International Journal of Environmental Research and Public Health

Research

19 pages, 1315 KiB

Open AccessArticle

“In the Village That She Comes from, Most of the People Don’t Know Anything about Cervical Cancer”: A Health Systems Appraisal of Cervical Cancer Prevention Services in Tanzania

by Melinda Chelva, Sanchit Kaushal, Nicola West, Erica Erwin, Safina Yuma, Jessica Sleeth, Khadija I. Yahya-Malima, Donna Shelley, Isabelle Risso-Gill and Karen Yeates

Int. J. Environ. Res. Public Health 2024, 21(8), 1059; https://doi.org/10.3390/ijerph21081059 - 13 Aug 2024

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Abstract

Introduction: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and [...] Read more.

Introduction: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations. Methods: We adapted Risso-Gill and colleagues’ framework for a Health Systems Appraisal (HSA), to identify HCPs’ perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018—participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology. Results: Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs. Conclusions: Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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14 pages, 304 KiB

Open AccessArticle

An Implementation Evaluation of the Smartphone-Enhanced Visual Inspection with Acetic Acid (SEVIA) Program for Cervical Cancer Prevention in Urban and Rural Tanzania

by Alyssa L. Ferguson, Erica Erwin, Jessica Sleeth, Nicola Symonds, Sidonie Chard, Safina Yuma, Olola Oneko, Godwin Macheku, Linda Andrews, Nicola West, Melinda Chelva, Ophira Ginsburg and Karen Yeates

Int. J. Environ. Res. Public Health 2024, 21(7), 878; https://doi.org/10.3390/ijerph21070878 - 5 Jul 2024

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Abstract

Introduction: The World Health Organization (WHO) recommends visual inspection with acetic acid (VIA) for cervical cancer screening (CCS) in lower-resource settings; however, quality varies widely, and it is difficult to maintain a well-trained cadre of providers. The Smartphone-Enhanced Visual Inspection with Acetic acid [...] Read more.

Introduction: The World Health Organization (WHO) recommends visual inspection with acetic acid (VIA) for cervical cancer screening (CCS) in lower-resource settings; however, quality varies widely, and it is difficult to maintain a well-trained cadre of providers. The Smartphone-Enhanced Visual Inspection with Acetic acid (SEVIA) program was designed to offer secure sharing of cervical images and real-time supportive supervision to health care workers, in order to improve the quality and accuracy of visual assessment of the cervix for treatment. The purpose of this evaluation was to document early learnings from patients, providers, and higher-level program stakeholders, on barriers and enablers to program implementation. Methods: From 9 September to 8 December 2016, observational activities and open-ended interviews were conducted with image reviewers (n = 5), providers (n = 17), community mobilizers (n = 14), patients (n = 21), supervisors (n = 4) and implementation partners (n = 5) involved with SEVIA. Sixty-six interviews were conducted at 14 facilities, in all five of the program regions Results SEVIA was found to be a highly regarded tool for the enhancement of CCS services in Northern Tanzania. Acceptability, adoption, appropriateness, feasibility, and coverage of the intervention were highly recognized. It appeared to be an effective means of improving good clinical practice among providers and fit seamlessly into existing roles and processes. Barriers to implementation included network connectivity issues, and community misconceptions and the adoption of CCS more generally. Conclusions: SEVIA is a practical and feasible mobile health intervention and tool that is easily integrated into the National CCS program to enhance the quality of care. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

16 pages, 736 KiB

Open AccessArticle

An Evidence-Based Guide for Delivering Mental Healthcare Services in Farming Communities: A Qualitative Study of Providers’ Perspectives

by Rebecca Purc-Stephenson, Nicole Roy, Adachukwu Chimaobi and Deanna Hood

Int. J. Environ. Res. Public Health 2024, 21(6), 791; https://doi.org/10.3390/ijerph21060791 - 17 Jun 2024

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Abstract

Individuals living in rural areas often face challenges in accessing healthcare, increasing their risk of poor health outcomes. Farmers, a sub-population in rural areas, are particularly vulnerable to mental health issues and suicide, yet they exhibit low rates of help-seeking behavior. The aim [...] Read more.

Individuals living in rural areas often face challenges in accessing healthcare, increasing their risk of poor health outcomes. Farmers, a sub-population in rural areas, are particularly vulnerable to mental health issues and suicide, yet they exhibit low rates of help-seeking behavior. The aim of our study was to develop an in-depth understanding of the issues influencing mental help-seeking among farmers living in rural areas from the perspectives of healthcare providers, as well as to explore the strategies providers use to navigate through these issues to effectively engage with this vulnerable population. Methods: We used a descriptive phenomenological approach to understand healthcare providers’ perspectives, experiences, and approaches to providing mental healthcare to farmer clients in rural areas. Semi-structured interviews were conducted with 21 participants practicing in Canada between March and May 2023. Results: Our analysis yielded five thematic areas: (1) ensuring accessibility, (2) establishing relatability, (3) addressing stoicism and stigma, (4) navigating dual roles, and (5) understanding community trauma. Conclusions: Healthcare service delivery for farmers is multifaceted. This study fills a gap in knowledge by translating these data to inform an evidence-based model and a list of recommendations for implementing agriculturally informed practices in rural areas. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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17 pages, 620 KiB

Open AccessArticle

Improving Outcomes for Regional Families in the Early Years: Increasing Access to Child and Family Health Services for Regional Australia

by Jessica Appleton, Deborah A. Stockton, Marie Dickinson and Deborah Debono

Int. J. Environ. Res. Public Health 2024, 21(6), 728; https://doi.org/10.3390/ijerph21060728 - 4 Jun 2024

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Abstract

Providing child and family health (CFH) services that meet the needs of young children and their families is important for a child’s early experiences, development and lifelong health and well-being. In Australia, families living in regional and rural areas have historically had limited [...] Read more.

Providing child and family health (CFH) services that meet the needs of young children and their families is important for a child’s early experiences, development and lifelong health and well-being. In Australia, families living in regional and rural areas have historically had limited access to specialist CFH services. In 2019, five new specialist CFH services were established in regional areas of New South Wales, Australia. The purpose of this study is to understand the regional families’ perceptions and experiences of these new CFH services. A convergent mixed-methods design involving a survey and semi-structured interviews with parents who had used the service was used for this study. Data collected include demographics, reasons for engaging with the service, perception, and experience of the service, including if the service provided was family centred. Triangulation of the quantitative and qualitative analysis uncovered three main findings: (i) The regional location of the service reduced the burden on families to access support for their needs; (ii) providing a service that is family-centred is important to achieve positive outcomes; and (iii) providing a service that is family-centred advances the local reputation of the service, enabling a greater reach into the community. Providing local specialist CFH services reduces the burden on families and has positive outcomes; however, providing services that are family-centred is key. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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12 pages, 3689 KiB

Open AccessArticle

Identifying Challenges and Solutions for Improving Access to Mental Health Services for Rural Youth: Insights from Adult Community Members

by Janessa M. Graves, Demetrius A. Abshire, Elissa Koontz and Jessica L. Mackelprang

Int. J. Environ. Res. Public Health 2024, 21(6), 725; https://doi.org/10.3390/ijerph21060725 - 3 Jun 2024

Cited by 1 | Viewed by 6447

Abstract

In the rural United States, provider shortages, inadequate insurance coverage, high poverty rates, limited transportation, privacy concerns, and stigma make accessing mental healthcare difficult. Innovative, localized strategies are needed to overcome these barriers, but little is known about what strategies may be feasible [...] Read more.

In the rural United States, provider shortages, inadequate insurance coverage, high poverty rates, limited transportation, privacy concerns, and stigma make accessing mental healthcare difficult. Innovative, localized strategies are needed to overcome these barriers, but little is known about what strategies may be feasible in, or acceptable to, rural communities. We aimed to identify barriers youth face in accessing mental healthcare in rural Washington State and to generate ideas to improve access. Methods: Semi-structured, key informant interviews were conducted by telephone with adult community members, including parents, teachers, and healthcare providers. Participants answered questions related to barriers to mental healthcare access that confront youth and approaches to improving access. Detailed, de-identified field notes were analyzed using conventional content analysis. Results: Limited resources and stigma were the two primary barriers to accessing mental healthcare that youth encounter in the community. Limited resources included lack of services and transportation, inconsistent funding and mental health programming, and workforce shortages. Stigma associated with seeking mental healthcare was of particular concern for youth with diverse identities who experience additional stigma. Conclusions: Improving access to mental healthcare for rural youth will require building a strong mental health workforce and championing efforts to reduce stigma associated with help-seeking. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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11 pages, 872 KiB

Open AccessArticle

Use of Antivibration Technology to Reduce Demands for In-Home Nursing Care and Support in Rural Settings for Persons with Essential Tremors: A Qualitative Study

by Fatemeh Mohammadnejad, Shannon Freeman, Tammy Klassen-Ross, Dawn Hemingway and Davina Banner

Int. J. Environ. Res. Public Health 2024, 21(6), 714; https://doi.org/10.3390/ijerph21060714 - 31 May 2024

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Abstract

Introduction: With the increased integration of technologies in the healthcare sector, it is important to understand the benefits emerging technologies may play to reduce demands on the health care system. The Steadiwear antivibration glove shows promise for enhancing the independence in functional abilities [...] Read more.

Introduction: With the increased integration of technologies in the healthcare sector, it is important to understand the benefits emerging technologies may play to reduce demands on the health care system. The Steadiwear antivibration glove shows promise for enhancing the independence in functional abilities for persons with essential tremors and for alleviating the need for support from the health care system. The objective of this study was to examine Registered Nurses’ (RN) perceptions of the potential for the Steadiwear antivibration glove to reduce the need for in-person support from community healthcare workers. Methods: Eleven RNs, experienced in providing care in rural communities, participated in a semi-structured interview sharing their perspectives towards use of the Steadiwear antivibration glove in community practice settings. Thematic analysis guided by Braun and Clarke was undertaken. Results: Nurses described the value of this technology to reduce client needs for support for activities of daily living (e.g., dressing, feeding) and independent activities of daily living (e.g., banking, transportation). Conclusions: Enhanced access to this technology may reduce the need for nursing and personal care support from the health system. Therefore the Steadiwear antivibration glove also shows potential to delay and/or prevent the need for more intensive support and mitigate the need for transition to a long-term care facility. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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30 pages, 1894 KiB

Open AccessArticle

Health and Wellbeing of Regional and Rural Australian Healthcare Workers during the COVID-19 Pandemic: Baseline Cross-Sectional Findings from the Loddon Mallee Healthcare Worker COVID-19 Study—A Prospective Cohort Study

by Mark McEvoy, Gabriel Caccaviello, Angela Crombie, Timothy Skinner, Stephen J. Begg, Peter Faulkner, Anne McEvoy, Kevin Masman, Laura Bamforth, Carol Parker, Evan Stanyer, Amanda Collings and Xia Li

Int. J. Environ. Res. Public Health 2024, 21(5), 649; https://doi.org/10.3390/ijerph21050649 - 20 May 2024

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Abstract

Background: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe [...] Read more.

Background: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers. Methods: Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020–May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test—Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale. Results: These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm² and 37.0% have a BMI of 25 kgm² or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). Conclusion: Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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17 pages, 364 KiB

Open AccessArticle

Health Service Implementation and Antifragile Characteristics in Rural Communities: A Dirt Research Approach

by Samuel Petrie and Paul Peters

Int. J. Environ. Res. Public Health 2023, 20(14), 6418; https://doi.org/10.3390/ijerph20146418 - 20 Jul 2023

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Abstract

The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities [...] Read more.

The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities that can facilitate successful program implementation better, ethnographic accounts of rural health and care services were compiled in rural communities within Canada, Australia, and Iceland. Ethnographic accounts are presented in the first and third person, with an accompanying reflexive analysis immediately following these accounts. Antifragility was the guiding concept of interest when investigating rural implementation environments, a concept that posits that a system can gain stability from uncertainty rather than lose integrity. These ethnographic accounts provide evidence of antifragile operators such as optionality, hybrid leadership, starting small, nonlinear evaluation, and avoiding suboptimisation. It is shown that the integration of these antifragile operators allows programs to function better in complex rural systems. Further, the presence of capable individuals with sufficient knowledge in several disciplines and with depth in a single discipline allows for innovative local thinking initiatives. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

9 pages, 305 KiB

Open AccessArticle

Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia

by Annie C. Arnold, Richard Fleet and David Lim

Int. J. Environ. Res. Public Health 2023, 20(10), 5821; https://doi.org/10.3390/ijerph20105821 - 14 May 2023

Cited by 3 | Viewed by 2019

Abstract

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and [...] Read more.

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

10 pages, 304 KiB

Open AccessArticle

A Qualitative Study of Rural and Remote Australian General Practitioners’ Involvement in High-Acuity Patients

by Sinead Turner, Vivian Isaac and David Lim

Int. J. Environ. Res. Public Health 2023, 20(5), 4548; https://doi.org/10.3390/ijerph20054548 - 3 Mar 2023

Cited by 2 | Viewed by 2245

Abstract

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic [...] Read more.

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough’s capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

16 pages, 659 KiB

Open AccessArticle

Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers’ Perspective

by David Lim, Emily Phillips, Clare Bradley and James Ward

Int. J. Environ. Res. Public Health 2023, 20(5), 4415; https://doi.org/10.3390/ijerph20054415 - 1 Mar 2023

Cited by 2 | Viewed by 2474

Abstract

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a [...] Read more.

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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18 pages, 571 KiB

Open AccessArticle

Understanding Unmet Care Needs of Rural Older Adults with Chronic Health Conditions: A Qualitative Study

by Dennis Asante, Craig S. McLachlan, David Pickles and Vivian Isaac

Int. J. Environ. Res. Public Health 2023, 20(4), 3298; https://doi.org/10.3390/ijerph20043298 - 13 Feb 2023

Cited by 7 | Viewed by 3535

Abstract

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better [...] Read more.

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better understanding of healthcare access and their specific unmet needs. This qualitative study sought the views of both rural-centric older people and healthcare professionals to understand health needs, barriers, and enablers of accessing health services, with a focus on chronic health condition(s). Methods: Between April and July 2022, separate in-depth interviews were conducted with 20 older people (≥60 years) in a rural South Australian community. Additionally, focus group interviews were conducted with 15 healthcare professionals involved in providing health services to older adults. Transcripts were coded using the NVivo software and data were thematically analysed. Results: Participants described a range of unmet care needs including chronic disease management, specialist care, psychological distress, and the need for formal care services. Four barriers to meeting care needs were identified: Workforce shortages, a lack of continuity of care, self-transportation, and long waiting times for appointments. Self-efficacy, social support, and positive provider attitudes emerged as crucial enabling factors of service use among rural ageing populations. Discussion: Older adults confront four broad ranges of unmet needs: Chronic disease management care, specialist care, psychological care, and formal care. There are potential facilitators, such as self-efficacy, provider positive attitudes, and social support, that could be leveraged to improve healthcare services access for older adults. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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8 pages, 1154 KiB

Open AccessArticle

The Dermatologic Care Needs of a Rural Community in South Florida

by Sara M. Asbeck, Brenda U. Imo, Okelue E. Okobi and Jennifer Dorcé-Medard

Int. J. Environ. Res. Public Health 2023, 20(4), 3071; https://doi.org/10.3390/ijerph20043071 - 9 Feb 2023

Cited by 4 | Viewed by 2533

Abstract

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of [...] Read more.

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of referral to dermatology in a rural and underserved community in South Florida. A retrospective chart review was conducted using medical records from the C.L. Brumback Primary Care Clinic in Belle Glade, FL. The most common skin conditions were fungal infections, unspecified dermatitis, pruritus, skin cancer concern, alopecia, and autoimmune skin disorders. The most frequent management strategy was medication prescription followed by specialist referral. Of the 21 percent of patients referred to a specialist, 55 percent of these were to dermatology. The most common diagnoses referred to dermatology were atopic dermatitis and alopecia. Only 20 percent of these patients reported attending their follow-up appointment, and the average distance to referral was 21 miles. Belle Glade is unique in its need for and access to dermatologic care. The lack of access to specialists in rural communities is a public health issue that more studies and outreach initiatives should address. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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19 pages, 4596 KiB

Open AccessArticle

Research on Co-Opetition Mechanism between Pharmaceutical Enterprises and Third-Party Logistics in Drug Distribution of Medical Community

by Zhao Li, Tie Xia, Wanzhi Shen and Sheng Chen

Int. J. Environ. Res. Public Health 2023, 20(1), 609; https://doi.org/10.3390/ijerph20010609 - 29 Dec 2022

Cited by 2 | Viewed by 1671

Abstract

Third-party logistics (3PL) has a relatively perfect distribution system in solving the drug distribution of the medical community and optimizing the distribution efficiency of pharmaceutical enterprises, and it has gradually become an indispensable component of drug distribution. By constructing the co-opetition model of [...] Read more.

Third-party logistics (3PL) has a relatively perfect distribution system in solving the drug distribution of the medical community and optimizing the distribution efficiency of pharmaceutical enterprises, and it has gradually become an indispensable component of drug distribution. By constructing the co-opetition model of “Pharmaceutical Enterprises—3PL”, this paper explores the game strategy choice between pharmaceutical enterprises and 3PL for the solution of drug distribution under the condition of information asymmetry, and it puts forward some suggestions to improve the competition and cooperation mechanism between pharmaceutical enterprises and 3PL in drug distribution in the medical community. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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14 pages, 619 KiB

Open AccessArticle

Fundamental Aspects of the Development of a Model of an Integrated Health Care System for the Prevention of Iron Deficiency Anemia among Adolescent Girls: A Qualitative Study

by Puspa Sari, Dewi Marhaeni Diah Herawati, Meita Dhamayanti and Dany Hilmanto

Int. J. Environ. Res. Public Health 2022, 19(21), 13811; https://doi.org/10.3390/ijerph192113811 - 24 Oct 2022

Cited by 3 | Viewed by 3597

Abstract

Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This [...] Read more.

Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This qualitative research employed a grounded theory approach in order to build a substantive theory. This study used in-depth interviews with adolescents, parents, teachers, health workers, and persons in charge of adolescent programs at the health office, education office, and ministry of religion. Purposive sampling was performed until data saturation was achieved. Codes, categories, and themes were generated through thematic data analysis to develop a substantive theory. Data analysis was performed using MAXQDA 2022 software. A total of 41 people participated in this study. This investigation generated twenty-two categories and seven themes. These themes relate to policymaker commitments, stakeholder governance, quality, adolescents’ lifestyles, adolescents’ self-factors, adolescents’ access to health services, and social support. The themes identified become fundamental aspects of the integrated health care system model for preventing IDA in adolescent girls. The model of the integrated health care system consists of several essential points, which include awareness and efforts from policymakers and adolescent girls, supported by parents, teachers, and the community. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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Review

Jump to: Research, Other

29 pages, 690 KiB

Open AccessReview

Exploring Allied Health Models of Care for Children with Developmental Health Concerns, Delays, and Disabilities in Rural and Remote Areas: A Systematic Scoping Review

by Georgia Gosse, Saravana Kumar, Helen Banwell and Anna Moran

Int. J. Environ. Res. Public Health 2024, 21(4), 507; https://doi.org/10.3390/ijerph21040507 - 19 Apr 2024

Viewed by 3166

Abstract

Background: Access to appropriate healthcare is essential for children’s healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models [...] Read more.

Background: Access to appropriate healthcare is essential for children’s healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models of care for children with developmental needs. This scoping review seeks to address this knowledge gap. Methods: Adhering to the PRISMA-ScR and Joanna Briggs Institute guidelines, a systematic search was conducted. A total of 8 databases (from inception to May 2023) and 106 grey literature sources were searched. Two reviewers independently undertook a two-stage screening process. Data were extracted using customised tools and narratively synthesised utilising the Institute of Medicine’s quality domains. This review is registered a priori via Open Science Framework. Results: Twenty-five citations were identified within the literature. Varied models of care were reported from five mostly Western countries. Models of care identified in these areas were classified as screening services, role substitution, consultative services, or online-based services. Positive impacts on quality of healthcare were reported across all quality domains (apart from safety) with the domain of effectiveness being the most commonly reported. Conclusions: Multiple models of care are currently in operation for children with developmental needs in rural and remote areas and appear to improve the quality of care. Due to complexities within, and limitations of, the evidence base, it is unclear if one model of care is superior to another. This review provides a basis for further research to explore why some models may be more effective than others. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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Other

Jump to: Research, Review

11 pages, 1080 KiB

Open AccessStudy Protocol

Empowering and Building the Capabilities of Mid-Level Health Service Managers to Lead and Support the Health Workforce—A Study Protocol

by Zhanming Liang, Jemma C. King, Cate Nagle, Tilley Pain and Andrew J. Mallett

Int. J. Environ. Res. Public Health 2024, 21(8), 994; https://doi.org/10.3390/ijerph21080994 - 29 Jul 2024

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Abstract

(1) Background: Mid-level managers in healthcare are central to improving safety and quality of care. Their ability in demonstrating leadership and management competency in their roles and supporting frontline managers and frontline staff has a direct effect on staff retention and turn-over. Yet, [...] Read more.

(1) Background: Mid-level managers in healthcare are central to improving safety and quality of care. Their ability in demonstrating leadership and management competency in their roles and supporting frontline managers and frontline staff has a direct effect on staff retention and turn-over. Yet, investment in their professional development and support for mid-level managers is often neither adequate nor effective, and high rates of staff turnover are evident. This study, set in northern Queensland, Australia, takes a strength-based approach to explore the role and strengths of mid-level managers and organisations’ existing mechanisms in supporting managers. With broad involvement and contribution from managers at different management level and frontline staff, the project will identify strategies to address the challenges mid-level managers face while building on their capabilities. (2) Methods: Using co-design principles, a situation analysis approach will guide a mixed-methods, multiphase design. Qualitative data will be collected using transcripts of focus groups and quantitative data will be collected by surveys that include validated scales. (3) Results: Thematic analysis of the transcripts will be guided by the framework of Braun and Clarke. Quantitative data will employ descriptive and inferential analysis, including chi-squared, t-tests, and univariate analyses of variance. (4) Conclusions: This study will generate evidence to guide two partner organisations, and other similar organisations, to develop strategies to improve support for mid-level managers and build their capabilities to support and lead frontline managers and staff. Competent mid-level managers are critical to high-quality patient care and improve the outcomes of the population they serve. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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19 pages, 1170 KiB

Open AccessSystematic Review

Models of Governance of Disability Therapy Support Workers in Rural and Remote Settings: A Systematic Scoping Review

by Anna Moran, Kim Bulkeley, Genevieve Johnsson, Elaine Tam and Catherine Maloney

Int. J. Environ. Res. Public Health 2024, 21(6), 693; https://doi.org/10.3390/ijerph21060693 - 28 May 2024

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Abstract

The National Disability Insurance Scheme (NDIS) ushered in a transformative era in disability services in Australia, requiring new workforce models to meet evolving participant needs. Therapy Assistants are utilised to increase the capacity of therapy services in areas of workforce shortage. The governance [...] Read more.

The National Disability Insurance Scheme (NDIS) ushered in a transformative era in disability services in Australia, requiring new workforce models to meet evolving participant needs. Therapy Assistants are utilised to increase the capacity of therapy services in areas of workforce shortage. The governance arrangements required to support this emergent workforce have received limited attention in the literature. This review examined the key components and contextual factors of governance in rural settings, specifically focusing on therapy support workers under the guidance of allied health professionals in rural and remote areas. Guided by the social model of disability and the International Classification of Functioning, Disability and Health, a realist perspective was used to analyse 26 papers (after deduplication), mostly Australian and qualitative, with an emphasis on staff capabilities, training, and credentialling. Success measures were often vaguely defined, with most papers focusing on staff improvement and few focusing on client or organisational improvement. Consistent staffing, role clarity, community collaboration, and supportive leadership were identified as enabling contexts for successful governance of disability therapy support workers in rural areas. Investment in capability (soft skills) development, tailored training, competency assessment, credentialling, and supervision were identified as key activities that, when coupled with the identified enabling contexts, were likely to influence staff, client and organisational outcomes. Further research is warranted to explore long-term impacts of governance arrangements, educational program accountability, and activities targeted at enhancing staff capabilities. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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