Rural and Remote Health 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 Wed, 29 May 24 06:15:49 +0000 Papir Journal Platform (Melissa Storey) (Webmaster) Rural and Remote Health Access to maternal health services for Indigenous women in low- and middle-income countries: an updated integrative review of the literature from 2018 to 2023 Approximately 97% of Indigenous peoples live in low- and middle-income countries (LMICs) and, owing to the ongoing effects of colonialism, experience high levels of poverty, discrimination and marginalization, and have poorer access to health care, are more likely to live in ill health and have lower life expectancies at birth than non-Indigenous peoples. This is compounded by a lack of data on Indigenous peoples' health and needs. Indigenous women in LMICs can experience many barriers to access to maternal health services (antenatal care, postnatal care and childbirth), including the 'top-down nature' of interventions, a lack of cultural awareness from providers, language barriers, cost, poor awareness of services, and geographical barriers such as distance and transport. This Integrative Review explores the extent of the published literature on Indigenous women's access to maternal health services in LMICs from 2018 to 2023. The results update a previous review, and allow the authors to comment on how barriers might have changed, new barriers that have been identified and the WHO's aim of achieving Universal Health Coverage by 2030.   Sat, 25 May 24 00:00:00 +0000 Farming and the risk of developing osteoarthritis in Alberta, Canada Farming is physically demanding and may be associated with a higher risk of joint diseases including osteoarthritis. However, there is sparse literature on the association of farming and risk of osteoarthritis. In this Original Research study, Rahmanzadeh Koucheh and colleagues examined administrative databases in Alberta, Canada, to evaluate the association between farming and osteoarthritis. They followed over 350,000 adults over a 20-year period and observed a higher risk of osteoarthritis in farm and non-farm rural residents compared with urban residents. Additional work is required to examine factors associated with the higher risk and interventions that may reduce this risk.   Fri, 24 May 24 00:00:00 +0000 Virtual communities of practice for novice occupational therapists: a vehicle for learning, support and professional identity strengthening? In South Africa, around 40% of the population lives in rural areas. The responsibility for rehabilitation services in rural and underserved areas frequently rests on a group of novice practitioners completing a year of compulsory Community Service after graduation. Many of these therapists are placed in settings where services are underdeveloped or where they are the only occupational therapist. Previous studies have reported that they are often provided inadequate management, support, and supervision, and experience increased vulnerability to burnout. One area of practice that these novice therapists have reported as being challenging is hand therapy, of which there is substantial demand because of high levels of hand trauma largely resulting from interpersonal violence, road accidents, and work-related injuries. This Original Research article reports on participants' experience of a virtual Community of Practice (CoP) for providing support and sustained learning partnerships for novice, generalist occupational therapists delivering hand therapy services in rural and underserved areas.     Wed, 22 May 24 00:00:00 +0000 Ability to pay and catastrophic health expenditure of urban and rural deceased households over the past decade (2009-2018) Health status between urban and rural areas is particularly important in the context of regional equity. Owing to factors like inequitable distribution of healthcare providers, the distance to access healthcare services and socioeconomic factors, people living in rural and remote areas are often at a disadvantage relative to people in urban areas for access to health resources and health outcomes. Understanding the healthcare and financial burden of death and how this differs in rural and urban areas is an important, but understudied, part of the equity equation. The cost of health care for people before they die depends on factors including the type of treatment, geographic location, and socioeconomic status of the individual. Catastrophic health expenditure (CHE), calculated as the ratio of out-of-pocket expenditure to the household's ability to pay, is a useful indicator of household financial burden. This study examines ability to pay and equity of CHE between households of deceased members in urban and rural areas of South Korea. Tue, 21 May 24 00:00:00 +0000 ‘There’s no waiting list, just press play’: listeners' experiences of mental-health-related podcasts Podcasting has grown dramatically over the last two decades. Health-related podcasts provide a way of making health information available to a wide audience at low or no cost. They often facilitate discussions from medical professionals and have been used to increase health literacy and deliver educational resources to a range of clinical and non-clinical populations. A wide variety of mental-health-related podcasts are available to the public. Recent research has demonstrated that people who listen to mental-health-themed podcasts hold fewer stigmatizing attitudes than the general population, but little is known about listeners' experiences. This Original Research study sheds light on the motivations, listening habits and outcomes for mental health-related podcast listeners.   Tue, 14 May 24 00:00:00 +0000 Exploring arts-health ecologies in the very remote Barkly Region of Australia The Barkly, in the Northern Territory, Australia, is a highly creative region, with seven art centres and a range of creative practices across its multicultural population. Alongside the Barkly's cultural and artistic strengths, there exists extreme socio-economic disadvantage, with indicators of homelessness, domestic violence, unemployment, poverty and ill health at much higher than national Australian averages. The region is very remote - extreme weather conditions are experienced for long consecutive periods and distances between communities are many hundreds of kilometres on roads of very poor condition. Discussions of health and wellbeing are prefaced with First Nations' conceptions of health due to the authors' positionality and the significant proportion of the Barkly Region's population who are First Nations' peoples. This Original Research paper offers a snapshot of the overall arts-health ecology in the Barkly in order to advance our understanding of how the arts can be inextricably intertwined with social, cultural, political and place-based health determinants in remote contexts. These insights are illuminating for health policies and practices in remote regions more broadly. Wed, 08 May 24 00:00:00 +0000 Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review Māori, the Indigenous Peoples of Aotearoa New Zealand, are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD treatments than non-Māori New Zealanders. Rural Māori experience additional barriers to treatment access, poorer health outcomes, and a greater burden of CVD risk factors, compared to Non-Māori and Māori living in urban areas. Inequities in CVD outcomes and access to CVD healthcare for rural Māori are similar to those experienced by rural Indigenous Peoples internationally. Despite these inequities, literature exploring access to CVD healthcare for rural Indigenous Peoples is limited. This Scoping Review identifies and summarises literature that explores the barriers and facilitators influencing access to CVD healthcare for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the findings within an equity-and-Indigenous-rights based framework. Fri, 03 May 24 00:00:00 +0000 Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families The current economic crisis is resulting in more Australian families having to spend more money out of their own pocket for health care, known as out-of-pocket healthcare expenditure (OOPHE). When finances are tight, families forgo food or do not attend medical appointments just to get by, which can worsen chronic conditions. In this Original Research article, the authors explore OOPHE impacts for Aboriginal patients and families living in the Far West of South Australia.   Fri, 26 Apr 24 00:00:00 +0000 Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia Skin and soft tissue infections (SSTIs; e.g. cellulitis, wound infections, boils and abscesses) present a substantial financial burden on Australia's health system. A single episode of hospitalisation for SSTIs costs at least AU$670 per day and individuals living in rural and remote Australia often require aeromedical retrieval service to access emergency department and inpatient care, which also represents a sizeable financial cost. The Torres and Cape Hospital and Health Service (TCHHS) is the main, publicly funded health service in the Torres Strait, a body of water bounded by mainland Papua New Guinea to the north and Cape York, Queensland, to the south that includes 18 inhabited islands. Approximately 64% of the population of 4500 people serviced by the TCHHS identify as Aboriginal and/or Torres Strait Islander. This Short Communication defines the health service utilisation and health system costs associated with SSTIs in the Torres Strait in order to identify ways of improving the quality of regional healthcare delivery.  Thu, 18 Apr 24 00:00:00 +0000 Why surveys are ‘very hard’: exploring challenges and insights for collection of authentic patient experience information with speakers of Australian First Nations languages Survey tools are commonly used to collect patient experience data to monitor, evaluate and improve health services and health outcomes, but the quality of data collected can be compromised in contexts where languages and cultures are different to those in which the surveys were developed. Health service improvement is imperative to address persistent disparities in health outcomes between First Nations and other Australians. Best-practice models emphasize both the time required for adapting surveys and the need for co-design through shared expertise in language, culture and context. This collaborative qualitative study explored the acceptability, relevance and translatability of two patient-experience survey tools intended for use with speakers of First Nations languages in the Northern Territory, Australia, where more than 100 First Nations languages and dialects are spoken, and the majority of First Nations residents speak one or more of these languages at home.   Wed, 17 Apr 24 00:00:00 +0000 Farmers’ perceptions about the risk of suicide and the available help schemes: a qualitative study in France In many countries, the suicide rate is higher among farmers than in the general population, but farmers seem to seek help less frequently. In France, the Mutualité Sociale Agricole has developed several schemes to help farmers in difficulty (discussion groups, retraining assistance, subsidy for a replacement, and an anonymous telephone helpline) and most farmers are registered with a GP and receive reimbursement for medical consultations and treatment costs. Yet, French farmers consult their GPs less than other workers and have a higher suicide mortality rate than all other active socio-professional categories. This Original Research study analyses the perceptions of farmers in Ille et Vilaine, Brittany, about suicide and the help offered to farmers at risk of suicide.   Mon, 25 Mar 24 00:00:00 +0000 Development of a rural strategy for an urban-based medical program: a pragmatic reality Significant differences exist in health outcomes between rural and urban areas in Aotearoa New Zealand (NZ), and rural workforce issues (including heavy reliance on overseas-trained doctors and a maldistribution towards urban areas) compound these disparities. The medical programme at the University of Auckland has implemented several approaches to address these pressures, including providing 25-50% of general practice placements in a rural setting and admitting students of rural origin via the Regional Rural Admission Scheme (RRAS),  but there has been little indication of an increase in medical students wanting to pursue a rural career. This Original Research article reports on the results of interviews with key stakeholders that sought to identify the processes required to develop a rural strategy, including possible facilitators and challenges that need to be addressed.   Thu, 21 Mar 24 00:00:00 +0000 Rehabilitation models for community integration of adults with acquired brain injury in rural areas: a scoping review Acquired brain injury (ABI) includes conditions like stroke and traumatic brain injury, and is one of the leading causes of disability in working-age adults worldwide. Depending on the extent and location of the injury, individuals with ABI may experience a complex combination of deficits in motor, sensory, cognitive, perceptual, and emotional domains and often require proactive services and persistent professional support after discharge home to help them overcome diverse challenges related to family life, social participation, the return to work, and finances (known as 'community integration'). This scoping review maps the current research literature to identify existing models for the provision of rehabilitation services that promote community integration in rural home-dwelling adults with ABI.   Tue, 19 Mar 24 00:00:00 +0000 Understanding rural pharmacists’ perspectives: lived experiences and insights associated with rural recruitment and retention The shortage and maldistribution of healthcare professionals, such as doctors, nurses and allied health professionals, continues to impact the health and wellbeing of rural and remote communities globally. Pharmacists, who do much more than dispense medication, provide access to primary health care services including vaccinations, chronic disease management, wound care, oral health care and mental health support. They are an important part of the overall health care picture and, in some cases, may be the only health professional locally available for people in rural and remote communities. This original research study develops a deeper understanding of pharmacists' perspectives concerning factors influencing their recruitment and retention in rural and remote communities.   Mon, 18 Mar 24 00:00:00 +0000 Learning process of implementing a cutaneous leishmaniasis capacity-building program, using an innovative pedagogy for rural populations in Colombia Infectious diseases associated with poverty disproportionately impact rural populations with limited access to health care. Cutaneous leishmaniasis (CL) is caused by infection with leishmania parasites and spread by the bite of sandflies; it is challenging to control owing to its epidemiological, clinical, and biological complexity. Colombia reported the second-highest number of CL cases in the Latin America region in 2020. Community capacity building and education is needed to achieve effective prevention and control. This article presents the learning process of implementing a capacity-building program, which sought to provide tools to the community to improve CL prevention and control in the municipality of Pueblo Rico, Colombia Doenças infecciosas associadas à pobreza têm impacto desproporcional em populações rurais com limitado acesso à atenção em saúde. A Leishmaniose Cutânea (LC) é causada pela infecção por parasitas leishmania e é transmitida através da picada de flebotomíneos; é um desafio controlá-la devido à sua complexidade epidemiológica, clínica e biológica. Em 2020, a Colômbia notificou o segundo maior número de casos de LC na América Latina. A capacitação e a educação da comunidade são necessárias para alcançar a prevenção e o controle eficaz da LC. Este artigo apresenta o processo de aprendizagem para a implementação de um programa de capacitação que buscou fornecer ferramentas à comunidade para melhorar a prevenção e o controle da LC no município de Pueblo Rico, Colômbia. Las enfermedades infecciosas asociadas con la pobreza afectan de manera desproporcionada a poblaciones rurales con acceso limitado a atención médica. La Leishmaniasis Cutánea (CL) es causada por una infección por parásitos leishmania y se transmite por la picadura de mosquitos flebótomos. Su control es difícil debido a su complejidad epidemiológica, clínica y biológica. Colombia reportó el segundo mayor número de casos de LC enLatinoamérica en 2020. Se necesita educación y desarrollo de capacidades comunitarias para lograr una prevención y un control efectivos. Este artículo presenta el proceso de aprendizaje de la implementación de un programa de desarrollo de capacidades, que buscó brindar herramientas a la comunidad para mejorar la prevención y el control de LC en el municipio de Pueblo Rico, Colombia.   Thu, 14 Mar 24 00:00:00 +0000 Emotional reactions to concepts of racism and white privilege in non-Aboriginal professionals working in remote Aboriginal communities The need to address racism in Australian health services is recognised at every level of national and state governance. Despite this, a barrier to developing antiracism is the strong emotional reactions that white people have when confronted with the topic of racism. These reactions, a result of implicit bias and intergenerational social and cultural learning, shut down critical reflection about racism, and can interrupt antiracist efforts and uphold white supremacy. Although documented mostly in universities, these reactions have been observed in the wider community, so it is likely they occur in workplaces too. With antiracism now an inherent part of professional practice guidelines in health, it is necessary to resolve this gap in the research. This Original Research article identifies how emotional reactions affect antiracism and decolonising health service delivery in Aboriginal communities. Fri, 08 Mar 24 00:00:00 +0000 Understanding and responding to racism and the provision of culturally safe care by interdisciplinary health professionals in the aged care sector in regional, rural and remote areas: a scoping review Internationally, racism, historical and present trauma and settler colonialism are catalysts for compromised health and well-being in a landscape of community and family dysfunction. The health impacts of racism are well documented in the lower life expectancy, burden of disease and elevated levels of psychological distress experienced by First Peoples. There is evidence to suggest that the ability of health professionals to integrate cultural safety into their practice is intrinsic to dismantling racism and to improving the health of First Peoples and other marginalised groups but little is understood about how health professionals understand racism in the context of providing culturally safe care. Utilising international research, this Scoping Review explores how interdisciplinary health professionals in the aged-care sector in rural areas understand and respond to racism and understand and provide culturally safe care. Thu, 07 Mar 24 00:00:00 +0000 Rural healthcare provider recruitment: time to focus on opportunities rather than scarcity Rural healthcare human resources challenges persist, despite the existence of many different initiatives to increase rurally focused training opportunities. This Commentary makes the case for a paradigm shift away from specialist curricula and training in urban centres, towards decentralization of training and capitalizing on the opportunity to increase rural practitioner mentorship of trainees. The concept of rural training in place is introduced, enabled by distance learning technology, to provide an immersive, longitudinal, rural training model, that would allow learners to build and maintain community integration throughout training. Wed, 28 Feb 24 00:00:00 +0000 A qualitative exploration of the experiences of Aboriginal and Torres Strait Islander people using a real-time video-based telehealth service for diabetes-related foot disease Rural and remote Indigenous communities are disproportionately affected by diabetes-related foot disease (DFD), one of the most prevalent causes of global hospitalisation and morbidity. Early identification of wounds and multidisciplinary management can significantly reduce amputation rates, but there are important barriers to health care for rural Indigenous communities, including access to culturally appropriate care, distance to care, dislocation from family and cultural support, exposure to racism, and poor communication with healthcare professionals. Telehealth has been identified as a strategy to improve access to health care for rural and remote communities and may address some of these barriers, but there is little research exploring the use of telehealth in the management of DFD in Indigenous people. This Original Research study investigated experiences of rural and remote Aboriginal and Torres Strait Islander people with DFD utilising a newly established real-time video-based telehealth service.   Wed, 28 Feb 24 00:00:00 +0000 Regional health inequalities in Australia and social determinants of health: analysis of trends and distribution by remoteness Inequalities often exist between urban and rural areas in health status and in the distribution of social determinants such as income, education and employment. Monitoring regional health inequalities can provide evidence and support for policies to reduce inequality. Much point-in-time evidence exists for Australia, but this Original Research article reports on analyses of Public Health Information Development Unit (PHIDU) data to investigate the nature of change in inequalities over 3 decades and to categorise local government areas into remoteness categories. Improved understanding of what has changed over time (or not) and diversity in health and social determinants of health both within and between remoteness categories can inform more effective policy and services to rural and remote areas.   Tue, 27 Feb 24 00:00:00 +0000