https://www.rrh.org.au Rural and Remote Health is an open-access international academic journal serving rural and remote communities and publishing articles by rural health practitioners, educators, researchers and policy makers. en-gb Sun, 24 Aug 25 08:03:55 +0000 Papir Journal Platform melissa.storey@rrh.org.au (Melissa Storey) webmaster@commonline.com.au (Webmaster) https://www.rrh.org.au/images/rrh_og_branding.jpg https://www.rrh.org.au https://www.rrh.org.au/journal/article/9477 https://www.rrh.org.au/journal/article/9477 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. Wed, 20 Aug 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9723 https://www.rrh.org.au/journal/article/9723 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. Mon, 18 Aug 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9796 https://www.rrh.org.au/journal/article/9796 To lower Indonesia's maternal and infant mortality rates, the Indonesian government encourages women to give birth in medical buildings (eg. hospitals and health centers). However, in several remote and underdeveloped provinces, use of these services remains low due to unequal access to transportation and communication across the Indonesian archipelago. Maternity waiting homes, places or rooms located near a health center or hospital that can be used by pregnant women and their families for several days pre-labor and post birth, have been introduced to help address these challenges. This Original Research article investigates the use of maternity waiting homes and their impact on increasing institutional deliveries in remote island regions of Indonesia. Sat, 16 Aug 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9143 https://www.rrh.org.au/journal/article/9143 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. Tue, 05 Aug 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9505 https://www.rrh.org.au/journal/article/9505 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. Tue, 05 Aug 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9644 https://www.rrh.org.au/journal/article/9644 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. Mon, 28 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9205 https://www.rrh.org.au/journal/article/9205 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. Fri, 25 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/10063 https://www.rrh.org.au/journal/article/10063 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.   Fri, 18 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9450 https://www.rrh.org.au/journal/article/9450 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. Thu, 10 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9343 https://www.rrh.org.au/journal/article/9343 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. Tue, 08 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9494 https://www.rrh.org.au/journal/article/9494 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. Thu, 03 Jul 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9355 https://www.rrh.org.au/journal/article/9355 In response to the need to attract and retain more physicians in rural family medicine, much research has focused on the traits of medical students that choose to practice in rural settings. Being a rural doctor has been described as requiring 'clinical courage, the adaptability and willingness to work at the limits of, or beyond, training and experience to meet the needs of patients. Among other characteristics, clinical courage requires self-efficacy: elements of which include confidence and self-belief. Although there have been no studies looking at rural practice self-efficacy at different stages of medical training, it is expected that this measure could be impacted by the medical school experience. This Original Research study proposes a rural practice affinity model in which general self-efficacy leads to rural practice intentions when mediated by medical training to develop emergency medicine competency and rural practice self-efficacy. Mon, 30 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9705 https://www.rrh.org.au/journal/article/9705 During 2021-2022, corresponding with above-average rainfall and flooding in the region, several critically unwell patients with necrotising fasciitis were admitted to the Hervey Bay Hospital (Qld, Australia) intensive care unit. All patients had been in saltwater rivers hunting for green mud crabs or descaling barnacles from their vessels. Cultures revealed Vibrio species to be the agents of infection in four of the patients. Necrotising fasciitis caused by Vibrio species carries a high morbidity and mortality, and often progresses rapidly into a life-threatening soft tissue infection, multi-organ failure and fatal sepsis. This case series reviews the clinical documents for each patient, and data from Pathology Queensland, to highlight a potential public health issue that could become more common with future floods caused by climate change and the cyclic return of the La Niña. Thu, 26 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9395 https://www.rrh.org.au/journal/article/9395 Research demonstrates rural clinical placements during medical school - especially extended rural placements and especially if they are positive experiences - improve clinical skills and likelihood of practising in rural or remote locations later in a doctor's career. This Original Research article reports on specific clinical learning experiences during a rural placement that contribute to final-year medical students reporting them as 'high quality',  with a focus on whether the supervising doctor's background and training influences the quality of students' clinical learning experiences.   Tue, 24 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9675 https://www.rrh.org.au/journal/article/9675 Training registrars in rural and remote settings is essential for developing GPs with the relevant skills for the scope of practice and context required. Although many rural and remote doctors may be too busy with their own clinical practice to supervise a registrar, evidence has shown that remote supervision can be effective. Good supervision is more than clinical advice; it also includes attending to the registrar's wellbeing, supporting them through challenging situations, and brokering their relationship with the practice and the community. Guidelines for remote supervision have been developed by the Royal Australian College of General Practitioners (RACGP) to facilitate supervision and learning. This article reports on the practicality, safety, effectiveness and efficiency of the guidelines for the remote supervision of registrars in pilot locations. Sun, 22 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9468 https://www.rrh.org.au/journal/article/9468 The shortage of health professionals in rural areas is a global issue. One effective approach for increasing the rural health workforce is to establish rural medical education programs involving engagement in rural communities and highlighting rural practice that prepares medical students for careers in rural medicine. In Papua New Guinea, the Divine Word University Bachelor of Medicine and Bachelor of Surgery programs have introduced rural clinical placement blocks for each medical student in the fourth year of study. This Original Research study evaluates medical students' perceptions of rural clinical placement in Papua New Guinea, including their preference to work in rural locations. Fri, 20 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9650 https://www.rrh.org.au/journal/article/9650 The USA has a shortage of primary care providers in rural areas, especially those trained in pediatrics and mental health. Concerningly, chronic health conditions occur in one out of four children and pediatric mental health diagnoses have increased significantly since the pandemic. Pediatric nurse practitioners in primary care can provide high-level care, positive patient outcomes, lower medical costs, and higher quality of life among patients but the transition to practice in rural settings is challenging and requires training and support. Nurse practitioners who enter practice through residencies or fellowships have better adjustment to practice, reduced burnout and greater intent to stay in their roles. This Project Report uses a pediatric primary care fellowship example to outline the needs of graduate nurse practitioners, describe the rationale for postgraduate training, highlight program content and structure, and identify ways to collect data for evaluating the quality and efficacy of primary care fellowship programs. Fri, 13 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9309 https://www.rrh.org.au/journal/article/9309 Inter-hospital transfers from rural to urban hospitals in Aotearoa New Zealand are often essential for diagnostic investigations or specialist care that is unavailable rurally. Clinical information is coded and stored for health system analyses, including rural-urban differences in health outcomes. Anecdotally, clinical coding is often performed by clinicians or reception staff without formal coding training in many NZ rural hospitals, and by a designated hospital clinical coding team with university or sub-tertiary coding training in urban hospitals. No NZ literature has been found comparing the accuracy of clinical coding between rural and urban hospitals. This Original Research article examines whether any discrepancies exist in primary diagnosis codes for patients who underwent an inter-hospital transfer from a rural to an urban hospital. Thu, 12 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9260 https://www.rrh.org.au/journal/article/9260 Over the past 20 years, nearly half of Australia's birthing centres, predominantly in rural areas, have closed. This substantial reduction in number of rural birthing centres has correlated with a 47% increase in births occurring before reaching hospitals. Evidence highlights the comparably poorer outcomes for both mothers and neonates in unplanned out-of-hospital births, with increased incidence of post-partum haemorrhage, perineal tears, delayed third stage of labour and need for neonatal resuscitation. This Scoping Review explores paramedics' confidence in managing prehospital obstetric emergencies, identifies influencing factors and examines the implications of confidence on patient and paramedic welfare. Wed, 04 Jun 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9430 https://www.rrh.org.au/journal/article/9430 Artificial Intelligence (AI) is permeating every industry, including health care, and has the potential to help address common challenges in primary care settings through increasing workforce capacity, optimizing resource allocation, enhancing health research, and reducing burnout. Many Canadian healthcare settings have begun piloting AI scribes, tools that transcribe patient-PCP interactions and create electronic medical record notes, in the hope that they might significantly alleviate administrative burden. This Commentary outlines the administrative burden on primary care providers and the benefits and challenges of AI scribe technology within the context of northern, rural, and remote primary care settings. Mon, 02 Jun 25 00:00:00 +0000