Dissertations / Theses: 'Rural community health'

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Molapo, Maletsabisa. "Designing with community health workers: feedback-integrated multimedia learning for rural community health." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27977.

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Community Health Workers (CHWs) are an integral part of the rural health system, and it is imperative that their voices are accommodated in digital health projects. In the mobile health education project discussed in this thesis (The Bophelo Haeso project), we sought to find ways to amplify CHWs' voices, enabling them to directly influence design and research processes as well as technological outcomes. The Bophelo Haeso (BH) project equips CHWs with health videos on their mobile phones to use for educating and counselling the rural public. We investigated how to best co-design, with CHWs, a feedback mechanism atop the basic BH health education model, thus enabling their voices in the design process and in the process of community education. This thesis chronicles this inclusive design and research process - a 30-month process that spanned three sub-studies: an 18-month process to co-design the feedback mechanism with CHWs, a 12-month deployment study of the feedback mechanism and, overlapping with the feedback deployment study, a 17-month study looking at the consumption patterns of the BH educational videos. This work contributes to the field of Human Computer Interaction (HCI) in three distinct ways. First, it contributes to the growing knowledge of co-design practice with participants of limited digital experience by introducing a concept we termed co-design readiness. We designed and deployed explorative artefacts and found that by giving CHWs increased technical, contextual, and linguistic capacity to contribute to the design process, they were empowered to unleash their innate creativity, which in turn led to more appropriate and highly-adopted solutions. Secondly, we demonstrate the efficacy of incorporating an effective village-to-clinic feedback mechanism in digital health education programs. We employed two approaches to feedback - asynchronous voice and roleplaying techniques. Both approaches illustrate the combined benefits of implementing creative methods for effective human-to-technology and human-tohuman communication in ways that enable new forms of expression. Finally, based on our longitudinal study of video consumption, we provide empirical evidence of offline video consumption trends in health education settings. We present qualitative and quantitative analyses of video-use patterns as influenced by the CHWs' ways of being and working. Through these analyses, we describe CHWs and their work practices in depth. In addition to the three main contributions, this thesis concludes with critical reflections from the lessons and experiences of the 30-month study. We discuss the introduction of smartphones in rural villages, especially among elderly, low-literate, and non-English-speaking users, and present guidelines for designing relevant and usable smartphones for these populations. The author also reflects on her position as an African-born qualitative researcher in Africa, and how her positionality affected the outcomes of this research.

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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.

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Bennett, Amanda Dawn. "Project GENESIS: Community Assessment of a Rural Southeastern Arizona Border Community." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/194342.

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Purpose/Aims: The aim of this study was to understand the health issues of a rural Southeastern Arizona border community. More specifically, this study used community assessment with ethnographic principles to: 1) Conduct a community assessment centered on definitions of health, access to care, quality of care, and health needs in a rural Southeastern Arizona border community; and 2) Compared the findings of this study to previous studies, models, and theories of rural nursing and rural health.Background: It is important to understand that each community has a unique set of health priorities that are dictated by these factors; making every rural community different. Much of the work that has been done in rural America has been performed in the Midwest, Southeast, or Northern states. There is limited information regarding Arizona or even Southern US border communities and whether previous work can be generalized to areas that have not been studied.Sample and Methodology: This study utilized community assessment with ethnographic underpinnings through the use of focus groups, key informant interviews, participant observation, and secondary data analysis of existing community data. Sampling for the focus groups and key informants was purposive. Focus groups included: 1) participants who use local health services and 2) participants who do not.Analysis: Lincoln and Guba's (1985) guidelines for rigor in qualitative studies was utilized. Thematic analysis and thick description were used to analyze data. Theoretical triangulation was performed between individual, group, and community level data with theoretical linkages made to community capacity theory and rural nursing key concepts.Implications and Conclusions: The location of this project, rural Arizona community, near the US-Mexico border, posed an interesting contrast to the proposed concepts widely being used today. From this study, healthcare leaders in this community are better equipped to provide relevant, high-quality, and safe services; but an informed community emerged that has an interest in promoting the health and well-being of the community as a whole.

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Kent, Ruth Margaret. "Health needs of disabled people in a rural community." Thesis, University of Newcastle Upon Tyne, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363892.

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Beatty, Kate, Michael Meit, Emily Phillips, and Megan Heffernan. "Rural Health Departments: Capacity to Improve Communities' Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6838.

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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

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Gibbon, Marion. "Meetings with meaning : health dynamics in rural Nepal." Thesis, London South Bank University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298023.

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This thesis investigates the understanding of health needs of women in rural Nepal using a participatory action research (PAR) framework. This framework was evaluated using a multiple case study design. The cases were women's groups being observed and researched by the researcher. The thesis is concerned with developing and evaluating the PAR methodology and is thus second order research i.e. it considers the process of researching research and the issue of multiple perspectives is an important feature. The justification of the use of a PAR framework is to be found in the forms of research that takes place 'with' people. The distinction between PAR methods and other qualitative methods is a philosophical one (Tolley and Bentley, 1996) between the roles played by the researcher and researched. The researcher "outsider" and participants "informants" are partners, sharing and learning together. The work is divided into two stages. The first is to determine the usefulness of the PAR framework in helping participants make assessments of their health needs, analyse their situation, develop strategies for solving problems themselves, and implement their own action plans. The second is to reflect on the research process itself, which allows for generation and testing of the methodology. This thesis has enhanced the contribution to the literature in this field. A development of the PAR framework emerged called the Health Analysis and Action Cycle (HAAC), via evaluating the PAR framework. The HAAC was found to be useful in allowing women's groups to assess their health needs, plan and take action to improve their health situation. For example, five of the six groups considered the importance of diarrhoea and developed strategies to reduce the incidence of diarrhoea in their communities. The sixth group's work centred on reducing the incidence of respiratory illness in their community. All the groups were able to assess, plan and implement projects to improve their environmental and hence health situation. The research stimulated collective action and empowerment of women participating in the research as it was the first time women had worked together to identify issues of diarrhoeal disease and respiratory illness and introduced preventative measures within their community. The HAAC approach, an additional innovation in this field, has relevance to the current theory and practice debate within the development sector. The model developed has possible implications for t~e concept of developing 'partnership' within the health and development sector and the development of emergent evaluation through developmental decision science.

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Durdle, Jodi L. "Women, health and social change in a rural Newfoundland community." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ63977.pdf.

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Lidquist, Helene. "Collaboration between health promoting actors in a rural community - Maciene, Mozambique." Thesis, Mälardalen University, Mälardalen University, Department of Caring and Public Health Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-4273.

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In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself.

Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.

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Faber, M. "Community-based growth monitoring in a rural area lacking health facilities." Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52737.

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Thesis (PhD)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: A community-based growth monitoring (GM) project was established in a rural village in KwaZulu-Natal. The project is an example of community-based activities that were based on a participatory approach of problem assessment and analysis. The first phase of the study comprised of a situation assessment. The aim was to evaluate the nutritional status and related factors of children aged 5 years and younger. It included a cross-sectional survey (questionnaire and anthropometric measurements), focus group discussions and interviews with key informants. From a nutritional point of view, the situation assessment identified a need for regular GM of infants and small children, increased availability of foods rich in micronutrients, and nutrition education. Relevant findings of the situation assessment were used during a project planning workshop that was attended by community representatives. The community's concern about the health of the preschool children and the lack of health facilities, and the need for regular weighing of their children prompted the establishment of a community-based GM project. The GM project was run by nutrition monitors, through home-based centres (named Isizinda). Monthly activities at the Isizinda included GM, nutrition education, and recording of morbidity and mortality data. Children who were either in need of medical attention or showed growth faltering were referred to the nearest clinic. During the latter half of the study, the GM project was integrated with a household food production project and the Isizinda served as promotion and training centres for agricultural activities. Project activities were continuously monitored by reviewing the attendance register, scrutinising the Isizinda files, observation and staff meetings. Community meetings (at least twice a year) allowed for two-way feedback and addressing questions and concerns. Acceptability of the GM activities was measured in terms of attendance and maternal perceptions. The coverage of the Isizinda project was estimated at approximately 90% and at least 60% of these children were adequately covered. The Isizinda data showed an equal distribution of child contacts over the various age categories and was representative of the community. The attendance data suggest that community-based GM is a viable option to be used for screening and nutrition surveillance, and as platform for nutrition education. Most mothers comprehended the growth curve. Positive behavioural changes have been observed in the community and the Isizinda data showed a steady decline in the prevalence of diarrhoea. The Ndunakazi mothers were appreciative towards the Isizinda project because of a better understanding of the benefits of regular GM. They expressed a sense of empowerment regarding the knowledge that they have gained. The community had a strong desire for the project to continue. The Isizinda project showed that community-based GM can provide the infrastructure for developing capacity for agricultural activities within the community. Data from the household food production project showed that maternal knowledge regarding nutritional issues can be improved through nutrition education given at the GM sessions and that, when GM is integrated with agricultural activities, a significant improvement in child malnutrition can be obtained. The Isizinda project falls within the framework of the Integrated Nutrition Programme, and can bridge the gap in areas which lack health facilities.
AFRIKAANSE OPSOMMING: ’n Gemeenskaps-gebaseerde groeimoniteringsprojek is tot stand gebring in ’n landelike gebied in KwaZulu-Natal. Die projek is 'n voorbeeld van gemeenskapsgebaseerde aktiwiteite wat gebaseer was op 'n deelnemende benadering van probleem bepaling en analise. Die eerste fase van die studie was a situasie analise. Die doel was om die voedingstatus en verwante faktore van kinders 5 jaar en jonger te bepaal. Dit het 'n dwarssnit opname (vraelys en antropometriese metinge), fokus groep besprekings en onderhoude met kern persone ingesluit. Uit 'n voedingsoogpunt het die situasie analise 'n behoefte vir gereelde groeimonitoring van babas en klein kinders, verhoogde beskikbaarheid van voedsels ryk in mikronutriente and voedingsvoorligting aangedui. Toepaslike bevindinge van die situasie analise was gebruik tydens ’n beplannings werkswinkel wat deur verteenwoordigers van die gemeenskap bygewoon is. Die gemeenskap se besorgdheid oor die gesondheid van voorskoolse kinders en die gebrek aan gesondheidsfasilitieite, asook hul behoefte om hul kinders gereeld te laat weeg, het aanleiding gegee tot die totstandkoming van ’n gemeenskaps-gebaseerde groeimoniteringsprojek. Die program is gedryf deur monitors deur tuisgebaseerde sentrums (genoem Isizinda). Maandelikse aktiwiteite by die Isizinda het groeimonitering, voedingvoorligting en die insameling van morbiditeit en mortaliteit inligting ingesluit. Kinders wie mediese sorg benodig het of wie groeivertraging getoon het, is na die naaste kliniek verwys. Die groeimoniteringsprojek is tydens die laaste helfte van die studie met ’n huishoudelike voedselproduksieprojek geintegreer en die Isizinda het as promosie- en opleidingsentrum vir die landbou aktiwitiete gedien. Projek aktiwiteite is deurgaans gemonitor deur die bywoningsregister en Isizinda leêrs deur te gaan, waarnemings en personeel vergaderings. Vergaderings met die gemeenskap (ten minste twee per jaar) het voorsiening gemaak vir wedersydse terugvoering en die aanspreek van vrae en besorgdhede. Die aanvaarbaarheid van die groeimoniterings aktiwiteite is gemeet in terme van bywoning en persepsies. Die Isizinda projek het ongeveer 90% van die kinders gedek, van wie ten minste 60% voldoende gemoniteer is. Die Isizinda data het ’n eweredige verspreiding van besoeke oor die verskillende oudersdomgroepe aangetoon. Die Isizinda data was ook verteenwoordigend van die gemeenskap. Die bywoningssyfers dui aan dat gemeenskapsgebaseerde groeimonitoring 'n lewensvatbare opsie is vir sifting en voeding opnames, en as 'n platform vir voedingvoorligting. Meeste moeders kon die groeikaart interpreteer. Positiewe gedragsveranderinge is in die gemeenskap waargeneem en die Isizinda data het ’n geleidelike afname in die voorkoms van diarree getoon. Die Ndunakazi moeders was waarderend teenoor die Isizinda projek as gevolg van 'n beter begrip ten opsigte van die voordele van gereelde groeimonitering. Hulle het 'n gevoel van bemagteging uitgespreek ten opsigte van hul verbeterde kennis. Hulle was mening dat die projek moes voortgaan. Die Isizinda projek het aangetoon dat gemeenskapsgebaseerde groeimonitoring die infrstruktuur kan skep vir die ontwikkeling vir kapasiteit vir landbou aktiwiteite binne die gemeenskap. Inligting van die huishoudelike voedselproduksieprojek het aangetoon dat die moeders se kennis ten opsigte van voedings verwante aspekte verbeter kan word deur voedingvoorligting wat gegee word tydens die groeimonitering sessie en dat, as groeimonitoring geintegreer is met landbou aktwiteite, 'n verbetering in die voedingstatus van die kind verkry kan word. Die Isizinda projek val binne die raamwerk van die Geintegreerde Voedingsprogram en kan die gaping dek in areas waar geen gesondheidsfasilteite is nie.

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Vaughan, David James. "Acceptability of primary care a study of one community in Montana /." Thesis, Montana State University, 2007. http://etd.lib.montana.edu/etd/2007/vaughan/VaughanD0507.pdf.

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Florence, James, Robert P. Pack, Jodi L. Southerland, and Randolph F. Wykoff. "The Depth of Rural Health Disparities in America: ABCDE's." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/1325.

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Health-related disparities remain a persistent, serious problem across the nation's more than 60 million rural residents. Rural Populations and Health provides an overview of the critical issues surrounding rural health and offers a strong theoretical and evidence-based rationale for rectifying rural health disparities in the United States. This edited collection includes a comprehensive examination of myriad issues in rural health and rural health care services, as well as a road map for reducing disparities, building capacity and collaboration, and applying prevention research in rural areas. This textbook offers a review of rural health systems in Colorado, Kentucky, Alabama, and Iowa, and features contributions from key leaders in rural public health throughout the United States.

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Nimegeer, Amy. "Considering community engagement for remote and rural healthcare design in Scotland : exploring the journey from rhetoric to reality." Thesis, University of the Highlands and Islands, 2013. https://pure.uhi.ac.uk/portal/en/studentthesis/considering-community-engagement-for-remote-and-rural-healthcare-design-in-scotland(9418ba56-720c-41b6-b97f-f345cfad0ffa).html.

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The way healthcare services are delivered in remote and rural Scottish communities is in a state of reconfiguration. At the same time the NHS faces pressure to plan these new services in partnership with communities themselves. Evidence, however, suggests that this is not necessarily being done well. This study considered the contextual aspects of remote and rural Scottish communities that may impact on healthcare-related engagement, and examined current understanding of what constitutes a ‘good’ engagement process. It then went on to consider a two-year action research project (RSF) that took place in four remote and rural Scottish communities to engage local residents in an anticipatory process co-designing their own future healthcare services. Finally, this study examined ways in which individuals were able to wield power within the engagement described in the RSF project, by using a combination of participant observation and Foucauldian Discourse Analysis. As well as making a number of practical recommendations for future engagement practice in a remote and rural context, this study makes three key contributions. Firstly, it contributes further contextual knowledge about the challenges of engaging with remote and rural Scottish communities for local healthcare service design; a topic about which little has been written. Secondly, it contributes a novel method for anticipatory healthcare budgeting aimed at a remote and rural Scottish context, namely the RSF Game. Thirdly, it draws the conclusion that individual (non-elite) community members have the ability to use French and Raven’s bases of social power to impact the engagement process at all stages, and also posits that discourse can be used within rural engagement as a new ‘base of power’, which contributes to the debate around individual power and agency within remote and rural community engagement for healthcare, which few studies have examined.

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Lackey, Douglas Eugene. "Participation in rural health development : a case study in Kenya." Thesis, London School of Economics and Political Science (University of London), 1997. http://etheses.lse.ac.uk/2479/.

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Achieving active participation of community members in community-based health care programmes (CBHC) is a challenging and complex task. It is also a criterion for successful programming and is promoted as a universal truth and requirement for primary health care development. Nevertheless, most CBHC programmes admit that more needs to be done to achieve satisfactory levels of community involvement. Thus, a better understanding is required as to why success in community involvement has been in most part, elusive. The thesis uses a historical perspective to examine the emergence of participation in the period prior to and during the community development era in Africa and the post-independent period in Kenya. The emergence of participation and it's progression as an international health strategy in the 1980's and 1990's within WHO, a leading international organisation promoting community involvement in health is critically examined. At the community level, people's perception and understanding of community participation and an analysis of how they participated in the case study CBHC programme provided an operational assessment of community participation. A particular focus was community contributions as a mechanism of participation. Thus, the primary aim of this thesis was to examine in rural Kenya the socio-economic and institutional support factors which can potentially enhance or limit participation of community members in rural community-based health development programmes. The main socio-economic factors examined were education, income, group membership and domestic factors such as harmony in the household and women's time. The roles of local structures and support personnel such as community health volunteers (CHVs), health committee members (HCMs) and local leaders in promoting participation were also analysed. The method used was interviews with a sample of these respondents. Based on the case study research results, the thesis draws conclusions on the factors that appear to be most significant in relation to community participation. The importance of education, group membership and regular monthly visits by CHVs were identified as particularly significant factors. A more informed understanding of these relationships will enable health planners in designing integrated programme strategies which can help promote broader community participation in health development programmes. An awareness of these factors and their inter-relationships by operational-level health staff will enable them to enhance community participation when developing and implementing community-based health care programmes.

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Amos, Isaac Thompson. "Health care access for a rural community in Akwa Ibom State, Nigeria." Thesis, University of Phoenix, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3583317.

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Inadequate health care infrastructures and lack of qualified and trained health care professionals are barriers against timely and prompt access to health care services in the rural communities of Akwa Ibom State. The absence of immediate health care services, coupled with the lack of basic infrastructure and qualified health care professionals, has led to high mortality from preventable causes. Compounding the problem are poor governance, endemic corruption, and lack of involvement of trained professionals for management of human and material resources to support health care delivery, particularly in building the capacity and removing barriers and obstacles to effective delivery of primary health care services at the local community level. A quantitative quasi-experimental research study was used to evaluate access to health care services in the rural community in Etim Ekpo Local Government Area of Akwa Ibom State, Nigeria by introducing mobile phones and community health care educators. Four sets of hypotheses were tested to provide answers to two research questions using statistical analysis. The results indicated the importance of health care facilities and access to qualified health care professionals and the direct link to improved clinical outcome. The myriad of evidence presented in the literature that telemedicine infrastructure has been effectively used to create access to rural communities in most third world and developing countries was supported through this study. The results indicated mobile communication technology can make the difference in the Nigerian health care service delivery, particularly in remote villages.

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Dillmann, Maria [Verfasser]. "Impact of a newborn community health project in rural Kenya / Maria Dillmann." Ulm : Universität Ulm. Medizinische Fakultät, 2016. http://d-nb.info/1081774207/34.

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Fox, Janice M. "Rural ills and community health care : a case study 1989 to 1992." Thesis, University of East Anglia, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384942.

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McColl, Lisa Maree, and n/a. "The Influence of Bush Identity on Attitudes to Mental Health in a Queensland Community." Griffith University. School of Arts, Media and Culture, 2005. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20060810.121042.

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The main objectives of this research were to determine the influence of bush identity on attitudes to mental health in rural Australia, what influence these attitudes have on service provision and utilisation, and what measures can be taken to improve attitudes to mental health and services in the bush. The research has included an extensive literature review of Australian historical and contemporary rural culture, the political economy of rural restructuring, rural mental health, as well as State and Federal policies and programmes for mental health care delivery. An ethnographic community study of Ruraltown, a rural centre in Queensland, was undertaken over a three-year period which involved semi-structured interviews, questionnaires, observations and community interaction. The results from the questionnaires and interviews in the community study indicate that attitudes to mental health in rural areas are influenced by bush identity, defined by reference to historical and current characteristics which include self-reliance, resilience, independence and stoicism. Social identity theories have been applied in this study to determine how the socialisation processes have incorporated these characteristics among the rural population, and rural males especially. In turn, these incorporated attributes and values have a direct impact on their attitudes to mental health and the willingness to seek help for problems of a psychological nature. Other aspects of rural life such as perceived lack of confidentiality and anonymity, fear of gossip, and isolation also impact on attitudes and the utilisation of mental health resources. Stigma is a significant barrier to recognition and acceptance of mental health issues. Hence, seeking help for mental health problems does not form part of the coping strategies for many in the bush. Mental health services, therefore, are not as readily accepted or utilised in rural Australia. Although some rural people do access mental health services, many more go on suffering with mental health problems rather than addressing them. Recommendations have been made to promote awareness and enhance education and attitudes to mental health, improve services and increase service utilisation. The study has also identified the problems facing mental health consumers in Ruraltown and some suggestions have been made to overcome these and assist in consumer empowerment.

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Davis, Kierrynn Miriam Davis. "Cartographies of rural community nursing and primary health care : mapping the in-between spaces /." [Richmond, N.S.W.] : University of Western Sydney, Hawkesbury, 1998. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030509.135659/index.html.

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LeGrow, Tracy L. "Access to health information and health care decision-making of women in a rural Appalachian community." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=746.

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Price, Lisa M. "The electrifying impact on the fuelwood resources of a Namaqualand rural community." Thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/26651.

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Jones, Ashley May. "Improving the Management of Obesity in a Rural Community." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/594400.

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Background: Nearly half of the US population is overweight or obese, carrying with them a higher risk for morbidity and mortality and rising healthcare costs. Rural women are disproportionately affected, with higher rates of obesity, obesity-related chronic diseases, and poorer health outcomes (Befort, Nazir, & Perri, 2012; Penney, Rainham, Dummer & Kirk, 2014). There may be several factors. In general, rural health systems are more isolated, with a lack of healthcare resources including quality providers, technology, and public health services (IOM, 2009). Purpose: The purpose of this quality improvement project was to assess how obesity is managed in women residing in one rural community - Ritzville, Washington. Methods and Aims: Charts of all women ≥ 18 years of age receiving care at Hometown Family Medicine clinic (HTFM) were queried for a diagnosis of obesity. The prevalence of obesity in this group was calculated. Of those identified as obese, thirty charts were selected at random and reviewed. The following was determined: 1) Prevalence of chronic disease in adult women who receive care at HTFM; and 2) The management of obesity at HTFM compared with current evidence-based guidelines. This was followed by a community assessment to determine the resources available for the prevention and treatment of obesity in Ritzville, WA. Results: The prevalence of obesity (36.9%) and chronic diseases (hypertension, diabetes type 2, dyslipidemia, and heart disease) in the population studied were found to be significantly higher than both state and national averages. Due to a lack of basic resources, (access to weight loss specialties, exercise facilities, healthy foods, etc.) management of obesity in Ritzville, WA may be challenging. Findings from this study helped to inform resource allocation and identified opportunities to improve the management of obesity based on current practice guidelines. Primary health care may be the only opportunity to promote healthy behaviors and improve health outcomes in this vulnerable population. Action needs to be taken or the burden of obesity will continue to rise.

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Pretorius, Lizél. "A community-based disability programme for rural areas / Lizél Pretorius." Thesis, North-West University, 2009. http://hdl.handle.net/10394/4276.

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This study was conducted in the Heuningvlei community in the Kgalagadi District Municipality in the Northern Cape Province. This study was part of the "Tshwaragano Project" with the general aim of empowering the disadvantaged communities in rural areas. The aim of this research was to develop, implement and evaluate the effectiveness of a community-based disability programme for poverty stricken families in rural areas of the Northern Cape Province. To achieve this aim, the following objectives needed to be attained: w> To study the interrelation between health, poverty and disability? This objective was achieved by means of a critical review and analysis of the relevant literature. It can therefore be concluded that the interrelation between health, poverty and disability is significant. Poverty makes people more vulnerable to disability and disability can lead to isolation, lack of support and lack of resources. Many people still remain ill-fed, ill-housed, under-educated and defenceless to preventable diseases. To establish what the bio-psychosocial needs of the Heuningvlei community with regard to a community-based disability programme are? The researcher also established a profile on the community members with disabilities in the Heuningvlei community. The study showed that the highest prevalence of disabilities involves physical disabilities, with hearing, blindness and mental impairments also represented. The causes of disabilities are mostly illness related causes, substance abuse and natural causes. All three aspects which could, on the whole be prevented through general health awareness and a healthier lifestyle. It was also palpable that crucial disability management- and support services lack in this rural area. Partnership working between government organizations and Non Government Organizations (NGO's) seems a foreign affair and the community members with disabilities and their families an elapsed entity. To design and implement a community-based disability programme for rural areas. This programme was presented successfulfy over a stretch of five group sessions to ten community members with the aim to improve their knowledge regarding disability matters. They also received skills to start their own food garden. By means of this programme the members of the group also enhanced their social functioning and showed great interest in disability awareness and management. To evaluate the effectiveness of this community-based disability programme in empowering community members with disabilities, their care-takers and the wider community to manage disability related matters in a poverty stricken area. The evaluation by utilizing a focus group with the identified key role players in the community. The results obtained through this evaluation indicated that the programme had brought a significant change in the lives of the members. It can therefore be concluded that the programme was very successful and effective in the sense that members felt that there was a transition in their lives. In summary it can be stated that proof has emerged from this research that a scientifically founded, well-planned community-based disability programme can undoubtedly be applied to improve the social functioning of poverty stricken rural families.
Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2010.

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Arhin, Dyna Carol. "Willingness to pay for rural health insurance : evidence from three African countries." Thesis, London School of Economics and Political Science (University of London), 1998. http://etheses.lse.ac.uk/2863/.

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The vast majority of Africans living in rural areas do not have access to health insurance and policy related questions to assist health planners design and implement financially viable rural health insurance schemes have yet to be fully addressed. This thesis seeks to fill some existing gaps in the knowledge about the performance of existing schemes and methods of assessing "willingness to pay" (WTP) and financial feasibility. It begins with a review of the literature on the theory of insurance and its practice in rural areas in Sub-Saharan Africa, that contributed to the research conceptual framework and implementation. Two health insurance schemes (La Carte d'Assurance Maladie and the Abota in Burundi and Guinea Bissau), were evaluated regarding their social and financial performance in rural areas. The research instruments were household surveys, focus group discussions and health facility costing. In both schemes access to health care appeared to have improved and the findings suggested that were quality of care improved, the schemes would considerably reduce financial concerns faced by people at the time of illness. They would also raise significant revenue. In the third study country, Ghana, a study of preferred benefit options, WTP, and community rated premiums for a proposed health insurance scheme was undertaken in a rural area. In undertaking this feasibility study, the research developed a WTP instrument and used a contingent valuation approach. Eight hundred households participated in the study. Eighty percent of households said they would be willing to pay the premium required to recover 100% of the non-salary recurrent costs of providing OPD care in a local clinic and inpatient care in a hospital. The stated WTP was conditional on; a) the insurance scheme giving access to health care in which drugs and basic laboratory investigations would be available, b) health staff being professionally qualified and respectful, and c) a local solidarity association having a role in administering the participating health facilities. Econometric analysis of households' WTP for outpatient insurance cover supported the hypothesis that WTP is influenced by a) the experience of frequent difficulties in paying for health care in the past; b) the perception that adults in the household are healthier than those in other households; and c) the household head's sex, education and religion.

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Kimmel, Ainslee. "Mental health perceptions of rural community members and firefighting personnel after a wildfire." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Education, c2012, 2012. http://hdl.handle.net/10133/3285.

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Wildfires in Canada and around the world are increasing in frequency each year from factors such as accumulated fuel load, climate changes, and pine beetle infestation. Due to an increased proportion of individuals living in the wildland–urban interface areas within Canada and due to the increasing need for firefighters to fight the growing number of fires that burn each year, the potential threat for humans is also becoming greater. Conducted on the 2009 West Kelowna, British Columbia wildfires, this descriptive, exploratory, qualitative study incorporates quantitative validity measurements to investigate factors related to individual variations in psychological distress and posttraumatic growth (PTG). The findings revealed that perception of control, social support, compounding stressors (i.e., dual roles, ongoing responsibilities and personal issues), and coping methods (i.e., debriefing, humour, self-care behaviours, and reflection) were precursors to psychological health and resilience. Since wildfires are increasing in Canada as well as on a global scale, understanding how they affect residents and firefighting personnel from a mental health perspective is important to research, as it can lead to identifying more effective interventions, better provision of disaster relief services, and increase individual resilience.
xi, 193 leaves ; 29 cm

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Eastmond, Cheryl. "Implementation of a cardiovascular health-promotion program in a rural Africa-American community." NSUWorks, 2014. https://nsuworks.nova.edu/hpd_con_stuetd/20.

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Wiese, Lisa Kirk. "Development and testing of a measure of Alzheimer's disease knowledge in a rural Appalachian community." Thesis, Florida Atlantic University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3585017.

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Rural West Virginia has a very high percentage of older adults. The age-related disease of Alzheimer’s threatens the health of older Appalachians, yet research on Alzheimer’s disease (AD) in this population is scarce. In order to improve screening rates for cognitive impairment, Appalachians need to understand their vulnerability. The first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational descriptive study was conducted with 240 participants from four samples of older adults in south central rural Appalachian West Virginia using surveys and face-to-face interviews. Results from tests for stability, reliability including Rasch modeling, discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of education [F(2, 226) = 170.51, p = .001]. Using multiple regression, the predictors of AD knowledge included caregiver status, miles from a healthcare provider, gender, and education; (R²=.05, F(4,187) = 2.65, p =. 04). Only years of education accounted for a significant proportion of unique variance in predicting the total BKAD score (t = 2.14, p =. 03). Implications include the need for further tool refinement, testing for health literacy, coordination with recent statewide efforts to educate the public regarding AD, and community based participatory research in designing culturally effective education programs that will ultimately increase screening and detection of Alzheimer’s disease in rural populations.

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Kirkwood, Sandra Jane. "Frameworks of culturally engaged community music practice in rural Ipswich." Thesis, Griffith University, 2009. https://eprints.qut.edu.au/132103/2/132103.pdf.

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This study is a critical reflection on two music projects that I conducted in my home area of Ipswich, Australia, prior to undertaking this research. The music projects involved participatory action research to investigate the music heritage and culture of the rural Ipswich region. The purpose of this study is to review and analyse the creative processes that I used in the rural Ipswich music projects in order to develop suitable practice frameworks for similar projects in future. The first music project was a collaborative investigation of the music history of Purga in rural Ipswich (2003-2005). Local people and those who used to live in the area were invited to come back to share memories of the music from the area with one another. People collaborated creatively: This allowed me to write The Purga Music Story and Harold Blair (2005), an inter-generational community education package. In 2003, we established the Purga Music Museum as a meeting place where the music heritage and culture of our neighbourhood is performed and displayed. The second music project (2006) was a study of contemporary music in rural Ipswich that resulted in community consultation and the development of a Music Action Plan for the area. I continued facilitating community music in rural Ipswich, as the curator of the Purga Music Museum, until 2008. Both music projects presented different challenges in the establishment of processes that would be effective for the needs and interests of people from various cultural groups. The work was fraught with complex decisions and ethical dilemmas about representation and music cultural heritage management because our neighbourhood previously contained the Purga Aboriginal Mission (1915-1948). The findings therefore relate to the struggles of the ‘Stolen Generation’-- Aboriginal and Torres Strait Islander people who were taken away from their families and forced to live in government-controlled residential situations. New, respectful approaches had to be found, conducive to the health and well-being of all concerned. For this reason, participatory action research methods were developed and a ‘Community of Discovery’ approach was used. Throughout this study, I investigate issues that arose as people told their music stories, and passed on music heritage and culture from one generation to the next. The key question is “What are appropriate frameworks of culturally engaged community music practice for rural Ipswich?” This study also draws on findings from the music projects to address the sub-questions, “How did community music practice function in the past in rural Ipswich?” “What is the current situation regarding contemporary community music practice in rural Ipswich?” and “What can be done to enhance future community music practice for rural Ipswich?” Aspects of music and health practice complement each other in this study. As a dual qualified music and health professional, I draw on expertise from both of these areas. Ethnographic methods were used to record and review the findings from each music project. The analysis is grounded in review of literature and other sources, creative display and performance, analysis of music history, community consultation, and critical reflection on my own community music practice. Finally, this evidence-based process of professional reasoning leads to the development of appropriate practice frameworks that transform the way that I intend to deliver services in future, and will hopefully inspire others. The thesis has five parts. The context and rationale for the research are outlined in Part 1. This is followed by description of the two music projects in Part 2. Part 3 is an exploration of how my music practice is situated in relation to scholarly literature (and other sources) and outlines the chosen theoretical constructs or models. This prepares for critical analysis and discussion of specific issues that arose from reflection on practice in Part 4. The conclusions of the research, presented in chapter 9, outline the creative processes, underlying principles, and the philosophy of my practice. The study concludes with an epilogue, which is a consideration of the present situation and suggested future directions for service provision and research.

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Fisher, Vicky Mitchell. "Help-Seeking for Depression in Rural Women: A Community Portrait." VCU Scholars Compass, 2005. http://scholarscompass.vcu.edu/etd/681.

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This study was conducted with fourteen participants who lived in a rural Virginia community. The focus of the study was exploration of the nature of the experience of depression and of help-seeking for depression in one rural woman and in her community social network. The need for exploration of the community social network was influenced by the DeFacto Services Model of Rural Mental Health, which emphasized the influence of community factors in making decisions to seek mental health care. Findings of the study included the following themes, which related to the nature of depression: 1) linkage of experiential depression to diagnostic criteria; 2) overcoming depression using willpower; 3) connection of depression to abuse and violence, and 4) masking the inner world of depression. The following themes related to the nature of help-seeking emerged from the data: 1) family role in help-seeking; 2) insider/outsider status impact on help-seeking; 3) role of family and work functioning in help-seeking, and 4) role of informal and formal networks in help-seeking. Tentative conclusions were reached based on the findings that suggest depression and help-seeking may be experienced in distinctive ways by rural dwelling women in this particular community. Further research was suggested as a way of understanding more about how rural women seek help for depression within the context of their own community social networks.

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Ulbrich, Sherri. "A stage-based community intervention to promote physical activity in healthy adults." free to MU campus, to others for purchase free online, 2002. http://wwwlib.umi.com/cr/mo/preview?3052224.

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Brodie, Kimberly Becknel. "Intrapersonal and community-related influences of rural adolescent pregnancy: A mixed-method approach." ScholarWorks, 2009. https://scholarworks.waldenu.edu/dissertations/674.

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The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting groups. Two sample t tests revealed significant differences between groups relative to personal sexual values and attitudes toward premarital sex. There were no significant differences between groups for sexual health knowledge scores or self-esteem scores. Qualitative focus group discussions with one group, consisting of pregnant, parenting, nonpregnant, and nonparenting participants, assessed community opportunity structure as a behavior-influencing dynamic. Open-coding analysis revealed perceptions of strained employment and education-related structures, low community expectations of pregnant adolescents, and the influence of peer-related normative beliefs in early sexual intercourse. To bring about social change, community organizations should collaborate to engage participant-driven research while prioritizing the implementation of county-wide, comprehensive sex education programs. Improved programming could repair social norms, increase sexual health knowledge, and encourage personal responsibility over sexual health decisions.

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Winters, Krysta. "A voice in the wilderness a needs assessment of a developing rural community /." Online full text .pdf document, available to Fuller patrons only, 2002. http://www.tren.com.

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Uta, Joseph J. "Health communication to rural populations in developing countries : with special reference to Malawi." Thesis, Loughborough University, 1993. https://dspace.lboro.ac.uk/2134/13774.

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The findings of KAP studies and health reports indicate that in spite of continuing efforts by developing countries like Malawi, to raise health awareness among their peoples, the majority of the people remain inadequately informed and are generally found to lack basic knowledge about most prevalent diseases. As a result most people are unable to participate fully in primary health care activities. Two parallel surveys were carried out: (i) on activities of providers of information; and (ii) on information-seeking behaviour of a sample of the public. A health knowledge test was conducted to a sample of the public in order to assess their levels of Aids and bilharzia awareness. On matching the findings from the two surveys the following deficiencies were identified. The major cause of problems was that information provision was fragmented. Conflicting messages were given by different agencies which appeared to compete with each other. Distribution and access to the available information was also found to cause problems. Lack of research-based knowledge among health information providers about information needs and information-seeking behaviour of the people they are planning services for compounds the problems of information provision. Potential solutions include coordinating all activities of health communication from top-to-bottom (i.e. from planning to implementation at the community level). Efforts towards strengthening extension services, consolidating and repackaging of information, and consolidating of health grey literature are argued to be appropriate. Promoting use and marketing of the available information among the rural populations is also argued to be appropriate.

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Kizer, Elizabeth A., and Elizabeth A. Kizer. "Using Social Theory to Guide Rural Public Health Policy and Environmental Change Initiatives." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624313.

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The study of health disparities and the social determinants of health has resulted in the call for public health researchers to investigate the mid- and upstream factors that influence the incidence of chronic diseases (Adler & Rehkopf, 2008; Berkman, 2009; Braveman P. , 2006; Braveman & Gottlieb, 2014; Krieger, 2011; Rose, 1985). Social ecological models (SEMs) provide important conceptual tools to inform this research and practice (Krieger, 2011; Golden & Earp, 2012; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008; Glanz, Rimer, & Lewis, 2002). These models can help us look at the social and physical environments in rural Arizona communities and consider how health policies and environmental interventions address mediating factors, such as disparities in access to fresh food, that contribute to ill health in marginalized, rural, populations. Rural residents are at greater risk for obesity than their urban counterparts (Jackson, Doescher, Jerant, & Hart, 2006; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008). And while human life expectancy has steadily increased over the past thousand years, current projections indicate that the rise in obesity-related illnesses will soon result in its decline (Olshansky, et al., 2005). One reason for this decline, may be the reduced availability of healthy food – an important predictor of positive health outcomes including reduced obesity and chronic disease - in many parts of the United States (Brownson, Haire-Joshu, & Luke, 2006; Ahen, Brown, & Dukas, 2011; Braveman & Gottlieb, 2014; Braveman, Egerter, & Williams, 2011). The United States Department of Agriculture (USDA) defines food deserts as geographic areas in which there is limited access to grocery stores and whose populations have a high rate of poverty. In Arizona, 24% of the rural census tracts are considered food deserts; compared to an average of eight percent of rural census tracts across the nation (United States Department of Agriculture, 2013). Food deserts are one example of the upstream factors influencing the health of rural populations. Local health departments have been encouraged through the National Association for City and County Health Officials (NACCHO) and through the Public Health Accreditation Board (PHAB) to conduct community health assessments (CHAs) in order to identify unique contexts and community resources, health disparities, and the social determinants of health as well as potential areas for advocacy, policy change, environmental interventions, and health promotion interventions. Public health challenges like chronic diseases, which have multiple causes, can be explored in-depth through CHAs. CHAs often contain recommendations for action and/or are followed by community health improvement plans (CHIPs) which help local health departments prioritize resources and set measurable goals. In Florence, AZ recommendations made in a CHA are being acted upon by a non-profit agency, the Future Forward Foundation (3F). This investigation explores two interrelated issues regarding the use of CHAs and CHIPs as practical tools to set public health priorities. First, what makes a CHA useful to rural public health practitioners? What methods of conducting a CHA and subsequently analyzing the data results in actionable policy recommendations and/or environmental level interventions? Second, to what extent can public health agencies engage nontraditional partners to work in partnership to address the social determinants of health? As an example, I will look at the impact of a volunteer-based non-profit agency, located in a rural food desert on improving the social and physical nutrition environment as recommended by a local CHA. This inquiry will provide insights to public health practitioners seeking to identify and implement policy and environmental change addressing complex, multi-causal, public health issues, and provide insights regarding engaging nontraditional partners who may not self-identify as public health agencies.

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Twikirize, Janestic Mwende. "Community health insurance as a viable means of increasing access to health care for rural households in Uganda." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/8243.

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Includes abstract.
Includes bibliographical references (p. 219-239).
This study investigated the viability of community health insurance (CHI) as a means of increasing access to health care for rural households in Uganda. This was against the background that health care is a basic need and right and that, despite this, households especially in the rural parts of Uganda are still lacking effective access to health care. The study is informed by different theories of justice in health care delivery, namely, the libertarian, egalitarian and utilitarian theories. It also borrows concepts from Andersen's (1968) behavioural model of health services access and utilization as well as Kutzin's (2001) framework for analysis of health financing arrangements to assess the viability of CHI as a strategy to increase access to health care.

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Yakong, Vida Nyagre. "Rural Ghanaian women's experience of seeking reproductive health care." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/3805.

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Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.

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Davis, Kierrynn, University of Western Sydney, Faculty of Social Inquiry, and School of Social Ecology. "Cartographies of rural community nursing and primary health care: mapping the in-between spaces." THESIS_FSI_SEL_Davis_K.xml, 1998. http://handle.uws.edu.au:8081/1959.7/470.

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This postmodern feminist ethnographies research aimed to explore the everyday meanings of primary health care (PHC) held by rural community nurses. Secondly, the research aimed to explore the everyday meanings of care held by the clients of the rural community nurses who participated in the study. The representation of this research is written in four voices which converse with each other to varying degrees in each chapter. This writing strategy is a deliberate one aimed at destabilising the usual approach to representation of research. It is also a strategy which seeks methodological coherence. The third aim therefore is to deliberately trouble the acceptable grounds concerning how nursing research is represented. The research utilised dialogical (conversational)and participant observation methods concerning the everyday meanings of nurses and their clients.The meanings I made of the information were created from a deconstruction of the texts. These texts included fieldnotes of participant observations and transcripts of conversations with nurses and their clients. The form of deconstruction utilised was informed from multiple sources and involved three levels of analysis. A realist interpretation was followed by an oppositional interpretation and then a reconstructive movement. The results revealed that rural community nurses practice is both spatio-temporally contextualised and metaphorically situated in an in-between space. This in-between space is situated between margin and the centre. Rural community nurses working on the margins traverse this space in order to overcome further marginalisation whilst working with Indigenous Australians and the aged. Moreover, the in-between space encompasses and creates opportunities to mutually exchange the gift of desire that being - empowering and compassionate relationships with clients and colleagues. Futhermore, whilst rural community nurses are strongly committed to the philosophy of PHC, their evryday working life is discursively constructed by powerful discourses which result in oppositional tensions. The tensions and the 'in-between' space allow the rhetoric of PHC to be resisted and reframed. Consequently, the oppositional constructs of their practice were displaced. Moreover, this necessitated the negotiation of space and place, and required the reconstruction of subjectivity, intersubjectivity and becoming
Doctor of Philosophy (PhD)

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Van, Hoi Le. "Health for community dwelling older people : trends, inequalities, needs and care in rural Vietnam." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-47467.

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Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations. The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services. Conclusions There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups. Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services.
Aging and Living Conditions Program
Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec

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Baine, Sebastian Olikira. "Improving the health of Uganda's rural populations : the role and potential of community financing." Thesis, Keele University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397676.

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Beyers, Belinda. "Experiences of community service practitioners who are deployed at a rural health facility in the Western Cape." Thesis, University of Western Cape, 2013. http://hdl.handle.net/11394/3321.

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Magister Curationis - MCur
South Africa has a general shortage of most categories of health professionals, which include nurses, doctors, dentists and pharmacists. However, the problem is exacerbated by the fact that most of these professionals either work in the private health sector or have migrated to more affluent countries. Shortages of nurses in the rural setting continue to pose a problem for the Department of Health. The community service policy is stated in Section 40 of the Nursing Act, of 2005, and in the Regulations relating to Performance of Community Service published in the Government Notice No. 765 of 24 August 2005. In 2008, the first professional nurses started with their community service. Community service for health professionals is a policy proposal of the Department of Health that reacts to the lack of meeting the health requirements in poor communities, particularly in rural areas. It offers graduating health professionals with the prospect of gaining first-hand working experience in conditions of poverty and underdevelopment. South Africa is implementing community service for health professionals as a plan to manage the difficulties of human resources in the health sector. The transition period for community service practitioners in a rural setting is different, which implies that most support may need to be strengthened due to the remoteness of the rural setting. The purpose of this study was to describe the experiences of community service practitioners during their community service at a rural health facility. From the findings, guidelines were described for the operational managers who are responsible for supporting the community service practitioners at a health facility in a rural area. A qualitative, exploratory, and descriptive design was applied, using individual unstructured interviews and field notes. Each interview took around 30-45 minutes to complete. The purposively selected sample consisted of community service practitioners (n = 10) who were practicing at rural health facilities. The process of inductive coding of Thomas (2003:5) was used to analyse the data. The results of this study indicate that a process is needed for community service practitioners fresh from university and an urban environment to adapt to a remote rural health facility. Some of the participants did receive an orientation programme at the beginning of their community service year. However, most of the community service practitioners that took part in the study learned from their experience during the year of their placements. For some, the learning opportunities were more available in the rural setting than when they had worked as students at the urban hospital during their training.

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York, Kathie J. "The Community Health Workers' Role in the Community-Directed Treatment with Ivermectin Program in the Morogoro Rural District of Tanzania." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1323349445.

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41

Mlcek, Susan Huhana Elaine. "Paucity management models in community welfare service delivery." View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/33647.

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Thesis (Ph.D.)--University of Western Sydney, 2008.
A thesis presented to the University of Western Sydney, College of Arts, Social Justice and Social Change Research Centre, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

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42

Oum, Sophal. "Development, implementation and evaluation of community-based surveillance system in rural Cambodia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://researchonline.lshtm.ac.uk/4646504/.

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A community-based surveillance system was developed and implemented in rural areas in Cambodia. The system aimed to provide timely and representative information on major health problems and life events that would permit rapid and effective control of outbreaks and communicable diseases in general in rural communities. In the system, lay people were trained as Village Health Volunteers to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. An evaluation conducted one year after implementation of the community-based surveillance system began found that the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to continuously provide updated information on pregnancies, births and deaths in the rural areas. The sensitivity and specificity of case reporting by Village Health Volunteers were found to be quite high. In addition, the community-based surveillance system triggered effective responses from both health staff and Village Health Volunteers in outbreak and disease control and prevention. The results suggest that a community-based surveillance system can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Empowered local people and health staff can accurately report, analyse and act upon significant health problems in their community within a surveillance system they develop, own and operate. The community-based surveillance system could easily be integrated with the current disease surveillance system. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries would be likely feasible and beneficial, as well as cost-effective.

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Johnson, Deborah Susan, and Deborah Susan Johnson. "Exploring Barriers and Resources to Train and Retain PMHNPS in a Rural Community." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626692.

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The prevalence of mental health disorders in the United States is estimated at 1 in 5 persons in any given year, with a lifetime prevalence of approximately 50% (National Institute of Mental Health, 2016a, 2016b). Despite scientific progress towards effective behavioral and psychopharmacological treatment, nearly 50% of Americans with mental illness do not receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). This project will identify key geographical and logistical factors restricting recruitment and retention of psychiatric providers (MD or NP) for an underserved region in California. The results of the study will be used to develop a model for effective partnerships aimed at a “grow your own” approach to addressing the shortage of psychiatric providers. In California, the Mental Health Services Act (MHSA) was approved by the voters as Proposition 63 in 2004, funding expansion of mental health resources and specifically, workforce development (California Department of Health Care Services [DHCS], 2017). National funding also supports the expansion of PMHNP training and capacity through Health Resources and Service Administration (HRSA) and SAMHSA. Despite administrative and funding resources from MHSA and HRSA, the shortage of psychiatric providers continues in rural and remote areas. While few national studies have included nurse practitioners in the findings, a growing body of evidence suggests that nurse practitioners can serve similar if not the same function as physician colleagues (DiCicco-Bloom & Cunningham, 2014; National Governors Association, 2012; Newhouse et al, 2011). Barriers to mental health services in rural communities include challenges around a) availability, b) accessibility, c) affordability, and d) acceptability (Wilson, Bangs, & Hatting, 2015). Using a descriptive design, this project explores these factors necessary for patient access to psychiatric services in rural areas. A logic model is used to create a summary of the findings, which will be used to propose a clinical training partnership between an urban university-based PMHNP education and a rural clinic-based training to be completed upon conclusion of the project.

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Rahman, Syed Azizur. "Utilisation of primary health care services in rural Bangladesh : the population and provider perspectives." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682288/.

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This thesis is about the Utilisation of Maternal and Child Health Care Services (MCH) in Rural Bangladesh. Investigations have been made to identify the underlying causes of low use of the MCH services provided through the public sector health care facilities, which is a major concern for the government of Bangladesh. This thesis focuses on the factors that are affecting the use of MCH services both from population and provider perspectives. Socio-economic condition of people, their knowledge and attitudes towards the public sector health care services are considered as population factors, while different aspects of quality of public health services, access to the service facilities and provider's behaviour are explored as the providers' factors. Aims: The aim of this research was to provide policy recommendations for improving utilisation of the public health services at the primary health care level by redesigning more accessible, acceptable and quality health care services, especially for rural women and children. Scope: Maternal health services: antenatal care; tetanus vaccination; place of child delivery; and postnatal care are considered in this study. While two major killer diseases: diarrhoea and acute respiratory infections, and immunisation of children under five years of age are included as child health care services. Methods: A combination of qualitative and quantitative methods are used to collect data /information from 360 mothers, 28 formal and informal community leaders, 44 various types of health care providers and 22 public sector facilities in a rural area of Bangladesh. The World Health Organisation (WHO) recommended 30 cluster sampling method was used in sample design. Household survey, in-depth interview, informal and formal discussion, participant observation and document analysis have been carried out to obtain necessary information/data. Data analyses: The quantitative data have been analysed by using STATA and SPSS statistical computer programme, performing descriptive, bivariate and logistic regression analysis. The qualitative information has been analysed in a descriptive way. Results: The results show that the use of government health facilities: THC, FWC and VHCP is generally very low with an exception of the use of VHCP for TT vaccination to women and child immunisation. The use of VHCP is encouraging for the government policy makers and planners. THC is partially meeting the health care need of rural people and mainly serving the interest of people of relatively high socio-economic condition. FWC is the most unused health care facility at the rural areas of Bangladesh. The majority of people (86%) received health care from non - qualified health care providers. Among the socio-economic factors - family education and income were found to be significant both individually and jointly with the variations of use of MCH services. The majority of the sample population does not have knowledge about the MCH service availability and possessed negative attitudes towards the public sector MCH services. These are attributable to the under utilisation problem. Nine gaps have been identified between peoples' `reasonable expectation' and the `existing' MCH service delivery system. Peoples' involvement in the health service organisation at the thana and union level was found almost nil. However their involvement in the operation of VHCP was encouraging. Low (2-3 minutes) consultation time, lack of privacy in treatment, unregulated involvement of public sector provider in private practice, lack of accountability, supervision and improper behaviour of providers deteriorating the quality of services hence decreases the use of public sector facilities. Unavailability of drug was found to be the single most important reason that deters people from using public facilities. Difficulties in access to quality services were found to be a major problem than access to the service facilities. Conclusions: This thesis suggests that giving priority to improving the service qualities of the existing facilities rather than construction/development of additional facilities at PHC level. It also suggests the initiation of behaviour change programmes for public sector health care providers. Secondly an effective mechanism needs to be developed to ensure peoples' involvement in the management and operation of public health care facilities to enhance accountability of public sector provider to the population and reduce the gap between them. Initiatives could be taken to improve the quality of non-qualified health care providers, as they are the main source of health care for the majority of population. Finally, increasing the education level of rural population particularly for women could increase the use of health services.

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Hale, Nathan, Kate E. Beatty, and Michael Smith. "The Intersection of Residence, Community Vulnerability, and Premature Mortality." Digital Commons @ East Tennessee State University, 2019. https://doi.org/10.1111/jrh.12318.

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Purpose: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within comparable levels of deprivation. Methods: Rural‐urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural‐urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Findings: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. Conclusions: This study noted a differential effect in mortality‐related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.

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Hosegood, Victoria. "Anthropometry and mortality : a cohort study of rural Bangladeshi women." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1997. http://researchonline.lshtm.ac.uk/682248/.

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Many authors suggest that low anthropometric levels are associated with higher mortality risk in adults, In developing countries however there have been few opportunities to test this hypothesis. In addition, there is increasing interest in the role of women's nutritional status in their own health and survival as distinct from its impact on infant outcomes. This thesis describes the results obtained from a longitudinal historical follow-up of a cohort of 2,314 rural Bangladeshi women over a period of 19 years (1975-1993). The demographic, socio-economic, and anthropometric characteristics of the study cohort are described with reference to the methods of data extraction, preparation and validation. The risk of mortality associated with different levels of the anthropometric indicators (height, weight, arm circumference and body mass index) were analysed using Cox's proportional hazards models. In addition to the basic survival models, the effects of confounding, early mortality, missing data, and young subjects, on the estimates are discussed. A significant association between BMI and mortality (p=0.009) was found in adjusted analyses which used categories that distinguished the women in the highest and lowest 10% of the cohort BMI distribution. Women with BMI levels between 10% and 90% and >90% had hazard ratios of 0.45 (95% confidence intervals 0.27,0.73) and 0.55 (0.25,1.22) respectively, when compared to women with BMI <10%. The strength of the association between BMI and mortality risk was reduced after adjusting the models for early mortality (<4 years), (p=0.068). No significant associations were found between height, arm circumference and mortality risk. In conclusion, these data provide no evidence that these anthropometric indicators would be useful in population-based screening programmes in rural Bangladesh to identify women at higher mortality risk. The findings are considered with respect to the study's methodological constraints and comparisons with other studies in order to produce recommendations for those working in research and health programmes in women's nutrition.

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Lasher, Michael. "Interprofessional Relationships in Rural Offender Re-Entry and Management: Mental Health Treatment Providers and Community Supervision Professionals." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etd/3444.

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The current prevailing approach to managing offenders in the community involves community supervision professionals such as probation and parole officers partnering with other community professionals, such as psychologists, social workers, and other mental health providers to address offenders’ needs. Each type of professional draws from a unique field with goals, values, and theoretical orientations, which do not necessarily overlap. These relationships are rarely studied, and previous examinations are limited. The current study aims to address this deficit in the empirical literature. Drawing on data obtained from qualitative interviews, four aims were examined. First, using thematic analysis, interview data are analyzed open-endedly to identify major themes. Second, these partnerships are examined against the interprofessional competencies in the healthcare system. Third, the perceived impact of partnerships on offenders’ success in the community is discussed. Finally, differences in themes within community supervision professionals and mental health providers were quantitatively examined by comparing groups using a variety of demographic variables. Major themes identified by mental health providers include the appreciation for and challenges to collaboration, individual characteristics and roles, characteristics of collaboration, elements of interprofessional relationship, and the involvement of the courts. Community supervision professionals discussed issues pertaining to collaboration and services coordination, professional roles, when conflict occurs, and their lack of basic knowledge about other professionals. Themes identified in the initial thematic analysis resembled healthcare values and ethics competencies and roles and responsibilities competences; healthcare competencies regarding interprofessional communication and teamwork showed partial congruence with the current data’s themes. Perceived impact on offender outcomes was most evident in how collaboration helps each professional complement the others’ work. Few significant quantitative patterns within groups were evident. Overall, treatment providers and supervision professionals value interprofessional collaboration. Their priorities differ, which provides better opportunities to address clients’ needs but also creates the potential for conflict. Benefits to re-entry outcomes are the result of treatment providers addressing the needs of clients and supervision professionals addressing the motivation of clients. This research highlights the strengths of this type of interprofessional collaboration, and offers suggestions for improving the efficacy of collaborations.

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Dooley, Anthony Jason. "Redefining the Community Hospital: a Small Town Approach to Medical Planning and Design." Thesis, Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-04012007-181350/.

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Bogel, Marianne. "Closing the Gaps in Rural Healthcare in Texas: A Formative Bounded Case Study." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7601.

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Maldistribution of healthcare professionals persists in remote and rural communities throughout the world. Adoption of a Community Paramedic (CP) program could improve access to quality healthcare for rural communities. The conceptual framework defined rural communities by their distinct characteristics — community efficacy, weaknesses, attitudes, assets, deficits, local culture, and the driving and restraining forces — and not defined by their small populations or distances to cities. The theoretical foundation was a synthesis of theories of Bandura, Rogers, and Lewin. This study assessed community characteristics that may influence the likelihood of success, sustainability, or program failure of the Australian CP model in a single remote Texas border community. In this qualitative formative bounded case study, 3 bounded groups were examined; data collection was by in-person interviews. Group members were purposively selected: 5 residents and 3 EMS members. The 3rd group consisted of 4 randomly self-selected resident interviews, field observations, news articles, and local social media. Data transcripts were coded using theoretical coding based on the conceptual framework and theoretical foundation. Strong individual and group efficacy, efficacy resilience, adaptability, strong communications, overlapping groups, and a strong sense of community program ownership were evident in this study. The probability of establishing an effective CP program based on the Australian model is high based on study findings. Improved access to quality healthcare in remote and rural communities could result in improved health of community members and significant social change.

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Holland, Sherlina Daishernai. "Opioid Abuse in Rural Communities Among Adolescents With Bipolar Disorder." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7151.

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Abstract Low population density in rural areas makes it difficult to deliver services to people with mental health problems and nonmedical prescription opioid abuse remains a problem in the United States. The purpose of this cross-sectional study was to determine whether a parent's socioeconomic status affected care opportunities for children 12 to 17 years of age and whether bipolar disorder increased the likelihood of substance abuse in those children. The theory of reasoned action/planned behavior provided the framework for the study. Secondary data from the Interuniversity Consortium for Political and Social Research 36361 data system, specifically the National Survey on Drug Use and Health 2014, were collected that included information about the socioeconomic status of adolescents and their parents. Cross-sectional analysis was used to analyze data. The first research examined the extent to which bipolar disorder influenced opioid abuse in those between the ages of 12 and 17. There was a nonsignificant association between the variables: chi-square probability values (p > 0.05) for mental health difficulties and ever-used pain relievers non-medically. There was a significant association between mental health and emotional difficulties at p < 0.05. The second research question examined whether a parent's socioeconomic status impacted the level of care opportunities for those 12 to 17 years' old in relation to bipolar disorder in rural communities. Using multivariate logistic regression analysis, no significance was found between level-of-care opportunities and a parent's socioeconomic status. The findings of this study have potential to bring about social change by increasing clinician skills related to intervention planning related to opioid abuse in rural communities among adolescents with bipolar disorder.

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Dissertations / Theses on the topic 'Rural community health'

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