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 Mon, 04 Aug 25 05:14:25 +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/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 https://www.rrh.org.au/journal/article/9398 https://www.rrh.org.au/journal/article/9398 South Africans with disabilities, especially in rural areas, are subjected to poorer access to health care and are more likely to report illness and experience a greater need for healthcare services compared with their non-disabled counterparts. Rehabilitation services in South Africa prior to the pandemic were already considered low priority, but they halted during COVID-19 lockdowns because they were considered non-essential health services. This Original Research article explores the perspectives and experiences of Eastern Cape rehabilitation practitioners who served persons with disabilities in this region during the COVID-19 pandemic. Sat, 31 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9140 https://www.rrh.org.au/journal/article/9140 Adaptation over many generations of living in the harsh and extreme conditions of the Russian Arctic has produced a 'northern' type of metabolism, characterized by increased protein-lipid metabolism and minimization of carbohydrate metabolism. Increasing urbanization in the region has resulted in less reliance on traditional diets and lifestyles, leading to increased incidence of obesity and non-communicable diseases. This Original Research study investigates the status of lipid metabolism and variability in body mass related to ethnicity and lifestyle in Russian Arctic residents. Thu, 29 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9626 https://www.rrh.org.au/journal/article/9626 Rural populations face inequitable access to primary healthcare services and are increasingly challenged to sustain a sufficient healthcare workforce. In addition, in the USA, the rural physician workforce is expected to decrease by 23% by 2030. Despite this, there are encouraging trends in the rapidly increasing numbers of nurse practitioner (NP) graduates. NPs have advanced clinical education, are qualified to provide primary care services, and are more likely to practice in rural communities than their physician colleagues. This Integrative Review synthesizes the scholarly literature about the early career experiences of NPs in rural health care and identifies the gaps in the literature for future research. Tue, 20 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9269 https://www.rrh.org.au/journal/article/9269 Intimate partner violence (IPV), any behaviour within an intimate relationship that causes physical, sexual or psychological harm, is a major public health concern worldwide. While the violence prevention research landscape is still evolving, only in the past two decades has it started to become a high priority for practitioners and researchers to devote resources into conducting more primary prevention research. Community-based interventions, particularly community mobilisation interventions, can transform attitudes towards social norms and reduce IPV behaviours when rigorously planned, have a robust theory of change and are rooted in knowledge of local context. This Original Research study assessed the effect of a community mobilisation intervention on attitudes supportive of physical IPV, women's experiences of IPV and men's perpetration of IPV in rural communities of South West Nigeria. Thu, 15 May 25 00:00:00 +0000 https://www.rrh.org.au/journal/article/9618 https://www.rrh.org.au/journal/article/9618 While incarcerated, women experience multiple barriers to accessing primary and specialty health care. When women are released from prison, they face barriers to timely access to primary health care, substance use disorder support and treatment, and mental health services, compounded by the need to navigate a complex web of services and systems to access housing and food, reconnect with children and access parenting supports. This Scoping Review identifies what is known about the health outcomes and health experiences of women and gender-diverse people who are currently incarcerated or recently released from prison into rural areas. Wed, 30 Apr 25 00:00:00 +0000