Volume twenty-five, Issue 1

Health justice partnerships (HJPs) are integrated service models established to mitigate the impacts on health from issues that have a legal origin and that, if left unattended, can be detrimental to the health of individuals. Evidence from HJPs demonstrates the positive contribution of legal services on the mental health of program recipients, including improvements in depression, stress, anxiety and wellbeing upon delivery of legal assistance. This Project Report adds to the limited available research literature about HJPs for youth by presenting the perceptions of regional young people and workers about the impact of legal matters on health and wellbeing and the role of an HJP in the health of young people in regional Victoria, Australia.

This exploratory study presents self-reported dietary supplement use among peri-menopausal women in rural Hawaiʻi. Regular use of supplements was notably higher in this population compared with results reported in communities in other nations and different geographic regions of the US. As the majority of respondents reported receiving supplement information from a clinician, healthcare providers are encouraged to engage in thoughtful discussion with their patients regarding supplement use.

Rural doctors practising in resource-limited settings display courage when they are required to work at the limits of their scope of practice to provide the medical care that is required by their community. Although courage can be an integral part of clinical practice, the underlying attributes of clinical courage are not well described in the literature. This Original Research article contributes to the study of clinical courage in rural doctors by reporting on testing of a recently developed questionnaire. Better understanding of clinical courage may contribute to training, support and retention strategies for rural healthcare professionals.

Advanced Skills Training (AST) is an opportunity for GPs to further refine their skills across one or more medical specialties. Rural training pathways have evolved to suit the needs of rural communities, trainees, trainers, health services and medical colleges. However, current rural training opportunities may be missing the mark on bridging the gap between urban and rural health and the demands on GPs have expanded beyond traditional boundaries, necessitating a re-evaluation of the skills and competencies required to address the complex and multifaceted health needs of diverse patient populations. This Review article examines the current value and fitness for purpose of AST for rural clinical practice.

A holistic definition of wellbeing includes the physical, social, emotional, cultural and ecological dimensions of both the individual and the community. While some research has been conducted on persons with disabilities in rural settings in South Africa, there is limited research into inclusion of persons with disabilities in cultural rituals. This Original Research study explores the experiences of persons with disabilities in Xhosa rituals and traditions in rural South Africa and how these experiences contribute to health and wellbeing.

The KidsFirst North program is a maternal–child health support program in rural northern Saskatchewan, Canada. The program serves both Indigenous and non-Indigenous families, and the majority of participants in the study are Indigenous. This Original Research article takes a community-based participatory research approach to investigate factors of success and barriers, from the perspectives of families, frontline workers, and administrators alike.

Professional education for community physicians is essential but there are challenges in balancing educational responsibilities with the practical demands of clinical work. This Research Letter examines the stressors and buffers for community-attending physicians accessing professional education. These insights will be useful in ensuring the sustainability and efficacy of professional educational practices.

A lack of appropriate and sustainable resources (including workforce and supplies), inadequate infrastructure (including unreliable internet connectivity) and lack of funding and governance impact the sustainability and feasibility of healthcare delivery in isolated areas. A telehealth model or mobile model of care may be most appropriate for these isolated regions but, paradoxically, these regions are the least likely to have infrastructure and resources to support the model. This Original Research article reports on the results of a needs assessment of healthcare services in Far East Gippsland, Victoria, Australia, and outlines feasible and sustainable services as suggested by the people that live there.

This cross-sectional study examines the impacts of health promotion workshops led by a multidisciplinary student team. Results suggest these workshops are associated with positive gains in health knowledge by participants, and satisfaction by partnering agencies. Further development of similar initiatives may prove useful in extending health literacy in rural communities.

South Africa has a history of mental health care provided primarily at tertiary level in institutions. However, in line with World Health Organization guidance, attempts have been made to decentralise and streamline the integration of public mental health care into general health care systems at primary and secondary levels. The currently implemented Mental Health Care Act 17 of 2002 serves as the national guideline to implement policy into practice, thereby increasing access and the quality of care to service users. This, of course, has implications for the roles workers and facilities are now called upon to play. This Original Research article presents data from a project that investigated issues regarding access and provision of mental health care in the Eastern Cape province of South Africa. The authors studied the experiences of public health care workers at PHC clinics and the associated referral hospitals, focusing mainly on exploring their views on the ability and readiness for access to and provision of mental health care to state health service users in the area.

Research on caring for children with disabilities in sub-Saharan African contexts has primarily focused on female caregivers, leaving male caregivers understudied. This Original Research article reports on a study exploring the journeys of male caregivers in rural Kenya as they navigate the complex landscape of health care for their children with disabilities. The authors uncover valuable lessons that can inform the development of better support services and make a positive impact on the lives of children with disabilities in rural settings by improving access to quality health care.

The learning environment has proved important for medical students’ wellbeing, satisfaction and academic results. Although complex and multifactorial, positive initiatives include integration of learners as active members of communities of practice and tailored guidance by teachers to aid learners’ development. Decentralized curricular models are potentially vulnerable for learning environment deterioration due to their remote location and limited student numbers. Prior investigations of learning environments in decentralized medical curricula describe inconsistent results, and are limited to certain geographical areas. This Original Research article compares learning environment perceptions of students in a decentralized curricular model in Norway with those of their urban counterparts, and with students in international medical curricula.

Living in a rural or remote area should not limit access to healthcare services or compromise quality of health care. However, the reality is that individuals in rural and remote regions often face significant barriers to appropriate health care, leading to poorer health outcomes and exacerbation of existing health disparities. This Letter to the Editor draws attention to innovative strategies for improving access to quality care for residents of rural and remote areas, including blockchain technology for health records, drone technology for medical supply delivery, and mobile health applications (mHealth).

Deep structural inequalities between places have consequences that reach far beyond the economy and impact overall wellbeing. Rural proofing is a tool aimed at helping policy makers develop more nuanced rural-friendly policies, making them fit for purpose in rural areas and helping them avoid unintended consequences from the urban bias in policy making. It entails the early sharing of evidence about rural dynamics during the policy development process, enabling policymakers to make adjustments before finalising the policy. This Policy Report looks at how to embed rural proofing into the policy space by setting up mechanisms that systematically assess policies for their impacts in rural areas to foster more balanced results. The report is based on a literature review of published research and discussions facilitated by the OECD, focusing on rural proofing.

During the first waves of the COVID-19 pandemic, healthcare professionals around the world were scrambling to understand the risk factors for the development of a serious clinical condition of patients. Procedures were often insufficient or even incorrect. Due to recurrent waves of illness caused by the SARS-CoV-2 virus, the decreasing population of vaccinated people, and the emergence of new variants of the virus that have changed the symptoms of the disease, we are still dealing with patients in serious condition, with concomitant sepsis leading to death. This Original Research article reports on risk factors for COVID-19 deaths among patients treated in a rural community hospital in south-eastern Poland.

Low birth weight (LBW) is a major cause of neonatal death. Many factors can cause LBW, including genetic, demographic, and psychological factors, limited access to medical services (especially obstetrics and antenatal care), lack of nutrition, maternal diseases during pregnancy, and exposure to toxins. This Original Research study investigates the factors contributing to LBW in Indonesia.

Skin cancer (melanoma and non-melanoma skin cancer (NMSC)) is a major public health issue in Australia. Rural populations have a higher melanoma mortality rate than metropolitan populations but, given they are not reportable conditions, it is difficult to ascertain whether the same trends exist for NMSCs. This Clinical Review investigates the detection of melanoma skin cancer and NMSC in a rural general practice in the South West region of Victoria, Australia.

Rural people across most nations, regardless of relative national wealth and development, live shorter lives, on lower incomes, with less formal education, and experience greater poverty, illness and injury than their urban-dwelling peers. Multiple causes for this inequity have been suggested, including greater physical risk associated with farming, poorer general and health literacy, distance from infrastructure, limited public transport, internet, health service resourcing, and shortages. All these factors, at their most fundamental, are features of geography. In rural and remote health, there appears a dominant assumption that increased inconvenience and cost for accessing health care are features of rural geography that should be expected by rural people. This Review challenges this assumption by applying concepts from critical geography to suggest rural geography has been shaped to result in exactly the health outcomes experienced by rural people, and that focusing policy on reshaping rural geography through the lens of spatial justice may result in better health services and outcomes.

Despite decades of government and professional efforts, small rural communities across Australia continue to grapple with a chronic shortage of healthcare professionals, particularly medical personnel. In rural South Australia, where general practices had been chronically understaffed for many years, the Riverland Mallee Coorong Local Health Network (RMCLHN) created the Riverland Academy of Clinical Excellence (RACE) to focus on training a clinical workforce to ensure sustainable care for rural communities. This Personal View outlines the strategies and tactics employed by RMCLHN to address enduring medical workforce challenges and reports on the success of the RACE.

Diabetic foot complications and amputations are significant in Fiji, accounting for 40% of all surgeries. This may be attributed to poor education, awareness and footcare practices among patients. Despite extensive research on diabetic foot complications and management, there is a significant gap in understanding patients' perceptions. This Original Research article explores the perceptions of type 2 diabetes patients in Fiji regarding diabetic foot complications and their self-management practices.

'Perceived social support' describes the perception of adequacy of support being provided by a person’s social network. Higher perceived social support has been linked to multiple health-related, psychological, and other benefits. The Multidimensional Scale of Perceived Social Support (MSPSS) was originally developed in English and has been widely translated and used in other languages. However, a recent review found that many studies among non-English-speaking people have used the scale without attempting to understand the meaning and context or to reconcile linguistic and cultural differences. This Original Research article reports on a study that coordinated the translation of the MSPSS into Diné bizaad, the language of the Navajo tribal members, by local community groups, with a focus on developing understanding of the cultural and language-specific meaning of concepts.

Cognition, physical function and life purpose constitute an important triad for functional and successful aging. The populations of many countries are aging, so increasing our understanding of experience of aging is crucial for making future public health decisions. Most studies on the experience of aging have been in urban areas but nearly half of the world’s population lives in rural areas and can have vastly different experiences from people living in urban areas. This Systematic Review describes the main characteristics and ways of aging in rural communities around the world, focusing on cognition, physical function, functionality and purpose in life.

Cognição, função física e propósito de vida constituem uma importante tríade para um envelhecimento funcional e bem-sucedido. As populações em muitos países estão envelhecendo, portanto, aumentar a compreensão da experiência de envelhecer é crucial na tomada de decisões futuras em saúde pública. A maioria dos estudos sobre a experiência de envelhecer é de áreas urbanas, entretanto, cerca de metade da população mundial vive em áreas rurais e pode ter experiências muito diferentes das populações urbanas. Esta revisão sistemática descreve as principais características e modos de envelhecer em comunidades rurais ao redor do mundo, com foco na cognição, função física, funcionalidade e propósito de vida.

La cognición, la función física y el propósito de vida constituyen una tríada importante para un envejecimiento funcional y exitoso. Las poblaciones de muchos países están envejeciendo, por lo que aumentar nuestra comprensión de la experiencia del envejecimiento es crucial para tomar futuras decisiones de salud pública. La mayoría de los estudios sobre la experiencia del envejecimiento se han realizado en áreas urbanas, pero casi la mitad de la población mundial vive en áreas rurales y puede tener experiencias muy diferentes a las de las personas que viven en áreas urbanas. Esta Revisión Sistemática describe las principales características y formas de envejecimiento en las comunidades rurales de todo el mundo, centrándose en la cognición, la función física, la funcionalidad y el propósito de vida.

This Original Research article presents results from a study exploring young people’s perceptions of how the rural setting influences their mental health. Utilising an ecosystems approach, the study explores the complex interplay of factors that impact on rural youth wellbeing, allowing for the development of nuanced and contextually appropriate approaches to improve mental health in this at-risk demographic. Understanding the influences on rural youth mental health allows for the exploration of interventions that amplify the protective aspects of rural living while mitigating the risk factors.

In recent decades, gambling has greatly expanded globally, in particular to online markets. This has been of concern due to the potential risks of gambling, such as problem or pathological gambling, as well as links to harms such as intimate partner violence, financial or career difficulties, association with mental health problems, and substance use. This Original Research article reports on differences in the prevalence, format and risk of problem gambling for people living in urban and rural areas.