Volume twenty, Issue 3

Longstanding gaps in physiotherapy service delivery exist in rural areas across Australia. This study explored how stakeholders defined the success of a public-private partnership model of service delivery in a rural setting and examined if the model was successful according to stakeholder definitions. Barriers and enablers (mechanisms) were identified and linked to stakeholder-defined success measures.

This original research article reports on a study designed to compare the prevalence of dental caries among rural and urban elementary school-aged children in the United States. Findings indicate higher prevalence of dental caries in rural than in urban communities.

In Eswatini, rural populations experience unnecessary snakebite-inflicted injuries and deaths. Children are at the highest risk because of their small size and curious nature. This qualitative study explores the current knowledge and attitudes about snakebite, and the perceptions of a musical intervention, titled Iculo Ngenyoka (“Snake Song” in Zulu), as an educational tool aimed to raise awareness about snakes in the Lubombo region, Eswatini.

The shortage of health workers is a worldwide problem but is particularly critical in sub-Saharan Africa. In Mali, there are insufficient health workers and their retention is low, particularly in rural and remote areas. This study examined the factors contributing to the shortage and poor retention of health workers in two rural districts of Mali.

Riverine populations living along the rivers of the Amazon region face difficulties accessing services like health care and education and rely on fishing, subsistence farming, gathering of forest products and federal government aid. This study analyses the work processes of fluvial family health teams who access these communities in boats or ships.

After years of decline, pneumoconiosis in coal miners (black lung) is rising in the USA. Providing specialized care for miners living in rural communities is a challenge. A Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Clinic was developed to provide structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals and others. This study demonstrates the success of the virtual multidisciplinary community of practice in sharing information and skills within and across stakeholder groups, with the goal of ensuring the delivery of high-quality interdisciplinary care to miners in pneumoconiosis mortality hotspots in the USA.

This article reports on a study examining barriers and facilitators to physical activity for children living in a rural and isolated region in Canada. Findings suggest a need to understand contextual barriers specific to rural environments, and specific to particular rural regions.

There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care – particularly for chronic diseases. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care.

Geographic maldistribution of medical practise exists worldwide. One strategy for producing doctors for practise in rural areas is to establish a ‘pathway’ that selects students from a region and offers undergraduate and postgraduate clinical training activities in that region. This study examines the association between postgraduate training location and doctors’ practice location once fully qualified in a medical specialty from one regionally based medical school in Australia and one in Canada.

Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. This study characterises the field of rural health research to inform how it can be fostered.

There is little available data about neonatal pneumothorax outside of neonatal intensive care units, especially amongst regional health services with paediatric facilities. This study reviews the role of Australian regional health services in managing this condition.

Rural health services, and the workforces that provide those services, are under unprecedented pressure due to insufficient health workforce numbers and distribution of health workforce weighted to urban areas. This creates health service access issues in rural areas, further compounding existing health inequalities between rural and urban people. This paper presents a call to action to pursue a complementary approach – that being supporting the capability of the rural health workforce.

During the coronavirus pandemic of 2020, countries rapidly mobilized front-line healthcare workers, including physicians, to address workforce shortages. Yet, international medical graduates remained an under-utilized pool of talent. This commentary describes key barriers faced by physician-migrants seeking licensure in a new country and provides examples from COVID-19 pandemic emergency deregulation efforts that may offer insights into reducing bureaucratic regulatory barriers.

This scoping review provides a synthesis of the literature on patient and provider perspectives of eHealth initiatives in rural Australian and Canadian communities. The focus on first person perspectives draws attention to the importance of centering patient voices in the evaluation of healthcare interventions such as eHealth.

Invasive fungal infections are becoming increasingly more prevalent in clinical practice. Subcutaneous fungal masses can often masquerade and imitate common dermatological lesions such as cysts. This case study describes a subcutaneous knee mass in an immunosuppressed farmer.

Being diagnosed with cancer and undergoing treatment is a life-changing experience, and many cancer patients find the physical, emotional, and social effects of the disease to be stressful. This study explores the experiences of cancer patients and their relatives from all parts of Northern Norway visiting the centralized cancer support centre.

In May 2019, there was a severe diarrhoea outbreak in a very remote and isolated community on Anuta Island, halfway between the Solomon Islands archipelago and Tuvalu. This Short Communication reports on the investigation and response to the outbreak, highlights the system challenges faced in mounting the response and provides suggestions that may help overcome these challenges.

The Indigenous Youth Mentorship program is a Canadian health promotion initiative designed to reduce chronic disease risk factors, and improve health and well-being for Indigenous youth. This project report draws on a case study approach to describe the implementation of an Indigenous Youth Mentorship Program First Nations community schools in the province of Alberta. It provides information for development and implementation of similar programs health promotion programs for Indigenous youth in Canada and internationally.

The challenges of implementing standardized health promotion programs across diverse settings are clearly articulated in this article. The authors reflect on lessons learned, concluding that flexibility, organization, responsiveness, communication, and collaboration were routinely required to problem solve geographic, intervention-related, and workplace barriers to effective implementation.

Rural and remote Australia suffers from a shortage of allied health clinicians. The provision of quality rural placement experiences for allied health students has been a significant strategy to address these health workforce shortages. This report describes an innovative service learning placement model in Northern NSW, the ‘rural community-based work-ready placement program’.

There is a world-wide shortage of physicians; this is worse in rural areas, which typically have a large underserved rural and remote population. In Japan, this is exacerbated by a specialist-driven approach to medical education and public health. The Rural Generalist Program Japan (RGPJ) has been developed to meet the needs of Japanese rural communities. This paper outlines development of the RGPJ using the World Federation for Medical Education standards.

Pre-COVID-19, rural communities already experienced limited access to mental health care. Lockdown during the COVID-19 pandemic has resulted in social isolation, financial insecurity and weakening of social support systems, resulting in a deterioration in adult mental health. Many ideas and improvements are filling the gaps in mental health care during this difficult time, but, as this Letter to the editor highlights, more emphasis is needed on rural and remote communities.

Lockdown in India and Nepal in response to the COVID-19 outbreak resulted in a mass exodus of Nepalese migrant workers from India to Nepal. To limit the spread of COVID-19, the government of Nepal adopted quarantine measures. Schools, temples, and public spaces at the border between India and Nepal were converted into makeshift quarantine camps. The quarantine camps are now too overpopulated for social distancing, there is a lack of food, shelter, hygiene and sanitation and medical attention is very limited, leading to delays in diagnosis and adverse events including death.

COVID-19 is an important pandemic respiratory disease affecting more than 160 countries around the world. In this Letter, the authors describe an outbreak in a rural Thai tropical forest village, more than 100 km from Bangkok, starting with a man who had attended a Muay Thai fight in the city.

As of 1 May, 2020, more than 3.4 million cases of confirmed SARS-CoV-2 infections and more than 240,000 deaths due to Coronavirus Disease 2019 (COVID-19) had been reported worldwide. In Germany, about 85% of the COVID-19 patients are cared for mostly by family physicians in community practices, which allows hospitals to concentrate on critically ill patients. This Letter to the Editor reports on the first cohort of SARS-CoV-2 infected patients in a rural district in Germany.

The COVID-19 pandemic has not only been affecting people’s health, but has also had negative impacts on social interaction. This Letter to the editor reports on the experiences of elderly rural people in Japan preparing for the celebration of Obon (a traditional Japanese holiday week in August) during the pandemic.

Paediatric burns are a leading cause of childhood injuries, having significant physical and psychological impact to both parents and child. This Research Letter highlights a concerning trend in vehicle exhaust burns in children, requiring complex and challenging wound care in rural and remote Australia.

This analysis uses publicly available county level COVID-19 data to predict case fatality rates by county, across the rural continuum. While acknowledging limitations in calculation of case fatality rates where county-level testing rates are unavailable, the authors report that the mortality burden of COVID-19 is exceptionally high in rural areas in the US, despite their overall lower rate of cases. Many rural areas face substantial challenges in disease surveillance, testing, and treatment. Case fatality rates can provide information beyond crude case rates and numbers of deaths to identify vulnerable and underserved rural populations, so that resources can be allocated more equitably.