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The confluence of the two major challenges has combined to create special challenges for rural nonprofits serving victims of crime: the fluctuation of federal funding, and the Covid-19 pandemic. We discuss the challenges faced by Child Advocacy Centers in northwestern South Carolina in the context of these shifting challenges. From qualitative interviews conducted at 14 centers in this primarily rural region, we explain the challenges they face and the potential effects on the communities they serve interpreted through the lens of Resource Dependence Theory, which predicts that organizations reduce uncertainty of funding through increasing their partnership bonds with cooperative entities. [ABSTRACT FROM AUTHOR]

Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform v. a pen-and-paper interview(PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18–49 years old from rural Burkina Faso (n 116 INDDEX24; n 115 PAPI). A WFR was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percentage error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups and quantities (modalities' divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at P < 0·05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percentage within ±20 % for WFR, 17–45 % for macronutrients, 5–17 % for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost. [ABSTRACT FROM AUTHOR]

Aim: This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice. Background: There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation. Methods: This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce. Findings: Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved. [ABSTRACT FROM AUTHOR]

Health education goes a long way in changing people's behavior towards health matters. One of the major roles of health education is the creation of awareness on the "dos" and "don'ts" that pertains to health matters. In northern Nigeria ("north"), many people, particularly in the rural areas, engage in the use of Sakkiya in the treatment of their body swellings. Sakkiya care has been reported repeatedly in the literature to have associated lethal risks on the health of those treated with it. Sakkiya is an act of using a hot pointed metallic tip to puncture a body swelling, with the purpose of achieving a cure. Furthermore, studies had recommended the need for the introduction of community Sakkiya education programs in northern Nigeria to enlightened people on the risks associated with Sakkiya and also inform them about better treatment options. This paper proposes a systematic approach to adopt in organizing an effective community Sakkiya education in the "north". The approach devised in this study was adapted from the Community Action Model (CAM) developed by the Brazilian educationist named Paulo Freire. [ABSTRACT FROM AUTHOR]

Telemedicine use surged during COVID-19, and a significant amount of recent research has relied solely on online surveys to assess patient perceptions. However, these surveys may be biased since they require an internet connection and digital literacy skills. We compare local perceptions of telemedicine visits in rural areas across two methods of data collection: online-only vs. paper surveys. We collected 100 paper and 108 online surveys in two rural counties with a total population of 10,000. The results show that significant differences exist in the demographics of people completing each type of survey and in the perceptions of telemedicine, with paper-based respondents generally demonstrating a higher degree of confidence in telemedicine. Ordered logistic regressions controlling for potentially influential underlying demographic characteristics (income, hours worked, and presence of children) show that paper-based respondents tend to have higher opinions of telemedicine, but that overall levels of comfort are similar across survey types. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success. [ABSTRACT FROM AUTHOR]

Background: Australia's National Disability Insurance Scheme (NDIS) was launched in 2013 to provide financial support packages for people with disability to purchase supports and services to enhance independence. People with disability are required to develop a plan with the National Disability Insurance Agency (NDIA), the government department responsible for managing the NDIS. This scoping review aims to ascertain the level of research into people's experience of the NDIS planning process in these geographic areas. Methodology: Research publication databases were searched using a specific search string to identify research about people with disability and their families/carer's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications focused on Aboriginal and Torres Strait Islander people were additionally appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications' contents was undertaken to ascertain people with disabilities and carers experience of the NDIS planning process. Results: Ten (N = 10) research papers were found that met the inclusion criteria. Two papers were policy reviews and reported on the improvements of the NDIS planning process since its conception. The analysis found the research archive focused on five themes: (1) healthcare workforce and NDIA staff; (2) NDIS package holders and carers lack of awareness of the NDIS; (3) cultural/socio‐economic barriers; (4) travel funding; and (5) emotional burden of the NDIS planning process. Conclusion: There are limited papers available that explore people's experiences of the NDIS planning process in regional, rural and remote regions of Australia. This systematic review illuminates the difficulties, barriers and concerns of people with disability and their carers about the planning process. [ABSTRACT FROM AUTHOR]

Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

Purpose: This paper assesses the impact of this program on the rural women's employment opportunities using data from the 2015 round of the household's living standard survey (HLSS) of Côte d'Ivoire. Design/methodology/approach: In 2013, in order to improve the living conditions of the rural population, the Ivorian government launched the National Program for rural electrification (PRONER) to electrify all localities with more than 500 inhabitants. Findings: The results show that PRONER, while reducing the time allocated to performing household chores, increases women's employment through the reallocation of time to full-time paid work in the agricultural and non-agricultural sectors. The authors also find that the allocation of men's time is not affected by this programme. A possible mechanism that would explain such a pro-women effect is the labour-saving technology introduced to home production as an effect of the reform. Research limitations/implications: As a limitation, it is important to note that these results were obtained in the specific context of PRONER in Côte d'Ivoire and are not necessarily applicable to rural electrification programmes in other contexts. Furthermore, the choice of other indicators to measure women's empowerment is limited by the quality of the data available. It would be interesting for future research to extend this analysis to include other aspects of women's empowerment and household welfare. Originality/value: This paper is the first to the author's knowledge to apply a robust econometric method by combining an inverse probability weighted regression adjustment model with Heckman sample selection method to access a robust causal effect of the PRONER in Côte d'Ivoire. [ABSTRACT FROM AUTHOR]

The present paper studied the impact of educational inequality on child mortality in the states of southern region of India during the period 1991 to 2019. The study applied the Gini coefficient technique to investigate the education inequality in each state of the region. The paper observed the highest educational inequality in Andhra Pradesh while the lowest in Kerala among the states. However, such educational inequality is highest in the rural areas as compared to the urban areas in each state. The improvement of the average years of schooling contributed to the reduction of education inequality in the region. The study observed that the reduction of education inequality leads to the growth of per capita NSDP in each state of the region. Similarly, the expansion of education sector leads to reduction of child mortality rate in each state of the region. [ABSTRACT FROM AUTHOR]

Agriculture is the backbone of the Indian economy, and it is essential for the country's food security and rural development. In order to boost agricultural production and productivity, farmers need access to credit. Agricultural credit institutions are financial institutions, that provide loans to farmers for agricultural purposes through various schemes. The Kisan Credit Card (KCC) scheme is one of the schemes designed to provide farmers with timely and adequate credit support through a simplified and flexible process. An attempt is made in this paper to study and analyze the performance of KCC in India and Karnataka. The study is based on the secondary data collected from various reports, journals, and websites. The study found that the Kisan Credit Cards issued by commercial banks have shown an increasing trend during the study period in India and fluctuation in the growth of operative KCCs and the amount outstanding in Karnataka for the study period. The study concluded that to uplift the well-being of farmers, financial institutions should educate them in utilizing these schemes and implementing KCC properly. [ABSTRACT FROM AUTHOR]

In this paper, we present findings from a three-year research project funded by the US Institute of Museum and Library Services that examined how advanced broadband measurement capabilities can support the infrastructure and services needed to respond to the digital demands of public library users across the US. Previous studies have identified the ongoing broadband challenges of public libraries while also highlighting the increasing digital expectations of their patrons. However, few large-scale research efforts have collected automated, longitudinal measurement data on library broadband speeds and quality of service at a local, granular level inside public libraries over time, including when buildings are closed. This research seeks to address this gap in the literature through the following research question: How can public libraries utilize broadband measurement tools to develop a better understanding of the broadband speeds and quality of service that public libraries receive? In response, quantitative measurement data were gathered from an open-source broadband measurement system that was both developed for the research and deployed at 30 public libraries across the US. Findings from our analysis of the data revealed that Ookla measurements over time can confirm when the library's internet connection matches expected service levels and when they do not. When measurements are not consistent with expected service levels, libraries can observe the differences and correlate this with additional local information about the causes. Ongoing measurements conducted by the library enable local control and monitoring of this vital service and support critique and interrogation of the differences between internet measurement platforms. In addition, we learned that speed tests are useful for examining these trends but are only a small part of assessing an internet connection and how well it can be used for specific purposes. These findings have implications for state library agencies and federal policymakers interested in having access to data on observed versus advertised speeds and quality of service of public library broadband connections nationwide. [ABSTRACT FROM AUTHOR]

The phenomenon of population aging in rural China presents a compelling societal challenge, necessitating a growing demand for both the quantity and quality of facilities supporting the needs of older people. However, a lack of comprehensive understanding concerning the underlying mechanisms that drive the emergence of these facilities, coupled with the distinctive historical backdrop and social development stage of the nation, engenders complexities in achieving sustainable rural eldercare services. This paper endeavors to comprehensively elucidate diverse eldercare facility types in rural China, delineating their intrinsic characteristics and prerequisites for construction. Additionally, the research delves into the political and economic contexts and advancements in healthcare and eldercare services, culminating in the formulation of an integrated framework that interconnects eldercare support patterns with the political landscape and public service provisions. The implications derived from this nuanced framework provide insightful reflections on significant historical transitions, intricacies faced by rural eldercare facilities, and strategic pathways for fostering future eldercare service delivery systems and allied facilities. The paper's findings furnish insights for bolstering the well-being of the aging population in rural China and lay a substantive foundation for addressing the evolving requisites of eldercare within this distinctive context. [ABSTRACT FROM AUTHOR]

This paper explores how neoliberal ideologies inform both social and political agendas that influence how social workers can provide support to trans and gender diverse people attempting to access gender-affirming healthcare, using an analysis of social workers' experiences working in mental health in Nova Scotia, Canada. Qualitative semi-structured interviews provide a perspective of the experiences of social workers in Nova Scotia and how their ability to provide mental health services to trans and gender diverse people is impacted by neoliberalism. Most social workers attributed the structural context of working within a bio-medical system as contributing to social workers being disempowered, undermined, and not able to practice according to the values of their profession thus limiting their ability to provide affirming mental health supports to trans and gender diverse people in ways that align with their social work professional ethics and values. Through examining how neoliberal ideologies create notions of ideal social citizens by controlling the body, the paper explores how lived experience of neoliberal practices in mental health social work reinforce transnormativity. This paper highlights the necessity for social workers to resist dominant neoliberal and medicalized discourses which serve as mechanisms of power and control. The paper concludes with recommendations for social work practice with trans and gender diverse populations. [ABSTRACT FROM AUTHOR]

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Global commitments to the education of children with disabilities, have led to progressive policy developments in India, and a surge in the enrolment of children who were traditionally excluded from the formal education system. This paper examines the perceptions and practices of mainstream teachers in rural government schools, within the context of increased learner diversity, focusing on how teachers understand, and respond to, the needs of children with disabilities. Data were collected through semi-structured interviews with teachers and classroom observations, in six primary schools, in three districts of Haryana. Our findings suggest that deficit-oriented views dominated teacher thinking, but they showed a readiness to engage with disability issues, recognising the value of education for all. However, they struggled in their classroom practices in relation to meeting diverse learner needs and exclusionary practices were further amplified for children with disabilities. Teachers were unwilling to take responsibility for the learning of children with disabilities, expressing significant concerns about their own preparedness, while highlighting the lack of effective and appropriate support structures. The paper concludes by drawing attention to the pressing need for effective teacher professional development opportunities and other support structures, to provide quality education. [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]

Background: Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia's Great Southern region in 2021 to describe GPs' perspectives on the service and reflect on how it may help alleviate rural GP workload. Methods: The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. Results: A total of 45 GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs' confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. Conclusions: Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings. GPs provide most of the mental health care and deal with an increasing number of patients with complex problems; this is more acute in rural areas where there are fewer services. This paper shows how a rural GP psychiatry phone line operated by local psychiatrists helps GPs manage their patients' mental health problems and may, in turn, reduce the workload rural GPs experience. The results add to the limited evidence and have implications for other rural locations characterised by limited resources. [ABSTRACT FROM AUTHOR]

Introduction: Despite the advancements in Patient and Public Involvement and Engagement (PPIE), the voices of traditionally underserved groups are still poorly reflected in dementia research. This study aimed to report on a PPIE partnership between academics and members of the public from underserved communities to co‐design Forward with Dementia—Social Care, a resource and information website supporting people receiving a dementia diagnosis. Methods: The PPIE partnership was set up in four stages: 1–identifying communities that have been under‐represented from PPIE in dementia research; 2—recruiting PPIE partners from these communities; 3—supporting PPIE partners to become confident to undertake their research roles and 4—undertaking research co‐design activities in an equitable fashion. Results: To address under‐representation from PPIE in dementia research we recruited seven PPIE partners from Black, Asian and other minority ethnic groups; lesbian, gay, bisexual, transgender, queer+ communities; remote/rural area; religious minorities and partners living with rare forms of dementia. The partners met regularly throughout the project to oversee new sections for the study website, refine existing content and promote the website within their communities. Conclusion: Strategies can be used to successfully recruit and involve PPIE partners from underserved communities in co‐design activities. These include networking with community leaders, developing terms of reference, setting out 'rules of engagement', and investing adequate resources and time for accessible and equitable involvement. These efforts facilitate the co‐design of research outputs that reflect the diversity and complexity of UK contemporary society. Patient or Public Contribution: This study received support from seven members of the public with lived experience of dementia from communities that have been traditionally underserved in dementia research. These seven members of the public undertook the role of partners in the study. They all equally contributed to the study design, recruitment of participants, development and revision of topic guides for the interviews and development of the website. Three of these partners were also co‐authors of this paper. On top of the activities shared with the other partners, they contributed to write independently of the academic team the section in this paper titled 'Partners' experiences, benefits and challenges of the partnership'. Further, they provided input in other sections of the paper on a par with the other (academic) co‐authors. [ABSTRACT FROM AUTHOR]

Introduction: Vertical transmission of HIV remains a major challenge in Guinea, especially, in low-resource rural areas. This paper presents the results of a pilot project designed to enhance the prevention of vertical transmission through a comprehensive improvement plan implemented across 66 large-cohort sites. Methods: Data from 66 large-cohort of mother to child transmission prevention (PMTCT) sites from 2019 to 2022 were analysed to compare PMTCT metrics before (2019–2020) and after (2021–2022) the improvement initiative. Key indicators were reviewed, and trends were statistically analysed using Mann‒Whitney tests, with a p value less than 0.05 indicating statistical significance. Results: The implementation of this strategy significantly increased the antiretroviral therapy rate among HIV-positive pregnant women from 66 to 94%, and full antiretroviral prophylaxis coverage was achieved in infants. However, early infant diagnosis via polymerase chain reaction testing falls short of the national target, highlighting deficiencies in laboratory and specimen transport capacities. The study also revealed regional disparities in the use of PMTCT services. Conclusion: The improvement plan effectively enhanced antiretroviral therapy and prophylaxis use, demonstrating the benefits of structured interventions and capacity development. Despite improvements, challenges such as insufficient polymerase chain reaction (PCR) testing and uneven access to services remain. Future initiatives should aim to equip PMTCT sites with essential resources and promote community-driven health-seeking behaviours in underserved areas. [ABSTRACT FROM AUTHOR]

Understanding the psychological wellbeing of people with cancer is a key component of assessment and intervention in quality cancer care. However, the unique experiences of rural cancer populations are less often explored than those from urban centres. The aim of this study was to perform a meta-analysis of Australian studies that compared the psychological wellbeing experiences of people with cancer from rural and urban locations. Five databases were searched, and 19 studies, involving 16,947 participants, assessing and comparing the psychological wellbeing of rural and urban populations with cancer were included. The analysis indicated that Australian rural cancer populations have greater odds of worse psychological wellbeing than those from urban areas (OR = 1.54, 95% CI [1.01, 2.35], p = 0.044). This disparity remains when cancer types are analysed separately, with a slightly smaller odds ratio for rural people with breast cancer (OR = 1.29, 95%CI [1.01, 1.64], p = 0.046) and a slightly larger odds ratio when cancers excluding breast cancer were reviewed (OR = 1.78, 95% CI [1.59, 2.01], p = <.001). Significant heterogeneity was found. Despite increasing emphasis in Australia on psychological wellbeing throughout the cancer journey, there remain significant disparities whereby rural people experience greater impacts upon their psychological wellbeing. The wellbeing of Australian rural populations with cancer remains an area in which clinical and political focus is imperative. Whilst screening is a necessary first step, additional clinical implications for improving rural access to appropriately skilled health professionals who provide oncology-specific assessment and intervention are suggested. What is already known: Cancer is a major public health issue, and its psychosocial impacts are substantial, not just on patients but on their families and the broader community. The prevalence of clinically significant psychological distress is higher amongst people with cancer than the general population. However, identification, treatment, and provision of psychological support is inconsistent across services and geographical areas, and notably lacking in rural areas. Disparities in screening, assessment and intervention for psychological wellbeing in people with cancer remain, despite the fact that systematic application of screening, appropriate referral, and intervention can improve quality of life and reduce healthcare costs associated with inpatient and outpatient cancer care. What this paper adds: This article extends outcomes from previous systematic reviews and analyses from Australia and internationally with the addition of meta-analytic methods. It was specifically designed to solely focus on Australian cancer populations. The results suggest that Australian rural populations with cancer may have anywhere from 30% to 70% greater odds of experiencing poorer psychological wellbeing than those from urban areas. This paper highlights ongoing disparities in rural psycho-oncology that may be impacting wellbeing outcomes from rural people in Australia, and urges psychologists, other health professionals, and policy-makers to proactively address these inequities with improved screening, assessment and intervention for their rural populations. [ABSTRACT FROM AUTHOR]

Background: With the growing integration of technology in education, the adoption of blended learning (b‐learning) has gained attention. B‐learning combines traditional classroom teaching with online components, holding potential to enhance student outcomes and educational efficiency. Yet, current research predominantly concentrates on higher education institutions in urban areas, creating a void in understanding its impact on K‐12 education, particularly in rural settings. Objectives: This qualitative study aims to propose recommendations for successful implementation of blended learning in rural K‐12 areas by addressing the key stakeholders influencing its adoption and identifying the main factors affecting its success. Methods: We performed a content analysis of grey literature documents detailing the implementation of b‐learning in K‐12 education. Additionally, interviews with crucial stakeholders such as teachers, principals, and experts in rural schools in South America provide insights into the challenges and prospects of b‐learning adoption in these contexts. Results and Conclusions: The study identifies pivotal stakeholders for effective b‐learning implementation, outlining their roles and addressing challenges inherent in rural settings. Recommendations for enhancing b‐learning's implementation in developing countries are also proposed. The research underscores the significance of involving diverse stakeholders such as governmental bodies, school leaders, educators, students, and families to ensure a holistic and efficient approach to blended learning. Lay Description: What is currently known about this topic: Blended Learning Definition and Benefits: Blended learning combines face‐to‐face and online instruction, enhancing student engagement and personalization by providing diverse learning pathways.Growth in K‐12 Implementation: Blended learning gained traction in K‐12 education, boosting academic outcomes, driven by recognition of learner diversity and potential in meeting students' needs.Contextual Challenges: Implementation challenges arise in low‐income households and rural areas, including limited access to technology and internet connectivity, impacting student engagement and success. What does this paper add: Focusing on Rural Dynamics: This study helps to fill a gap by investigating blended learning in rural K‐12 settings, spotlighting key players and success drivers in these unique contexts.Recommendations from Various Sources: By combining interviews and grey literature, this research generates comprehensive, practical recommendations grounded in both empirical insights and real‐world perspectives.Insights into Rural Hurdles: This paper extends the discussion on blended learning by addressing specific rural barriers, proposing family involvement, private sector partnerships for training, and tailored pedagogical strategies. Implications for practice or policy: Leadership and Collaboration: Effective school leadership and collaboration with local governments are pivotal for fruitful blended learning implementation, ensuring defined roles, responsibility, and accountability.Adaptable Curriculum Design: An adaptable, centralized curriculum aligns with recommendations, fostering efficient tracking of student progress and enabling customized learning.Engagement‐Centric Pedagogies: Recommendations spotlight interactive, student‐centered teaching methods, tailored to diverse student needs, nurturing active participation and elevated learning outcomes. [ABSTRACT FROM AUTHOR]

Networked (neoendogenous) development is a prescriptive of rural development that merges the positive aspects of exogenous and endogenous approaches by integrating bottom-up demands and top-down planning, internal and external resources and networks, and vertical political-administrative and interterritorial contexts. The current paper opted for a multicase analysis approach and used a tailored networked rural development institutional analysis and development (NRD-IAD) framework to analyse four organizational aspect changes, namely, institutional characteristics, configuration and structure, actions and activities, and outcomes and evaluation, among four case studies; two studies came from the EU LEADER (links between actions for the development of the rural economy), and the other two came from China's resident work team in poor villages (RWTIPV). The research questions are as follows: What is the difference and common principle between these two approaches, and to what extent can they engage in exchange and be mutually learned from? Primary data were collected through involvement, observation, and open-ended interviews with actors in rural regions of China. Secondary data consisted of the resident cadre's job log, resident work team ledger, minutes of the meeting, village's work reports, government regulations, guidelines for poverty-alleviation planning in China's RWTIPV cases, and published journals and internet sources in EU LEADER cases. In terms of difference, we identified the LEADER system mainly as a regulation-based network with relationships as supplementary information, while the RWTIPV system was mainly found to be a relationship-based network with regulations as supplementary information. Although the two systems seem different, the underlying logic is the same, that is, to engage with a collective reflexivity and action agency (CRAA), embedded in the locality and representing much of the local resource base, and to obtain a sufficient level of relational capacity to create the necessary conditions for integrated rural development. These common principles enable exchange and mutual learning to occur between the LEADER and RWTIPV systems through the unified idea (theory) of CRAA. The current findings contribute to the emergence of a new rural development paradigm mechanism and the role of institutional work. [ABSTRACT FROM AUTHOR]

Background: Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment. Methods: We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study. Results: We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains—such as training, equipment, and supportive supervision—it is likely that the CHW cadre will continue to be seen as informal health care workers. Conclusions: CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment. [ABSTRACT FROM AUTHOR]

This paper overviews the importance of justice and health-care partnerships in a MOUD feasibility trial in a rural Appalachian community. Research partners included a local jail, a local community supervision office, and a local community federally qualified health center. This paper describes the pilot feasibility study participants and methodology, as well as lessons learned including the challenges encountered and needed changes to address feasibility as the environment changes over time. Implications for social work research, practice, and policy advocacy focused on delivery of extended-release naltrexone and other MOUDs are discussed. [ABSTRACT FROM AUTHOR]

Aims: This paper describes the investments made, approaches taken and lessons learnt by three rural Australian academic health departments engaged in the delivery of the Health Career Academy Program (HCAP). The program seeks to address the under‐representation of rural, remote and Aboriginal populations within Australia's health workforce. Context: Significant resources are directed towards rural practice exposure for metropolitan health students to address workforce shortages. Fewer resources are directed towards health career strategies that focus on the earlier engagement of rural, remote and Aboriginal secondary school students, those in Years 7–10. Best practice career development principles highlight the importance of earlier engagement in the promotion of health career aspirations and in influencing secondary school student career intentions and uptake of health professions. Approach: This paper describes: delivery contexts; the theory and evidence that has informed the HCAP; program design, adaptability and scalability; program focus on priming the rural health career pipeline; program alignment to best practice career development principles; enablers and barriers confronted in program delivery, and lessons learnt to inform rural health workforce policy and resourcing. Conclusion: There is a need to invest in programs that seek to attract rural, remote and Aboriginal secondary school students to health professions if Australia is to develop a sustainable rural health workforce. A failure to invest earlier undermines opportunities to engage diverse and aspiring youth in Australia's health workforce. Program contributions, approaches and lessons learnt can inform the work of other agencies seeking to include these populations in health career initiatives. [ABSTRACT FROM AUTHOR]

This paper reviews major structural drivers of place-based health disparities in the context of Canada, an industrialized nation with a strong public health system. Likelihood that the COVID-19 pandemic will facilitate rejuvenation of Canada's northern and remote areas through remote working, advances in online teaching and learning, and the increased use of telemedicine are also examined. The paper concludes by identifying some common themes to address healthcare disparities for northern and remote Canadian residents. [ABSTRACT FROM AUTHOR]

Introduction. Key New Zealand ethical documents that describe appropriate ethical behaviour for doctors do not consider rurality and how this might impact on the practice of medicine. Aim. The aim of this study was to understand the literature on key ethical issues experienced by general practitioners in a rural context that might inform the development of a New Zealand agenda of rural medical ethics Methods. A rapid review was undertaken of three databases using a variety of key words relating to rurality, ethics, professionalism and medicine. Inclusion criteria were research articles focussing on the experience of doctors working in a rural healthcare setting, commentaries and narratives. The findings from the paper were synthesised and broad ethical categories created. Results. Twelve studies were identified that met the inclusion and exclusion criteria. Synthesis of the data revealed five ethical issues that predominately arose from living and working within communities. These ethical issues related to juggling personal and professional lives, managing friendships with patients, managing loss of privacy and anonymity, assuring confidentiality and practicing outside of comfort zones. Discussion. The majority of ethical issues arose from managing overlapping relationships. However, these overlapping relationships and roles are considered normal in rural settings. A tension is created between adhering to urban normative ethical guidelines and the reality of living in a rural environment. Professional ethical guidelines, such as those developed by the New Zealand Medical Council, do not account for this rural lived reality. Rural practitioners in New Zealand should be engaged with to progress a specific rural ethics agenda. [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]

Improving physical, mental and cognitive health is a strategic choice to help developing countries cross the middle-income trap. This paper used data from the 2019 China Rural Children Health and Nutrition Survey (n = 826), and used the Ordered Probit (Oprobit), Logit and ordinary least squares (OLS) analytical methods to systematically analyze the implications of parental migration on multidimensional health. The results indicate that parental migration significantly harms the physical and mental health of rural children, and that mobile phone addiction has a significant moderating effect. Moreover, parental migration has a greater impact on the physical health, mental health and cognitive ability of boys and rural children with low family income, while parents with higher nutrition knowledge and education can effectively improve the physical health and cognitive ability of their children. In conclusion, in order to improve the multidimensional health of rural children, the government should strengthen the policy of care and support for children whose parents migrate. Schools and families should pay attention to the supervision of rural children's mobile phone addiction. [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]

Purpose Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. Methods We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Findings Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Conclusions Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. [ABSTRACT FROM AUTHOR]

Background: Research has identified that rurally located persons face health inequities when compared to their urban peers. While health policies and practice frameworks to address the needs of rural people are largely developed on the principles of evidence-based medicine, it is not clear whether this evidence base appropriately considers geographic factors that may impact participant outcomes. The purpose of this project was to examine whether research within leading health and medical journals identified the geographic classification (location) of their participants, thus enabling the original authors and subsequent readers to appropriately consider this factor in the making of policy and practice recommendations. Methods: A retrospective analysis of study participants' geographic identifiers within articles from medical and health journals was carried out in this project. Eleven journals were chosen for evaluation, with 300 consecutive eligible papers from each journal retrospectively reviewed. All 3300 papers were analyzed to determine whether the research participants' geographic location was identified. This classification was then stratified into varying categories of rural or urban, as appropriate. Results: It was not possible to identify participants' geographic location in 2193 (66%) of the 3300 reviewed articles. A total of 121 papers (4%) had sole focus on rural residents, with another 95 articles (3%) comparing outcomes between rural and urban locations. Slightly more than a quarter (27%) of the articles either just featured urban participants or made no distinction between rural and urban locations. Conclusions: These findings indicate that insufficient attention is given to the geographic location of participants. This failure means that the outcomes and recommendations of the research base may be invalid for a large section of the world's population and result in inequities in healthcare services. There is an emerging concern about using this evidence base for developing health guidelines and policy frameworks, as the needs of a substantial proportion of the population may not have been appropriately captured. [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]

The application of STEM (Science, Technology, Engineering, and Math) education in solving real-world problems is challenging. To tackle this challenge, a project-based learning approach that integrates robots with cost-effective self-made toys to problem-solving was adopted to assist rural primary school students to apply STEM skills. The purpose of this study was to evaluate the effects of the project-based learning approach which includes lecturing and hands-on activities on primary school students' STEM learning outcomes and attitudes. An experiment was conducted with 25 primary school students who voluntarily participated in a STEM summer-camp programme. Students were asked to assemble a paper house equipped with an IoT control module and LED light switches, and write and edit robot scripts to produce a robot-based storytelling narrative using the paper house they made as a context. The results show that the project-based learning approach was an effective approach for cultivating primary school students' STEM knowledge and skills as evidenced from the post-written test. The relationships between the students' STEM learning outcomes and attitudes were also confirmed by a clustering analysis. Students who had higher learning attitudes also achieved higher STEM learning outcomes; the findings are also supported by the feedback from the open-ended questionnaire items. This study suggests that integrating low-cost self-made toys and robots in project-based learning activities is an effective and practical approach to enhance primary school students' learning outcomes and learning attitudes in STEM education. [ABSTRACT FROM AUTHOR]

This perspective paper presents a discussion around the issues of sexual violence (SV) in rural and remote areas and the associated discourses of shame. The authors propose that shame of SV adds additional trauma to survivors, further impacting survivors' mental health which may be exacerbated in rural areas. Shame is a complex emotion that can result in increased feelings of guilt, humiliation, and embarrassment. Shame has been identified as an underlying risk factor and a mechanism for post‐assault mental health problems. We propose it can be particularly pronounced for women subjected to sexual assault in rural or remote areas. This paper will explore the link between SV and shame, explain how shame attached to SV may be used as an informal social control mechanism for women, particularly in rural and remote areas, and discuss the role of health practitioners, particularly mental health nurses, who play a key role in supporting people impacted by SV. SV is an insidious social phenomenon that can have profound consequences for individuals, families, and communities. Addressing shame and stigma is a crucial component of supporting survivors of SV in rural and remote areas. There is a need for targeted community‐led interventions and responsive support services to address the complex and multifaceted issues contributing to SV in rural and remote communities. [ABSTRACT FROM AUTHOR]

There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. A search of PubMed was conducted in January 2023, using the search words, "policy", "telehealth", "broadband", and "Appalachia". New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth. [ABSTRACT FROM AUTHOR]

Globally, rural conditions are in states of change. They are often highly vulnerable to climate and environmental change, extreme weather events, conflict, socio-economic changes, inequalities, and demographic changes. These changes are putting stress on rural areas, which rely upon agriculture and natural resources for their livelihoods and are often the foundation of national economies. Communication for development (C4D) has played an important role in addressing these challenges. Its thinking is broadly consistent with rural development goals—indeed, the roots of C4D come in part from rural development and agricultural extension. Communication for development (C4D) was defined by the World Congress on Communication for Development as "...a social process based on dialogue using a broad range of tools and methods. It also seeks change at different levels, including listening, building trust, sharing knowledge and skills, building policies, debating, and learning for sustained and meaningful change. It is not public relations or corporate communications". However, after decades of action to address these interrelated rural development challenges, much remains to be done. This paper critically considers the following: What does inclusive rural development mean now, in light of environmental change, and how does this affect the conceptualisation and practice of C4D? This was done by using three countries as case studies: Malawi, Ukraine, and the Philippines. Each of these countries represented contrasting challenges and opportunities for rural development and environmental change, with lessons from their experiences shedding insight into the communication for development thinking. [ABSTRACT FROM AUTHOR]

Objective: There is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators. Methods: The data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit. Results: Two hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14–0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors. Conclusions: Attempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

Background: This study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries. Methods: A six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review. Results: Nearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people). Conclusions: This review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery. [ABSTRACT FROM AUTHOR]

Background: According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking. Methods: We searched five databases and included studies for adults (18–65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results. Results: Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting). Conclusions: Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults. Trial registration: PROSPERO: CRD42021283508. [ABSTRACT FROM AUTHOR]

Background and objective: On the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences. Methods: We used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities. We employed two different decomposition analyses: decomposition of mean differences in utilization using the Oaxaca–Blinder decomposition framework and differences in the income-related distribution in utilization using recentered influence function regressions between rural and urban areas. Results: Significant differences exist in the type of outpatient services used by the rural and urban population groups, with those living in rural areas having 3.4 times higher odds of using primary health centers compared to outpatient hospital care. We find that the use of primary health care is pro-poor and that outpatient hospital resources is concentrated among the more affluent section of the population, with this observed inequality consistent across settings but more severe in rural areas. The rural–urban gap in utilization is primarily driven by income and residence in the eastern region, while income-related inequality in utilization is influenced, aside from income, by residence in the central region, household size, and marriage and employment status of the household head. We do not find evidence of significant mean differences in overall utilization or inequality in utilization of inpatient health care services. Conclusions: While the differences in average contacts with health services are insignificant, there are prominent differences in the level of services availed and the associated inequality among rural and urban settings in Bhutan. Besides, while there are obvious overlaps, factors influencing income-related inequality are not necessarily the same as those driving the utilization gaps. Cognizance of these differences may lead to better informed, targeted, and potentially more effective future research and policies for universal health coverage. [ABSTRACT FROM AUTHOR]

A large body of literature shows that the emotional health of rural elders in China is negatively affected by the migration of their adult children. However, the precise mechanism that underpins this relationship has yet to be fully uncovered. This paper introduces two new dimensions of analysis to expand the understanding of this 'left behind' phenomenon, and offers statistical insights, theoretical explanations and policy recommendations, as well as suggestions for further study. Firstly, in this paper, rural elders have been distinguished based on whether all , or any , of their adult children have migrated. This distinction leads to the finding that rural elders suffer more adverse mental health impacts when all adult children from a household move away. Secondly, the temporal dimension of migration is investigated, finding that there is a 'turning point' after which the mental health of rural elders appears to recover after the migration of their adult children. Comparison of the two groups shows that rural elders who see any of their adult children migrate recover from depression twice as quickly as those who see all of their children migrate. Receiving financial support or providing child care can only partly mediate the negative influence of migration. Also, the level of depression and wellbeing of rural elders can be significantly moderated by the emotional closeness between them and their adult children. Providing (grand)child-care assistance and receiving economic support is shown to have smaller mitigating effects. This paper concludes with a discussion of how the notion of 'filial piety' could, directly and indirectly, play a role in the emotional health of rural elders, with policy implications provided. [ABSTRACT FROM AUTHOR]

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Developing Allied Health (AH) graduates who are skilled in responding to public health needs is crucial, particularly in rural areas where workforce shortages and poor health outcomes are common. However, workforce shortages make it difficult to provide rural work-integrated learning (WIL) opportunities to teach these skills. This paper presents a model of Service-Learning (SL) that innovatively employs WIL for AH students while addressing rural health needs. The model was developed based on the experiences of a rural WIL team who implemented over 400 SL WIL experiences over six years. Key aspects highlight the importance of relationship building and meeting the needs of three key stakeholders, namely the community and host-site, students, and the enrolled university. Student support, interprofessional education and evaluation were also embedded in the model. This SL model adopts a flexible approach and provides a useful guide for developing SL for WIL despite challenges in rural areas. [ABSTRACT FROM AUTHOR]

In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1–14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11–14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians' knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians' understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC. [ABSTRACT FROM AUTHOR]

Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings. [ABSTRACT FROM AUTHOR]