Volume twenty-three, Issue 2

This Editorial shares lessons from the National Rural Health Association’s Rural Health Equity Conference and 46th Annual Rural Health Conference, San Diego, California, USA in May 2023.

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.

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.

Rural areas worldwide face a continued shortage of suitably trained workforce to deliver healthcare services. In Papua New Guinea, workforce shortages are a continuous stressor on the delivery of healthcare services, including in the allied health professions, which are in their infancy in terms of provision of university-qualified practitioners. This study used a survey and focus group of University of Papua New Guinea Bachelor in Medical Imaging Science (BMIS) students to explore factors influencing choice to pursue rural radiography careers.

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.

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).

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.

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.

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.

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.

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 population-based study explored the role of wage differentials among allied health professionals across urban, rural and remote settings. Important imbalances were found in the gender and geographic distribution of the allied health workforce, although the impact of wage was not demonstrated as a financial incentive for rural and remote practice. This paper adds considerably to the rural healthcare literature by focusing on AHPs, a critical asset for the healthcare system.

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.

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.

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.

The COVID-19 pandemic was a major public health challenge for island communities. A peer support group was set up across British islands, led by Directors of Public Health, with the aim of using an action research approach to identify and share learning to inform aspects of the management of COVID-19 that were unique to island communities. This Project Report investigates the key public health lessons that can be learned from the COVID-19 pandemic across island communities around Britain.

This Letter to the Editor responds to a Scoping Review published in RRH Vol. 23, Issue 1 titled 'The safety of anaesthesia delivered by rural generalist anaesthetists: a scoping review of the literature' (https://doi.org/10.22605/RRH7358). The present authors draw attention to broader issues related to anesthesia services in remote areas, including the need for generalist rather than specialist providers in rural environments. They identify the need to involve local multidisciplinary healthcare teams in exploring options to improve anesthesia services in rural areas, and highlight the impact of lack of access to care when key services are withdrawn.