We performed a systematic review of prior reviews, a method also known as umbrella review [20-22], to synthesize the scientific evidence regarding interventions that support nurse retention in rural, peripheral or remoteareas. We used the following keywords, and their varia- tions, in combination with each other: nurse shortage, nurse retention, rural retention, systematic review or litera- ture review. We consulted the following databases: MEDLINE (PubMed interface), CINAHL, EMBASE and the search engine Google Scholar. While the search was international, we limited inclusion of publications from a 22-year period (January 1 1990 to July 31 2012). The in- cluded studies met the following inclusion criteria: (i) de- rived from a systematic review; (ii) involved nursing professionals; (iii) assessed factors that influenced retention in rural or remoteareas; and (iv) were published in English, French, or Spanish. We excluded studies that were not reviews, did not involve nurses, did not specifically con- cern rural and remoteareas, and were published in other languages.
Conclusion: This study found weak systems with low referral rates and poor access to CR in rural and remoteareas. Underlying factors include lack of health professional and public support, often based on poor perception of benefits of CR, compounded by scarce and inflexible services. Low levels of involvement of Australian First Peoples, as well as a lack of cultural understanding by non-Australian First Peoples staff, is evident. Overall, the findings demonstrate the need for improved models of referral and access, greater flexibility of programs and professional roles, with management support. Further, increased education and involvement of Australian First Peoples, including Indigenous health workers taking a lead in their own people’s care, supported by improved education and greater cultural awareness of non- Australian First Peoples staff, is required.
To help make research more relevant to the public, it is important that researchers partner with community members. People living in rural and remote communi- ties tend to be further away from where research typic- ally takes place and may be excluded from participation as team members. The goal of this project was to under- stand how researchers can better work with or engage community members from rural and remoteareas as partners on research projects. We talked to 12 commu- nity members with an interest in physical activity who live in northern British Columbia, Canada. Transcripts were analysed by researchers and knowledge users work- ing in population health at the local health authority and a regional non-profit organization. We identified three factors that were important for research partnerships: relevance, communication, and empowering participa- tion. Community members stated that they would not be interested in joining a research project that did not benefit their community. Participants also identified that they wanted to receive regular feedback about the re- search project, such as the findings, and to know that the results were used to create change. Community members should be recognized as the experts on the ap- proach that would work best in their community, be of- fered training on the research process, and compensated appropriately. In rural and remote communities, it is es- pecially important to focus on building trust and rela- tionships in-person before beginning research partnerships as there is a history of researchers coming in from other areas (often urban centres), collecting data, and leaving.
conceptualised is in terms of urban and rural. The attractive economics of higher population densities of urban areas encourage investment, whilst conversely the lower population densities associated with rural and remoteareas discourage investment. Quite simply, if a company was to invest a given amount of capital in its network in a urban market it would cover more potential subscribers than if the same investment was made in a rural and remote market. A key question, therefore, is how can the digital divide that results be overcome so that parts of society are not disadvantaged? The remainder of this paper explores this question with reference to rural and remote Scotland.
Background: Patient and public involvement (PPI) in health education is a practice whereby research and education are carried in collaboration ‘ with ’ patients and/or citizens, maintaining their role as a team member or expert. PPI in health education is of great interest for all stakeholders in the field, as it can make program development more relevant to the public and increase its utilization by the target population. However, little is known about how PPI should be implemented in different settings particularly in rural and remoteareas. Therefore, a deeper understanding of how PPI works in different environments is needed. We aim to explore how information and communication technologies (ICT) are used for PPI in health education programs in rural and remoteareas. Methods: We performed a scoping review. Two reviewers independently selected 641 studies from five electronic databases. Data were extracted, charted and validated by the senior researcher and study lead. We performed a narrative synthesis to map the literature.
I think [training is] definitely helpful if it’s presented in a way that’s appropriate to the context that we work in. Because it’s no good us going to something if it’s targeted at city folk and we don’t use that. So it’s always really useful to have someone who knows how unique our work is. Because I think our work is not always well understood. And remote work isn’t easily understood at all. [P3]
droughts and the loss of local industry 7 . Populations in ruralareas are decreasing and are also ageing, due to the drift of younger people to metropolitan areas in search of work 8,9 . Those who stay behind are more likely to have received a lower level of education, have poorer communication skills than their urban counterparts and
For public funding, general tax revenue is a common approach and is used in almost every country to finance certain components of health care . Some taxes can be earmarked for a particular purpose. Interventions can also be financed through a deficit that is itself funded through mechanisms such as the issuing of bonds, certi- ficates or long-term low-interest loans. Additionally, social health insurance can be a partial means to redis- tribute resources to improve health workforce retention in rural and remoteareas. For instance, this would be possible with a reimbursement policy favouring rural health practice or with special funds dedicated for spe- cial support to rural practice. Within the private sector, either for-profit or not-for-profit funding can be accrued through private health insurance, charitable or voluntary contributions, community participation, and NGOs. More generally, out-of-pocket expenditures – the main
Children in rural and remoteareas within developed and developing countries have poor vaccination and nutritional status [4, 5]. Thus, they suffer from growth and developmental issues and are more at risk of dying in the first five years of life [5–8]. Vaccination is the most effective public health intervention against vaccine preventable disease and has saved millions of children’s lives . Many parents however, have failed to realise the advantages of vaccina- tion, and thus have not benefitted fully from health care services . In Papua New Guinea (PNG), the majority of people live in ruralareas [3, 10–12]. Health facilities are located in diffi- cult to reach areas, with little support from government entities . Wide disparities and regional differences are common, and most of the resources are concentrated in urban areas [12, 13]. The poor socioeconomic conditions and geographical terrain linked to health facili- ties are some contributing factors to low vaccination coverage . Partially vaccinated children are at risk of resurgence of epidemics of vaccine preventable diseases from communities . It is also common to have low vaccination coverage in areas where outreach patrols are either non-existent or inconsistent . Consequently, children miss essential vaccinations that pro- vide protection.
Modelling was the most common response for Question Four. The next three frequent responses, practice, scenarios and resources provide some indication of what might best be modelled by lecturers. The importance of modelling good practice cannot be over-emphasised; particularly in online learning environments. It is the nature of online learning that lecturers’ actions are overt and often students are quick to judge (and point out) what is ‘good’ or ‘bad’ practice. Students also need to be presented with a wide range of teaching scenarios. This is particularly the case for students who may find themselves in rural and remoteareas teaching in multi-stage/multi-age classrooms. There may also be the expectation for teaching across a range of disciplines. Finally, students need to be shown how they might make best use of limited resources. Here, resources such as the Internet can help reduce the access gap allowing students in rural and remoteareas access to the same web-based resources as their counterparts in the larger population centres. Specific practices identified requiring modelling included:
(0.59), AUC (0.91), and percentage agreement (79.6%) and minimised discordant sites (n = 22) is presented in Table 4. Various categorisation of the covariates were assessed and those shown in Table 4 provided a balance between the best model fit and interpretability of the covariates. All categories of birth numbers were 18 to 90 times more likely to have a C-section facility compared to a catchment of less than 50 births. Time to nearest C-section facility also retained significance. Where facilities with C-section were more than one to 1.5 h away from an alternative C- section, they were 4-5 times more likely to offer C-section compared to closer facilities. This increased to 15 to 80 times more likely to be C-section facilities for longer travel time. Jurisdictions in ‘NSW, QLD, SA’ were 11 times more likely to have a C-section facility in rural and remoteareas compared to ‘VIC, WAplus‘. Although not significant in the final model, SES was retained based on an a priori de- cision to include this influential proxy measure for vulner- ability, and did marginally improve the R Neg 2 , AUC and the
Including rural health subjects in undergraduate health education is seen in some quarters as a panacea for addressing the shortage of health professionals in rural and remoteareas. Education is a process through which students construct foundations of thought and behaviour on the basis of acquiring knowledge and this is theoretically known as socialisation. A known outcome of educational socialisation is identity formation and this is an important driving factor in students’ decisions about career choice. Rural health education research has ignored this opportunity in favour of measuring students’ knowledge of key rural facts. Furthermore, measuring long term outcomes such as rural career uptake has been hampered by temporal constraints therefore researchers often rely on superficial indications of students’ intention to practise in ruralareas. In this paper the authors draw on the findings of doctoral work that is nearing completion about the socialising practices of rural health education regarding students’ identity formation.
Several studies have examined the experiences of Aboriginal and minority nurses in Canada, Britain, and the United States (Calliste, 1996; Calliste, 1993; Das Gupta, 1996; Gregory, 2007; Health Canada, 2006; Hezekiah, 2001; Hine, 1989; Martin & Kipling, 2006; Wasekeesikaw, 2003). Kulig and Grypma (2006) note very little is written about the history of Aboriginal nursing and despite Aboriginal nurses’ role in improving the health status of First Nations, Inuit, and Metis, very little research exists that explores the perspectives of Aboriginal nurses themselves. Kulig, Stewart, Morgan, Andrews, MacLeod, and Pitblado (2006) analyzed the results of a national survey of RNs working in rural and remoteareas of Canada, in which 210 of the 3933 respondents self-identified as having Aboriginal or Metis ancestry. They found that 69.6% of Aboriginal nurses were originally from rural/remote communities, and that 66.7% chose to return to such areas because they wanted to work with their own people and raise families in smaller communities. Although these studies help provide a broad overview of Aboriginal nurses, further research is required to understand the day-to-day realities of Aboriginal nurses, and the tensions and contradictions shaping their practice. Finding out the current realities of being an Aboriginal nurse in Atlantic Canada including how their Aboriginal identity influences the quality and nature of their professional lives, will inform policy that may facilitate evidence-based change within health care so that Aboriginal nurses are empowered and enabled to draw upon their unique lived experiences to improve the quality of their work life and ultimately influence the health outcomes of Aboriginal Peoples.
The existing literature has also demonstrated low rates of palliative care (PC) utilisation by Aboriginal Australians . The proportion of Aboriginal popula- tion living in rural and remoteareas in WA and the associated unavailability and inadequate access to spe- cialist PC services in rural/remote WA partially explain this low utilisation . Low utilisation can be the result of past experiences of Aboriginal people within main- stream health services and their vivid memories of pre- vious policies and oppressive treatments from past Australian governments that have created suspicion and mistrust among Aboriginal Australians [8,14]. The im- portance of trust-building processes has been identified as a core principle for Indigenous Palliative Care Service Delivery Model . Moreover, low PC service utilisation may also be indicative of the need for special cultural needs of Aboriginal Australians which differ significantly from non-Aboriginal cultures and that may not be ad- equately addressed in mainstream service provision. The establishment of culturally appropriate services may encourage participation and increase accessibility of ser- vices that otherwise would not have been utilised by the Aboriginal population .
Results: Majority, (70.1%) of the medical students wanted to practice in clinical care settings. However, only a small proportion of them showed interest to work in rural and remoteareas (21% in zonal and 8.7% in district/small towns). For most, internal medicine was the first specialty of choice followed by surgery. However, students showed little interest in obstetrics and gynecology, as well as in pediatrics and child health as their first specialty of choice. Medical students ’ attitudes towards their school in preparing them to work in rural and remoteareas, to pursue their career within the country and to specialize in medical disciplines in which there are shortages in the country were low. The binary logistic regression model revealed that a significantly increased odds of preference to work in rural and remoteareas was observed among males, those who were born in ruralareas, the medical students of Addis Ababa University and those who had the desire to serve within the country.
The quality of healthcare varies greatly throughout Ghana. Urban centers are well served, with hospitals, clinics, and pharmacies. In comparison, ruralareas often lack modern healthcare. Patients in these areas either rely on traditional African medicine or travel great distances for western healthcare.
In remote and ruralareas, there always a crisis for electricity to fulfil the load demands. So renewable energy sources based power generating system is a good option for that areas. Since all the inexhaustible sources are not accessible in the meantime, a blend of different power sources ought to be sent to fulfil the load on the basis of load demand during any particular period. The blend of sustainable power source with energy storing innovation is a proper answer for irregular yield intensity of sustainable power source based power producing framework .In this paper, a hybrid system based on Solar, biomass and battery storage is proposed to supply electrical power in rural and remoteareas. MPPT controller has been used in this proposed system to provide maximum output power at different operating and load conditions. The battery has been used to store excess power available from these two generating systems and also to support the nonstop supply in load power if one of these two generating systems fails.
Barriers to research in rural and remoteareas. Figure 5 illustrates the frequency with which barriers to research were identified by RRFPs participating in the focus group (n = 15) and key informant interviews (n = 10). Limited time to dedicate to research or busy schedules was the most commonly cited barrier for RRFPs, followed by feelings of intimidation, limited research skills, and limited access to research support and resources and financial support.