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Article
Publication date: 21 June 2019

Manas Ranjan Behera, Chardsumon Prutipinyo, Nithat Sirichotiratana and Chukiat Viwatwongkasem

Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The purpose of this paper is to assess the relevant policies and provisions with…

Abstract

Purpose

Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The purpose of this paper is to assess the relevant policies and provisions with respect to health care professionals, aiming to develop feasible retention strategies in rural areas of Odisha state of India.

Design/methodology/approach

The study employed documentary review and key informant interviews with policy elites (health planners, policy maker, researchers, etc.). The document review included published and unpublished reports, policy notifications and articles on human resources for health (HRH) in Odisha and similar settings. Throughout the study, the authors adapted World Health Organization’s framework to study policies relevant to HRH retention in rural areas. The adapted framework comprised of the four policy domains, education, regulation, financial incentives, professional and personal support, and 16 recommendations.

Findings

In Odisha, the district quota system for admission is not practiced; however, students from special tribal and caste (Scheduled Tribe and Scheduled Caste) communities, Socially and Educationally Backward Classes of citizens, and Persons with Disabilities have some allocated quota to study medicine and nursing. Medical education has a provision of community placement in rural hospitals. In government jobs, the newly recruited medical doctors serve a minimum of three years in rural areas. Doctors are given with location-based incentives to work in remote and difficult areas. The government has career development, deployment, and promotion avenues for doctors and nurses; however, these provisions are not implemented effectively.

Originality/value

The government could address the rural retention problems, as illustrated in the study and put in place the most effective policies and provisions toward recruitment, deployment and attraction of HRH in remote and rural areas. At the same time, implementation HRH strategies and activities must be rigorously monitored and evaluated effectively.

Details

International Journal of Workplace Health Management, vol. 12 no. 4
Type: Research Article
ISSN: 1753-8351

Keywords

Article
Publication date: 11 May 2015

Julie Willems, Keith Sutton and Darryl Maybery

The Gippsland Mental Health Vacation School program has been shown to positively change student participants’ interest and attitudes to living and working in a rural area…

Abstract

Purpose

The Gippsland Mental Health Vacation School program has been shown to positively change student participants’ interest and attitudes to living and working in a rural area. A range of factors are impacting on the future viability of the initiative including: limitations on the number of student participants, the reusability of content, staffing, time pressures, a dwindling funding base, and a drop-off in interest in living and working in a rural setting. The paper aims to discuss these issues.

Design/methodology/approach

A three-phase Delphi Study was employed to engage with expert knowledge of the program’s key stakeholder groups (student participants and service provider staff) in order to inform the initial steps of shifting the program toward a blended model, distributed across space and time.

Findings

The results suggest that: first, the current mode of delivery, a week-long intensive face-to-face format, should be transitioned to a more sustainable blended learning approach that includes both on-line content and an in situ component; and second, trailing the use of social media as a mechanism to maintain student interest in rural mental health work following the vacation school.

Originality/value

This study highlights how the transition to a sustainable approach to the delivery of a novel rural mental health workforce recruitment strategy was informed through a three-phase Delphi Study that involved the key stakeholders (groups of student participants and service provider staff). The study has important implications for addressing the shortage of mental health practitioners in rural areas. It will and be of interest to educators, administrators, researchers and bureaucrats.

Details

the Journal of Mental Health Training, Education and Practice, vol. 10 no. 2
Type: Research Article
ISSN: 1755-6228

Keywords

Open Access
Article
Publication date: 1 December 2020

Richard Colbran, Robyn Ramsden, Michael Edwards, Emer O'Callaghan and Dave Karlson

While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate…

Abstract

Purpose

While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of the rural workforce shortage. The NSW Rural Doctors Network (RDN) contributes its perspectives about the importance of a whole of life career and the meandering stream concept to support the retention of health professionals rurally. We unpack these concepts and examine how they bring to light a new and useful approach to addressing rural workforce challenges and potentially contribute to building a stronger integrated care approach.

Design/methodology/approach

The approach used involved tapping into RDN's 30-years of experience in recruitment and retention of remote and rural health professionals, combined with insights from relevant existing and emerging evidence.

Findings

We suggest that reframing retention to consider a life stage approach to career will guide more effective targeting of rural health policies, workforce planning, collaborative approaches and allocation of incentives. We posit that an understanding and acceptance of modern lifestyles and career pathways, and a celebration of career commitment to serving rural communities, is necessary for successful recruitment and retention of Australia's future rural health workforce beyond the training pipeline.

Originality/value

We outline and visually represent RDN's meandering stream approach to building and retaining a capable rural health workforce through addressing life cycle and workforce level needs. This perspective paper draws on RDN's direct experience in the field.

Details

Journal of Integrated Care, vol. 30 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 18 April 2018

Catherine Cosgrave, Myfanwy Maple and Rafat Hussain

Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting…

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Abstract

Purpose

Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff turnover of this workforce has been limited. The purpose of this paper is to identify work factors negatively affecting the job satisfaction of early career health professionals working in rural Australia’s public sector CMH services.

Design/methodology/approach

In total, 25 health professionals working in rural and remote CMH services in New South Wales (NSW), Australia, for NSW Health participated in in-depth, semi-structured interviews.

Findings

The study identified five work-related challenges negatively affecting job satisfaction: developing a profession-specific identity; providing quality multidisciplinary care; working in a resource-constrained service environment; working with a demanding client group; and managing personal and professional boundaries.

Practical implications

These findings highlight the need to provide time-critical supports to address the challenges facing rural-based CMH professionals in their early career years in order to maximise job satisfaction and reduce avoidable turnover.

Originality/value

Overall, the study found that the factors negatively affecting the job satisfaction of early career rural-based CMH professionals affects all professionals working in rural CMH, and these negative effects increase with service remoteness. For those in early career, having to simultaneously deal with significant rural health and sector-specific constraints and professional challenges has a negative multiplier effect on their job satisfaction. It is this phenomenon that likely explains the high levels of job dissatisfaction and turnover found among Australia’s rural-based early career CMH professionals. By understanding these multiple and simultaneous pressures on rural-based early career CMH professionals, public health services and governments involved in addressing rural mental health workforce issues will be better able to identify and implement time-critical supports for this cohort of workers. These findings and proposed strategies potentially have relevance beyond Australia’s rural CMH workforce to Australia’s broader early career nursing and allied health rural workforce as well as internationally for other countries that have a similar physical geography and health system.

Details

The Journal of Mental Health Training, Education and Practice, vol. 13 no. 3
Type: Research Article
ISSN: 1755-6228

Keywords

Book part
Publication date: 24 September 2010

Cecilia M. Watkins, John White, David F. Duncan, David K. Wyant, Thomas Nicholson, Jagdish Khubchandani and Lakshminarayana Chekuri

Consumer-Directed Health Plans (CDHPs) are proposed as an option to control healthcare costs. No research has addressed their applicability in rural settings. This study…

Abstract

Consumer-Directed Health Plans (CDHPs) are proposed as an option to control healthcare costs. No research has addressed their applicability in rural settings. This study analyzes three years (2003–2005) of healthcare expenditure and utilization incurred by two employers and a national carrier providing data from a rural state, Kentucky. The study included two measures of expenditures (health care and prescription drugs) and three measures of utilization (physician visits, hospital admissions, and hospital inpatient days). In general, the CDHP successfully controlled the growth of medical costs. These findings suggest that CDHPs may be a viable alternative benefit structure for rural employers.

Details

The Impact of Demographics on Health and Health Care: Race, Ethnicity and Other Social Factors
Type: Book
ISBN: 978-1-84950-715-8

Book part
Publication date: 20 October 2014

Jacy Downey and Kimberly Greder

The demographics of rural America are rapidly changing and concerns about mental health are growing. This study examined relationships between individual, family, and…

Abstract

Purpose

The demographics of rural America are rapidly changing and concerns about mental health are growing. This study examined relationships between individual, family, and community factors and depressive symptomology among rural low-income Latina and non-Latina White mothers.

Design

The sample for this study was drawn from the study, Rural Families Speak about Health. Data from interviews with 371 rural low-income mothers (36% Latina; 64% non-Latina White) were analyzed and descriptive and multivariate analyses were performed.

Findings

One-third of mothers experienced clinically significant depressive symptomology; non-Latinas experienced twice the rate as Latinas. Limitation in daily activities due to poor physical health predicted clinically significant depressive symptomology among both groups. Among non-Latinas, high levels of financial distress and lack of healthcare insurance predicted clinically significant depressive symptomology, and use of WIC and high levels of healthful eating and physical activity routines were protective factors. Age, single marital status, unemployment, transportation barriers, food insecurity, and inadequate health insurance predicted clinically significant depressive symptomology among Latinas.

Practical implications

Program administrators should consider factors associated with depression among specific populations as they design programs and services.

Research limitations

Factors not accounted (e.g., nativity of mothers) should be explored to more fully understand predictors of depressive symptomology among rural Latina and non-Latina mothers.

Value

This original research considers how the relationships between individual, family, and community factors and depressive symptomology differ between rural low-income Latina and non-Latina White mothers. The authors discuss potential factors and outcomes related to depressive symptomology and provide suggestions for research, programs and services.

Details

Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

Keywords

Book part
Publication date: 1 January 2006

Ivy L. Bourgeault, Rebecca Sutherns, Margaret Haworth-Brockman, Christine Dallaire and Barbara Neis

This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were…

Abstract

This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were collected from 34 focus groups (237 women), 15 telephone interviews and 346 responses from an online survey. Access to services, care quality and satisfaction are salient themes in these data. Problems include: travel, shortage of providers, turnover in personnel, delays associated in accessing care, lack of knowledge of women's health issues and patronizing attitudes of some health care providers. Health care service restructuring has led to deterioration in service availability and quality. Key areas for policy development need to address health care access and quality improvement issues, including increasing access to more (particularly female) providers who are sensitive to women's health issues.

Details

Access, Quality and Satisfaction with Care
Type: Book
ISBN: 978-1-84950-420-1

Book part
Publication date: 29 July 2009

James W. Grimm, D. Clayton Smith, Gene L. Theodori and A.E. Luloff

Information gathered from a sample of residents in four rural Pennsylvania communities is used to test the net effects of household resources (financial assets, supports…

Abstract

Information gathered from a sample of residents in four rural Pennsylvania communities is used to test the net effects of household resources (financial assets, supports, and community ties) upon respondents’ physical health and emotional well-being. Size and composition of households, types, and extent of insurance coverage, age, and aspects of household liquidity had major net effects upon physical health. Some measures of liquidity, a range of supports, and community ties had net impacts upon emotional well-being. The importance of considering the collective health needs of rural households in relation to their affordability and sustainability is stressed. The public policy implications of our results are discussed.

Details

Social Sources of Disparities in Health and Health Care and Linkages to Policy, Population Concerns and Providers of Care
Type: Book
ISBN: 978-1-84855-835-9

Book part
Publication date: 4 September 2013

James W. Grimm, D.Clayton Smith, Gene L. Theodori and A. E. Luloff

This chapter assesses the effects of two rural community residential advantages – economic growth and availability of health services – upon residents’ health and…

Abstract

Purpose

This chapter assesses the effects of two rural community residential advantages – economic growth and availability of health services – upon residents’ health and emotional well-being.

Methodology/approach

A de facto experimental design divided communities into four analytical types based on their economic growth and health services. Household survey data were gathered via a drop-off/pickup procedure and 400 randomly selected households were surveyed in each location. Physical health was measured with a subset of items from the Medical Outcomes Study’s 36-item short form. A 10-item emotional well-being index was used. Beyond sociodemographic items, questions concerned household assets, medical problems, social supports, and community ties. Nested regression analyses were used to assess the effects of residential advantage upon health, net of potentially confounding factors.

Findings

Contrary to expectations, both residential advantages were necessary for improved health. The most important negative net effect on health was aging. Beyond household assets and community economic expansion, miles commuted to work was the next most important factor enhancing physical health. In all types of communities, residents’ emotional well-being scores were independent of age, but positively related to household income and religious involvement.

Research limitations/implications

Obviously the study is limited by geography and by the small number of communities in each residential type. While we could measure the effects of household members not being able to address all health needs, we could not assess the effects of such problems on anyone else in the households beyond the respondents. Our survey approach is also unable to address the effects of rural residents being unable to meet their health needs over time.

Originality/value of study

Ours is the first study that we know of applying a de facto natural experimental design to assess community residential effects. The interrelated effects of residential community resources for residents’ health suggests that more studies like this one should be done.

Details

Social Determinants, Health Disparities and Linkages to Health and Health Care
Type: Book
ISBN: 978-1-78190-588-3

Keywords

Book part
Publication date: 28 March 2022

Judith Ortiz, Boondaniwon D. Phrathep, Richard Hofler and Chad W. Thomas

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with…

Abstract

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts.

Methodology/Approach: A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008–2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period.

Findings: Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of “ACO RHCs,” there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel.

Research Limitations/Implications: There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs.

Originality/Value of Paper: This chapter presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The US Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the US healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

Details

Health and Health Care Inequities, Infectious Diseases and Social Factors
Type: Book
ISBN: 978-1-80117-940-9

Keywords

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