Rural and Remote Health

Assessing the dietary behaviours and food choices of people with type 2 diabetes in the Wa Municipality of Ghana

Mon, 13 Jul 26 00:00:00 +0000

Introduction: Type 2 diabetes poses a growing global health challenge, with dietary behaviours and food choices playing a critical role in its management. This study assessed dietary practices, food preferences, and nutrition-related determinants among patients with type 2 diabetes in the Wa Municipality of Ghana, and further evaluated overall dietary behaviour using a dietary behaviour index derived from key dietary behavioural indicators.Methods: A cross-sectional survey was conducted among 208 adult respondents selected from diabetes clinics in the municipality using structured interviewer-administered questionnaires and 24-hour dietary recalls. Descriptive statistics were used to summarize demographics, food-choice determinants, dietary practices, and 24-hour food-group consumption. A total dietary behaviour score was computed from 10 dietary behaviour indicators, classified into a dietary behaviour index. Independent samples t-tests and one-way analysis of variance were used to examine differences in dietary behaviour score across selected participant characteristics at a significance level of p<0.05.Results: Most participants were female (69.2%), aged 45-64 years (49.0%), married (73.6%), had no family history of diabetes (48.1%), and had no formal education (39.4%). Major influences on food choices included food availability (79.8%), financial constraints (76.0%), appetite (71.6%), and nutrition advice from healthcare providers (72.1%). In the previous 24 hours, a high proportion of participants reported consuming meat, poultry, and fish (90.4%), whereas fewer reported consuming eggs (17.8%), fruits other than those rich in vitamin A (26.9%), and healthy fats (38.5%); 67.3% reported consuming foods containing trans fats. Participants had limited nutrition knowledge - 53.4% did not understand the glycaemic index, 60.6% did not know which carbohydrates raise blood sugar levels, and 63.9% never read nutrition labels. Most participants indicated moderate dietary behaviour (65.4%), while 23.6% had good dietary behaviour and 11.1% had poor dietary behaviour. Total dietary behaviour scores were significantly associated with eating situation (p=0.001), meal decision making (p=0.004), and nutrition label use (p<0.001), but not with gender (p=0.070), religion (p=0.254), or family history of diabetes (p=0.112). Participants demonstrated predominantly moderate dietary behaviour, with important gaps in fruit intake, carbohydrate monitoring, application of glycaemic knowledge, and nutrition label use. Household food arrangements and nutrition literacy were found to be more strongly associated with healthier dietary behaviour than basic sociodemographic characteristics.Conclusion: Context-specific interventions that strengthen practical nutrition education, improve food label literacy, and support household-level dietary decision making may improve diabetes dietary management in this setting.

Community knowledge, attitude and practice on rabies and retrospective study of human and animal rabies exposures in selected districts of the Southern Zone of Tigray, northern Ethiopia

Fri, 10 Jul 26 00:00:00 +0000

Mapping the knowledge, perceptions, and existing practices regarding rabies is considered an important milestone in the control and prevention of the disease. Although the magnitude and distribution of rabies exposure in the Tigray region of Ethiopia is high, there has been no coordinated study on the community's knowledge, attitudes, and practices (KAP) concerning rabies in the Tigray Region. This Original Research study assessed the community's level of KAP towards rabies and retrospectively analyzes human and animal rabies exposure cases over the past 5 years in the project area.

A qualitative study using an ecological model to understand factors affecting childhood immunisation in Papua New Guinea

Thu, 09 Jul 26 00:00:00 +0000

Introduction: Immunisation is an effective public health intervention for preventing and reducing vaccine-preventable diseases. This qualitative study was designed to explore individual, interpersonal, organisational and social relationships influencing the use of routine childhood immunisation services in two rural health centres in the Eastern Highlands Province of Papua New Guinea.Methods: A total of 28 mothers with children aged under 5 years were identified through purposive sampling. We conducted 12 semi-structured interviews with mothers and two focus group discussions with eight mothers who attended immunisation services. Data were transcribed verbatim and translated from Tok Pisin into English. A thematic analysis was conducted using both an inductive and deductive processes, interpreted by applying the ecological model of health promotion/primary prevention.Results: Participants discussed factors at an intrapersonal level that included knowledge about immunisation and concern of side effects. At the interpersonal level family support had a positive and negative effect on decision-making, and relations with older community members created agency to opt for vaccination services. Despite unequal gender-based power relations, women demonstrated agency and demonstrated independent capacity to act and attend immunisation services. Institutional issues such as health worker attitudes and waiting times affected vaccination uptake decisions. Societal environments including cultural obligations such as funerals, tribal fights and sorcery also influenced vaccination uptake.Conclusion: Complex and multilevel factors influence childhood vaccination services use. Understanding the influences of these multilevel factors power relationships is significant for informing policy and practice in redesigning immunisation services. Engaging parents, extended families, communities and health workers in the redesign and implementation planning is crucial for fostering positive decision-making regarding childhood immunisation.

Building therapeutic alliance with farmers seeking mental health care: a qualitative study of providers’ perspectives and recommendations

Mon, 06 Jul 26 00:00:00 +0000

Despite being particularly vulnerable due to the wide range of stressors they experience, farmers face ongoing challenges in accessing timely, appropriate, and culturally responsive mental health care. Barriers to help-seeking include stoicism, self-reliance, stigma, limited mental health literacy, and structural constraints such as distance, cost, and long wait times. In response to these barriers, mental healthcare providers have adapted their services to respond to the unique needs and challenges associated with the agricultural lifestyle. This Original Research study explored the perspectives of mental healthcare providers who work with farmers to identify their strategies for fostering trust and therapeutic alliance.

A scoping review of the healthcare needs of older community-dwelling adults living in rural areas

Wed, 01 Jul 26 00:00:00 +0000

Global population ageing has far-reaching implications, including for public health. Challenges like rising chronic disease burden, increasing disability, caregiving shortages and deficiencies in long-term care are particularly acute in rural and regional areas, where access to health care is constrained by workforce shortages, geographic isolation and socioeconomic disadvantage. Addressing these challenges using participatory co-design approaches that engage older adults in the development and evaluation of services is promising, but the evidence base underpinning such approaches in rural aged care contexts remains underdeveloped. This Scoping Review maps the existing literature on the care needs of community-dwelling older adults in rural areas.

Socioeconomic and lifestyle factors influencing non-communicable disease prevalence among rural Jamaican adults: a population-based study

Mon, 29 Jun 26 00:00:00 +0000

Non-communicable diseases (NCDs) are the leading causes of morbidity and premature mortality in Jamaica. NCD risk in the Caribbean is shaped by the interaction of socioeconomic constraints, environmental exposures, and health system limitations, some of which disproportionately affect rural residents, who face barriers to healthcare access that include limited diagnostic infrastructure and fragmented continuity of care. This Original Research study examined the prevalence and determinants of hypertension, diabetes, and obesity among rural adults in Jamaica using data from the Jamaica Health and Lifestyle Survey III.

Barriers to mental health help-seeking – rewriting the narrative for rural communities

Sat, 27 Jun 26 00:00:00 +0000

Rural Australians continue to experience significant mental health challenges, including higher suicide rates and poorer mental health outcomes, compared with their urban counterparts. Accessibility barriers, specifically relating to service availability, have been well documented in rural areas, but further research is required to better understand the unique internal barriers - such as high rates of stigma, lower mental health literacy, and stoicism - faced by rural people across Australia. This Original Research study investigates the differences between rural and urban populations in internal barriers to help seeking and mental health outcomes, and identifies the unique challenges of rural mental health.

Tobacco retailer density in the Northern Territory, Australia

Thu, 25 Jun 26 00:00:00 +0000

Nearly 21,000 deaths and 7.6% of the Australian disease and injury burden are attributable to tobacco use each year, with harms disproportionately impacting groups experiencing disadvantage and marginalisation. In Australia and globally, tobacco retailers are disproportionately concentrated in areas with greater disadvantage, and high tobacco retailer density is associated with higher smoking prevalence and lower smoking cessation success. This Original Research study maps the locations of tobacco retail licences in the Northern Territory, which has the highest smoking prevalence in Australia, and investigates associations between tobacco retailers, area remoteness and area-level socio-economic status.

Legal and regulatory pathways for telehealth and artificial intelligence in rural health care: implications for access, ethics, and global health equity

Wed, 24 Jun 26 00:00:00 +0000

Traditional healthcare delivery models have proven inadequate in addressing the multifaceted challenges faced by rural communities (geographical isolation, inadequate health infrastructure, and a shortage of qualified healthcare professionals), necessitating innovative approaches that leverage technological advancements. The emergence of telehealth and artificial intelligence (AI) presents unprecedented opportunities to revolutionize healthcare delivery in underserved rural communities, but the integration of these technologies introduces complex legal, ethical, and regulatory considerations that must be carefully addressed. This Review provides novel insights by synthesizing multidisciplinary perspectives on technology integration, regulatory requirements, and implementation strategies across diverse global contexts.

Exploring the use and experience of a digital platform to support rural health professionals in Australia

Mon, 22 Jun 26 00:00:00 +0000

In Australia, as globally, rural regions consistently struggle with severe health workforce shortages, exposing rural health professionals to the risk of professional isolation, increased stress and burnout. In addition, they have reduced access to continuing professional development, which is crucial for health professionals because it helps maintain and enhance professional knowledge, expertise and competence, and serves as an essential pathway to develop required personal and professional qualities. This Original Research study investigates rural health professionals' usage patterns and experiences with a digital support platform that offers news, resources, discussions, jobs and training.

The Pinnaroo Project: a longitudinal 3-year cross-sectional study of the impact of a community-based arts-in-health program on the health and wellbeing of a remote Australian community

Fri, 19 Jun 26 00:00:00 +0000

Substantial international evidence supports the role of the arts in promoting health and wellbeing. This Original Research article reports on the health, behavioural and economic outcomes associated with participation in the Pinnaroo Project, which aimed to improve the health and wellbeing of Pinnaroo, South Australia, residents through sustained, community-led engagement in a diverse range of arts and creative activities.

Dialling in for breastfeeding success, a mixed-methods approach to explore remote stakeholders’ perceptions and experiences of the use of telehealth for lactation support

Wed, 10 Jun 26 00:00:00 +0000

Breastfeeding has significant public health benefits for mothers and infants, and one of the determinants of successful breastfeeding to the recommended 2 years and beyond is support. The initial crucial period for breastfeeding support is the first 2 weeks but access to services can be limited in rural and remote settings. Evidence suggests that providing breastfeeding education and support by telehealth can increase exclusive breastfeeding and extend breastfeeding duration. This Original Research study investigates consumer and clinician perspectives of using telehealth to access or provide perinatal education and/or clinical service delivery in rural Western Australia.

The association between medical student selection and a fit-for-purpose medical workforce in low- and middle-income countries in the Asia-Pacific region: a scoping review

Mon, 08 Jun 26 00:00:00 +0000

For decades, medical schools have debated appropriate ways to select the future workforce. Empirical research and reviews on selection of medical students mostly originate from high-income countries, which might not lead to training the health workforce to meet the needs and priorities of communities in low- and middle-income countries (LMICs). This Review explores approaches that medical schools in LMICs in the Asia-Pacific region could utilize in their selection strategies.

Bridging knowledge and practice: strengthening cervical cancer screening uptake among rural women in low-resource settings

Fri, 05 Jun 26 00:00:00 +0000

This Letter to the Editor calls for more research into the factors that improve cervical screening uptake among rural women in low-resource settings.

Decentralised clinical training affects retention but not recruitment: a case study in East Nusa Tenggara, Indonesia

Sat, 09 May 26 00:00:00 +0000

The low recruitment and retention of doctors in rural areas is a significant barrier to achieving equitable health services globally. Various cross-country studies have shown that long-term clinical placements in rural areas through decentralised clinical training (DCT) - in which the location and model of clinical education is restructured into networks of health service facilities outside the primary teaching hospital - increase the probability of graduates practising in rural locations. This Original Research study investigates the influence of DCT duration on rural doctor recruitment and retention in East Nusa Tenggara, Indonesia.

Evolving patterns of child malnutrition in northern Nigeria: trends in stunting, wasting, and underweight from 2013 to 2018

Thu, 07 May 26 00:00:00 +0000

Child malnutrition is a critical global health challenge, disproportionately affecting low- and middle-income countries, where it contributes significantly to morbidity and mortality among children under 5 years of age. Northern Nigeria presents a unique case of child malnutrition due to its complex socioeconomic and geopolitical challenges. This Review article explores the trends and determinants of child malnutrition in Northern Nigeria, particularly the prevalence of stunting, wasting, and underweight among children aged under 5 years and the underlying factors contributing to these conditions.

Educational strategy for the prevention and basic care of chronic wounds in Mayan-Yucatecan Indigenous communities

Thu, 07 May 26 00:00:00 +0000

The incidence of chronic wounds (eg diabetic foot ulcers, venous ulcers, pressure ulcers, surgical wound dehiscence, and skin tears), is expected to rise alongside the increase in non-communicable chronic diseases (NCDs). Mexico faces significant healthcare challenges due to high rates of NCDs, a situation that is exacerbated in rural populations, which experience high rates of malnutrition, marginalization, discrimination, lack of access to specialized services, and a shortage of trained personnel. This Project Report examines the success of a co-constructed educational strategy for the prevention and basic care of wounds in Maya-Yucatecan Indigenous communities in the municipality of Chankom, Mexico.

When eggs in the same basket are apples and oranges: length of stay for public sector allied health professionals in regional, rural and remote southern Queensland, 2010–2021

Wed, 06 May 26 00:00:00 +0000

Despite recognition that the term 'allied health' encompasses disparate professions (differing markedly in their background, training, scope of practice and client populations), evidence related to retaining the allied health workforce in regional, rural and remote areas often treats these professions as a homogeneous group. Grouping allied health professions together risks missing professions and/or geographic differences that could be targeted for the development of specific retention strategies. This Original Research study assesses the retention patterns of different allied health professionals employed in regional, rural and remote regions of Southern Queensland.

Reducing the phenomenon of medical deserts by identifying the career plans of future doctors in Poland. Quo vadis?

Tue, 05 May 26 00:00:00 +0000

Provision of equal access to medical services for all citizens is a challenge for public healthcare systems across many European countries. Medical deserts, where medical services are inadequate for the local population, are caused by insufficient local workforce distribution and service availability, and commonly occur in rural and peripheral regions. A recent audit in Poland highlighted a lack of target numbers for medical professionals and a lack of analytical instruments or data necessary for long-term workforce planning. This Original Research study examines the determinants of professional plans (planned specializations and geographic locations) for future doctors.

Employment status and healthcare utilization in Indonesia: a multilevel analysis across developed and underdeveloped districts

Mon, 04 May 26 00:00:00 +0000

Informal workers have few formal legal protections and tend to have more exposure and susceptibility to health-threatening situations than formal workers; they also represent the predominant form of employment globally, making them a key population for improving health equity. In Indonesia, informal workers make up 57.95% of the working population. This Original Research study uses a multilevel modelling approach to monitor disparities in healthcare utilization between formal and informal workers in Indonesia and examines how geographic context and health insurance coverage shape these utilization patterns.