Providing cancer services to remote and rural areas: consensus study.
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SUBMITTER: Stevenson L
PROVIDER: S-EPMC2394474 | biostudies-other | 2003 Sep
REPOSITORIES: biostudies-other
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Project description:IntroductionScaling the Peaks is a cross-disciplinary research study that draws on medical ethnography, human geography and Geospatial Information Science (GIS) to address the issues surrounding the design and delivery of dementia-friendly services in rural communities. The research question seeks to understand the barriers and drivers to the development of relevant, robust, reliable and accessible services that make a difference among older rural families affected by dementia.Methods and analysisThis mixed methods study recruits both families affected by dementia who reside within the Peak District National Park, Derbyshire, and their service providers. The study explores the expectations and experiences of rural dementia by adopting a three-part approach 1 : longitudinal ethnographic enquiry with up to 32 families affected by dementia (aged 70 years plus) who identify themselves as rural residents 2 ; ethnographic semistructured interviews and systematic observations of a range of statutory, third sector, private and local community initiatives that seek to support older people living with dementia 3 ; and geospatial visual mapping of the qualitative and quantitative data. The ethnographic data will be used to explore the ideas of belonging in a community, perceptions of place and identity to determine the factors that influence everyday decisions about living well with dementia and, for the providers, working in a rural community. The geospatial component of the study seeks to incorporate quantitative and qualitative data, such as types, locations and allocation of services to produce an interactive web-based map for local communities to determine the future design and delivery of services when considering dementia-friendly services.Ethics and disseminationThe study is approved by the Leeds and Humberside Health Research Authority 16/YH/0163. The study is also approved by other participating organisations as required by their own governance procedures. The study includes people with dementia and as such adheres to the ethical considerations when including people with dementia. A publicly available interactive visual map of the findings will be produced in relation to current services related to location and, by default, identify gaps in provision. Formal reports and dissemination activities will be undertaken in collaboration with the study advisory group members.Study progressThe recruitment began in September 2016. The data analysis commenced June 2017, using 59 provider interviews and 27 family participants. Data collection will be completed June 2018.Note on terminologyPlease note that the term 'families affected by dementia' is the preferred term of usage by the family members of the Scaling the Peaks Study Advisory Group. The group wish to emphasise that they consider this term to be more representative of their lives than the term living with dementia.Trial registration numberNIHR IRAS 188103; Pre-results.
| S-EPMC5905771 | biostudies-literature
Project description:ObjectiveTo explore migrant physicians' conceptions about working in rural and remote areas in Sweden to understand what influences their motivation to work in these areas.Method and materialThe study employed a qualitative approach with semi-structured interviews with 24 migrant physicians. Transcripts were thematically analysed.ResultsConceptions were identified about foremost work content and tasks, and about living in rural and remote areas. Work content and tasks related to the health care systems, type of health care facility, duties, specialty, resources, patient population, colleagues, and professional development. Conceptions about living concerned geographical characteristics, people living in rural and remote areas, opportunities for travelling, family, leisure activities, social life, and language skills. Conceptions seemed to be influenced by individual, professional and societal aspects from both previous countries and Sweden. Conceptions and biographical aspects both appeared to affect motivation.DiscussionMotivation regarding working in rural and remote areas appeared to be influenced by conceptions of these areas. A specific type of place could be understood as being able to provide (or not) the external conditions needed for fulfilling needs and reaching goals, whether professional or personal, and as a tool for reaching or facilitating the achievement of these. Conceptions of an area can hence affect motivation and choices for where to work and live. However, biographical aspects also impact motivation. Our results indicate that positive rural experience in the recipient country might be a predictor for motivation.ConclusionProfessional and personal life and are intertwined. Conceptions about an area influence willingness to work there. Willingness is also affected by, and intertwined with, other aspects such as previous experiences, age, marital status and family circumstances.
| S-EPMC6331096 | biostudies-literature
Project description:ObjectivesIn 2007, the World Health Organization published a guide on age-friendly cities. However, little is known about interventions that have been implemented to promote age-friendly communities in rural and remote areas. This paper presents the findings from a scoping review undertaken to locate available evidence of interventions, strategies, and programs that have been implemented in rural and remote areas to create age-friendly communities.MethodsThis scoping review used the Joanna Briggs Institute (JBI) methodology.ResultsA total of 219 articles were included in this review. No intervention studies were referred to as 'age-friendly'. However, there were interventions (mostly healthcare-related) that have been implemented in rural and remote areas with older people as participants. There were also non-evaluated community programs that were published in the grey literature. This review identified the common health interventions in older people and the indirect relevance to the WHO age-friendly framework domains in rural and remote contexts.ConclusionsThe eight age-friendly domains were not explicitly utilised as a guide in the development of interventions for older people in rural and remote settings. Implementation of age-friendly interventions in rural and remote areas requires a multisectoral approach that is tailored to address the specific needs of individual communities. Age-friendly interventions also need to consider socio-ecological factors to adequately and holistically address community needs and ensure long-term sustainability.
| S-EPMC10083949 | biostudies-literature
Project description:BackgroundThe shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking.ObjectiveWe aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China.MethodsOur study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis.ResultsA total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support.ConclusionsThis study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support.
| S-EPMC9823570 | biostudies-literature
Project description:BackgroundAttracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention.MethodsThe review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case-control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit.ResultsOf 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments.ConclusionEducational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.
| S-EPMC8393462 | biostudies-literature
Project description:This scoping review used the Arksey and O'Malley approach to explore COVID-19 preparedness and response in rural and remote areas to identify lessons to inform future health preparedness and response planning. A search of scientific and grey literature for rural COVID-19 preparedness and responses identified 5 668 articles published between 2019 and early 2022. A total of 293 articles were included, of which 160 (54.5%) were from high income countries and 106 (36.2%) from middle income countries. Studies focused mostly on the Maintenance of Essential Health Services (63; 21.5%), Surveillance, epidemiological investigation, contact tracing and adjustment of public health and social measures (60; 20.5%), Coordination and Planning (32; 10.9%); Case Management (30; 10.2%), Social Determinants of Health (29; 10%) and Risk Communication (22; 7.5%). Rural health systems were less prepared and national COVID-19 responses were often not adequately tailored to rural areas. Promising COVID-19 responses involved local leaders and communities, were collaborative and multisectoral, and engaged local cultures. Non-pharmaceutical interventions were applied less, support for access to water and sanitation at scale was weak, and more targeted approaches to the isolation of cases and quarantine of contacts were preferable to blanket lockdowns. Rural pharmacists, community health workers and agricultural extension workers assisted in overcoming shortages of health professionals. Vaccination coverage was hindered by weaker rural health systems. Digital technology enabled better coordination, communication, and access to health services, yet for some was inaccessible. Rural livelihoods and food security were affected through disruptions to local labour markets, farm produce markets and input supply chains. Important lessons include the need for rural proofing national health preparedness and response and optimizing synergies between top-down planning with localised planning and coordination. Equity-oriented rural health systems strengthening and action on rural social determinants is essential to better prepare for and respond to future outbreaks.
| S-EPMC10651055 | biostudies-literature
Project description:Using travel time to cities of different sizes, we map populations across an urban-rural continuum to improve on the standard dichotomous representations of urban-rural interactions. We extend existing approaches by 1) building on central place theory to capture the urban hierarchy in access to services and employment opportunities provided by urban centers of different sizes, 2) defining urban-rural catchment areas (URCAs) expressing the interconnection between urban centers and their surrounding rural areas, and 3) adopting a global gridded approach comparable across countries. We find that one-fourth of the global population lives in periurban areas of intermediate and smaller cities and towns, which challenges the centrality of large cities in development. In low-income countries, 64% of the population lives either in small cities and towns or within their catchment areas, which has major implications for access to services and employment opportunities. Intermediate and small cities appear to provide catchment areas for proportionately more people gravitating around them than larger cities. This could indicate that, for countries transitioning to middle income, policies and investments strengthening economic linkages between urban centers and their surrounding rural areas may be as important as investing in urbanization or the rural hinterlands. The dataset provided can support national economic planning and territorial development strategies by enabling policy makers to focus more in depth on urban-rural interactions.
| S-EPMC7959575 | biostudies-literature
Project description:BackgroundAbout 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India.MethodsThe Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti-stigma campaign using multi-media approaches was conducted across the villages at the outset of the project. A pre-post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation.ResultsTraining was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project.ConclusionsThe intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up.
| S-EPMC5370210 | biostudies-literature
Project description:ObjectiveGlobally, cervical cancer (CC) incidence is higher in rural areas than in urban areas that could be explained by the influence of many factors, including inequity in accessibility of the CC prevention measures. This review aimed to identify and analyze factors associated with a lack of cervical cancer screening and HPV vaccination programs in people living in rural areas and to outline strategies to mitigate these factors.MethodsThe literature search encompassed two focal domains: cervical cancer screening and HPV vaccination among populations residing in rural areas, covering publications between January 1, 2004 to December 31, 2021 in the PubMed, Google Scholar, Scopus, and Cyberleninka databases, available in both English and Russian languages.ResultA literature review identified 22 sources on cervical cancer screening and HPV vaccination in rural and remote areas. These sources revealed similar obstacles to screening and vaccination in both high and low-income countries, such as low awareness and knowledge about CC, screening, and HPV vaccination among rural residents; limited accessibility due to remoteness and dearth of medical facilities and practitioners, associated with a decrease in recommendations from them, and financial constraints, necessitating out-of-pocket expenses. The reviewed sources analyzed strategies to mitigate the outlined challenges. Possible solutions include the introduction of tailored screening and vaccination campaigns designed for residents of rural and remote locations. New screening and vaccination sites have been proposed to overcome geographic barriers. Integrating HPV testing-based CC screening is suggested to counter the lack of healthcare personnel. HPV vaccination is essential for primary cervical cancer prevention, especially in rural and remote areas, as it requires less medical infrastructure.ConclusionCertain measures can be proposed to improve the uptake of CC screening and HPV vaccination programs among rural residents, which are needed to address the higher prevalence of CC in rural areas. Further investigation into cervical cancer prevention in rural and remote contexts is necessary to ascertain the optimal strategies that promote health equity.
| S-EPMC10624144 | biostudies-literature
Project description:Persistent organic pollutants (POPs) and polycyclic aromatic hydrocarbons (PAHs) used in agricultural, industrial, and domestic applications are widely distributed and bioaccumulate in food webs, causing adverse effects to the biosphere. A review of published data for 1977-2015 for a wide range of vegetation around the globe indicates an extensive load of pollutants in vegetation. On a global perspective, the accumulation of POPs and PAHs in vegetation depends on the industrialization history across continents and distance to emission sources, beyond organism type and climatic variables. International regulations initially reduced the concentrations of POPs in vegetation in rural areas, but concentrations of HCB, HCHs, and DDTs at remote sites did not decrease or even increased over time, pointing to a remobilization of POPs from source areas to remote sites. The concentrations of compounds currently in use, PBDEs and PAHs, are still increasing in vegetation. Differential congener specific accumulation is mostly determined by continent-in accordance to the different regulations of HCHs, PCBs and PBDEs in different countries-and by plant type (PAHs). These results support a concerning general accumulation of toxic pollutants in most ecosystems of the globe that for some compounds is still far from being mitigated in the near future.
| S-EPMC4857197 | biostudies-literature