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Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stakeholder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. © 2016 Wiley Periodicals, Inc.

Many rural diabetes educators feel isolated professionally. Access to resources, skilled peers and opportunities for ongoing education may be lacking or not known. Rural diabetes educators often have multiple roles and may be confused about their responsibilities in specific areas. Geographic and professional isolation and lack of role definition may prevent appropriate diabetes care. Some sole educators in metropolitan hospitals also experience lack of support and interaction with their peers, A survey was designed to identify and address the issues facing isolated educators, determine the proportion of diabetes educators who consider themselves isolated, identify the reasons for isolation and the difficulties which result from isolation, and elicit suggestions for addressing the problems identified. Reasons given for isolation included professional isolation, distance, lack of resources and lack of network/support. The most frequently suggested methods of decreasing isolation were networking, regional meetings, teleconferences, distance education and provision of a practice manual. Professionals working in isolated areas of Australia need organised continuing medical education, quality assurance programs, systems for networking and access to expert advice. Modem information technology, distance education programs and models for effective networking offer the potential to meet these needs.