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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

This paper aims to provide new insights into and offer potential solutions to the challenges encountered by mental health services working with remote, rural or underserved communities in the UK.

In this paper, the authors reflect on the utility of integrating conventional clinical approaches, with preventive care and empowering work within the community, to provide culturally sensitive and accessible mental health services. The authors describe an example of community intervention from a mental health service in Ghana designed to enhance reach within remote and rural communities and identify potential lessons for practice in the UK.

The partnership between community mental health services and the rural communities, including families and existing social frameworks, applies collaborative care to overcome the lack of resources and facilitate the acceptability of mental health services to the local population. There are a series of important lessons from this experience including the importance of understanding the culture of a community to optimise reach and the importance of working IN the community and WITH the community.

This paper is novel because it provides learning from a model of care applied in the global south that has potential for implementation with underserved populations in the UK. The authors suggest a reframing of the notion of community care to encompass existing frameworks of community, not merely a biomedical conceptualisation.

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.

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.

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.

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

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.

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.

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.

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

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.

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

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

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

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

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.

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.

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.

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.

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.