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 the Kimberley, north-western Australia, the prevalence of dental disease is significantly higher than other regional centres. Providing adequate access to timely dental care to remote Aboriginal communities in the region remains a challenge and is both a state and national priority, but establishing permanent full-time dental services is generally not considered viable or sustainable because of the vast, remote and sparsely populated  area. As a result, the Kimberley Dental Team, a non-government, volunteer-led organisation, was established to ‘fill the gaps’ and extend dental care to areas of unmet need. This paper describes the development, resources, operational factors and organisational characteristics of the Kimberley Dental Team.

In Indonesia, traditional medicine is well-known and practiced from generation to generation. The 2013 and 2018 results of the Indonesian Basic Health Survey indicated that, despite a lack of coverage by the National Health Insurance scheme, the use of traditional health services is increasing and it seems they are even expected to fill the gap in health coverage caused by a lack of modern health facilities in rural areas. This article reports on the use of traditional health services in rural Indonesia and how this relates to socioeconomic factors.

Providing culturally and linguistically appropriate rehabilitation services to older Indigenous adults is challenging, particularly within rural and remote settings. This article describes the community participatory action research process used to develop and evaluate a Community Rehabilitation Worker program to serve First Nation elders in Treaties 5 and 9, Canada. The resulting curriculum, which incorporates culture, spirituality, traditions, local language, and reintegration of elders into the community, is now being implemented. The authors reflect on the importance of a participatory approach when developing programs and services for Indigenous peoples.

In Papua New Guinea (PNG), tuberculosis (TB) is the leading cause of death from an infectious agent and many cases are multidrug-resistant. Optimising models of care for TB patients living in the Torres Strait/PNG international border region has been particularly difficult; geographical, geopolitical and socioeconomic challenges in the region have created healthcare disparities that affect diagnosis, referral pathways, treatment and management of TB patients. Delays between symptom onset and commencement of effective treatment contribute to ongoing TB transmission. This study assessed improvements in time to commencement of effective treatment in patients diagnosed with drug-resistant TB in the Torres Strait/Papua New Guinea cross-border region.

Severe mental disorders (eg major depressive disorder, bipolar mood disorder, schizophrenia and other psychotic disorders) affect 4% of the adult population globally and account for 26.1% of reported mental disorders in South Africa. Informal caregivers are the backbone of recovery for persons with severe mental disorders, particularly in rural areas where access to mental health services is limited. This article reports on the extent of subjective and objective burdens among informal caregivers of persons with severe mental disorders in rural South Africa.

Maldistribution and retention of health professionals in underserved areas are global problems, and burnout is one reason that health professionals leave rural areas. Nurses are the frontline health workforce and are critical in a health service facility. National Indonesian regulations have a target of 180 nurses per 100,000 people, but several rural provinces do not meet this target. Chronic burnout is linked to depression, and nurses have a higher risk of depression than the general population. This article reports on resilience and depression in Indonesian nurses and finds that the resilience profiles of Indonesian nurses differ from those of doctors, so tailored approaches are required to support nurses, improve resilience and improve workforce retention.

China has the heaviest burden of stroke in the world, and this burden has increased in the past 30 years. Stroke outcomes are worse in rural areas than in urban areas as a result of poorer living conditions but also because of the time it takes to access time-sensitive treatment. Rural and regional clinics and hospitals often lack the necessary imaging equipment and there is often a long travel distance to access appropriate care. Using data available in patient records, this Original Research article reports on the time lags from the onset of stroke symptoms to arrival at a stroke center for two archipelagic regions in China: main island (urbanized) and outer islets (rural).

In general practice, technical procedures have many areas of application, including prevention (eg vaccination or cervical smear), diagnosis (eg group A streptococcus testing), and treatment (eg wound dressing). These procedures require specific skills that are based on both knowledge and manual abilities. Along with communication, knowledge, clinical reasoning, emotions, values and reflection, technical skills are a dimension of medical competence and a part of the general practice curriculum in many countries. Lists of core technical procedures have been developed in Canada, the USA and Australia to serve as bases for training general practice students, but none is currently available in France. This study uses data collected as part of the ECOGEN study from 20,613 patient–GP encounters in rural and urban locations to describe the frequency and type of technical procedures in French general practice.

This unique study sought to explore the impact of wage differentials among urban, rural and remote healthcare settings as a potential factor in recruitment and retention of allied health professionals (AHPs). While the impact of wage was not demonstrated as an incentive for rural practice, additional factors such as gender, specific type of AHPs and remoteness are illuminated. This paper adds considerably to the rural healthcare literature by focusing on AHPs, a valuable asset to the healthcare team.

With the worldwide shortage of physicians living and practicing in rural and remote areas, it is important to understand better the nature of rural practice. A recent study that investigated the lived experience of rural doctors introduced the concept of clinical courage: a rural doctor’s adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This article describes the steps taken to develop a sound clinical courage questionnaire and presents the questionnaire, ready for testing with rural clinicians and refinement.

Delivering high-quality medical education in rural areas is of critical importance for producing skilled graduates who may be more inclined to later practice rurally. However, little attention has been given to understanding how rural clinical training may impact patients, host organisations, and rural communities where students undertake their training, despite engagement from these stakeholders being crucial to the success of rural training opportunities. This article describes how a series of consecutive student placements in a single practice of a small rural community have driven a series of clinical audits and interventions that continuously fed into the next placement, resulting in improved management of chronic disease. This evidence is important in demonstrating the impact that rural clinical training can have on health care and local health outcomes, while maintaining a high-quality student experience, and for identifying the program elements contributing to its success so that similar strategies can be more widely adopted.

Kowanyama, a very remote community in Cape York, northern Queensland, has a very high burden of disease and is ranked among the top five most disadvantaged communities in Australia. The community has access to 2.5 days per week of fly-in, fly-out GP-led Primary Health Care (GPLPHC) for a population of 1200 people. All patients requiring higher-level health care undergo aeromedical retrieval to a larger centre. This Short Communication reports that, on the basis of a clinical audit of aeromedical retrievals in 2019, greater access to GPLPHC may lead to fewer retrievals/hospital admissions for potentially preventable conditions and it might be cost-effective and improve patient outcomes to have a full-time on-site Rural Generalist GP-led service in this and other remote communities.

Attracting and retaining healthcare workers in remote and rural areas is still a global challenge, but is critical for achieving sustainable development goals. In Indonesia, to meet the target of universal health coverage, the government has established the National Social Security System – Healthy Indonesia Card with the Social Security Administering Agency managing health insurance and services for the community. To support this, it is necessary to have an equal distribution of health workers, including specialist doctors in hospitals. This Original Research study analyses the contextual factors that influence the retention of specialist doctors in rural Indonesia.

Rural populations routinely rank more poorly than urban populations on common health indicators. Although the complex interplay of various social determinants of health may partially explain this, some of this disparity may result from unique challenges healthcare providers face in rural settings. This Original Research article identifies several multidimensional barriers to healthcare access by patients and provision by healthcare providers in rural western Pennsylvania, USA. Patients experience cost-related barriers, more providers are needed to combat workforce shortage and burnout, and care delivery methods such as telehealth, satellite clinics, or advanced practice providers can help bridge the gaps caused by geographic dispersion. The authors recommend that policy efforts target all these aspects to appropriately address rural healthcare needs.

Nurses are often on the frontline of disaster management, providing care to patients with physical, mental, and emotional turbulence and acting as educators for disaster prevention. However, the literature suggests that nurses are underprepared to respond to disasters. This study examined the preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. The results suggest that nurses are poorly prepared for disaster responses, while those in rural settings are at a great disadvantage.

Transgender patients experience a myriad of barriers to accessing health care and receiving high-quality, non-discriminatory care. In rural Appalachia, people with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining competent and safe health care and experience increased risk of poorer health outcomes. This article reports on the development and implementation of a transgender healthcare provision training program for rural-serving medical residents in primary care in South Central Appalachia.

Although the output from health training institutions is increasing in most low-resource settings, the rural workforce availability remains low and suffers frequent rural–urban attrition. Improved retention – having healthcare workers stay longer in the post – is likely to alleviate the crisis. We interviewed healthcare workers and policymakers in Malawi and Tanzania to explore their perspectives on factors affecting retention. While policymakers’ views centred around the national-level retention policies, health workers considered the welfare of families and the immediate community more important in deciding to stay or relocate from a post. This article highlights the need to align retention policies with healthcare workers’ expectations.

People residing in rural areas of New Zealand have poorer health outcomes than those living in urban areas and this is accentuated for Māori. Internationally, in high income-countries, rural hospitals have been recognised as important healthcare providers, improving access to and integration of health services for rural communities. It is estimated that around 15% of New Zealanders rely on rural hospitals for health care, but there is no current description of rural hospital services and little published research regarding their role or value. This Original Research article presents the results from an exploratory study of the perspectives of rural hospital leadership on the place of rural hospitals in the New Zealand health system.

Poor mental health is under-recognised in rural locations. Although the prevalence of mental disorders is similar in rural and urban areas, suicide rates are 40% higher in rural communities. The level of readiness and engagement of rural communities to adapt to, or even acknowledge, poor mental health can impact effective interventions. This Review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities of the USA, UK and Guatemala.

The SARS-CoV-2 (COVID-19) pandemic brought about instability in healthcare providers worldwide, including in rural settings. In 2020, non-urgent elective care was suspended to free up hospital capacity in response to the pandemic. This Original Research article reports on the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland.

Although sex work is not criminalized in Brazil, female sex workers experience prejudice and discrimination. In rural areas, which tend to be poorer regions, female sex workers experience inequities in gender, race, class and, above all, bear marks of struggle and survival. This study reports on the meanings that women, in the experience of paid sexual work living in rural areas, attribute to the quality of life, according to Sartre's phenomenological perspective.