| 1. |
- Alehagen, Siw, et al.
(author)
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Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration
- 2012
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In: Rural and remote health. - 1445-6354. ; 12:3
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Journal article (peer-reviewed)abstract
- INTRODUCTION:Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality.METHODS:The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed.RESULTS:Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%.CONCLUSION:These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.
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| 2. |
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| 3. |
- Auer, K., et al.
(author)
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How can general practitioners establish 'place attachment' in Australia's Northern Territory? : Adjustment trumps adaptation
- 2010
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In: Rural and remote health. - 1445-6354. ; 10:1476
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Journal article (peer-reviewed)abstract
- Introduction: Retention of GPs in the more remote parts of Australia remains an important issue in workforce planning. The Northern Territory of Australia experiences very high rates of staff turnover. This research examined how the process of forming 'place attachment' between GP and practice location might influence prospects for retention. It examines whether GPs use 'adjustment' (short term trade-offs between work and lifestyle ambitions) or 'adaptation' (attempts to change themselves and their environment to fulfil lifestyle ambitions) strategies to cope with the move to new locations. Methods: 19 semi-structured interviews were conducted mostly with GPs who had been in the Northern Territory for less than 3 years. Participants were asked about the strategies they used in an attempt to establish place attachment. Strategies could be structural (work related), personal, social or environmental. Results: There were strong structural motivators for GPs to move to the Northern Territory. These factors were seen as sufficiently attractive to permit the setting aside of other lifestyle ambitions for a short period of time. Respondents found the environmental aspects of life in remote areas to be the most satisfying outside work. Social networks were temporary and the need to re-establish previous networks was the primary driver of out migration. Conclusion: GPs primarily use adjustment strategies to temporarily secure their position within their practice community. There were few examples of adaptation strategies that would facilitate a longer term match between the GPs' overall life ambitions and the characteristics of the community. While this suggests that lengths of stay will continue to be short, better adjustment skills might increase the potential for repeat service and limit the volume of unplanned early exits.
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| 4. |
- Biswas, Animesh, 1978-, et al.
(author)
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Unintentional injuries and parental violence against children during flood : a study in rural Bangladesh.
- 2010
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In: Rural and remote health. - Deakin West, Australia : Australian Rural Health Education Network. - 1445-6354. ; 10:1
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Journal article (peer-reviewed)abstract
- Introduction: Violence and injuries are under-reported in developing countries, especially during natural disasters such as floods. Compounding this, affected areas are isolated from the rest of the country. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country. The objective of this study was to examine unintentional injuries to children in rural Bangladesh and parental violence against them during floods, and also to explore the association of socioeconomic characteristics.Methods: A cross-sectional rural household survey was conducted in the worst flood-affected areas. A group of 638 randomly selected married women of reproductive age with at least one child at home were interviewed face-to-face using pre-tested structured questionnaires. The chi2 test and logistic regression were used for data analysis.Results: The majority of families (90%) were affected by the flood and were struggling to find food and shelter, resulting in the parents becoming violent towards their children and other family members in the home. Cuts (38%), falls (22%) and near drowning (21%) comprised the majority of unintentional injuries affecting children during the floods. A large number of children were abused by their parents during the floods (70% by mothers and 40% by fathers). The incidence of child injuries and parental violence against children was higher among families living in poor socio-economic conditions, whose parents were of low occupational status and had micro-credit loans during the floods.Conclusions: Floods can have significant effects on childhood injury and parental violence against children. The improvement of socio-economic conditions would assist in preventing child injuries and parental violence.
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| 5. |
- Cavicchi, A., et al.
(author)
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INFORMEG, a new evaluation system for family medicine trainees : Feasibility in an Italian rural setting
- 2016
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In: Rural and Remote Health. - 1445-6354. ; 16:3
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Journal article (peer-reviewed)abstract
- Introduction: In Italy the course to become a general practitioner (GP) lasts 3 years and includes both theoretical and practical study. Different from the theoretical part, until recently the practical activity has not been assessed at all. The Emilia Romagna Regional Health Authority has developed a special program called INFORMEG (Management of Tutoring during the Triennial Specific Training in General Practice), aimed at assessing primary doctor trainees' practical skills. INFORMEG includes a list of predefined cases of specific diseases, conditions or health problem, a web application and a smartphone app, aimed at assisting trainee self-management and helping the tutor in the assessment of trainee performance. The Emilia Romagna Regional Health Authority divided the pre-defined cases into three categories (A, B and C) according to their relevance to a trainee's education and coded them using the International Classification of Primary Care (ICPC). The aim of this project report is to illustrate the implementation of INFORMEG in a rural setting. Methods: Program evaluation took place from 2 May to 31 October 2013 during GPs' routine clinical activities. The following steps were accomplished during every meeting: (1) consultation recording; (2) identification of the reason for the encounter (RfE); (3) classification of the diagnostic procedure(s) performed (diagnostic/therapeutic/test results/administrative/advice); (4) classification of special procedures called 'practical clinical skills' and (5) elaboration of the final diagnosis after the encounter. Results: The number of cases of specific disease or condition encountered by the trainee were 98 for type A, 57 for type B and 22 for type C. A total of 605 RfEs were collected: 376 for type A cases, 147 for type B cases and 82 for type C cases. A total of 976 procedures were performed during the 6 months: 590 procedures for the type A cases, 271 for type B and 115 for type C. Conclusions: The pre-selected health problems were almost all addressed, thus confirming the good degree of representativeness of these clinical cases even in a rural setting. The ICPC coding helped the trainee in the construction of the case according to the logical process of family medicine. Two things to amend in INFORMEG are the absence of common arrhythmic conditions such as atrial fibrillation and the absence of means to assess the patient-trainee relationship.
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| 6. |
- Dalal, Koustuv, 1969-, et al.
(author)
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Non-utilization of public health care facilities : examining the reasons through a national study of women in India
- 2009
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In: Rural and remote health. - Deakin West, Australia : Australian Rural Health Education Network. - 1445-6354. ; 9:3
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Journal article (peer-reviewed)abstract
- Introduction: This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India.Methods: This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'.Results: Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care.Conclusions: This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.
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| 7. |
- Dubois, Hanna, et al.
(author)
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Patient participation in tele-emergencies : experiences from healthcare professionals in northern rural Sweden
- 2022
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In: Rural and remote health. - 1445-6354. ; 22:4
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden.METHODS: A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted.RESULTS: A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'.CONCLUSION: This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.
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| 8. |
- Eriksson, Ulrika, et al.
(author)
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Growing up in rural community : children's experiences of social capital from perspectives of wellbeing
- 2010
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In: Rural and remote health. - 1445-6354. ; 10:3
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Journal article (peer-reviewed)abstract
- Introduction: People are influenced by the neighborhood in which they live. The neighborhood may be particularly important for children’s wellbeing because of the constraints it imposes on their patterns of daily activities. Furthermore, the neighborhood is a central context for social development, being a place where children form networks and learn social skills and values. The aim of this study was to describe how social capital in the neighborhood is perceived by children living in rural areas, and to reveal what this adds to their sense of wellbeing.Methods: The study had a descriptive research design with a qualitative approach. Seven single-sex focus group interviews were conducted with children the in 6th grade (aged 11–12 years). Data were analyzed using deductive content analysis.Results: The children perceived a lack of social capital due to environmental and social constraints in their everyday lives. However, their wellbeing was enhanced by strong cohesion in the neighborhood. In addition, settings such as the school, the natural environment, and sporting associations were highly valued and emerged as crucial factors for enhancing the children’s wellbeing. The spatial isolation that characterizes rural areas created a special context of social network structures, cohesion and trust, but was also a breeding ground for exclusion and social control. The stories revealed paradoxical feelings of living in a good and safe area that simultaneously felt isolated and restricted.Conclusions: From a rural perspective, this study reveals the complexity of the children’s perceptions of their social environment, and the ways in which these perceptions have both positive and negative effects on wellbeing. The results highlight how important it is for health professionals in rural areas to consider the complex influence of bonding social capital on children’s wellbeing, and to be aware that it can promote exclusion as well as cohesion.
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| 9. |
- Gjessing, Kristian, et al.
(author)
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Exploring factors that affect hospital referral in rural settings : a case study from Norway
- 2009
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In: Rural and remote health. - Deakin West, ACT, Australia : Australian Rural Health Education Network. - 1445-6354. ; 9:1, s. 975-
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Journal article (peer-reviewed)abstract
- INTRODUCTION: A patients needs and the seriousness of the disease are not the only factors that determine referral to hospital. The objective of this study was to analyse whether locum doctors (LDs) have a different pattern of referral to hospital from regular GPs (RGPs).METHODS: All hospital referrals for one year (n = 5566 patients) from two Norwegian rural primary health care (PHC) centres to the nearby district hospital were analysed with regard to ICD-10 diagnosis groups. A major difference between the PHCs was that one had a continuous supply of LDs while the other had a stable group of RGPs. The equal-sized communities were demographically and socio-culturally similar.RESULTS: The PHC centre mainly operated by short-term LDs referred a relatively high number of patients to the district hospital within the diagnosis groups of chapter VI Diseases of the nervous system (proportionate referral rate 210%; p = 0.010), and chapter IX Diseases of the circulatory system (proportionate referral rate 130%; p = 0.048), and a comparatively low number of patients for the diagnostic groups in chapter X Diseases of the respiratory system (p = 0.018), and chapter XIV Diseases of the genitourinary system (p = 0.039), compared with the norm of the district hospitals total population. The number and proportion of the total number of referrals, adjusted for population size, did not differ between the two rural communities. The LD-run PHC centre differed significantly from the total norm in 5 out of 19 ICD chapters, equal to 41% of the patients.CONCLUSIONS: Only one significant difference in hospital referrals related to ICD-diagnoses groups were found between the studied rural PHC centres, but the LD-run PHC differed from the total norm. These differences could neither be explained from the districts consumption of somatic hospital care nor the demographical differences, but were related to staffing at the PHC, that is LDs or RGPs. The analysis also revealed that possible under- and/or over-diagnosing of certain diseases occurred, both having potential medical consequences for the patient, as well as increasing healthcare expenditure.
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| 10. |
- Glynn, Liam, et al.
(author)
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The Limerick Declaration on Rural Health Care 2022
- 2023
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In: Rural and Remote Health. - 1445-6354. ; 23:1, s. 7905-7905
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Journal article (peer-reviewed)abstract
- The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also considered the role of national health systems and all stakeholders, in keeping with the commitments made through the Sustainable Development Goals and the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being. This conference declaration, the Limerick Declaration on Rural Healthcare, is designed to inform rural communities, academics and policymakers about how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally. The recommendations focused on four major themes: rural healthcare needs and delivery, rural workforce, advocacy and policy, and research for rural health care. Equal access to health care is a crucial marker of democracy. Hence, we call on all governments, policymakers, academic institutions and communities globally to commit to providing their rural dwellers with equitable access to health care that is properly resourced and fundamentally patient-centred in its design.
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