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Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities.

ABSTRACT: Previous research has suggested differences between public and professional understanding of the field of environmental health (EH) and the role of EH services within urban and rural communities. This study investigated EH priority differences between 1) rural and urban residents and 2) residents and EH professionals, and presents quantitative and qualitative methods for establishing locality-specific EH priorities. Residents (N = 588) and EH professionals (N = 63) in Alabama identified EH priorities via a phone or online survey. We categorized rurality of participant residences by rural-urban commuting area codes and population density, and tested whether or not EH priorities were different between urban and rural residents. Built environment issues, particularly abandoned houses, and air pollution were high priorities for urban residents-whereas, water and sanitation issues, and paper mill-related pollution were high priorities in rural communities. EH professionals ranked food safety and water and sanitation issues as higher priorities than residents did. Results highlight the importance of urbanicity on environmental risk perception and the utility of simple and inexpensive engagement methods for understanding these differences. Differences between residents and EH professionals suggest improving stakeholder participation in local-level EH decision making might lead to greater awareness of EH services, which might in turn improve support and effectiveness of those services.

SUBMITTER: Wu CYH

PROVIDER: S-EPMC6880953 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities.

Wu Connor Y H CYH Evans Mary B MB Wolff Paul E PE Gohlke Julia M JM

Journal of environmental health 20171201 5

Previous research has suggested differences between public and professional understanding of the field of environmental health (EH) and the role of EH services within urban and rural communities. This study investigated EH priority differences between 1) rural and urban residents and 2) residents and EH professionals, and presents quantitative and qualitative methods for establishing locality-specific EH priorities. Residents (<i>N</i> = 588) and EH professionals (<i>N</i> = 63) in Alabama ident ...[more]

PMID: 31777405

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Project description:BACKGROUND:China's economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts' attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents. METHODS:Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected. RESULTS:Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents' good health (B?=?-?0.14, p?<?0.05; B?=?-0.23, p?<?0.001). Perceived garbage pollution had a positive effect on urban residents' poor health (B?=?0.33, p?<?0.01). Perceived water pollution had no significant effect on urban residents' health. The four types of perceived environmental pollution all had insignificant effects on rural residents' health. CONCLUSIONS:Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.

Project description:BackgroundFocus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019.MethodsSix focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019.ResultsConsistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019.ConclusionsApplying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

Project description:BackgroundIt is vital that health service delivery and health interventions address patients' needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach.MethodsThis multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3.ResultsOverall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas.ConclusionsThis study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.

Project description:Three-quarters of sub-Saharan Africa's urban population currently live under slum conditions making them susceptible to ill health and diseases. Ghana characterizes the situation in many developing countries where the urban poor have become a group much afflicted by complex health problems associated with their living conditions, and the intra-city inequity between them and the more privileged urban dwellers with respect to health care accessibility. Adopting Ghana's rural Community-Based Health Planning and Service (CHPS) programme in urban areas is challenging due to the differences in social networks and health challenges thus making modifications necessary. The Community Health Officers (CHOs) and their supervisors are the frontline providers of health in the community and there is a need to analyze and document the health sector response to urban CHPS.The study was solely qualitative and 19 in-depth interviews were conducted with all the CHOs and key health sector individuals in supervisory/coordinating positions working in urban CHPS zones to elicit relevant issues concerning urban CHPS implementation. Thematic content data analysis was done using the NVivo 7 software.Findings from this appraisal suggest that the implementation of this urban concept of the CHPS programme has been well undertaken by the health personnel involved in the process despite the challenges that they face in executing their duties. Several issues came to light including the lack of first aid drugs, as well as the need for the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) programme and more indepth training for CHOs. In addition, the need to provide incentives for the volunteers and Community Health Committee members to sustain their motivation and the CHOs' apprehensions with regards to furthering their education and progression in their careers were key concerns raised.The establishment of the CHPS concept in the urban environment albeit challenging has been fraught with several opportunities to introduce innovations which tailor the rural milestones to meet urban needs. Modifications such as adjusting timing of home visits and renting accommodation in the communities for the CHOs have been beneficial to the programme.

Project description:BackgroundThe demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness.MethodsData from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness.ResultsPhysical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty.ConclusionsCardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.

Dataset Information

Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities.

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Environmental Health Priorities of Residents and Environmental Health Professionals: Implications for Improving Environmental Health Services in Rural Versus Urban Communities.

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