Search

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Researchers have frequently described rural women as invisible, yet at 28 million, they represent over half of the rural population in the United States. We conducted a transcendental phenomenological study using semi-structured interviews and artifacts to explore 12 Midwestern rural-based mental health counselors' experiences counseling rural women through a feminist lens. Overall, we found eight themes organized under two main categories: (a) "perceptions of work with rural women" (e.g., counselors' sense of purpose, a rural heritage, a lack of training for work with rural women, and the need for additional research); and (b) "perceptions of rural women and mental health" (e.g., challenges, resiliency, protective factors, and barriers to mental health services for rural women). We offer specific implications for counselors to address the unique mental health needs of rural women, including hearing their stories through their personal lenses and offering them opportunities for empowerment at their own pace.

Purpose: The present study aimed to analyze the entrepreneurial resilience of small and medium-sized businesses among rural women. Design/Methodology: The study was conducted using a survey, and 269 individuals were selected through stratified random sampling. This research was conducted in three stages. First, the Lifespan Resilience Scale-Business was used to identify the factor structure of women's business resilience. Second, the resilience of women entrepreneurs' businesses was analyzed. And third, path analysis was carried out to identify the factors affecting the resilience of women's businesses. Findings: The business resilience of rural entrepreneur women was determined by the following components: external resources, internal resources, innovation, opportunity and adaptation, risk management, and family support. The results of the causal model indicated that the variables of marketing strategy, marketing mix, marketing methods, business communication, business plan preparation skills and supporting policies are effective factors in improving business resilience. Theoretical Implications: To improve the entrepreneurial resilience of rural women, it is necessary to identify the influential factors and their indicators to reduce entrepreneurial failure, analyze the factors that foster resilient behaviors in rural entrepreneurship, and provide contexts that are resistant against changes for women. Practical implications: Holding companies that specialize in agricultural development in Iran play an important role in improving women's entrepreneurial resilience. These companies could empower rural women to overcome barriers and apply new methods through educational and extension programs that are appropriate to changes in technology and the market. Originality/value: This study presents the Lifespan Resilience Scale-Business as a native model for measuring the resilience of rural women's businesses in Fars province of Iran.

Blending narrative portraiture and feminist methods, this study explored the lives of two rural women who are creative writers. The study asked (1) What are their critical purposes? and (2) How did gender and place intersect in their writing lives? The findings were that the women used creative writing to engage in praxis by creating and disseminating knowledge. Their writing critically interrogated and redefined conceptions of womanhood. Additional critical purposes were unique to women's intersectional identities and lived experiences. They ranged from interrogating societal perspectives of gender, sexuality, and race to interrogating rurality and sexual violence. The aesthetic texts they created articulated and advocated for intersubjective truths. Shifting the focus of critical literacy from pedagogy and reading to writing beyond educational spaces, the women drew upon critical literacy not as a means of being taught how to understand the power of texts, but to wield the power of texts themselves.

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

Background: Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact., Methods: A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance., Results: Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P =0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P =0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P =0.031; percent body fat: -2.32% [-3.40 to -1.24]; P <0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks., Conclusions: This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT03059472.

Women have been the major victims of the Colombian armed conflict for more than 50 years. Nowadays, when the country faces an aftermath focused on reconciliation, understanding women's experiences during the conflict is key to providing them tools for social justice and effective fulfilling of their needs. This qualitative synthesis of literature includes publications in Spanish and English of electronic databases over the past 20 years regarding rural women and the Colombian armed conflict. Studies were included for review if they were published between 2000 and 2019, were qualitative peer-reviewed articles, and addressed directly or indirectly the pregnancy process as well as the women's sexual and reproductive health in rural Colombia. Seven of 169 articles initially identified were included for an inductive analysis of categories and themes. After the analysis process, three main themes emerged from the literature: (a) crumbling families, (b) being a woman: the challenges between being a peacemaker and a victim, and (c) protecting and caring of life. These three themes comprise 10 categories and 20 subcategories that provide support to the inductive qualitative synthesis. This review provides a comprehensive synthesis of the Colombian armed conflict focused on the victimization of women. It concludes with reflections about the Colombian women's role in transitioning toward peace.

This study aimed at determining the factors that influence family planning practice among rural women of Pankshin district in Plateau state, Nigeria. A cross-sectional study using a simple random sampling method was conducted from October to December 2019. A self-administered questionnaire was used for data collection among 302 respondents. Among respondents, 48.3% had practised family planning and the most popular family planning method ever practised was injectables (57.5%). The determinants of family planning practice were age group 29-39 and 40-49 years old (AOR=4.373, p <0.001; AOR=5.862, p <0.001), discussion with partner (AOR=9.192, p <0.001) and partner's approval (AOR=2.791, p=0.007). Findings showed an encouraging family planning prevalence with the main determinants involving male partners. Further efforts need to be made to promote family planning practice among male partners and to empower women of all reproductive age groups by providing them with relevant information that is needed for them to make informed decisions.

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

Objective: To investigate sociodemographic characteristics and physical and mental health indicators between participants and nonparticipants of a large-scale 2-year exercise RCT including noninvited women living in nearby rural area in Finland., Study Design and Setting: From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in Kuopio Fall Prevention Study in 2016-2019. The participants were compared to non-participants (n = 4,536) and noninvited OSTPRE women (n = 7,119) living outside the urban recruitment area., Results: Participants were younger (P< 0.001) with higher education (P< 0.001) and had more often regular hobbies (P< 0.001) and physical exercising (P< 0.001) than nonparticipants or noninvited. They reported better functional capability (P< 0.001), mental (P< 0.001) and subjective health (P< 0.001), lower number of medications (P< 0.001), less fear of falls (P< 0.001), but more frequent falls (P= 0.002) and more often musculoskeletal diseases (P= 0.006).  Participants also showed better functional capacity in the clinical measurements. In register analysis, urban-rural differences in the prevalence of diseases were detected., Conclusion: In population-based exercise interventions, participants are more likely to be better off in respect to physical and mental wellbeing, functional capability and sociodemographic status. Recruiting participants only from cities increases unavoidable selection bias due to urban-rural differences which should be noticed when interpreting and generalizing RCT results., Trial Registration Number: ClinicalTrials.gov identifier NCT02665169., (Copyright © 2021. Published by Elsevier Inc.)

Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women's physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants' physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants' improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: -1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Human papilloma virus (HPV) has been widely implicated in cervical carcinogenesis and 90% of carcinoma cervix cases are due to high-risk HPV infection. This study was done to find the high-risk HPV genotypes in the rural women of Lucknow, North India., Materials and Methods: HPV-DNA testing has been carried out in 130 cases of squamous intraepithelial lesions (SILs) of the cervix to find HPV status and type of high-risk HPV genotype infecting the rural women. These cases were collected from the rural cervical cancer screening program carried out in the villages of West Lucknow, North India., Results: HPV status in 130 SIL cases revealed HPV positivity in only 17 cases (13.1%), whereas the remaining 113 cases were HPV negative (86.9%). HPV genotypes detected in the study were HPV-18, HPV-31, HPV-33, and HPV-35. HPV positivity was found highly associated with the young and sexually active group of women complaining of vaginal discharge. High HPV infection rate was also seen with multiparity and illiteracy as majority of women attending the camps were multiparous and illiterate., Conclusions: The present study revealed highly oncogenic HPV-18 alone or in combination with multiple infections of high-risk genotypes - 31, 33, and 35 - in the rural women of Lucknow, North India. Since HPV vaccine currently available in India is for HPV-16 and HPV-18 combined, efforts should be made to make region-specific vaccine according to their prevalence in that particular state of the country to provide effective HPV vaccination., Competing Interests: None

Healthy diet is essential to type 2 diabetes mellitus (T2DM) prevention for women with previous gestational diabetes mellitus (GDM). To evaluate the effect of a lifestyle intervention program on diet quality for rural women who were previously diagnosed with GDM, we conducted a randomized controlled study in two counties located in south-central China. A total of 404 eligible women were allocated into an intervention group and control group. Participants in the intervention group received 6-month lifestyle intervention including six group seminars and eight telephone consultations. Dietary data were collected at baseline and 18 months via a 24 h dietary recall, and dietary quality was measured by two indicators, Chinese Healthy Eating Score (CHEI) and Minimum Dietary Diversity for Women (MDD-W). Baseline CHEI scores (54.4 vs. 53.5, p = 0.305) and the proportions of participants who met MDD-W (73.8% vs. 74.5%, p = 0.904) were comparable between the two groups. The intervention group achieved a higher CHEI score (62.2 vs. 58.9, p = 0.001) and higher MDD-W proportion (90.6% vs. 81.2%, p = 0.023) at 18 months. Lifestyle intervention was associated with the change of CHEI ( p = 0.049) but not with MDD-W ( p = 0.212). In conclusion, compared with usual care, lifestyle intervention resulted in greater improvement of dietary quality among rural women with previous GDM.

This study set out to reveal to what extent women entrepreneurs operating in rural areas have been affected by environmental pollution and climate change. Besides, it emphasises how much they will be affected over the next 5 years throughout Turkey. The study covered rural areas of all seven regions in Turkey. Findings were analysed by using SPSS 23 programme. Women entrepreneurs were younger in less developed regions of the country, such as the Central, Eastern, and South-Eastern Anatolia, and were older in the more economically developed coastal areas. One-third of the respondents were microentrepreneurs; 12% employ five or more workers. The problems of rural women entrepreneurs are further complicated by environmental pollution and climate change. Among the significant environmental issues, women entrepreneurs endure a loss of income, loss of trade stock/goods, and loss of livestock, property damage and potable water supply. Women entrepreneurs agreed that, in the next 5 years, environmental problems would adversely affect customer demand, the quality of raw materials they use and the products they offer; therefore, customer demand would reduce. On the other hand, they were divided in their opinion about whether environmental problems will be affecting their business location and the need to invest in technology and equipment. The study showed that none of the participants obtained disaster insurance, and none of them was members of an environmental organisation.

In rural Ecuador pregnant women face complex challenges navigating the terrain between traditional and biomedical maternal health care services. Semi-structured interviews were conducted in three rural communities in Southern Ecuador that have presented active Chagas disease transmission with women who were pregnant or have given birth within the last five years. This study was conducted to identify and understand the experiences of mothers in these communities and the decisions they make to maintain the wellness of themselves and their children. The researchers recorded women's maternal health stories, analyzed their access to maternal health care, and explored factors influencing their birth location preferences and health seeking behaviors. The researchers found that women in this region are utilizing medical pluralism to sustain maternal health and the well-being of their children.

Religion and spirituality (R/S) are embedded in all aspects of life in India, a predominantly rural economy. The aim of this mixed methods study was to assess the associations between a culturally tailored intervention and preexisting religious/spiritual (R/S) practices with indicators of well-being and factors which contribute to happiness among elderly rural women from Haryana state, India. The study consisted of three groups: field experimental group (FEG; n = 24); practitioners of preexisting R/S practices for at least 6 weeks Satsang (SG, n = 54), Brahma Kumaris (BKG, n = 54), and Radha Soami (RSG, n = 30), and non-practitioners of R/S practices (n = 64). All groups completed self-report measures of overall happiness and life satisfaction, global health, quality of life, and health status and physical health. Results revealed that FEG participants improved significantly on physical health, body balancing, and self-care; no changes were observed on the other well-being measures following the intervention. Practitioners of preexisting R/S practices were found significantly different from the non-practitioners on some indicators of health, quality of life, and well-being. Qualitative measures pointed to the importance of R/S and family and interpersonal relationships among elderly rural women.

Aims: Metabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India., Methods: Data were gathered in a community-based study of 500 rural and tribal women residing in the Mysore district, between the age of 30-59 years. The study used the WHO STEPS approach, in which information on demographics and behavioral risk factors were collected. Along with anthropometric measurements, blood pressure, blood glucose, lipids were measured. A harmonized definition of MetS recommended by International Diabetes Federation Task Force on Epidemiology and Prevention was used in this study., Results: Three out of five study participants were found to have MetS (47.1%, n = 223). Of those, 56.5% met 3 of the 5 criteria, 32.2% met 4 criteria, and 11.2% met all 5 criteria. Among the entire sample, low HDL was the most prevalent criterion (88.4%), followed by elevated glucose (57.9%), elevated triglycerides (49.3%), elevated BP (41.5%), and increased waist circumference (15.3%). In this sample, women with METS were generally older (p < 0.001), housewives (p = 0.001), that consumed salty highly processed foods (p = 0.020) and had low physical activity (p = 0.015)., Conclusions: This study showed a high prevalence of MetS in rural women. There is a compelling need for interventions aimed at reducing CHD risk factors in this population., Competing Interests: Conflict of interest All authors have none to declare., (Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

China-Pakistan Economic Corridor (CPEC) has become a "game-changer" not only for policymakers but also for common citizens of China and Pakistan because of its potential benefits in the economic prosperity and sustainable development in the lives of individuals. Recently, scholars have shown a great interest in researching the eminence of CPEC. Despite prodigious efforts of scholars, the question "how CPEC would influence living standards of rural women and what they perceive?" has been remained unanswered. The present study is the first attempt to unearth the perceptions of rural areas' women towards CPEC. We collected empirical evidence through a structured questionnaire from 302 educated rural women and interviewing 32 uneducated rural women. The following major conclusions are drawn through structural equation modeling via AMOS 21: the rural women significantly directly perceive new opportunities through CPEC; however, they perceive that the CPEC would not directly influence their quality of life and self-enhancement, but through the development of these rural areas. Rural development partially mediates the relationship between CPEC development and perceived opportunities while it fully mediates the relationships between CPEC development and quality of life as well as between CPEC development and self-enhancement. Policymakers need to emphasize on development of rural areas that would improve living standards of poor communities. The government needs to meet the expectations of poor communities and rural women to ensure their sustainable development., Competing Interests: The authors have declared that no competing interests exist.

Background: Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran., Methods: In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba's Evaluative Criteria were used., Results: There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions., Conclusions: Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.

The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.

Household air pollution (HAP) from solid cooking fuels continues to affect 600 million people in China and has been associated with high blood pressure. The role of diet in HAP-associated high blood pressure has yet to be evaluated in China. The aim of this study was to estimate the impact of cooking fuel on change in blood pressure and evaluate whether intake of antioxidant- and omega-3 fatty acid-rich foods (fruits, vegetables, and seafood) attenuates any adverse effects of solid fuel use on blood pressure. We analyzed longitudinal data collected between 1991 and 2011 from nonpregnant women aged 18 to 80 years living in rural areas of China. We used linear mixed effects models to estimate the association between cooking fuel (coal or wood versus clean [electric or liquid petroleum gas]) and blood pressure. Possible mediation of the fuel effect by diet was assessed by the difference method. A total of 6671 women were included in this study. Women less than 40 years of age cooking with cleaner fuels over time had lower rates of change in systolic blood pressure compared to women cooking with coal ( p = 0.004), and this effect was not mediated by dietary intake. Associations between fuel use and change in diastolic blood pressure were not significant. These findings lend further support for there being a direct effect of reducing HAP on improvements in blood pressure, independent of concurrent dietary intake.

Objective: This study aimed to examine (1) whether the Strong Hearts, Healthy Communities intervention (SHHC) improved social network members' (SNMs') weight, exercise, and diet and (2) whether SNMs' weight and behavioral changes were modified by their relationship closeness and/or spatial closeness with trial participants., Methods: Eight towns received the SHHC intervention, which focused on building individual healthy behaviors and creating supportive social and built environments for exercise and healthy eating. Eight towns received an education-only control intervention. SNMs (n = 487) were recruited to complete a questionnaire at baseline and at 6 months that asked about demographics, weight, height, exercise, and eating habits., Results: SHHC's effect on SNMs differed depending on their relationship closeness with trial participants. Among SNMs who had a very close relationship with trial participants, those associated with the intervention group lost more weight and decreased BMI more than those associated with the control group (weight [kilograms] between-group difference: Δ = -1.68; 95% CI: -3.10 to -0.25; P = 0.021; BMI between-group difference: Δ = -0.60; 95% CI: -1.16 to -0.04; P = 0.034). Spatial closeness did not modify any of SHHC's ripple effects., Conclusions: Relationship closeness, rather than spatial closeness, played an important role in influencing a rural community-based intervention's ripple effects., (© 2020 The Obesity Society.)

Background . Time insufficiency is frequently cited as a reason for poor dietary habits. This does not adequately explain the variations in how time is perceived as a factor in healthy eating. Aims. This study placed the eating behaviors of rural Australian women within the contexts of their stories to understand the factors that influenced healthy eating and how rural communities could enhance their health and well-being. Method. A three-phase sequential multimode narrative inquiry was used within four communities in rural Queensland, Australia. Each phase used a different mode of data collection: photo elicitation focus groups, narrative interviews, participatory workshops. Data were thematically analyzed iteratively to inform subsequent phases. Results. Nine final themes were identified. This article explored the theme of time and two contrasting perceptions of time sufficiency regarding healthy eating within a rural context during a drought. Discussion. Exploration of "time as a commodity" and "time as a duty" allowed a deeper understanding of time as a social and environmental determinant of health. Conclusion. Time's influence on healthy eating is much more than the minutes it takes to prepare a meal. To fully appreciate its impact, time should be considered as a social and environmental determinant of health.

The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79-8.29), respiratory (OR = 5.04; 95% CI: 2.52-10.07), cardiovascular (OR = 6.07; 95% CI: 1.88-19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07-12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08-5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the peripartum transfusion rates for rural women compared with urban women in the United States., Methods: In this population-based retrospective cohort study, geocoded birth records from 2014 to 2016 from the National Center for Health Statistics were used to examine the rural-urban differences in blood transfusion among nulliparous women delivering singleton, vertex pregnancies at term. We compared transfusion rates across the counties on a continuum from urban to rural. We generated a multivariable logistic regression model controlling for age, race, nativity, education, insurance, prenatal care, maternal health, gestational age, intrapartum care, mode of delivery, peripartum factors, and county of delivery., Results: Among 3,346,816 births, the transfusion rates based on maternal county of residence increased as the counties became more rural: large metropolitan-center (1.9/1,000 live births); large metropolitan-fringe (2.4); medium metropolitan (2.6); small metropolitan (2.6); micropolitan (4.5); and noncore rural (5.3). Rural women living and delivering in a rural county had more transfusions (8.5/1,000 live births) than women in more urban counties (2.5/1,000). After adjusting for key covariates, the odds of transfusion were higher among women living in micropolitan (adjusted odds ratio [aOR] 2.25, 95% CI 2.09-2.43) and noncore rural (aOR 2.59, 95% CI 2.38-2.81) counties when compared with women living in large metropolitan counties. County of delivery had a higher association with transfusion than resident county. After adding delivery county to the regression model, the association of transfusion and living in a micropolitan (aOR 1.39, 95% CI 1.19-1.63) or noncore rural (aOR 1.32, 95% CI 1.12-1.55) county diminished., Conclusion: The odds of blood transfusion were higher for women in rural areas. The results indicate that the rurality of the county where the birth occurred was associated with more transfusion. This may reflect differences in maternity and blood banking services in rural hospitals and warrants further study to identify opportunities for intervention.

Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.

Purpose: The purposes of these analyses were to determine whether Strong Hearts, Healthy Communities (SHHC), a multilevel, cardiovascular disease risk reduction program for overweight, sedentary rural women aged 40 or older, led to improved functional fitness, and if changes in fitness accounted for weight loss associated with program participation., Methods: Sixteen rural communities were randomized to receive the SHHC intervention or a control program. Both programs involved groups of 12-16 participants. The SHHC program met 1 hour twice a week for 24 weeks where participants engaged in aerobic exercise and progressive strength training. Program content addressed diet and social and environmental influences on heart-healthy behavior. The control group met 1 hour each month for 6 months, covering current dietary and physical activity recommendations. Objective measures of functional fitness included the 30-second arm curl, 30-second chair stand, and 2-minute step test. Self-reported functional fitness was measured by the Physical Functioning Subscale of the MOS Short Form-36 (SF-36 PF)., Findings: The SHHC program was associated with increased strength and endurance, as represented by greater improvement in the chair stand and step test; and with increased physical function, as represented by the SF-36 PF. Adjustment for change in aerobic endurance, as measured by the step test, accounted for two-thirds of the intervention effect on weight loss at the end of the intervention., Conclusions: SHHC participants experienced improved performance on objective measures of functional fitness and self-reported measures of physical function, and changes in weight were partially accounted for by changes in aerobic fitness., (© 2019 National Rural Health Association.)

Background: Few studies of mental health or substance abuse have focused on rural life. This study aimed to evaluate the association between socio-demographic and clinical characteristics and the probability of rural alcoholic women seeking help on their own at a specialty treatment service., Methods: This exploratory study used a cross-sectional design to collect data from alcoholic women upon admission to a French outpatient department. Multiple logistic regression models tested whether the socio-demographic and clinical characteristics of these women predicted the likelihood that they would seek treatment at a specialty service on their own., Results: Among 50 rural alcoholic women, the probability of seeking help on their own at a specialty treatment service was 5.6 times greater (95% CI 1.2-25.7, P=0.03) for participants with a history of physical and/or sexual trauma and 5.1 times greater (95% CI 1.1-24, P=0.03) among women with no complementary health insurance., Conclusion: Increased knowledge of the specific characteristics of rural alcoholic women is needed to develop programs that will increase awareness of and access to specialty treatment services among these women., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

A Beijing-based non-governmental organization (NGO) strives to empower rural Chinese women and migrant girls by increasing their awareness of constitutional rights and promoting their capacities to exercise their civil and political rights. This article reports the NGO leaders' perceptions of the goals, strategies, and challenges in their citizenship endeavor, and analyzes their educational activities in theoretical and cultural contexts. By reporting a tension between the two founding leaders and unpacking the different approaches they take to engaging rural women, we demonstrate how the conceptualization of human rights education in the rural Chinese context is influenced by three approaches to human rights--the Confucian emphasis of rites, the Western tradition of emphasizing law, and the "human functional capacities" approach--and how the implementation process is constrained by China's political framework, the social conditions of rural women, and the NGO leaders' vantage points.

Exposure to biomass fuel smoke has detrimental health effects causing chronic diseases. This study investigated the relationship between biomass fuel smoke exposure and hypertension among the rural Bangladeshi women. A total of 410 women aged 19-60 years were enrolled in this study during April-May 2017 who regularly cooked with biomass fuel in traditional cook stove for the past ≥1 year. Self-reported daily cooking hours and lifetime cooking experience of the participants were recorded, and their blood pressure was measured. Participants' age ≥40 years, parental history of hypertension, body mass index ≥25 kg/m 2 , and cumulative exposure to biomass smoke were found to be the significant risk factors of hypertension. Every 1 year increase in cumulative exposure to biomass smoke eventually exacerbated the risk of hypertension by 61% (adjusted odds ratio 1.61, 95% confidence interval: 1.16-2.22; P < 0.01). This study provides evidence that long-term exposure to biomass fuel smoke is associated with hypertension., Competing Interests: None

HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.

Background: Despite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural and urban women in Ghana, ii) the extent to which existing disparities are due to differences in the distribution of the determinants of institutional delivery between rural and urban women, and iii) the extent to which existing disparities are due to discrimination in resource availability., Methods: Using Demographic and Health Survey data from 2003, 2008, and 2014, this study decomposed inequalities in institutional delivery rates among urban and rural Ghanaian woman using the Oaxaca, the Blinder, and related decompositions for non-linear models. The determinants of the observed inequalities were also analyzed., Results: Institutional delivery rates in urban areas exceeded those of rural areas by 32.4 percentage points due to differences in distribution of the determinants of institutional delivery between the two areas. The main determinants driving the observed disparities were wealth, which contributed to about 16.1% of the gap, followed by education level, and number of antenatal visits., Conclusion: Relative to urban women, rural women have lower rates of institutional deliveries due primarily to lower levels of wealth, which results in financial barriers in accessing maternal health services. Economic empowerment of rural women is crucial in order to close the gap in institutional delivery between urban and rural women.

Background: Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling., Methods: A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for their own use will be eligible to participate in this study. The participants will be randomly allocated to one of three study arms: a) voice and text messages; b) interactive telephone-based counselling; or c) control arm (no additional phone-based support). The intervention counselling module will be developed based on the Integrated Behaviour Model which was recently adapted, and tested for the family planning context in Pakistan. It will broadly cover birth-preparedness, importance of birth spacing, and postnatal care. The phone-based intervention aims to improve women's ability to use contraception by providing them with information about a range of methods, access to family planning methods through outlets such as Suraj SF providers, connecting them with MSS field health educators to help them reach the centres, motivation by re-enforcing the benefits of contraceptive use on women's quality of life, and dispelling myths and misconceptions about modern contraceptive methods. Risk differences will be used as the measure of effect of the intervention on the outcomes., Discussion: The study findings will highlight effectiveness of mobile phone in raising awareness of maternal health and contraception, which in turn, is expected to be translated into increased proportion of: at least four antenatal visits, skilled birth or institutional delivery, postpartum contraceptive use, postnatal check-up, child immunization, and breastfeeding. Moreover, if the text and voice messages approach is proven to be non-inferior to interactive calls, it will provide evidence to making promotion of healthcare less resource intensive, and thereby contribute in improving the efficiency of the healthcare system., Trial Registration: This trial was prospectively registered with the Clinical Trials registry ( NCT03612518 ) on August 2nd, 2018.

Aim: The aim of the study was to explore the care-seeking pathway of rural women living with rheumatoid arthritis (RA) and attending a tertiary health-care facility in Odisha, India., Background: RA is the third leading chronic health condition and causes severe pain and immense psychosocial stress. The prevalence of RA is three to four times higher in women than in men. Furthermore, in India, women delay care seeking due to the prevailing sociocultural norms. Women report more severe symptoms and greater disability; however, there is a lack of information on their care-seeking pathways., Method: We conducted 113 in-depth interviews among RA patients those who visited specialists at the outpatients' Department of Rheumatology, SCB Medical College Hospital, a tertiary care hospital in Cuttack, Odisha, India. The grounded theory approaches were used for data analysis., Findings: The key findings included physical pain and psychosocial stress in relation to RA, cultural issues in relation to RA, mapping of the health-care providers for RA, the first point of cares and changes in care-seeking pathways, the perceived challenge for seeking health-care, and coping strategies of patients and social supports. This study explored that the RA patients seek care from multiple providers - untrained, trained and specialist without any gatekeeping. However, the primary health centers were the first point of care for maximum patients due to accessibility and affordability. Furthermore, follow-up care is significant to prevent complication among RA patients; the primary health centers are the gateway for keeping RA patients. Hence, the availability of RA trained providers at primary health center including interprofessional care, such as physiotherapy providers, and proper referral system is essential to convalesce care-seeking pathways.