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1
Meyers, Emily Breanne. "Rural Health and Radiology: Health and Ethical Implications for Rural Citizens". NEOMED College of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ne2gs1619525106309102.
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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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Beatty, Kate, Michael Meit, Emily Phillips y 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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Mensch, Denise Lee. "Rural Montana: mobile health clinics". Thesis, Montana State University, 2011. http://etd.lib.montana.edu/etd/2011/mensch/MenschD0511.pdf.
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Residents of rural areas are faced with many barriers when accessing health care. Fewer health care providers, longer wait times for appointments, availability of employment providing health insurance, weather and road conditions, as well as personality traits including strong wills, independence, and self-sufficiency are some of the barriers rural residents face. This study's purpose was to explore the potential benefits of a mobile health clinic providing primary care to rural residents. The research questions were: (a) how do the people of this rural community meet their health care needs, (b) what health care services are lacking in this community, (c) if a mobile health clinic came to this community, would rural residents utilize the services it will provide, (d) are there any specific health care services rural residents feel should be available through the mobile health clinic, and (e) do rural residents feel a mobile health clinic would be beneficial for them. Penchansky and Thomas' (1981) framework on the five dimensions of access, availability, accessibility, accommodation, affordability, and acceptability, guided the study. Results revealed that, while the participants have access to health care, that access is approximately twenty miles away for basic health care services and approximately seventy miles away for tertiary care. Several participants states that due to the distance, they only sought health care in emergent situations and if they were sick. Eleven of the twelve participants believed that their community was lacking in access to health care. When asked if a mobile health clinic would be beneficial to their community, all twelve participants said yes. All but one participant stated that they would use the services a mobile health clinic would provide if it was available to them. Characteristics of a mobile health clinic that were reported as appealing included personality of the provider and staff, frequency of visits, and dependability. Unappealing or concerning characteristics included financing, inconsistency, and the health care provider's attitude toward patients. Implications and recommendations for practice include the need for further research on the use of mobile health clinics and how to maximize health care delivery in rural areas.
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Wallace, Rick L. "Rural Health Association of Tennessee". Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/8799.
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Solomon, Christine Lorraine. "Health and work in rural populations". Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430679.
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Wallace, Rick L. y Nakia J. Cook. "Connecting Rural Clinicians to Health Information". Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/8738.
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Objective: To determine if a personal digital assistant (PDA) with drug and evidence-based disease information software programs and with librarian training and follow-up can adequately meet at low cost the information needs of clinicians in rural areas with low information availability.
Methods: A randomized clinical trial methodology was used. Eight hospitals were selected in rural Appalachia based on accepted definitions of rurality. The hospitals were randomized into two groups of four hospitals with forty PDA users in each group. Both groups were treated equally, except the information needs of one group were measured using a validated instrument before the intervention and in the other group several months later. The survey instrument measured factors such as level of satisfaction with information retrieved in the clinic, required time to find an answer, and frequency of answers found for clinical questions.
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Weierbach, Florence M. "Determinants of Health for Rural Caregivers". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7374.
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Sandbulte, Natalie J. "Rural communities and mental health care". Theological Research Exchange Network (TREN), 2007. http://www.tren.com/search.cfm?p088-0180.
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Pavilonis, Brian Thomas. "Rural air quality and respiratory health". Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/2956.
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Chapter II describes results from 197 rural households that were sampled over five continuous days for indoor and outdoor PM10, PM2.5, and endotoxin. Geometric mean indoor concentrations of PM10 and PM2.5 (21.2 πg m-3, 12.2 πg m-3) were larger than outdoor concentrations (19.6 πg m-3, 8.2 πg m-3; p =0.072, p<0.001). While geometric mean endotoxin levels were almost six times larger in outdoor air compared to indoor (1.47 EU m-3, 0.23 EU m-3; p <0.001). Airborne PM10 and endotoxin concentrations in a rural county were elevated compared to those previously reported in certain urban areas. Furthermore, during the harvest season, concentrations of endotoxin in ambient air approached levels that have been shown to cause decreased respiratory function in occupational workers. Chapter III evaluated the effectiveness of using Radiello passive monitors to measure hydrogen sulfide (H2S) in close proximity (<40 m) to a medium sized CAFO. A total of eight passive H2S monitors were deployed 7-14 days around a swine confinement for seven months. Additionally, a separate laboratory study was carried out to determine the monitor's H2S uptake rate. Concentrations of H2S measured near the confinement were varied and ranged from 0.6 to 95 ppb depending on the sampling period and proximity to the lagoon .The uptake rate provided by the supplier (0.096 ng ppb-1 min-1) was significantly larger (p=0.002) than the rate determined experimentally (0.062 ng ppb-1 min-1). In Chapter IV we evaluated the association between residential proximity to swine operations and childhood asthma. A metric was created to determine children's relative environmental exposure to swine CAFOs which incorporated facility size and distance and direction of the CAFO to the home. When controlling for six significant asthma risk factors, children with a larger relative environmental exposure to CAFOs had a significantly increased risk of physician-diagnosed asthma (OR=1.20, p=0.009). In stratified analysis that adjusted for a respiratory infection before the age of two years, the association between relative exposure and childhood asthma was significantly increased in children with a respiratory infection (OR=1.45, p=0.001) but not in children free from respiratory infection (OR=1.12, p=0.355).
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Jiang, Yuansheng. "Health insurance demand and health risk management in rural China /". Frankfurt am Main [u.a.] : Lang, 2004. http://www.gbv.de/dms/zbw/387845968.pdf.
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Yan, Nicole y 甄錦樺. "Exploring health in China's rural villages: apublic health field exercise". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46943821.
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Weierbach, Florence M. "Relationships Between Rural Family Caregiver Health and Health Promotion Activities". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7400.
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Graham, Anna-Louise. "Psychological health of retirees in rural Scotland". Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/8005.
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Background: In order to aid effective assessment and detection of psychological health, a clear understanding of the risk factors for disturbance is required. This study was undertaken to test the hypothesis that demographic factors, health factors, social factors, attitudes to ageing, number of life events in the last year and relocation status would each significantly account for, and contribute to, the variance in psychological health. Method: The study employed a cross-sectional design in which 1,080 individuals over the age of 55 were randomly drawn from the community health index (CHI) of a rural health board in Scotland and invited to participate in the study. One hundred and ninety-six respondents completed questionnaires assessing psychological health and a range of potential predictors. Results: Overall, negative attitudes to ageing were the most prominent predictors of poor psychological health. Psychosocial loss was the only variable found to be a predictor of all seven outcome variables, including anxiety and depression, physical, psychological, social, and environmental quality of life, and general psychological and social functioning. Other predictors included a higher number of life events, poor social support from friends, poor self-rated health and not having a spouse/partner. Conclusions: Attitudes to ageing appear to play a significant role in the psychological health of older adults. Promoting positive perceptions of ageing in society may potentially pay dividends in the prevention of emotional distress in later life. Psychological interventions, such as cognitive behaviour therapy (CBT), may be key to addressing negative attitudes to ageing at an individual level.
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Edgeworth, Ross. "Self-care for health in rural Bangladesh". Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1006/.
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An interest in human coping applicable to endemic disease environments such as Bangladesh now includes disease mitigation and management through self-care. Although a frequently utilised treatment, research into the reasons behind self-care preference, types of self-care practised and the implications this has for individuals and communities in developing countries such as Bangladesh is lacking. This research therefore examines the adoption of self-care in Bangladesh and seeks to understand if it is an effective disease management strategy. A mixed methods approach was employed, targeting a representative sample of different gender, age and socioeconomic status across three locations. 630 questionnaires, 47 semi-structured interviews, 15 focus group discussions, 20 key informant interviews and a series of participatory research tools were applied to explore how and why people use self-care. Data were also used to identify behaviours indicative of appropriate and inappropriate self-care that are beneficial or detrimental to the individual. A detailed and complex picture of self-care emerged. It is widely used to prevent and respond to illness through traditional, herbal and modern pharmaceutical actions. Common illnesses and endemic diseases such as fever and diarrhoeal diseases were most frequently treated through self-care. A declining natural resource base, a hazardous flood environment and communication breakdown between doctors and patients can restrict self-care adoption. However, economic savings on healthcare expenditure, reduced opportunity costs and the means to preserve dignity represented positive aspects of self-care amongst participants. Examination of these factors demonstrated the failings of current health service provision as well as the potential for better self-care integration into existing healthcare approaches. Wider lessons for disease management were therefore derived from self-care including the importance of low cost manifold strategies and the value of local knowledge and ownership. It is concluded that although self-care is not a panacea for the burden of ill health there is evidence to suggest it can play a crucial role in coping with the insurmountable disease risks people face in Bangladesh. In doing so the research contributes to understanding self-care in developing countries as an integrated and integral component of the primary health care system and infectious disease risk reduction more widely.
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Flowers, Lena Butler. "Health education in the Black Rural Church". DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2005. http://digitalcommons.auctr.edu/dissertations/3277.
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The purpose of this project was to develop a Health Education program for the Black rural church that would serve to educate and inform the Black church on the health disparities facing a community and to provide programs that lead to healthier lifestyles. The project for this dissertation has three components:
1. Health Fair 2. Health Education Bible Study 3. Enrichment Challenge ( Personal Development of Holistic Healing)
Bellview African Methodist Episcopal Church (AME), located in Aragon, Georgia, was the site of the project. The participants were composed of members of varying denominations in Aragon and Rockmart, Georgia, These communities are know for having "good" church and for their ethnic fellowship meals consisting of fried chicken, seasoned collard greens with "fat back," macaroni and cheese, candied yams, potato salad, hot-buttered cornbread, chocolate and caramel cake, and sweet tea. These meals, typically served during the church fellowship, are high in fat, cholesterol, sugar, and salt. A steady diet like this can lead to hypertension and heart disease further resulting in strokes, heart attacks, and eventual death. It was the purpose of this project to provide meaningful health-related educational intervention that would result in healthier lifestyles. The program presented embraces the concept of holistic health. It provided six elements of health intervention: spiritual, intellectual, emotional, social environmental, and physical intervention strategies.
The Health Fair model gave the participants the opportunity to check for high blood pressure, diabetes, body fat, and disorders of the feet. This provided the individuals with and awareness of various ailments. Small and large group discussions were held throughout the day. The health fair was a first step focused on eliminating the racial disparities in health in the Black rural church.
Te Bible Study model gave the participants an opportunity to study health education with and emphasis on good nutrition. It was a blend of faith and health. Personal development is important to individual growth, therefore, a program of personal development with emphasis on holistic healing was used as a reinforcement activity to strengthen the participant in the area of social, environmental, physical, spiritual and intellectual health. This model of holistic healing with a biblical foundation helped the participant to understand that all six methods of intervention are essential for total healthy growth.
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Hartman, R. y Florence M. Weierbach. "Elder Health in Rural America, Policy Monograph". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/7369.
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Excerpt: The focus of this paper is 1)to provide an overview and brief analysis of the current status of rural communities, rural elder health, policy, and practice, and further 2)to suggest guidance/recommendations for future policy based on a systems approach which incorporates sustainability, best practice, quality, efficiency, effectiveness, with a conceptual basis for care within the context of people and place which constitutes rural America.
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Matsuda, Sandra J. "Information-seeking activity of rural health practitioners /". free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9946278.
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Vitale, Caitlin McManus. "TheRole of the Social Determinants of Health in Rural Health Equity:". Thesis, Boston College, 2020. http://hdl.handle.net/2345/bc-ir:109012.
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Thesis advisor: Karen S. LyonsBackground: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts
Thesis (PhD) — Boston College, 2020
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Burton, Salma. "Evaluation in health promotion : assessing effectiveness of Healthy City Project evaluations". Thesis, London South Bank University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326942.
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Eastman, Martha Anne. ""All for Health for All": The Local Dynamics of Rural Public Health in Maine, 1885-1950". Fogler Library, University of Maine, 2006. http://www.library.umaine.edu/theses/pdf/EastmanMA2006.pdf.
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Crespo, David. "Mobile phones and rural health workers in Peru : the potential of m-health in isolated rural areas of Peru". Thesis, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542419.
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Weierbach, Florence M. "Elder Friendly Rural Communities". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7389.
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Weber, Amy Judith, Olubunmi Kuku y Edward Leinaar. "Differences in Access to Contraceptive Services Between Rural and Non-Rural Clinics in South Carolina". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/125.
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Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.
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Ochoa, Diaz Lopez Hector. "The epidemiology of inequalities in health and health care in rural Mexico". Thesis, London School of Hygiene and Tropical Medicine (University of London), 1992. http://researchonline.lshtm.ac.uk/682334/.
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The objective of this study was to document the social inequalities existing in both health status and health care utilization in rural areas of the Mexican state of Tlaxcala. Whilst previous studies on the subject undertaken in Mexico and elsewhere have focused on examining differences between heterogeneous socio-economic groups within urban areas and between urban and rural areas, this investigation concentrated on analysing differences between groups and communities within rural areas which are considered to be more homogeneous. Particular attention was paid to examining differences between agricultural and non-agricultural occupations and between agricultural groups. To compare the overall health of groups and areas, three different kinds of health measures were used: self-reported morbidity, childhood mortality, and positive health (based on self-appraisal of health state). Four types of morbidity measures were used: overall morbidity, number of symptoms reported, morbidity of high severity, and type of illness reported. Health care utilization was analysed in relation to perceived need. Social markers included both individual and area-based measures of socio-economic status. The. former included measures such as educational level, occupation, land tenure and type, social class, source of medical care, entitlement to social security, frequency of meat consumption and housing conditions. The area-based measures included a composite index of living conditions and size of. the locality. The data were collected during a health interview survey of 1238 households (6622 individuals), sampled from households in localities with less than 15,000 inhabitants in the state of Tlaxcala. The sample was drawn by a multistage stratified cluster sampling scheme. The general trend found was a significant rise in morbidity with decreasing socio-economic position, living standards and size of the locality. Agricultural occupations showed worse perceived health conditions than non-agricultural occupations, and among the former, waged labourers and peasants with access to poor-quality-land tended to have higher morbidity rates and appraised more unfavourably their health. Among females, those working at their homes had worse health conditions. Amongst the morbidity measures, the one based on severity of illness displayed the largest differentials and showed an inverse association between socio-economic status and prevalence of gastrointestinal diseases and musculoskeletal problems. Nervous and mild psychiatric problems were more prevalent in deprived small villages. Childhood mortality was higher among children in families whose head had less schooling, a lower agricultural occupation, no social security, poor housing conditions, and among those living in the most deprived villages. Findings on unfavourable ratings of health paralleled those on perceived morbidity and showed the largest differentials between, social groups. Among the social measures, education allowed the construction of groups that displayed the widest differentials. The results showed a decreasing trend in health care utilization (illness-related and preventive contacts) with decreasing socio-economic position and living standards. The pattern of utilization suggests that the access to the health services is highly stratified and does not reflect the level of real need. The relatively high use of private services suggests a poor quality of the public services. The advantages and limitations of the different health indicators and social measures used is discussed. The results have implications for health policy and planning at both central and local levels. The recommendations suggested have implications which are far wider than the health sector alone.
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Beatty, Kate, Paul Campbell Erwin, Ross C. Brownson, Michael Meit y James Fey. "Public Health Agency Accreditation among Rural Local Health Departments: Influencers and Barriers". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6822.
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Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB).
Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study).
Setting: United States.
Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey.
Main Outcome Measures: LHDs decision to seek PHAB accreditation.
Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). 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 (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%).
Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.
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Harris, Jenine K., Kate E. Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson y Michael Meit. "The Double Disparity Facing Rural Local Health Departments". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6825.
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Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Morrisey, Karyn Marie. "Access to health care services in rural ireland". Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.502767.
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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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Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click y Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.
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Beatty, Kate, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva y Kathleen Wojciehowski. "Barriers and Incentives to Rural Health Department Accreditation". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6826.
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Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities.
Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective.
Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities.
Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs.
Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation.
Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.
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Beatty, Kate y Michael Meit. "Opportunities and Challenges Facing Rural Public Health Agencies". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6835.
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Iversen, Lisa. "Exploring respiratory health in rural and urban Scotland". Thesis, University of Aberdeen, 2006. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU214168.
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The study aimed to describe: the epidemiology of self-reported chronic respiratory disease, patterns of respiratory-related health service utilisation and quality of life in the community in Scotland, in relation to rural and urban locations, and to investigate change over time. At baseline compared with urban respondents, rural respondents reported a significantly lower prevalence of any chest illness, asthma, more than two other chronic conditions and eczema/dermatitis. Rural respondents were less likely to report a number of respiratory symptoms. Respiratory-related health service utilisation was significantly lower among respondents from rural rather than urban practices. Rural residency appeared to be associated with better health status among those with COPD and/or emphysema but the results were not adjusted for potential confounding. At follow-up, the cumulative incidence of self-reported chronic respiratory disease and respiratory symptoms was similar among respondents from rural and urban practices. Patterns of respiratory-related health service use were similar to baseline. There was no evidence of significant rural-urban differences in changes in quality of life scores. The Scottish Executive Urban Rural Classification produced similar results to the general practice-based rural-urban definition. The intermethod reliability study found that some conditions tended to be over-reported, especially those likely to be self-diagnosed. Importantly, there did not appear to be any systematic rural-urban difference in the strength of agreement between self-reported information and the medical records. Where there were rural-urban differences in mean FEV1, FVC or PEF values, rural residents had higher (better) values than urban dwellers.
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Morrissey, Joanna Lynn. "Understanding health through the eyes of rural adolescents". Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/2950.
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The purpose of this study was to develop a theory grounded in the health experiences of rural adolescents. By exploring the embodied experiences within a unique population of rural Iowan adolescents, many who are overweight/obese and/or of Hispanic descent, the developed theory was also used to inform a tailored health intervention for middle school students. The review of the literature revealed that the study of adolescent physical activity and body image concerns is largely measurement driven, and often explored from a deficit perspective. Thus, there remains a gap in the literature regarding the contextualized experience of health. This project used a qualitative approach to generate a theory grounded in stories adolescents shared regarding their health.
Eighteen adolescents (13-15 years old) participated in one-on-one interviews. Grounded theory principles were used to understand how personal health experiences were socially constructed and explored the meanings participants derived from such experiences. An unstructured interview guide was used to gather information on health, physical activity, nutrition, and body image. The interviews were transcribed verbatim and analyzed using Charmaz's (2006) version of grounded theory. A total of 28 codes emerged from the data to construct the Theory of Embodied Health and Wellness. The complex interplay of personal health behaviors, eco-sociocultural influence, and everyday experience mold adolescents' embodied health and wellness experiences. Participants reported a wide range of personal, social, cultural and environmental influences on their health experiences. Feeling in control, connected, and competent were major themes in how participants experienced, maintained, or challenged their health experiences within their sociocultural environment. In addition to constructing the Theory of Embodied Health and Wellness, this project engaged adolescents in conversations related to their own health experiences to develop a sociocultural tailored health intervention. This project provides a practical example of how the target population of an intervention can be included during the formative research phase to ensure the intervention is tailored to meet their needs and interests.
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Khe, Nguyen Duy. "Socioeconomic differences in a rural district in Vietnam : effects on health and use of health services /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-984-6/.
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Billmeyer, Tina W. "Evaluation of a behavioral health integration program in a rural primary care facility". Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=755.
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Cremer, Mary Ellen. "Voluntary giving for rural health care: the Sweet Grass County Health Care Foundation". Thesis, Montana State University, 1991. http://etd.lib.montana.edu/etd/1991/cremer/CremerM1991.pdf.
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The purpose of this thesis is to identify factors influencing community support for rural hospitals. Hospitals in rural areas are liable to experience unfavorable financial situations in the near future. Data from a specific fund drive were utilized to develop a model of voluntary giving that may be helpful in predicting the success or failure of other similar drives for the purpose of providing support to these hospitals. Results indicate that voluntary giving is consistent with economic utility maximization theory.
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Wen, Siying y 溫思穎. "Health insurance effects on health care access for rural residents in Guangzhou city". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942749.
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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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Lackey, Jennifer Hayman. "A Model of Rural Delinquency: Collective Efficacy in Rural Schools". Bowling Green State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1479137758630378.
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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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Lamb, Maxwell, Sean Vinh, Chandler Parris, Emily K. Flores y KariLynn Dowling-McClay. "Impact on Student Attitudes through Participation in Interprofessional Student Teams at a Remote Area Medical Event in Rural Appalachia". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/18.
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Interprofessional teamwork is being adopted as the best way to care for patients, but it is also important to determine how future healthcare providers view this model of patient care. What are their attitudes and beliefs after having the opportunity to work in an interprofessional team? The primary objective of this study was to determine changes in health profession students’ attitudes toward interprofessional collaboration through participation in a Remote Area Medical (RAM) event in rural Appalachia. Researchers hypothesized that working in interprofessional teams positively impacts students’ attitudes toward interprofessional practice. To explore these variables, RedCap was utilized to collect demographic information, generate a pre/post survey matching code, and administer previously validated interprofessional education (IPE) questionnaires to RAM clinic student volunteers (representing five ETSU health sciences colleges and various undergraduate programs) before and after the event. Students were allowed to voluntarily complete the pre-survey online prior to participating in the event or at sign-in and the post-survey at sign-out or online after the event. The Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2), which is validated for use in pre- and post-surveys, utilized 5-point Likert-type questions (strongly disagree to strongly agree) to evaluate students’ perceptions of their role on the team and the team’s impact on healthcare and patient outcomes. The Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R), which is only validated for use in post-surveys, required students to simultaneously evaluate their ability to perform tangible interprofessional team skills before and after the event using 5-point Likert-type questions (poor to excellent). At the event, students were placed into interprofessional teams to provide care to patients. Faculty members from a variety of professions provided leadership to the teams and guidance as needed. The pre-survey had 107 responses and the post-survey had 108 responses. However, after matching the pre- and post-surveys with student-generated codes, there were 70 valid matched responses. Data analysis was conducted using SPSS version 25. There were no statistically significant changes in SPICE-R2 IPE constructs from the pre-survey to post-survey. However, high pre-survey scores indicated that this student cohort already had a high level of appreciation for interprofessional teams, with mean scores of 4.5 out of 5 for teamwork, 4 out of 5 for roles and responsibilities, and 4.36 out of 5 for healthcare outcomes. The mean overall composite score on the ICCAS-R increased from 3.65 out of 5 on the pre-event portion to 4.03 out of 5 on the post-event portion (p < 0.001) , indicating that students increased their self-evaluated ability to perform tangible skills used in the interprofessional team through participation in the RAM clinic. Findings of this research may allow educators in both classroom and healthcare settings to better understand how hands-on IPE experiences influence students’ interprofessional attitudes and beliefs.
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Hale, Nathan, Tamar Klaiman, Kate E. Beatty y Michael Meit. "Rural Health Departments and Clinical Services: Transition to Whom?" Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6845.
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Thomas, Elizabeth Ann. "Rural Place Experience and Women's Health in Grandmother-Mothering". Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/194952.
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The conceptual orientation of this study was informed by social ecology theory coupled with the concept of rural place, to investigate social processes embedded within the physical, social and symbolic environment affecting the health of rural grandmothers raising grandchildren. A modified grounded theory methodology was used to generate a middle range theory explicating the basic social process of rural grandmother-mothering. The Rural Grandmother-Mothering as Cushioning model explains how the rural place experience of the physical, social and perceptual environmental context influences the health of rural grandmothers raising grandchildren.This research has significance for the scientific community by demonstrating how place is fused with human experiences. Results can inform nursing interventions tailored to the unique social processes in rural settings and designed to promote the health of the increasing numbers of women engaged in grandmother-mothering.
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Baron, Karen. "Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients". NSUWorks, 2012. http://nsuworks.nova.edu/gscis_etd/85.
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Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use include lack of computer and internet access, poor computer or health literacy, security concerns, and provider disengagement. PHRs may help those living in rural areas and those with chronic conditions such as heart failure, monitor and manage their disease, communicate with their health care team and adhere to clinical recommendations. To provide some much needed actual research, a descriptive mixed methods study of the usability, usefulness, and disease management potential of PHRs for rural heart failure patients was conducted. Fifteen participants were enrolled.
Usability issues fell into three categories: screen layout; applying consistent, standard formatting; and providing concise, clear instructions. Participants used PHR features that were more convenient than other methods or that had some additional benefit to them. There was no difference between rural and urban participants. A heart failure nurse promoted recording daily heart failure symptoms in the PHR. Most participants did so at least once, but many found it cumbersome. Reasons for recording included the comfort of having clinical staff monitor the data. Participants who were stable did not find recording as useful as did those who were newly diagnosed or unstable. Participants used asynchronous communication to send messages to the heart failure nurse that they would not otherwise have communicated.
The study expands the knowledge of PHR use by addressing useful functionality and disease management tools among rural patients with heart failure. The patients were able to complete tasks they found useful. The increased communication and disease management tools were useful to some.
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McGrath, Alicia University of Ballarat. "Changing rural general practitioner practice : evaluating health assessment uptake". University of Ballarat, 2003. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12770.
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The Enhanced Primary Care Package aimed to improve health and quality of life through enhancing primary health care for those over 75 years, Aboriginal and Torres Strait Islanders over 55 years and those with chronic conditions and multidisciplinary needs. A multi-level approach was implemented to promote the package. West Vic Division of General Practice conducted the General Practice Education Support and Community Linkages implementation program for the package in Western Victoria and focused on health assessments for those over 75 years. This research investigated what factors affected change in rural general practitioner practice through surveying general practitioners and collecting Health Insurance Commission data prior to and following the program. Patients were also interviewed to determine acceptance of health assessments and nurse involvement. The program increased awareness, but had little effect on increasing uptake, as only 53% of general practitioners began undertaking health assessments. However the general practitioners indicated an increased frequency of health assessment prescription. Health Insurance Commission data suggested an immediate increase in the use of the assessments, however the rate fluctuated and then declined. Lack of sustained uptake of the program was not associated with remuneration, as 77% of general practitioners did not regard finance as a barrier. Respondents’ major barrier was time (40% pre-education, 73% post-education). This data reflected a rural environment where general practitioners face competing priorities, time constraints, workforce shortage and long consultation lists. A notable change did however occur from practice nurse employment as the involvement of a practice nurse generally resulted in patient satisfaction with the assessment. It was apparent that a complex multifaceted and longer-term view is needed to address factors which limit rural general practitioners’ ability to change. This needs to be addressed at the Commonwealth level and not in isolation in order to produce an integrated framework to enhance and promote, rather than demand change.Master of Applied Science
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Dong, Hengjin. "Health financing systems & drug use in rural China /". Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-3982-9/.
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Wanless, Deanna. "Health differentials among elderly women : a rural-urban analysis /". Burnaby B.C. : Simon Fraser University, 2005. http://ir.lib.sfu.ca/handle/1892/2041.
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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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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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