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1 – 10 of over 22000
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: 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

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

Article
Publication date: 12 January 2015

Mika Immonen, Jyri Vilko, Jouni Koivuniemi and Kaisu Laasonen

The purpose of this paper is to focus on the availability and demanded locations of health care services in a rural context. The authors analyse subjective experiences…

Abstract

Purpose

The purpose of this paper is to focus on the availability and demanded locations of health care services in a rural context. The authors analyse subjective experiences because mobility and other individual factors influence the availability of public services.

Design/methodology/approach

Results from a mail survey in southeastern Finland are presented. Data collection was conducted using a random sample of 3,000 people from age 60 to 90 years. A total of 1,121 valid responses were received.

Findings

The acceptable distance to service sites depends on learned behaviour where differences exist between suburban and rural residents. The authors found that service networks can be sparser in rural areas if the service sites are located in the daily activity space of the residents and travel burdens caused by distance and time are adequately solved. However, continuous downscaling of the provision may lead to the loss of health benefits which is harmful for individuals and expensive for society.

Research limitations/implications

Further research should assess a broader variety of residential areas from the perspective of service availability. The results presented do not enable a direct comparison of the service availability between cities and sparsely populated rural areas.

Originality/value

The paper contributes to the debate on access barriers to public service in rural regions. The question of availability of public services is topical because increasing overall demand requires urgent productivity improvements in public services. Currently this is solved by centralisation to search economies of scale.

Details

International Journal of Public Sector Management, vol. 28 no. 1
Type: Research Article
ISSN: 0951-3558

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

Book part
Publication date: 17 September 2014

Bharat Mehra

This chapter explores the perspectives of rural librarians about the information behaviors of children with special needs (CSN) and services available for the…

Abstract

Purpose

This chapter explores the perspectives of rural librarians about the information behaviors of children with special needs (CSN) and services available for the disenfranchised population in the Southern and Central Appalachian (SCA) region.

Methodology/approach

Qualitative feedback is collected from 31 SCA rural librarians via phone interviews and a web-based survey about: (1) The most important information needs/wants of the CSN in the SCA rural libraries; (2) The most important information resources and services that the CSN seek/use in the SCA rural libraries; (3) Extent of perceived need for effective library services for the CSN in rural areas; (4) Ways that the SCA rural libraries can improve to better serve the CSN in their local communities.

Findings

Content analysis of the data generated quantitative representation of response counts for specific themes that resulted in practical user-centered suggestions for positive change in delivering effective library services for the CSN in the SCA region.

Originality/value

Research significance lies in its first-time effort to understand the information needs and information uses of the CSN in the SCA rural library environments from the perspective of a rural librarian immersed in an American society that perceives a parochial regional work setting. This research presents data that challenges notions stereotyping and marginalizing of the “South” in its documentation of positive and meaningful efforts that rural librarians suggest should be made to improve the conditions experienced by the CSN in this region.

Details

New Directions in Children’s and Adolescents’ Information Behavior Research
Type: Book
ISBN: 978-1-78350-814-3

Keywords

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

Article
Publication date: 15 June 2020

Nikolaos Apostolopoulos, Vanessa Ratten, Stavros Stavroyiannis, Ilias Makris, Sotiris Apostolopoulos and Panagiotis Liargovas

The COVID-19 crisis has brought to the forefront the importance of rural health enterprises (RHEs), the peculiarity, in these terms, of rural areas, and the impact of…

Abstract

Purpose

The COVID-19 crisis has brought to the forefront the importance of rural health enterprises (RHEs), the peculiarity, in these terms, of rural areas, and the impact of rurality on health entrepreneurial activities. This paper aims to undertake a literature review regarding RHEs in the EU, identify research gaps and set future research directions.

Design/methodology/approach

A systematic literature review was conducted and the key aspects coded across four thematic areas – after examining 68 papers.

Findings

The findings reveal that more intense research should be conducted across four area which emerged; rural health providers vs urban health providers; RHEs and rural development; RHEs and quality of life; and social RHEs.

Research limitations/implications

Future research avenues were identified and suggestions for further research on RHEs were provided.

Practical implications

The paper provides insights into how rural areas can attract health enterprises and how health enterprises can operate in rural areas.

Originality/value

This research expands on the limited existing knowledge of RHEs and sets the foundations for further research.

Details

Journal of Enterprising Communities: People and Places in the Global Economy, vol. 14 no. 4
Type: Research Article
ISSN: 1750-6204

Keywords

Book part
Publication date: 30 December 2004

Mary K. Zimmerman and Rodney McAdams

This paper focuses on the impact of recent federal health policy on local community efforts to support the survival of rural hospitals. Rural communities in the United…

Abstract

This paper focuses on the impact of recent federal health policy on local community efforts to support the survival of rural hospitals. Rural communities in the United States have an established tradition of providing public financial support to local hospitals. The Balanced Budget Act of 1997 (BBA) expanded Medicare’s prospective payment system to non-acute care services, which promised reduced hospital reimbursement. Part of this legislation, the Critical Access Hospital (CAH) program, was specifically designed to counter the negative impact the broader legislation was expected to have. This study was designed to investigate the hypothesis that counties receiving financial relief for local hospitals through participation in the CAH program would show decreases in county subsidy levels compared to other hospitals. All 123 hospitals in Kansas were studied in 1994, well before BBA legislation, and again in 2001. Data on county-level health care spending for each of the two years were abstracted from all county budgets in Kansas. The amounts counties contributed to local hospitals were calculated and compared in terms of CAH versus non-CAH hospitals with attention to patterns of increase. Results showed that CAH hospitals, in spite of participation in the federal program, received greater local public financial support and experienced greater funding increases than other community hospitals. The implications of these findings are discussed in terms of the circumstances of rural hospitals and recent changes in the CAH program.

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

Article
Publication date: 5 April 2013

Edward Nketiah‐Amponsah, Bernardin Senadza and Eric Arthur

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

Abstract

Purpose

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

Design/methodology/approach

The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.

Findings

The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.

Research limitations/implications

The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.

Practical implications

The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.

Originality/value

A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

Details

African Journal of Economic and Management Studies, vol. 4 no. 1
Type: Research Article
ISSN: 2040-0705

Keywords

1 – 10 of over 22000