Rural and Remote Health is an open-access international academic journal serving rural and remote communities and publishing articles by rural health practitioners, educators, researchers and policy makers.

In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GPs’ activities according to their location. This study analyzed French GPs’ activity according to their rural or urban practice location.

Physician shortages in rural and remote areas challenge accessibility and delivery of care to rural and remote communities, including within Scotland. Whilst there is evidence to support aspects of medical education that enhance the likelihood of practicing rurally, the mechanism by which these educational initiatives work is not clearly understood. Using a theoretical framework exploring career embeddedness, mobility and success, this study examines medical students’ perceptions of rural and remote practice. It also explores how these perceptions motivate their interest to practice rurally and what aspects of education are thought to influence these perceptions.

Expanding community pharmacists’ scope of practice in rural and remote locations has the potential to improve access to health care and improve health outcomes. Internationally, a lack of support from other health professionals has presented a barrier to the uptake of expanded pharmacy models. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings.

Palliative and end-of-life care is provided inconsistently across Australia, particularly in regional, rural and remote areas. Systematic solutions can help to address identified gaps and improve access and quality of care and support for patients, their families and carers at the end of life. This narrative report describes the ‘Far West NSW Palliative and End-of-Life Model of Care’, a consistent and contextually adaptable, patient-focused palliative approach, and identifies the essential elements to implement or maintain the Model elsewhere.

Farmers are thought to have a higher risk of skin cancers, but there is no direct evidence of this risk, and some population evidence of no greater risk to farmers of melanoma. The agricultural region of the Darling Downs in Queensland, Australia has the highest incidence of skin cancer in the State. This study defines the specific occupation risk for skin cancer among Darling Downs farmers compared with other community residents.

This Short Communication reports on the first investigation of a waterborne outbreak of Escherichia coli in Greece performed with the collaboration of a local pharmacy. The COVID-19 pandemic favored the use of alternative resources and channels of communication with the local population that can also be used in the future, especially in remote areas of the country.

Despite significant progress in the last decade, Greece still deals with a large number of road traffic accidents every year. This study provides an epidemiological approach to road traffic injuries presenting to a secondary hospital in a geographical area with a very low quality road network, and indicates possible preventive measures and actions.

The medical literature is replete with examples of studies about groups in which researchers from the ‘outside’ present and discuss their findings without any reflection of the views of those who have been researched. RRH has taken the decision that an article about people in any country or region without authors from that country or region will not be published and a recent RRH article provides an excellent example of how communities can be meaningfully engaged in research. This Editorial is a call to the international health science community to develop and adopt research and publication policies so that there is “nothing about us without us”.

Safe drinking water and effective sanitation in remotely located Indigenous communities are essential services and their provision is a human right. Yet sustainable provision of these services can be challenging. This narrative review identifies five key enablers to effectively and sustainably provide essential water and sanitation services to remote Indigenous communities.

Unpaid carers play a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing is often impacted in this role. There are limited data on how carer strain, depression and empowerment may be improved for carers. This study investigates the effectiveness of a carer support program developed with a community-based participatory action research approach in four remote Aboriginal communities in Western Australia.

Public health agencies around the world are concerned about the ever-increasing burden of type 2 diabetes and related disability. This study examines patterns of primary care provider use among people with and without diagnosed diabetes in a large survey of over 230,000 people in New South Wales, Australia.

Community health workers (CHWs) connect patients in rural and remote communities to health service organizations. This diverse group of healthcare workers have aided in improving healthcare access and outcomes and enhancing the quality of life for people in hard-to-reach communities. This systematic review examines the socio-cultural challenges that CHWs experience, focusing on the unique history, geography and socio-cultural milieu of South Asia.

This case-series study describes how a small rural healthcare system managed COVID-19 patients admitted between March and May, 2020. The authors describe their "hub and spoke" approach to best utilize scarce system resources, the assembly of a multidisciplinary clinical team to manage patients admitted and the challenges faced in adapting to the rapidly changing standards of care. The authors describe how a small team of generalist physicians and others can, in a crisis, provide a level of care comparable to that found in academic centers. They conclude that the development of strong clinical and research networks will help equip rural areas to respond not only to current and future pandemics, but more broadly to emerging care delivery challenges.

Responding in the Scottish Outer Hebrides presents a number of challenges above and beyond standard prehospital work owing to its remoteness and the limited resources available on the island. As a prehospital physician, it is important to have an excellent working relationship with all local emergency services and with the wider community. One’s emotional resilience will be tested when responding and living in a rural setting, when you are far less removed from the tragedies you encounter.

Research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just ticking the boxes on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice.

Facemasks are widely recommended as a COVID-19 prevention strategy, but decisions to wear a mask depend on multiple factors. While surges in cases within rural communities are likely an impetus for behavior change, rising case rates likely explain only part of mask-wearing decisions. This study examined the relationship between county-level indicators of rurality and mask wearing.

Grey nomads are people over the age of 55 who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Although grey nomads are challenging the established view of ageing in Australia, some evidence suggests that they exert a significant burden on rural health services. This scoping literature review explored the characteristics and behaviours of grey nomads, many of whom live and travel with diabetes.

Immunization is one of the most cost-effective methods for reducing the mortality and morbidity rate of children. Children being fully vaccinated helps prevent the occurrence of diseases that would have great societal costs otherwise. Incomplete vaccination poses public health risks and challenges. This study examines the issue of incomplete vaccination in Indonesia.

It is critical that those working with Aboriginal and Torres Strait Islander communities engage in culturally safe practice by acknowledging and understanding the impacts of trauma. In this Commentary, the authors examine the origins of cultural safety as a recommended practice for working with Indigenous peoples, demonstrating its flaws and shortcomings in practice and argue that without an understanding of the impacts of trauma, ‘ticking the box’ of cultural safety training simply is not enough to achieve equity in Indigenous health outcomes.

Water is crucial for food security and health, but fewer than 40% of rural households in Brazil are connected to the water distribution network. Boardwalk Cisterns is a rainwater harvesting program that provides clean water for populations with precarious access to water in Brazil. This study reports on the perceptions of farmers about the impact of the Boardwalk Cisterns program in the northeast, semi-arid region of the country.

A água é crucial para a segurança alimentar e saúde, mas menos de 40% das famílias rurais no Brasil estão conectadas à rede de distribuição de água. O Cisternas Calçadão é um programa de captação de água da chuva que fornece água potável para populações com acesso precário à água no Brasil. Este estudo relata a percepção de produtores rurais sobre o impacto do programa Cisternas Calçadão na região semi-árida do Nordeste do país.

According to the World Health Organization, there are more than 800,000 deaths by suicide every year. Of these, 20% are from pesticide poisoning and 80% occur in low- and middle-income places, especially in rural and agricultural areas. This study investigates which countries have the most publications about suicide among agricultural workers, examines the factors that lead to either suicide or intent, identifies the methods of suicide or attempted suicide and proposes preventive measures so that rural agricultural workers are not exposed to risk factors for suicide.

De acordo com a Organização Mundial da Saúde, ocorrem mais de 800.000 mortes por suicídio a cada ano. Destes, 20% são por intoxicação por agrotóxicos e 80% ocorrem em locais de baixa e média renda, principalmente em áreas rurais e agrícolas. Este estudo investiga quais países têm mais publicações sobre suicídio entre trabalhadores agrícolas, examina os fatores que levam ao suicídio ou ideação suicida, identifica os métodos de suicídio ou tentativa de suicídio e propõe medidas preventivas para que os trabalhadores agrícolas rurais não sejam expostos a fatores de risco para suicídio.

This study evaluated pilot community paramedicine (CP) programs from the perspectives of paramedics to gain program recommendations related to both rural and urban settings. Researchers distributed an online questionnaire to paramedics with and without CP experience employed at eight emergency medical services providers in northern Ontario. Results demonstrate the value of CP and indicate areas for CP program inprovement.

This study examined whether social support, problem solving and family function predicted depressive symptoms, caregiving-related life changes, self-care and caregiver burden in rural heart failure caregivers. It also compared differences in these variables between rural and urban caregivers. Findings suggest important considerations for reducing burden and improving outcomes for rural heart failure caregivers.

Remote area nurses often work in isolated and extreme geographical locations, alongside and with Aboriginal and Torres Strait Islander people. This study investigated what remote area nurses perceived were enablers and barriers to being involved in the delivery of care to an Aboriginal person with a terminal diagnosis passing away on their traditional lands.

Type 2 diabetes mellitus (T2DM) and social disadvantage are related. In Australia, this association is most pronounced amongst Indigenous people. Indigenous Australians are among the most socially disadvantaged in the country, with the worst social determinants of health (SDoH). This study combines the perspectives of Indigenous Australians with T2DM and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing T2DM, and how SDoH could be incorporated into usual clinical care for Indigenous Australians with T2DM.

While cancer deaths have decreased nationally, declines have been much slower in rural areas compared with urban areas. This cross-sectional study explored the association between breast cancer service capacity, and breast cancer incidence and mortality, in Arizona’s low populous counties. Compared to urban counties, rural county status was associated with lower breast cancer incidence rates, although there were no statistically significant differences in breast cancer mortality. These findings may reflect the challenges of using county level data, particularly per capita data, in a state where counties average over 7500 square miles.

The number of maternal deaths remains high in sub-Saharan Africa. Although improved antenatal care (ANC) service provision has been prioritized across the region, research is limited on the ANC experiences of Indigenous women. This study describes ANC attendance patterns at a hospital, and characterizes factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda.

Rural and remote children with burn injuries are disadvantaged if their burns require hospitalisation and specialist rehabilitation. In Queensland, Australia, most specialist burn rehabilitation is provided in regional or metropolitan cities by a multidisciplinary team, requiring rural and remote patients to travel. This project reports on the development of an Occupational Therapy-Led Paediatric Burn Telehealth Review Clinic at Townsville University Hospital to provide ongoing rehabilitation to rural and remote children closer to home.