper is to provide an illustration of a research design that explores this systemic complexity. The design is conceptually underpinned by the transformative paradigm; a critical approach that reflects social work principles of social justice. The methodology is based on an ecosystems approach to assessment, using multiple methods to explore interactions between systems of care at policy, practice and individual levels. This application of systems theory to research presents an innovative opportunity for social work research to reflect long-established practices of understanding complex phenomenon within its sociocultural context. [ABSTRACT FROM AUTHOR]

Introduction: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community--primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. Methods: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. Results: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community--primary care partnership. Lack of previous collaborations with the formal health system was common to both. Conclusion: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore what is known about equine-assisted activities and therapies based on Roy's adaptation model. Quality of life for vulnerable populations who engage with equine-assisted activities and therapies is considered the main concept here. This state-of-the-art review was conducted from four databases ranging from January 2019 to February 2020. Limited studies examined the effect of equine-assisted activities and therapies on cancer survivors, although preliminary data were promising. The rural context was not extensively examined. Thus, equine-assisted activities and therapies may enhance the quality of life through four adaptation modes. [ABSTRACT FROM AUTHOR]

Despite growing scholarly interest in the identities and experiences of girls, little attention has been paid to the identities and experiences of rural girls, and in particular how girls' subjectivities are discursively constituted in rural spaces. Using interviews and focus group discussions with girls and young women who attended a girls' empowerment program, this paper draws on feminist poststructuralism and positioning theory to examine how rural gendered subjectivities are constructed and negotiated by girls and young women within the social, spatial, and discursive boundaries of a rural Canadian community. I examine how the girls and young women positioned themselves and were positioned by others as "small town girl" and "country girl" subjects, and how rural positionality was accomplished through invoking real and imagined notions of more urban "others." It is through these contrasts to urban subjecthood that the variability of rural positionality is made visible. The findings of this study complicate and extend the dominant narrative of the urban-rural binary, and gendered identities and performances within rural spaces, by demonstrating the plurality of feminine rural subjectivity. This study offers new applications for the role of girls' empowerment programs in shaping girls' identities, experiences, and perspectives. [ABSTRACT FROM AUTHOR]

Purpose: Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana. Methods: The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts. Findings: Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization. Conclusion: This case study identified limits to the H&S model utility in supporting states' abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana. [ABSTRACT FROM AUTHOR]

This paper explores the generationing of education and development in five villages in Northern Sierra Leone. Understood as 'fields' governed by power dynamics, we consider how the interactive 'fields' of generation, education and development coalesce, re/structuring adult and child 'being' and 'doing'. We explore the tensions that arise between transformation and preservation in the field in light of wider social, cultural and economic change, and the negotiation of the generational contract in contexts of high risk and inter-dependency. [ABSTRACT FROM AUTHOR]

Women living in rural Australia who are labelled as depressed, by either themselves or professionals, contend with spatial injustices of limited service provision that converge with the dominant constructions of mental health and knowledge authorisation. Informed by a feminist social constructionist standpoint, semi-structured interviews were conducted with 27 women living in rural New South Wales in Australia. This paper explores how rural women navigate experiences labelled as depression. The women's stories conveyed an overwhelming sense of loss, abuse and betrayal, and the pathologisation of their experiences of structural violence and oppression is of significant concern. Yet, the women also showed agency by using to their best benefit multiple and often divergent explanations for their experiences of depression. While many accepted the diagnosis of their symptoms, most resisted a sole pathological cause and actively created individually meaningful narratives of their depression experiences. The language of 'depression' provided a passport for some, allowing access to formal supports that would have otherwise been unavailable or highly stigmatised. Rurality and the associated structural disadvantage, particularly in regard to service provision, was only marginally present in the women's stories. The alternative narratives of healing uncovered challenge the centrality of formal service delivery to the wellbeing of a community. Further, while the pathologisation of structural oppression must be resisted, the women's stories demonstrate the importance of not invisibilising the agency they demonstrate in this difficult and contested space. [ABSTRACT FROM AUTHOR]

Traditionally, Chinese families have been the primary provider of care for older adults, and older people expected family care. However, along with the modernization and demographic transition, family functions have been weakened, and state-based care has begun to play an essential role in supporting family care for older people. This paper aims to assess the care preferences of older people and the different responsibilities of individuals and communities in modern China. Using data from the 2014 China Longitudinal Aging Social Survey (CLASS) and multinomial logistic regression modeling, we find that family care remains the cornerstone for older adults and their care preferences are associated with individual and community factors, mainly including the number of children, education level, residential area, the presence of health infrastructure and care facilities, and the values associated with filial piety of older adults. [ABSTRACT FROM AUTHOR]

We report results from a large qualitative study regarding the process of parents coming to understand the child has autism starting from the time of initial developmental concerns. Specifically, we present findings relevant to understanding how parents become motivated and prepared for engaging in care at this early stage. The study included primary data from 45 intensive interviews with 32 mothers and 9 expert professionals from urban and rural regions of Ontario, Canada. Grounded theory methods were used to guide data collection and analysis. Parents' readiness (motivation and capacity) for engagement develops progressively at different rates as they follow individual paths of meaning making. Four optional steps account for their varied trajectories: forming an image of difference, starting to question the signs, knowing something is wrong, and being convinced it's autism. Both the nature of the information and professional help parents seek, and the urgency with which they seek them, evolve in predictable ways depending on how far they have progressed in understanding their child has autism. Results indicate the need for sensitivity to parents' varying awareness and readiness for involvement when engaging with them in early care, tailoring parent support interventions, and otherwise planning family-centered care pathways. What is already known about the topic? Parents of children with autism often learn about their child's autism before diagnosis and can spend long periods seeking care (including assessment) before receiving a diagnosis. Meanwhile, parents' readiness to engage in care at this early stage can vary from parent to parent. What this paper adds? This study revealed how parents come to understand their child has autism—on their own terms, rather than from just talking to professionals. It also explained how parents' growing awareness of their child's autism leads them to feel more motivated to engage in care by seeking information and pursuing services. Four "optional steps" described how parents' growing readiness to engage in care at this early stage can vary, depending on their personal process. Implications for practice, research, or policy The results suggest ways that professionals can be more sensitive (a) to parents' varying awareness of autism and (b) to their varying readiness for being involved in early care. They also suggest ways to tailor parent supports to their individual situation and design care that is more family centered. Not all parents want high levels of involvement. Depending on their personal process, some parents may need care and support that is directed at them before feeling ready for professionals to engage them in care directed at the child. [ABSTRACT FROM AUTHOR]

Objectives: To compare rural–urban health care costs among Latinx adults ages 51+ and examine variations by dementia status. Methods: Data are from the Health and Retirement Study (2006–2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. Results: Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p <.001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p <.001). Dementia status was not an effect modifier. Discussion: Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority. [ABSTRACT FROM AUTHOR]

Intestinal ostomy can have significant effects on lives and lived experiences. However, limited research exists on the experiences of persons with ostomy in low-resource settings, such as rural Haiti. This study aimed to explore the lived experiences of Haitians with an ostomy, focusing on the physical, psychological, and social aspects of their post-operative lives. We conducted 9 semi-structured, in-depth interviews with participants who had undergone ostomy surgery at the Hôpital Universitaire de Mirebalais in Haiti. Employing interpretative phenomenological analysis (IPA), we iteratively examined transcripts to identify convergent and divergent codes, which were then grouped into themes to better understand the participants' experiences. Three themes emerged: (a) ostomy as a social disease, which has severe impacts on relationships and place in society; (b) ostomy as altering self-image, leading participants to reflect on their identity and the underlying causes of their condition and to reevaluate their necessities and abilities; and (c) ostomy as an arduous medical journey, characterized by pain, distress, uncertainty, and disillusionment, but also resiliency, improvisation, and hope. This study highlights the multifaceted experiences of persons with ostomy in the low-resource rural environment of Haiti and underscores the need for improved access to medical care, financial support, and psychosocial and caregiving resources for these individuals. Findings also emphasize the importance of medical providers' improved understanding in making medical decisions, and cultural and socioeconomic factors in developing effective support strategies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was aimed to explore the trajectory of thoughts and feelings related to religiosity and spirituality using a holistic approach following attendance at group—Quran Recitation (QR) sessions among annual flood victims. Design: This is a qualitative study with an in-depth retrospective interview conducted data in 2019. Methods: The purposive sampling was applied to conduct face-to-face individual video-recorded semistructured interviews. Seventeen participants followed six QR chanting sessions in Bandung, Indonesia. Data were transcribed verbatim and analyzed using inductive analysis. Findings: After extracting evidence expressions of participants, the research team generated the central theme of "Holism of Religiosity and Spirituality," using three influential sub-themes, including obedience to God's will, growing a positive mindset through spirituality and life started to be delighting from nine categories. Conclusion: The relationship of body-mind concepts of holism through QR among flood sufferers was explored. The effect of QR chanting is beneficial to change awareness about the wisdom of spirituality. The holistic approach of religiosity and spirituality in nursing care is recommended to promote all service settings, especially community and disaster nursing in the Indonesian context. Future research is needed to develop QR chanting activities among multiethnic and socio-cultural groups as alternative therapy quantitatively. [ABSTRACT FROM AUTHOR]

The perception of the value of children (VOC) can elucidate why individuals consider it beneficial to have children by uncovering their subjective intentions and experiences regarding their fertility decisions. Using VOC perceptions to understand fertility change in the modernization process, this qualitative study explores how parents' VOC change meshes with China's socioeconomic and cultural contexts. This article examines intergenerational VOC evolution under the support and constraints of socioeconomic environments and cultural norms. Grandparents, embedded in the rural economy and traditional culture, exhibit economic/utilitarian and social/normative VOC. Young parents, living, and having grown up in urban economic and modernized cultural contexts, recognize emotional/psychological VOC for fertility intention. Migrant parents living in urban economies but bound by traditional culture believe that social/normative VOC is important for fertility intention. The results advance understanding of the integration of individuals' psychological intentions with the socioeconomic-cultural contexts that influence their fertility and VOC. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare eHealth literacy—one's perception of one's ability to use the Internet for health care—among otolaryngology patients in 3 geographic settings of the same department. Setting: An academic otolaryngology department. Method: Patients' opinions and perceptions of their eHealth literacy were assessed with a validated paper survey administered in the summer of 2017. Results: Of 381 asked, 351 people completed the survey, 149 at a university town teaching hospital clinic (group A), 101 at a nearby rural clinic (group B), and 101 at a remote rural clinic (group C). Mean scores were 30.80, 28.97, and 29.03 for groups A, B, and C, respectively. The overall mean was 29.76 ± 5.97. Three surveys reported the minimum score of 8, and 26 reported the maximum score of 40. Results were statistically significantly different among all sites (P =.001), between groups A and B (P =.027), and between groups A and C (P =.0175). Women reported higher eHealth literacy (30.13 ± 6.27) than men (28.87 ± 5.11) (P =.045). Participant age and role (patient or parent of a patient) were statistically insignificant. Mean scores were similar to those previously reported in other patient populations. Conclusions: Otolaryngology patients in a university town had better eHealth literacy than patients in more rural settings, suggesting that online medical resources and access points are less likely to be useful in rural populations. [ABSTRACT FROM AUTHOR]

Aims: Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses’ experiences with population-based work. Methods: A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway. Results: Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses. Conclusions:The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed. [ABSTRACT FROM AUTHOR]

A workshop with virtual consultation practice-based professional development model for self-regulated strategy development persuasive writing instruction was evaluated in a randomized controlled trial. Nineteen general education teachers and 564 Grade 5 and 6 students in 16 low-wealth rural schools participated. Following training, teachers provided instruction in their inclusive classrooms. Results indicated that students receiving instruction improved in the number of persuasive elements and words written when compared with students in the control group. Differences in element type were evaluated with largest effects noted for reasons and explanations. Student group differences were noted with nonstruggling students having greater gains than struggling students. [ABSTRACT FROM AUTHOR]

Several studies have reported on the shortage of drugs with the changing demographic and disease profile, especially triggered by the growing burden of lifestyle diseases. However, very few have evaluated the demand-side challenges from the objective of universalisation of healthcare. Therefore, this study was designed to evaluate the factors that have impeded access to affordable generic and essential drugs in non-metropolitan urban and rural India. The study was conducted in six states and responses were elicited from a sample of doctors, pharmacists, nurses, accredited social health activist (ASHA) workers, state officials, warehouse managers and patients across the study states. The study reveals that while the acceptance of prescribing generic drugs has improved over the last decade, the use of branded drugs has been restricted only to complex cases or where generic drug efficacy has not been established. The centralised procurement efficiencies seem to have hit a plateau in terms of assuring drug availability to the last mile, thereby impacting local purchase, especially pandemic procurement. Most states have also established dedicated corporations for drug procurement, albeit at different levels of organisational maturity as far as adherence to the processes and systems are concerned. However, supply chain phenomena like the bullwhip effect gets accentuated given the levels of our public health system. Learnings from other consumer-facing sectors with similar challenges of increased variability and uncertainty are yet to be explored for the health sector to leapfrog towards achieving improved 'drug availability' or 'zero stock-out'. Standardising drug categories, regular updating of the essential drug list (EDL) reflecting the demographic and disease profile, various practices like complete digitisation, rolling forecasts, stock-keeping unit rationalisation, flexible public procurement contracts, etc., have been explored as potential solutions in this paper. Creating a dedicated team of forecasters within the procurement organisations, well adept at using analytics, could be key to real-time demand estimation, paving the way for a quarterly rolling forecast to facilitate procurement using well-designed rate contracts with suppliers that captures variability in such rolling forecasts. [ABSTRACT FROM AUTHOR]

Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

We explored student and industry supervisors' experiences of virtual work-integrated learning (vWIL) health promotion placements during the COVID-19 pandemic. Using a descriptive phenomenological qualitative methodology, we conducted semi-structured interviews with eight students and eight supervisors of undergraduate health promotion–related placements at community, not-for-profit and government organizations. We asked participants about the aspects of their placement they found most enjoyable and challenging, their preparation, workload, and thoughts on placement structure. We audio-recorded and had the interviews transcribed. Our thematic analyses revealed four key themes: (1) the impact of COVID-19 on work and study, (2) benefits of vWIL (real-world application and career clarification, transcending barriers and saving time, and feeling less intimidated), (3) challenges of vWIL (experiencing workplace culture, providing support and guidance to students, and relationship building), and (4) recommendations on the evolution of vWIL (increased preparation and consider a hybrid model). Our findings suggest that vWIL is a viable and sound mode of delivery for health promotion–related placements, particularly in situations that inhibit face-to-face learning. It has the capacity to enhance the work-readiness of health promotion graduates while adding flexibility to professional preparation workplace-based training programs, providing opportunity for capacity building locally across rural and remote areas, as well as globally. Future research should examine the effectiveness, practicality, and feasibility of implementing placements across different models including face-to-face, virtual and hybrid. [ABSTRACT FROM AUTHOR]

This study explores the effect of grandparental care with no parents at present on children's efforts, using the data from China Family Panel Studies from 2010 to 2018. In order to avoid the endogeneity of family childcare decisions, we use two instrumental variables (IVs): community caregiving rate (IVI) and whether the parent is born before 1978 (IVII). We find that grandparental care significantly reduces children's efforts, and the finding remains robust. The negative marginal effect of this care pattern is more pronounced in rural and middle school children. Compared with parental care, grandparental care has increased the parental fertility intentions and decreased parental involvement and supervision investment to children, which leads them to be more likely to spend time on recreational and non-academic activities. [ABSTRACT FROM AUTHOR]

School violence and bullying are current and problematic events during adolescence. They are likely to have a marked presence in places highly exposed to armed conflict and violent environments, representing a double public health problem. The study aims to estimate the prevalence of different types of school violence perpetrated and experienced by school adolescents in a community with a history of exposure to armed conflict. Two thousand one hundred eighty-five school adolescents from a municipality in Colombia (males = 54.1%, 14–16 years = 38.6%) participated in the study. Nine educational institutions were included. A systematic random sampling was designed, with a proportional allocation of 35% within each school year from sixth to eleventh grade. The School Coexistence and Circumstances Affecting it—ECECA survey was applied. The prevalence and risks of bully and bullying were estimated. RRa were calculated with the 95% confidence interval adjusted for the other confounding variables. Analyses were constructed from generalized linear models, under the Poisson family and a logarithmic link function. We found a 9.3% of bullying victimization and a 3.5% prevalence of bully. A higher risk of bully was found among males, persons between 10 and 14 years of age, residents of rural or urban dispersed areas, residents of violent neighborhoods, alcohol consumers at school, and victims of aggression in childhood (RRa > 1.0, p -values <.05). The risk of victimization of bullying was higher in students younger than 15 years old, as residents of urban areas, having a history of childhood aggression, suffering abuse by a close person, and as alcohol users at school. This study provides evidence of risk factors for aggression and bullying that have implications for possible prevention measures in multiple social domains, including the individual, the family, and the school environment. [ABSTRACT FROM AUTHOR]

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes. [ABSTRACT FROM AUTHOR]

This study explores how information and communication technologies (ICTs) influence transforming attitudes toward intimate partner violence (IPV) and women's empowerment in Pakistan and Nepal. By analyzing data from married women using recent Demographic and Health Surveys, the research reveals that owning multiple ICTs is associated with decreased experiences of physical IPV and reduced acceptance of wife-beating. Notably, increased ownership of ICTs corresponds to heightened participation in household decisions. Furthermore, regular internet use further diminishes the likelihood of experiencing physical IPV and justifying wife-beating. These findings underscore ICTs' potential to empower women, reshape gender norms, and enhance decision-making autonomy. The study advocates for gender-inclusive policy interventions that leverage the transformative influence of ICTs in fostering positive sociocultural changes. [ABSTRACT FROM AUTHOR]

Developing preservice teachers with a strong understanding of culturally relevant pedagogy should be a priority for all teacher education programs. Although much focus is placed on diversity in urban areas, diverse classrooms are found in all education settings. This paper demonstrates how a rural opportunity expanded the cultural awareness and culturally responsive teaching of four preservice special education teachers. Knowledge shared between teachers in an Old Order Mennonite community and these preservice teachers resulted in growth for all participants. Through immersion with the Mennonite community, four key themes emerged: (a) culturally relevant communication, (b) goal setting, (c) culturally sensitive curriculum materials, and (d) creation of a classroom to match the students' needs. [ABSTRACT FROM AUTHOR]

Despite tremendous challenges, in the early 20th century school nurses provided the first, and often only, medical care for thousands of schoolchildren and their families. However, multiple barriers impeded the developing role. Influences of historical events, financial support, lack of knowledge regarding benefits of the school nurse role, limited access to training, and issues of poor pay affected the Commonwealth of Virginia's attempts to develop and provide school nursing throughout the diverse rural counties across the state. School nurses continue to face these challenges today. The purpose of this social historical research is to identify, describe, and analyze the origins and evolving role of the school nurse in the rural counties of Virginia, 1900–1925; investigate how this history influences school nursing today; and offer several suggestions rooted in findings for moving the profession forward as outlined by Cowell's response to recommendations made by the Institute of Medicine. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes impacts millions and poor maintenance of diabetes can lead to preventable complications, which is why achieving and maintaining target A1C levels is critical. Thus, we aimed to examine inequities in A1C over time, place, and individual characteristics, given known inequities across these indicators and the need to provide continued surveillance. Methods: Secondary de-identified data from medical claims from a single payer in Texas was merged with population health data. Generalized Estimating Equations were utilized to assess multiple years of data examining the likelihood of having non-target (>7% and ≥7%, two slightly different cut points based on different sources) and separately uncontrolled (>9%) A1C. Adults in Texas, with a Type 2 Diabetes (T2D) flag and with A1C reported in first quarter of the year using data from 2016 and 2019 were included in analyses. Results: Approximately 50% had A1Cs within target ranges (<7% and ≤7%), with 50% considered having non-target (>7% and ≥7%) A1Cs; with 83% within the controlled ranges (≤9%) as compared to approximately 17% having uncontrolled (>9%) A1Cs. The likelihood of non-target A1C was higher among those individuals residing in rural (vs urban) areas (P <.0001); similar for the likelihood of reporting uncontrolled A1C, where those in rural areas were more likely to report uncontrolled A1C (P <.0001). In adjusted analysis, ACA enrollees in 2016 were approx. 5% more likely (OR = 1.049, 95% CI = 1.002-1.099) to have non-target A1C (≥7%) compared to 2019; in contrast non-ACA enrollees were approx. 4% more likely to have non-target A1C (≥7%) in 2019 compared to 2016 (OR = 1.039, 95% CI = 1.001-1.079). In adjusted analysis, ACA enrollees in 2016 were 9% more likely (OR = 1.093, 95% CI = 1.025-1.164) to have uncontrolled A1C compared to 2019; whereas there was no significant change among non-ACA enrollees. Conclusions: This study can inform health care interactions in diabetes care settings and help health policy makers explore strategies to reduce health inequities among patients with diabetes. Key partners should consider interventions to aid those enrolled in ACA plans, those in rural and border areas, and who may have coexisting health inequities. [ABSTRACT FROM AUTHOR]