Volume twenty-five, Issue 4

This Letter to the Editor reflects on lessons for the Philippines from Houghton et al's (2023) study of the barriers to healthcare access in rural and Indigenous communities in Guyana and Peru. The author calls for urgent action in the Philippines to achieve Universal Health Coverage.

Teletherapy is an effective form of mental health service delivery for many populations and can extend mental health services to rural and remote communities that otherwise have limited access to care. This Original Research article describes the need for contextual humility among health professionals in urban centers when providing teletherapy to patients in rural areas. Key themes are identified through analysis of critical event narratives provided by physicians providing teletherapy to rural Alaskan communities.

In Australia, farming has one of the highest mortality rates among all industries. The internet is a key resource for disseminating health and safety information to agricultural workers but, although numerous studies have assessed the quality of health information online, there is a notable lack of research on safety information. This Original Research study reports on the content, accountability and readability of websites focused on agricultural safety.

Effective management of type 2 diabetes requires proactive, integrated, continuous, patient-focused health care, but in low- and middle-income countries, the capacity of health services to manage chronic conditions can be limited. This is particularly the case in Amazonas, Brazil’s largest state by area, where remote areas have limited healthcare access, a shortage of health services, and a shortage of medical professionals. Few studies in Brazil have examined the care provided by health institutions for chronic conditions from the service user’s perspective. This Original Research study reports on associations between individual characteristics, including sociodemographic, clinical, behavioral, and functional performance variables, and the PACIC score (designed to measure the perceived level of chronic illness management) in the primary care setting in remote municipalities of the Brazilian Amazon.

As of 2024, approximately 62% of Sub-Saharan Africa’s population resided in rural areas, with Tanzania reporting 65% rural residency. During the COVID-19 pandemic, Tanzania’s complete vaccination rate reached only 54% (for both one and two doses of vaccines combined), compared with the global average of 67%, as of December 2023. This disparity is particularly concerning given Tanzania’s predominantly rural population and the continued emergence and re-emergence of infectious diseases and pandemics. This Original Research article examined COVID-19 vaccination advocacy strategies in rural settings, specifically in Tanzania, that could be adapted to improve preparedness and response plans against future pandemics.

In Brazil, breast cancer is one of the most prevalent tumor types among women, and is the leading cause of cancer-related mortality. In rural and remote areas, women can miss out on early detection, timely diagnosis and treatment of breast cancer owing to their distance from healthcare facilities and screening services, and limited availability of mammography services. Despite these well-documented challenges, a paucity of empirical evidence is available on the performance of breast cancer screening programs in remote regions of the Brazilian Amazon. This Original Research article reports on the implementation of a breast cancer screening program in remote regions of the state of Acre, Brazil.

Internationally, suicide rates tend to be higher in less populated, rural areas. Community-based suicide prevention interventions often include community education, gatekeeper training, establishing or increasing access to mental health and crisis services and encouraging community-building through action groups and peer support networks. Despite anecdotal increases in such initiatives in rural and regional Australia, formal evaluations remain limited. This Review maps the breadth of community-based suicide prevention initiatives, examines their impacts and outcomes in rural and remote Australia, New Zealand and the Pacific Islands, and identifies evidence-based practices, knowledge gaps and future research directions.

Papua represents one of the most disadvantaged provinces in Indonesia, with high maternal mortality, remote geography, limited health infrastructure, and entrenched cultural practices that hinder care-seeking. Previous studies on maternal mortality in Indonesia have mostly emphasized biomedical complications or relied on national-level averages, without accounting for sharp structural differences across regions. Few have applied a multilevel framework to capture both individual- and community-level determinants simultaneously. This Original Research study addresses that gap by analyzing maternal deaths in Papua using the 2020 Indonesia Population Census, paying particular attention to rural–urban residence and providing new evidence to inform equitable maternal health strategies in rural and remote settings.

Many rural populations have limited access to timely and appropriate emergency medical services (EMS), which can result in higher mortality rates compared with cities. To address this, the Korean Government has initiated extra measures in EMS-vulnerable areas. One recent measure is an information and communication technology-based emergency medical services (ICT-EMS) system specifically targeting North Chungcheong Province. Its key features include real-time transmission of patient information, triage based on severity, selection of appropriate hospitals, remote medical consultations, coordinated transportation, and the secure sharing of critical patient data. This Original Research study evaluates the effectiveness and practical implications of the North Chungcheong Province ICT-EMS system from the perspectives of hospital stakeholders.

Rural and remote health in Australia relies on a consistent health workforce to service the population, but attracting and maintaining health professionals to work in rural locations is a well-documented and ongoing issue. Although allied health professionals are an important part of the health workforce, previous studies have identified a perceived lower priority for research into the allied health workforce compared with the medical workforce. This Scoping Review identifies, describes and addresses workforce recruitment and retention issues and initiatives for allied health professionals in rural and remote Australia.

Scotland continues to face doctor shortages, particularly in remote, rural and socioeconomically deprived areas. Conventional medical training has not resolved geographical or specialty imbalances. Increasing student numbers alone is insufficient; curricula must provide sustained rural and primary-care exposure to cultivate the skills, resilience and adaptability these settings demand. The Scottish Graduate-Entry Medicine (ScotGEM) program seeks to meet this need through a 4-year program that immerses graduates in community and rural practice. This Short Communication reports on ScotGEM graduates' self-reported preparedness for clinical practice.

Strengthening the primary healthcare system is particularly critical in low- and middle-income countries like Paraguay, where there are resource constraints and workforce shortages and healthcare infrastructure is limited. This Original Research study reports on the service readiness of public healthcare facilities in Paraguay using the World Health Organization's Service Availability and Readiness Assessment (SARA) tool and identifies areas for improvement.

Marginalised communities worldwide often face poor health outcomes and these disparities are frequently rooted in historical disadvantages and challenging socioeconomic conditions. Among the most affected are the Narikuravar population of Tamil Nadu, India, who experience limited access to education and unstable income, further perpetuating these inequities. This Original Research article investigates the healthcare needs and access challenges for the Narikuravar people living in Poonjeri, India.

Quality of life in adults and family health are two interrelated dimensions that play a fundamental role in the general wellbeing of people and their families. In Peru, previous studies have examined rural health, socioeconomic conditions and quality of life independently but few have explored how family health vulnerability interacts with socioeconomic factors to influence perceived quality of life. This Original Research study investigates the relationship between family health vulnerability and quality of life in residents of a rural district in southern Peru, while accounting for key socioeconomic variables.

Each day, approximately 800 pregnant women die globally, predominantly in low- and middle-income countries. The leading causes of maternal mortality are preventable and intricately tied to social inequality, which is linked to place of residence; in many places, sharp divides in access to social resources exist between urban and rural areas. In Colombia, there has been a concerning increase in maternal mortality since 2013. This Original Research study investigates social inequalities in maternal mortality by area of residence in Colombia.

Owing to the ongoing effects of colonization, Indigenous Peoples are disproportionately affected by systematic inequalities including racism, disadvantage, and disconnection with culture, which can manifest in disparities in health. Previous research has found that suicide rates for Indigenous young people are higher than in non-Indigenous young people. Mental health for Indigenous Peoples in Colombia is understood as spiritual harmony, balance between body, territory, community, and spirit. This Original Research study explored spiritual harmony in the Indigenous pediatric population of an Embera Dobidá community in Colombia, particularly factors relating to mental health, food security, general health, and connection to the land.

Despite their critical roles in underserved areas, the work of rural nurses can be invisible in health policy, research, and training curricula. Rural nurses face unique challenges, such as geographic isolation, lack of resources, and insufficient educational preparation, which contribute to high levels of stress and professional dissatisfaction. These factors affect individual health professionals but also have an impact on the quality of care delivered in rural populations. This Review identifies and maps the rewards and challenges, or factors contributing to 'pleasure' and 'suffering'– as derived from the work of Christophe Dejours – for rural nurses.

In Bangladesh, nearly 70% of people live in rural areas and face difficulties accessing health care because of low availability of providers and the high costs of care. To mitigate this situation, the Bangladesh government hired more than 6000 physicians in 2014, but whether this increased access and improved health status for rural people has not been studied to date. This Original Research article presents one of the first studies to assess the impacts of physician recruitment on access to care and the health status of rural people in Bangladesh. 

It is well established that medical students enrolled in a rural clinical school (RCS), particularly those who also have a rural background, are more likely to work rurally than medical students who only undertake metropolitan-based training. In response to rural workforce shortages in Western Victoria, Australia, the Deakin University Medical School introduced a rural training stream (RTS) to specifically recruit students from the local rural area and train them in the same region, with the aim that they will become local rural clinicians. To augment the introduction of the RTS, an innovative 3-day rural immersion program was developed to provide students with practical experience and knowledge about the RCS environment and help with preferencing decisions. This Policy Report contributes to the literature on medical students’ RCS preferencing decisions and presents students’ perceptions of the rural immersion program.

This Letter to the Editor responds to a recent <i>Rural and Remote Health</i> article about the clinical courage in rural doctors. The authors reflect on how courage relates to community, culture and care for rural doctors in the Philippines.