Volume twenty-five, Issue 3

Retaining an allied health workforce is one of the many challenges faced by rural and remote health services. Supporting rural allied health professionals through targeted professional development positively impacts workforce satisfaction and retention. The Allied Health Rural Generalist Pathway (AHRGP), designed to develop and recognise the specialist skills and knowledge required for rural and remote allied health practice, was introduced in regional local health networks (LHNs) across South Australia in 2019. This Original Research article describes the personal and organisational contextual factors that contribute to successful completion of the AHRGP by trainees in regional LHNs in South Australia.

Pharmacists and pharmacies play an integral part in the Australian healthcare system. However, rural and remote Australia has a shortage of practising pharmacists, which may impact fair and equitable access to medicines, primary healthcare advice and over-the-counter medicinal products for rural people. This Original Research article describes employers’ perceptions of the extent and nature of the barriers involved in recruitment and retention of pharmacists in their rural and regional practices, and the efforts employers have made to address these barriers.

The effectiveness of rural health services depends on factors such as the distribution and motivation of the rural health workforce, the adequacy of health infrastructure and the accessibility of health services to local communities. The attitudes of university students towards rural health services can be indicative of their intention to work in rural areas post-graduation and understanding these attitudes can be useful for developing  policies and education to support rural health services. This Original Research study presents a valid and reliable psychometric tool to measure the attitudes of health students towards rural health services in Turkey.

Recruitment and retention of the rural healthcare workforce is crucial to maintaining access to services and provision of care in rural communities. Past research has found that healthcare professionals being born or brought up in a rural area remains the strongest indicator of rural career intention, and rural placements during training may also have an impact. Several studies have also investigated the role of 'community attractiveness', including place-related features such as recreational opportunities, spousal satisfaction, schools, shopping, housing, social networks and general perception of the community. All these elements relate to the concept of Asset-Based Community Development (ABCD), which aims to support communities to make best use of the assets available to them to improve their situation. This Original Research article examines how NHS job advertisements represent the community to which they are recruiting, drawing on ABCD to focus on which social and professional community assets are given prominence and how.

There is a significant gap in understanding how rurality influences the epidemiology of oral and maxillofacial (OMF) injuries. This Original Research study provides novel insights into the epidemiology of OMF injuries across Queensland, with a particular focus on rural areas. By using a comprehensive, broad dataset spanning several years, the research offers a unique perspective that can significantly inform public health initiatives, resource allocation and policy development aimed at reducing the incidence and impact of these injuries, particularly in underserved rural areas.

In this Letter to the Editor, the authors describe the use and challenges of ultrasound in family medicine in Greece and call for structured and continual ultrasound training for family physicians.

Recruiting healthcare professionals to rural and remote areas remains a persistent challenge. Research has found that if healthcare students have favourable rural placements, it enhances their willingness to return to practice in rural areas. The positivity of a rural placement experience often stems from the feeling or sense of belonging during the placement period but limited research has explored what contributes to ‘belonging’. This Scoping review explores the events and experiences that influence medical, nursing and allied health students’ sense of belonging in rural and remote communities while on clinical placement.

Communities on small islands can experience limited access to health care because of the large travel distances to available services. In Indonesia, a country of more than 16,000 islands, community health centres, which are spread across the country, fulfil a pivotal role in the healthcare system, acting as the primary entry point for individuals seeking care. Patients requiring specialist or hospital care are referred to different facilities. This Original Research study explores the referrals process in the Sangihe Islands Regency, a group of approximately 150 islands and one of the outermost regions in Indonesia, and provides suggestions to enhance the referral of patients from community health centres on small islands and in border regions to regional hospitals.

In this article, Professor Lucie Walters pays tribute to Professor Jill Konkin, a trailblazer and inspiration in rural medical education and rural health care.

Polypharmacy is linked to various health events, including falls, hospitalization, and mortality. However, no previous studies have investigated the association between polypharmacy and off-island referrals that prevent older island residents from remaining on their islands of residence. Okinawa Prefecture comprises a large main island at the southernmost tip of Japan and several smaller remote islands. This Original Research study describes the cases of non-return after off-island referrals in Okinawa Prefecture, Japan, and examines the relationship between polypharmacy and non-returned off-island referrals in the primary care setting of remote islands.

Longitudinal Integrated Clerkships (LICs) immerse students longitudinally in a clinical environment, whereby they undertake continuous learning from supervisors, peers and patients, achieve core clinical skills in an integrated manner and foster relationships between all parties. The combination of continuous learning and active engagement in patient care is thought to be important in encouraging students to take up careers in low-resource settings, where there is often a maldistribution in the medical workforce. Understanding the reasons that students self-select rural LICs offers a distinct perspective that may inform selection policies and recruitment strategies. This Original Research article explores LIC graduates’ preferencing decisions and the attributes they consider most important in students undertaking a rural LIC.

Allergic rhinitis (AR) is a common non-communicable chronic inflammatory disease of the nasal mucosa with a prevalence as high as 50% in many European countries. AR frequently occurs in conjunction with other conditions, including asthma, and most people with allergic asthma and at least 50% of those with non-allergic asthma suffer from AR. Treatment guidelines emphasize the importance of simultaneously targeting both asthma and AR, but few data exist that evaluate the control of symptoms and health-related quality of life in patients, especially rural patients, with AR and asthma. This Original Research study compares asthma and comorbid AR control among primary care patients in urban versus rural areas in Greece and identifies factors that might influence the control of asthma and co-morbid AR.

Rural stroke patients can experience obstacles (few healthcare professionals and long travel distances) in accessing stroke unit care, brain imaging within 24 hours, carotid imaging, and consultations from neurologists, physiotherapists, occupational therapists, and speech language pathologists. Additionally, they are less likely to be transferred to inpatient rehabilitation facilities. This Original Research article examines the impact of residential location on the quality of life and self-efficacy of stroke patients in rural Türkiye.

Several studies have found that, once licensed, physicians tend to remain in the region in which they studied. In France, undergraduate medical students must do their professional training in the region of the medical faculty that they attend. This is a problem for the most medically underserved region in France, the Centre-Val de Loire (CVDL), because many students from the CVDL prefer to enrol at the medical faculties in the nearby cities of Limoges and Poitiers, which are in a different region, rather than the only medical faculty in the region. In this Original Research article, the authors report on the number of students from a rural country in the CVDL enrolled at the local CVDL medical faculty and the medical faculties at Limoges and Poitiers, compare first-year pass rates between each faculty and identify factors that influence students’ choice of medical faculty.

Indonesia is predominantly an agricultural country, with 10.5% of its labour force engaged in the agricultural sector, but little is known about the health status of the Indonesian farming population. Several factors contribute to poor health outcomes among farming populations around the world, including living in rural areas, where access to socioeconomic opportunities and health services can be limited compared with urban dwellers, hazardous environmental conditions (including use of agrichemicals) and injuries (including from motorbike and quad bike accidents). This pilot study describes the health and wellbeing status, and the behavioural, lifestyle and safety risk factors, among farmers in Indonesia.

Self-esteem has profound implications for mental and emotional wellbeing, particularly during adolescence, when fluctuations can affect psychological development and have long-term effects into adulthood. Despite recognition of the role of self-esteem in adolescent health and development, it remains understudied. This Original Research study compares self-esteem levels among secondary school adolescents in urban and rural settings in Oyo State, Nigeria, and identifies key predictors of low self-esteem.

In Malawi, where 42% of the population is aged 0–14 years, the paediatrician-to-child ratio is very low and most paediatricians work in urban areas, where only 18% of the population lives. To address this workforce inequity, the Kamuzu University of Health Sciences initiated a specialised training program in 2012, the Bachelor of Science in Paediatrics and Child Health (BSc PCH) for clinical officers (formerly often referred to as non-physician clinicians). This Original Research article investigates the workplace satisfaction of BSc PCH clinical officers and the likelihood of their retention in current positions.

Between July 2021 and March 2022, 51 experts from around the world contributed to an eight-part webinar series on rural health equity convened by the World Health Organization (WHO) and the World Organization of Family Doctor’s Working Party for Rural Practice (Rural Wonca), with inputs from partners including the Organisation for Economic Co-operation and Development (OECD) and agencies in the United Nations Inequalities Task Team subgroup on rural inequalities. The webinar series aimed to share technical/operational know-how, insights and lessons learnt for both health systems strengthening and action on social and environmental determinants of rural health inequities. This Original Research article presents an analysis of the expert narratives from the WHO Rural Health Equity webinar series that tests the framing of rural health equity, considers the drivers of rural health inequities within and beyond the health system and explores the implications for governance approaches.

This declaration, made during the Global Rural Health Summit in Bengaluru, India, on 4 April 2025, urges governments, international organisations, healthcare providers, civil society and the private sector to prioritise rural health in national and international development agendas by taking the following steps:

• Promote effective acute, preventative and continuous care in rural areas by teams of health professionals with broad generalist skills, led by Advanced Practice Rural Family Medicine doctors;
• Initiate formally recognised postgraduate rural Family Medicine training for advanced rural skills and remunerate this appropriately;
• Support the use of these skills by funding local reliable point-of-care testing and advanced digital technologies; and
• Incentivise universities, colleges and rural health services that support extended exposure of medical students and junior doctors to rural practice, and include rural teachers as faculty.

Social relationships are crucial for mental health, providing emotional support and facilitating access to care. However, individuals living in rural areas are often challenged by a culture that discourages open discussion of mental health issues. To date, there has been a paucity of research examining mental health discussion networks focused specifically on rural settings. This Original Research article examines the characteristics of rural people, relationships and networks that make mental health discussions more likely.

Carers play multiple roles in palliative care, and provide physical, emotional, social and spiritual support while contributing to healthcare economics. In rural areas, carers can fan face location-related challenges including late involvement of palliative care services, lack of trained providers and paucity of local health care, information and bereavement services. However, they may also be positively supported by rural attitudes, such as resilience, acceptance of death and engagement in community support networks. This Original Research article presents a conceptual framework to inform reflections and discussions to provide meaningful support for carers involved in palliative care in rural areas.

A fully staffed and skilled allied health workforce is imperative to manage and improve the poorer health experienced by rural and remote populations but complex challenges in recruitment, retention and turnover of allied health practitioners (AHPs) affect the provision of services. Although several reviews have explored health professional retention factors, findings and recommendations have largely been drawn from studies examining the medical profession. To date, findings relating to the allied health workforce have been isolated and have not been synthesised collectively. This Scoping Review explores gaps in evidence by examining the length of employment of AHPs and significant factors and costs associated with the recruitment, retention and turnover of the rural and remote allied health workforce.