Showing papers on "Rural area published in 2016"

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

Abstract: Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

Rural Marginalisation and the Role of Social Innovation; A Turn Towards Nexogenous Development and Rural Reconnection

Abstract: Rural development in Europe is a long-standing issue that has been supported through EU policies in various ways. The effects of rural development have been uneven, and differences between well-to-do and marginal rural areas have been increasing both across and within countries. This process is reinforced by the current financial crisis. Recently, social innovation has been introduced as the new panacea for realising development and growth while, at the same time, warranting social inclusion and counteracting social inequality. A central question of this article is whether social innovation may help to effectively fight rural marginalisation, why that could be the case and what conditions then must be met. Three examples of rural social innovation are used to distil specific features of social innovation and compare them with other concepts and approaches to rural development. Rural social innovation is distinctive in its dependence on civic self-reliance and self-organisation due to austerity measures and state withdrawal, and its cross-sectoral and translocal collaborations. This article concludes that it is time to go beyond earlier ideas of exogenous versus (neo-)endogenous development and introduces the idea of nexogenous development with socio-political reconnection as an engine of revitalisation.

Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability.

Abstract: Introduction With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success. Methods A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically. Results Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment. Conclusions Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.

Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States.

Abstract: Objectives. To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care.Methods. We linked Medical Expenditure Panel Survey (2005–2010) data to geographic data from the American Community Survey (2005–2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural–Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met.Results. African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical screening (OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which r...

Twenty Years of Rural Entrepreneurship: A Bibliometric Survey

Abstract: Entrepreneurship has become a dynamic field of research in the last two decades. However, ‘rural entrepreneurship’ has been largely overlooked. It seems therefore timely to present a quantitative survey of the literature in this particular area. Based on 181 articles on rural entrepreneurship published in journals indexed in Scopus, we found that rural entrepreneurship is an essentially European concern, whose most prolific authors are affiliated with institutions in the UK and Spain. Organisational characteristics, policy measures and institutional frameworks and governance have attracted considerable attention in recent years, being considered emergent topics of research. In contrast, theory building has not attracted much research over the period in analysis, which suggests that the theoretical body of rural entrepreneurship is still incipient, hindering the establishment of its boundaries and of a suitable research agenda. Empirical literature on rural entrepreneurship has focused mainly on developed countries, most notably, the UK, the USA, Spain, Finland and Greece. Given the potential rural entrepreneurship represents for less developed and underdeveloped countries, more research on the topic targeting these countries is an imperative.

Rural Health Care Access and Policy in Developing Countries

Abstract: Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to delive...

Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration

Abstract: Background and Objectives Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014–2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh. Methods This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community. Results The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities. Conclusions The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this population. These identified factors can inform policy makers and program implementers to adopt socially and culturally appropriate interventions that can improve deliveries with skilled attendants and thus contribute to the reduction of maternal and neonatal mortality and morbidity in rural Bangladesh.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.

Abstract: PurposeThe authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.MethodIn November 2015, the authors searched databases (MEDLINE, ERIC,

Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study.

Abstract: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25–70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04–13.57; women, 33.9 %; PR: 4.11, 3.13–5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98–37.84; women, 54.2 %; PR: 6.63, 5.04–8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73–5.40; women, 9.2 %; PR: 1.81, 1.25–2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50–7.98; women, 10.2 %; PR: 2.21, 1.30–3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.

Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability

Abstract: This version of 'Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability' has been replaced by a corrected version. www.rrh.org.au Introduction: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success. Methods: A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically. Results: Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment. Conclusions: Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.

Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study

Abstract: Background In developing countries, inadequate access to effective screening for cervical cancer often contributes to the high morbidity and mortality caused by the disease. The largest burden of this falls mostly on underserved populations in rural areas, where health care access is characterized by transport challenges, ill equipped health facilities, and lack of information access. This study assessed uptake of cervical cancer screening and associated factors among women in rural Uganda. Methods This descriptive cross sectional study was carried out in Bugiri and Mayuge districts in eastern Uganda and utilised quantitative data collection methods. Data were collected using a semi-structured questionnaire on cervical cancer screening among females aged between 25 and 49 years who had spent six or more months in the area. Data were entered in Epidata 3.02 and analysed in STATA 12.0 statistical software. Univariate, bivariate and multivariate analyses were performed. Results Of the 900 women, only 43 (4.8%) had ever been screened for cervical cancer. Among respondents who were screened, 21 (48.8%) did so because they had been requested by a health worker, 17 (39.5%) had certain signs and symptoms they associated with cervical cancer while 16 (37.2%) did it voluntarily to know their status. Barriers to cervical cancer screening were negative individual perceptions 553 (64.5%) and health facility related challenges 142 (16.6%). Other respondents said they were not aware of the screening service 416 (48.5%). The independent predictors of cervical cancer screening were: being recommended by a health worker [AOR = 87.85, p<0.001], knowing where screening services were offered [AOR = 6.24, p = 0.004], and knowing someone who had ever been screened [AOR = 9.48, p = 0.001]. Conclusion The prevalence of cervical cancer screening is very low in rural Uganda. Interventions to increase uptake of cervical cancer screening should be implemented so as to improve access to the service in rural areas.

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis.

Abstract: Background : It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective : The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design : We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results : In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately much higher mortality burden than those living elsewhere. Slum communities had higher coverage of maternal health services than rural communities but it was not possible to compare maternal mortality rates across these residential domains. Compared to rural areas, slum communities had lower fertility and higher contraceptive use rates but these differences were reversed when slums were compared to other urban populations. Slum–rural differences in infant mortality were found to be larger in Bangladesh compared to Kenya. Conclusion : Mortality and morbidity indicators were worse in slums than elsewhere. However, indicators of access to care and health service coverage were found to be better in slums than in rural communities. Keywords: slum; rural; urban health; health; comparative analysis (Published: 2 December 2016) Citation: Glob Health Action 2016, 9 : 33163 - http://dx.doi.org/10.3402/gha.v9.33163egu@aphrc.org

Shrinking cities in a rapidly urbanizing China

Abstract: Many cities across particular areas in Europe and North America have a dwindling population, emerging vacant spaces, and the underuse of existing urban infrastructure (Haase et al., 2014). As one of the more prosperous urbanized countries in the world, China has witnessed an unprecedented active stage of urban expansion (see the Beijing City Lab Ranking 8 for details, http://www.beijingcitylab.com/ranking/), which also attracted extensive attention from academics (Deng et al., 2010). Our previous study on mushingrooming Jiedaos (the basic administrative unit of a city proper) indicates that urbanization in China often involves a significant political dimension. Largely rural settlements (e.g., Zhen) could be accorded with the city status (e.g., Jiedao) overnight by administrative power, which further accelerates the urban process (Wu et al., 2015). Meanwhile, some large cities and inshore developed cities in East China have attracted huge numbers of migrants from rural areas and small cities during the last ten years. Vacant villages have been widely reported in the context of China (Long et al., 2012), while we observe shrinkage at township and city levels. For all the townships in Mainland China, we estimated their population (residents not Hukou) based on the Population Censuses of China in 2000 and 2010, respectively. We found that 19 882 among all 39 007 townships were losing their population during 2000–10, and the total area was 3.24 million km, which covered almost about one third of the territories of China (Figure 1). Those shrinking townships are distributed in both rural and urban areas. Among them are 1147 urban townships with a total area of 47 420 km in 367 cities. Besides the shrinking townships observed, we further identify 180 shrinking cities in China including one provincial capital city, Urumqi—40 prefectural-level cities and 139 county-level cities (Figure 1). In addition, we use a cartogram to reveal population density in 2010 at the prefectural level, based on which shrinking prefectures are mapped (Figure 2). More work is needed to understand these shrinking localities, the reasons behind the population falls, and possible policy tools. Both decision makers and city planners are accustomed to the urban growth and population increasing in China. We hope that these featured graphics will inform them of our findings. In addition, we have established the

Rural Education As Rural Development: Understanding the Rural School–Community Well-Being Linkage in a 21st-Century Policy Context

Abstract: Despite the significant proportions of rural Americans, schools, and public school students situated in the geographic peripheries of an increasingly urbanizing country, rural education in the United States has consistently occupied both scholarly and policy peripheries. This is to the detriment of rural America, especially to the extent that public policy and educational practice may work at cross-purposes with the vitality and well-being of rural communities. This paper examines these issues and, more specifically, considers the relationship between rural education and rural community development. I argue that rethinking the purposes of education, particularly within rural contexts, may help not only to more clearly articulate a sensible rural education policy, but, in the process, more clearly articulate broader rural development policy.

Prevalence of type 2 diabetes mellitus among inland residents in China (2000-2014): A meta-analysis.

Abstract: Aims/Introduction Besides the aging population in China, the following have become serious public health problems: increasing urban population, lifestyle changes and diabetes. We assessed the epidemiology of type 2 diabetes mellitus in China between 2000 and 2014, and analyzed time trends to better determine the prevalence status of diabetes in China and to provide a basis for prevention and decision-making. Materials and Methods In our systematic review, we searched China National Knowledge Infrastructure, Chinese VIP Information, Wanfang and PubMed databases for studies on type 2 diabetes mellitus between 2000 and 2014 in China. Two investigators extracted the data and assessed the quality of the included literature independently. We excluded studies that did not use 1999 World Health Organization criteria for diabetes. We also excluded reviews and viewpoints, studies with insufficient data, studies that were not carried out in mainland China and studies on troops, community, schools or physical examination people. We used stata 12.0 to combine the prevalence of all studies, calculated the pooled prevalence and its 95% confidence interval, and analyzed the differences among men/women, urban/rural areas and year of study. We calculated the prevalence of seven geographic areas of China, respectively, and mapped the distribution in the whole country to estimate the pooled prevalence of each area. Results Our search returned 4,572 studies, 77 of which satisfied the inclusion criteria. The included studies had a total of 1,287,251 participants, in which 680,574 cases of type 2 diabetes mellitus were recorded. The overall prevalence (9.1%) has been increasing since the 1970s, and it increased rapidly with age. The prevalence of the 65–74 years group was as high as 14.1%. Meanwhile, the prevalence among men/women and urban/rural areas was significantly different. The prevalence was 9.9% for men and 11.6% for women, which were significantly higher than the average at the end of the last century and the beginning of this century. The prevalence rate in urban areas (11.4%) was significantly higher than that in rural areas and in urban-rural fringe areas, and the prevalence in rural areas (8.2%) was slightly higher than that in urban-rural fringe areas (7.5%). In addition, the prevalence in each geographic area were estimated and mapped, which showed a large imbalance in the map. Conclusions Our analysis suggested that type 2 diabetes mellitus is highly prevalent in China. These results underscore the urgent need for the government to vigorously strengthen the management of diabetes prevention and control.

China's Hukou Puzzle: Why Don't Rural Migrants Want Urban Hukou?

Abstract: Despite the fact that urban hukou is understood to be far superior to rural hukou and that rural migrants have strong intention to stay in cities for many years, responses to hukou reforms that increase opportunities to obtain urban hukou have been less than enthusiastic. This article addresses this puzzle by showing how the respective values of rural hukou and urban hukou have changed in recent decades. The access and benefits that are tied to rural hukou—including farming and housing land, compensation for land requisition, and more relaxed birth control—are considered increasingly valuable. Thus, many migrants are opting to straddle and circulate between the city and countryside rather than giving up their rural hukou. Meanwhile, the competitive advantage of urban hukou has declined as China seeks to expand basic public services to all and as the market’s role in distributing food, housing, and other needs increases. The mismatch between rural migrants’ preference for large cities and hukou reforms’ focus on medium-sized and small cities and towns also undermines the reforms’ effectiveness. From a policy point of view, this article’s findings suggest that China’s urbanization strategy should take multilocality seriously and should focus on rural migrants’ livelihood and well-being in cities, rather than on hukou conversion alone.

Identifying social innovations in European local rural development initiatives

Abstract: Social innovation is attracting increasing attention in research and policy, heightened by continuing austerity across Europe Therefore, this paper examines earlier research into community-led local development (CLLD) initiatives in rural areas of Europe to develop our understanding of the meaning and scope of rural social innovation We draw on a Schumpeterian view where innovations emerge from new combinations of resources that bring about positive changes and create value in society A Schumpeterian social innovation framework is derived as the basis for re-analysing data from previous evaluations of LEADER policy in five different national contexts This elicits a clearer understanding of social innovation in a rural development context, identifying different processes and outcomes that create social value As the CLLD agenda and the demand for innovation in Europe gather pace, our aspirations are to inform future research and other initiatives on how to integrate social innovation into the design and evaluation of new rural development policies and programmes