Introduction: Rehabilitation and disability services in South Africa have been profoundly shaped by apartheid policies, post-apartheid reforms, and global disability rights movements. Rural and remote areas continue to experience inequitable access to rehabilitation services. This article explores the historical evolution of disability and rehabilitation in rural South Africa from the 1960s to the present, with particular attention to community-based rehabilitation (CBR), end-user participation, and collaborative approaches that have emerged in response to rural inequities.Methods: A qualitative document review was conducted using multiple archival documents housed by the Disability Action Research Team. The review included unpublished reports, policy documents, program records, training materials, evaluations, and organisational archives spanning more than five decades. Data were analysed thematically to identify key historical phases, actors, and conceptual shifts in rural rehabilitation practice.Results: Archival evidence reveals how faith-based initiatives, rural therapists, and organisations of persons with disabilities exposed previously 'hidden' rural disability, catalysed the development of CBR, and influenced national rehabilitation and disability policy. Despite significant progress, persistent challenges related to funding, workforce shortages, and policy implementation remain.Conclusion: Collaboration with end users has been central to advancing disability rights and rehabilitation in rural South Africa. Sustained investment, recognition of community-based rehabilitation workers, and community-driven solutions are essential to achieving equitable and accessible rehabilitation services in rural and remote contexts. Key words: accessibility, community-based rehabilitation, disability history, equity, qualitative document review, rural South Africa.
Introduction: South Africans use both Indigenous and formal health care to address surgical conditions; however, these sectors are often siloed, leaving care for the individual disjointed. This study aimed to improve person-centered surgical care in rural South Africa by identifying community-prioritized surgical conditions and exploring Indigenous and formal healthcare stakeholder buy-in to collaborative solutions.Methods: This phenomenological qualitative study used focus group discussions and a multi-stakeholder workshop. Study participants included Indigenous knowledge healers, clinic and hospital staff, community members, and community health workers. Perceived barriers and facilitators to collaboration and solutions improving care within a dual health system were explored. Data were collected and analyzed using Rapid Research, Evaluation and Appraisal Lab sheets.Results: Three focus group discussions of different stakeholder groups were held with five to eight participants each (18 participants total). A total of 33 participants attended the multi-stakeholder workshop. All stakeholders agreed that Indigenous knowledge healers could play a role in improving surgical care. Collaborative solutions included bilateral referral systems and cross-sector education. Barriers included lack of communication and transparency between Indigenous and formal health sectors.Conclusion: Person-centered care includes acknowledging that many people in rural South Africa with surgical conditions will seek care in both the Indigenous and formal health sectors. Improving communication and referrals between the sectors may streamline care and improve health outcomes and community wellbeing.
Introduction: Rural, regional and remote (henceforth 'rural') communities face unique health challenges, including limited access to health care, workforce shortages, and higher disease burden. Consumer and community involvement is essential for addressing real-world health needs and fostering equity, yet its role in shaping research priorities remains largely underexplored, particularly in rural contexts. This study aims to identify consumer priorities for rural health research in Australia and to describe the process and learnings of a novel approach to promoting involvement of rural consumers in health research.Methods: We adopted the World Café method, involving a 1-day workshop and pre- and post-surveys with rural consumers and researchers from the Western Downs region of Queensland, Australia. We invited participants to share their health experiences and identify local health priorities. Discussions were graphically recorded during the workshop. Participants and facilitators notes were content-analysed to identify key research categories. Demographic data and pre- and post-workshop surveys were analysed descriptively.Results: Five key priorities were identified: (1) recruiting and retaining GPs in rural towns; (2) expanding multidisciplinary care; (3) increasing community awareness of local health and wellbeing services; (4) enhancing chronic care options, including remote monitoring; and (5) addressing links between health and hardship, such as housing and financial challenges. Consumer and researcher participants reached consensus on the need for tailored, community-driven interventions and increased collaboration between researchers, policymakers, and local communities.Conclusion: Active involvement of consumers is important for determining user needs and research priorities in rural community settings and should be routine when planning and prioritising healthcare services in order to foster improved health outcomes.
Introduction: The shortage of GPs and the aging population in Germany, with older people requiring increasing amounts of medical care, is creating considerable strain on the German healthcare system. The lack of young doctors in general practice poses challenges to the health care of the population. The 'Excellent Project' aims to draw interest in the field of general practice/family medicine and rural work among medical students. The project provides structured and supervised internships designed to present general practice as a valuable professional choice, and as an attractive and fulfilling career option in rural settings. This cross-sectional study investigated the impact of a structured internship program in a rural general practice. The internship combined intensive one-on-one supervision by experienced GPs with an accompanying teaching program. To assess the impact, former students were asked by questionnaire about their interest in general practice before and after participation, as well as their willingness to work in rural areas. Methods: The project was offered as a 4-week internship as part of the block internship required by the German Licensing Regulations for Physicians. Participation in the project was open to all medical students at German universities. Participants were placed in rural general practices across the Bavarian Forest, a rural region in the south-east of Germany. As part of the internship, in addition to interactive teaching sessions and gaining experience in general practice, exploration and leisure activities in the rural environment played a significant role. During the project, the students built connections with peers and mentors. To evaluate the 'Excellent Project', the evaluation focused on changes in students' career aspirations towards general practice and rural work. Specifically, the main outcome measure was whether students reported greater interest in becoming GPs after completing the internship compared with before the program. Additional outcomes included self-reported growth on personal and professional levels. Results: The internship promotes development on both personal and career-related levels. After completing the internship, the participants' preference for pursuing a career in general practice increased. On a scale from -100 to +100, the wish of being a GP in the future increased from a median of -40 (interquartile range (IQR): -70-20) before the project to a median of 30 (IQR: -12.5-52.5) after the project. The participants' interest in working in rural areas was assessed on a scale of -100 to +100 and showed that the further the participants progressed in their careers, the greater their desire to work in rural areas in the future (students: median 20 (IQR: -20-50); further training: median 35 (IQR: 0-60)). A total of 24.3% of participants who have already obtained their medical license have decided to pursue further training in general practice. Conclusion: A structured rural practice experience during the initial years of a medical career can sustainably increase medical students' motivation to choose further training in general practice and work in rural areas, with lasting effects still observable years later. Initiatives such as the 'Excellent Project' can help to address the shortage of GPs in rural areas.
Introduction: Despite independent associations of rurality and sleep with cognitive function in aging adults, studies examining their interactive association are limited. We aimed to determine whether rurality impacts the sleep-cognition relationship in aging adults.Methods: Participants (N=61) aged ≥50 years completed measures of self-report sleep (Pittsburgh Sleep Quality Index (PSQI): total sleep time, sleep efficiency, and total subscores) and objective cognition (Sternberg working memory task, Wisconsin Card Sorting Test, Stroop color-word test (controlled trials and interference scores) and Posner cueing task (exogenous and endogenous scores)). Self-reported US ZIP codes dichotomized rural and non-rural areas. Moderated regressions examined associations between rurality and self-reported sleep with cognition, controlling for age, sex, and education.Results: In rural residents, shorter PSQI total sleep time score (β=-144.40, p=0.004) and worse PSQI total score (β=41.79, p=0.01) were associated with worse Stroop interference scores, while worse PSQI total scores was associated with better exogenous attention (β=-3.27, p=0.01). In non-rural residents, lower PSQI sleep efficiency scores were associated with worse working memory (β =0.01, p=0.02) and exogenous attention (β=-1.10, p=0.03).Conclusion: Findings suggest rurality-specific associations between self-reported sleep and objective cognition in mid-to-late life. Overall, patterns of results suggests that shorter sleep duration and poorer global sleep quality may be associated with worse higher order cognitive functioning (eg inhibitory control) in rural aging adults, whereas poorer sleep quality may be linked to better performance on lower order attention functioning (eg exogenous spatial attention). In non-rural aging adults, greater overall sleep fragmentation may broadly impact cognition. Future studies should examine urban-specific characteristics (eg traffic noise) and rural-specific characteristics (eg limited healthcare access and social support) that may play a role in the sleep-cognition relationship.
Introduction: Many countries use rural admission pathways and bonded scholarship programs to address persistent shortages of physicians in underserved areas. In Japan, the Chiiki-Waku (regional quota) system was established to recruit and train medical students who are expected to contribute to rural and remote health care. However, variations in educational support and limited understanding of students' lived experiences may weaken the effectiveness of such programs in fostering long-term professional commitment. This study aimed to explore the learning experiences and educational needs of Chiiki-Waku medical students, with particular attention to how these experiences shape professional identity formation and future commitment to rural practice.Methods: We conducted a qualitative study at the University of the Ryukyus in Okinawa, Japan, a setting characterized by geographically remote islands and challenges in healthcare access. Semi-structured interviews were undertaken with medical students admitted through the Chiiki-Waku system across different academic years. Purposive sampling was used to ensure variation in gender, year of study, and rural background. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically through an iterative coding process involving multiple researchers to enhance credibility. The analysis focused on identifying factors that facilitated or hindered students' professional identity formation and their anticipated commitment to rural practice.Results: Four interrelated themes were identified: increased exposure to rural health care, addressing the loss of identity, enhancing communication between educators and students, and balancing the appeal and obligation of rural health care. Students highlighted the importance of repeated and meaningful rural clinical exposure, educational opportunities that reinforced their role as future rural physicians, proactive communication with faculty, and access to mentors. Participants also described tension between contractual obligation and intrinsic motivation, suggesting that professional commitment to rural practice may be strengthened when educational experiences foster both a sense of purpose and personal aspiration.Discussion: These findings suggest that rural workforce commitment among Chiiki-Waku students is not simply a direct outcome of admission status or contractual obligation but is shaped through an ongoing process of professional identity formation. Repeated rural exposure, recognition of students' distinct roles, communication with educators and peers, and opportunities for reflection interacted to help students negotiate the tension between externally imposed service obligations and intrinsic motivation.Conclusion: Strengthening support for Chiiki-Waku medical students may be important for sustaining their commitment to rural health care. Educational strategies that provide repeated rural exposure, mentorship, recognition of students' distinct roles, and opportunities for reflection may help students negotiate the tension between obligation and aspiration and contribute to long-term rural workforce sustainability.
INTRODUCTION:Rural and remote communities in Australia continue to face challenges in attracting and retaining doctors, highlighting the need for medical graduates who feel confident and motivated to practise rurally. This study explored medical students' emotional responses to future rural practice after completing a rural clinical school (RCS) placement, and identified demographic and placement factors associated with both anxiety and positive attitudes. METHODS:This retrospective, cross-sectional study analysed data from 6371 medical students who completed RCS placements between 2013 and 2022, using responses from the Federation of Rural Australian Medical Educators survey. Feelings were assessed using Likert scale responses to statements about experiencing anxiety (a 'sinking feeling') and positive attitudes towards rural work. Associations with sociodemographic characteristics and placement experiences were examined using χ2 tests and multinomial logistic regression. RESULTS:Most students (76%) did not report anxious feelings, while 68% expressed positive feelings about future rural practice. Males were more likely than females to report neutral feelings towards rural practice regarding anxiety (odds ratio (OR)=1.23, 95%CI 1.04-1.45). International fee-paying students had significantly higher odds of reporting both neutral (OR=1.95, 95%CI 1.28-2.98) and anxious feelings (OR=2.41, 95%CI 1.46-3.98). Students with rural backgrounds were less likely to report neutral feelings (OR=0.75, 95%CI 0.60-0.94) and more likely to express positive feelings. Having a rural-based mentor was associated with lower odds of anxiety and higher odds of positive feelings. Students who identified rural generalism as a career aspiration were more likely to report positive feelings than those who preferred a specialist career. CONCLUSION:RCS placements were associated with positive feelings and confidence in rural practice among medical students. However, specific student groups, such as international students, remained more apprehensive. Mentorship was identified as a significant modifiable factor associated with reduced anxiety and higher rural positivity, suggesting that structured mentorship programs could nurture a commitment to rural practice. In addition, a rural background was strongly associated with positive sentiment towards rural practice. Targeted recruitment and supported pathways to expand the proportion of rural-origin students in medical programs could therefore foster rural intent in the pipeline.
Introduction: Rural and remote communities in Australia continue to face challenges in attracting and retaining doctors, highlighting the need for medical graduates who feel confident and motivated to practise rurally. This study explored medical students' emotional responses to future rural practice after completing a rural clinical school (RCS) placement, and identified demographic and placement factors associated with both anxiety and positive attitudes.Methods: This retrospective, cross-sectional study analysed data from 6371 medical students who completed RCS placements between 2013 and 2022, using responses from the Federation of Rural Australian Medical Educators survey. Feelings were assessed using Likert scale responses to statements about experiencing anxiety (a 'sinking feeling') and positive attitudes towards rural work. Associations with sociodemographic characteristics and placement experiences were examined using χ2 tests and multinomial logistic regression.Results: Most students (76%) did not report anxious feelings, while 68% expressed positive feelings about future rural practice. Males were more likely than females to report neutral feelings towards rural practice regarding anxiety (odds ratio (OR)=1.23, 95%CI 1.04-1.45). International fee-paying students had significantly higher odds of reporting both neutral (OR=1.95, 95%CI 1.28-2.98) and anxious feelings (OR=2.41, 95%CI 1.46-3.98). Students with rural backgrounds were less likely to report neutral feelings (OR=0.75, 95%CI 0.60-0.94) and more likely to express positive feelings. Having a rural-based mentor was associated with lower odds of anxiety and higher odds of positive feelings. Students who identified rural generalism as a career aspiration were more likely to report positive feelings than those who preferred a specialist career.Conclusion: RCS placements were associated with positive feelings and confidence in rural practice among medical students. However, specific student groups, such as international students, remained more apprehensive. Mentorship was identified as a significant modifiable factor associated with reduced anxiety and higher rural positivity, suggesting that structured mentorship programs could nurture a commitment to rural practice. In addition, a rural background was strongly associated with positive sentiment towards rural practice. Targeted recruitment and supported pathways to expand the proportion of rural-origin students in medical programs could therefore foster rural intent in the pipeline.
Introduction: Frailty syndrome represents a state of vulnerability that significantly affects the elderly. Chronic exposure to high altitudes may accelerate this process due to chronic hypoxia. Peru's aging population has increased from 5.7% in 1950 to 13.6% in 2023, with 42.6% residing in rural areas. This demographic shift has led to increased prevalence of geriatric syndromes, particularly frailty syndrome. The prevalence of frailty syndrome varies globally, ranging from 5.8% to 27% in European countries and 19.6% in Latin America and the Caribbean. In Peru, previous studies report prevalences between 7.7% and 27.8%, with high-altitude Andean communities showing higher rates. The study's purpose was to determine the association between very high altitude and frailty syndrome in rural community residents of Junín Department, Peru.Methods: A cross-sectional study was conducted in 2023. A total of 393 participants aged ≥60 years residing in rural communities located at high altitudes (2500-3500 m above sea level (a.s.l.)) and very high altitudes (3500-5800 m a.s.l.) were evaluated. Frailty syndrome was assessed according to Fried's criteria: unintentional weight loss (≥4.5 kg in the past year), self-reported exhaustion, low physical activity measured by the Minnesota Leisure Time Activity Questionnaire (lowest quintile <383 kcal/week in men, <270 kcal/week in women), slow walking speed (adjusted for sex and height), and muscle weakness (grip strength below 20% of normal limit, adjusted for BMI and sex). Categories were defined as robust (0 criteria), prefrail (1-2 criteria), and frail (≥3 criteria). Non-probabilistic convenience sampling was used to select 14 population centers. Bivariate analysis and Poisson regression were performed to determine associations.Results: The overall prevalence of frailty syndrome was 44.53% (n=175). Among the frail elderly, 80.6% (n=141) resided in very-high-altitude communities. A significant association was found between very high altitude and frailty (adjusted prevalence ratio=3.11, 95%CI 1.87-5.17, p<0.001). Associated factors included female sex (63.43% of frail versus 47.25% of non-frail, p=0.001), primary education or no formal education (94.28%), agricultural occupation (62.86% of frail versus 39.91% of non-frail, p=0.001), regular self-perceived health (58.86% of frail versus 47.25% of non-frail, p=0.001), and mild functional dependence (54.29%). Cognitive impairment was present in 73.14% of frail versus 15.60% of non-frail elderly (p=0.001). Moderate/severe physical limitation affected 58.86% of frail versus 20.64% of non-frail elderly (p=0.001).Conclusion: There is a significant association between residing at very high altitudes and frailty syndrome in the elderly from Peruvian rural communities. Elderly residents at very high altitude have three times higher prevalence of frailty than residents at high altitudes. The findings suggest the need to implement specific preventive programs for this vulnerable population. Chronic exposure to hypobaric hypoxia at extreme altitudes may accelerate the depletion of physiological reserves, predisposing to frailty development. Future longitudinal studies are needed to establish causal relationships and clinical trials are needed to evaluate specific interventions for high-altitude populations.
Introduction: Varicella-zoster virus (VZV) remains an occupational hazard for healthcare workers (HCWs), yet serological screening and catch-up vaccination policies are inconsistently implemented. We aimed to estimate VZV IgG seroprevalence and vaccination coverage among Greek HCWs, assess the validity of self-reported immunity, and explore the feasibility and yield of brief cognitive screening in this population.Methods: In this cross-sectional study, physicians, nurses, paramedical and administrative staff completed a standardized questionnaire on demographic characteristics, varicella/herpes zoster history and vaccination. Serum VZV immunoglobulin G (IgG) was measured using a commercial enzyme-linked immunosorbent assay. Agreement between self-reported immunity and serostatus was quantified with Cohen's κ. Cognitive performance was assessed with the General Practitioner Assessment of Cognition (GPCOG) in an exploratory analysis.Results: Seventy-four HCWs (mean age 40.8 years; 67.6% female) were enrolled; 77.0% reported prior varicella vaccination and 4.1% reported herpes zoster vaccination. VZV IgG seroprevalence was 93.2% (6.8% seronegative). Self-reported immunity showed high crude agreement but no concordance beyond chance with serostatus (κ=0.03), with 14.9% underestimating and 5.4% overestimating their immunity. GPCOG step 1 scores were strongly skewed to the maximum (mean 8.77/9), yielding marked ceiling effects and no detectable association with VZV markers in exploratory analyses.Conclusion: In this sample of Greek HCWs, VZV immunity was high but not universal, and self-reported history was an unreliable proxy for serological status. Our findings support serological screening and targeted vaccination of susceptible HCWs for infection-control purposes. Cognitive screening with GPCOG in this relatively young workforce showed minimal discrimination and should be considered exploratory. These findings are particularly relevant to rural and remote health services, where limited staffing flexibility can magnify the impact of susceptible healthcare workers on service continuity and infection control.
Introduction: Student research placements may contribute to enhancing health service research capacity and culture. However, little is known about their implementation in rural settings. The aim of this study was to explore the motivations, barriers, facilitators, benefits, and burdens of hosting student researchers in rural health services to inform a tailored, context-specific implementation tool.Methods: The study adopted a qualitative exploratory design using semi-structured interviews with staff members from rural health services across Victoria, Australia. A thematic analysis approach was applied to the data. The implementation tool was developed using findings from the interviews and the Quality Implementation Framework and the Getting to Outcomes Framework.Results: Nine individuals from seven health services across Victoria participated in the interviews. Participants reported that motivations for hosting student researchers included strengthening university partnerships, enhancing research capacity, and supporting workforce recruitment. Key facilitators included strong university relationships, existing research infrastructure, flexible supervision models, and alignment with health service priorities. Barriers included limited time and staff capacity, conflicting expectations surrounding the placements, and lack of experience with rural health service research. While placements provided benefits such as increased research activity and strengthened partnerships with universities, they also created burdens related to supervision workload and accountability (eg data security, student outputs). The implementation tool derived from these findings consists of 11 steps to facilitate planning, implementing, and evaluating research placements in rural health services.Conclusion: This study describes the experiences of student research placements in rural health services, including challenges and benefits. Despite several barriers to implementation, student placements show promise in fostering local research capacity and culture. The tailored implementation tool developed in this study offers a resource for rural health services, with future research needed to test its utility.
Introduction: Efficient use of health worker time is critical for improving service delivery in low resource and rural settings, where persistent workforce shortages limit progress toward universal health coverage. Ethiopia faces a severe health workforce deficit, yet empirical evidence on how hospital-based professionals utilize their working hours, particularly in rural and remote hospitals, remains limited. This study assessed productive time use among health professionals and examined factors associated with achieving an 8-hour productive workday.Methods: A cross sectional time-motion study was conducted in 18 public and private hospitals, including rural facilities across Ethiopia. A total of 180 health professionals representing five cadres were observed over two full working days using a standardized time-motion protocol. Productive activities included direct and indirect patient care and essential administrative functions. Structured interviews assessed workload, workplace conditions, and performance management practices. Descriptive statistics and multivariable logistic regression identified predictors of high productivity.Results: Health professionals spent a total of 5.55 hours per day on productive activities (69.4% of official working hours). Nearly one-third of time was lost to non-productive activities, primarily waiting for patients and having extended breaks. Productivity was positively associated with postgraduate training, greater experience, higher daily patient load, and receipt of performance appraisal. Patterns were consistent across rural and urban hospitals, though rural facilities reported longer waiting times and greater supply constraints.Conclusion: Despite systemic constraints, health professionals dedicate a substantial share of their time to productive tasks. A portion of non-productive time reflects system-level factors such as patient flow disruptions and supply constraints rather than individual inefficiency, particularly in rural hospitals. Addressing these bottlenecks - alongside strengthening workforce capacity through training, supervision, and performance systems - could improve efficiency within existing resources and support equitable, high-quality care.
Introduction: Common mental disorders are major contributors to global disability in Africa. The Friendship Bench is a scalable problem-solving therapy model that employs a community-based approach to addressing mental health disorders. However, evidence on its implementation strategies, contextual barriers, and integration of person-centered care (PCC) remains fragmented. This article reviews evidence on the implementation of the Friendship Bench model in African health systems, highlighting key strategies, barriers, facilitators, and the integration of PCC principles.Methods: Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines, a systematic review was conducted across selected databases. Studies were eligible if they implemented the Friendship Bench intervention for common mental disorders in Africa. Studies were appraised using CASP (Critical Appraisal Skills Programme) checklists and the Mixed Methods Appraisal Tool. Data were extracted on study characteristics, implementation strategies, PCC elements, and outcomes. Studies were appraised using appropriate tools, and results were synthesized narratively.Results: Eleven studies (from Zimbabwe and Malawi) met the inclusion criteria. Participants had common mental disorders with or without comorbid HIV or non-communicable diseases. The Friendship Bench was feasible and acceptable across all studies. Clinical effectiveness was consistently demonstrated for depression symptom reduction (Patient Health Questionnaire-9) but was mixed for anti-retroviral therapy adherence and viral suppression, with one large trial showing no adherence benefit. The PCC principles of empathy, respect for autonomy, confidentiality, and holistic support were central to the implementation's success. Facilitators included structured supervision, task-shifting, community engagement, and cultural adaptation. Barriers included stigma, limited supervision, logistical constraints, and inadequate incentives.Conclusion: The Friendship Bench intervention uses PCC principles to reduce depression symptoms in Zimbabwe and Malawi. Scale-up to other African settings is plausible but requires context-specific adaptation, external supervision, and routine fidelity monitoring. Cost-effectiveness was demonstrated under enhanced supervision but not under basic internal champion models.
Introduction: The aim of this study was to evaluate posture disorders, physical activity level, pain, and body awareness in rural factory workers in Türkiye, and to examine their interrelationships.Methods: A total of 133 volunteer participants were included in the study. Demographic information, working period, income and education level of the participants were recorded. The Visual Analogue Scale was used for pain assessment, the Body Awareness Questionnaire (BAQ) for body awareness, the New York Posture Analysis Questionnaire (NYPA) for posture assessment, and the International Physical Activity Questionnaire-short form to assess physical activity level.Results: The participants had a mean age of 35.6±9.9 years and a mean BMI of 25.3±4.9 kg/m². Most reported mild-to-moderate pain at rest, during activity, and at night. Common postural deviations included head protraction (30.8%) and foot arch disorders (30.1%), despite generally adequate NYPA scores. Physical activity was predominantly low, with 54% inactive. Vigorous activity was positively correlated with activity pain (r=0.215, p=0.015), and moderate activity with night pain (r=0.200, p=0.024). BAQ scores were positively associated with activity pain (r=0.189, p=0.034), while years of employment correlated with pain at rest (r=0.292, p=0.009) and at night (r=0.243, p=0.031).Conclusion: Musculoskeletal problems are highly prevalent among rural factory workers, presenting as mild-to-moderate pain and postural deviations such as head protraction and foot arch deformities. Despite generally adequate NYPA scores, significant individual deviations were revealed by detailed assessment. Physical inactivity likely exacerbates pain and postural imbalance, while longer employment duration is associated with increased rest and night pain. These findings highlight the cumulative impact of physically demanding work and underscore the need for workplace-based preventive strategies, including ergonomic interventions, task variation, micro-breaks, and physiotherapist-guided exercise programs.
Introduction: The purpose of the study was to evaluate the workforce outcomes and costs associated with implementing Rural Generalist Training Positions (RGTPs) in public health services in Queensland, Australia.Methods: A retrospective analysis was conducted between January 2019 and October 2021. Rural and organisational retention of employees was calculated as the median time to event, either transfer to a non-rural or remote Queensland Health service or permanent separation from the organisation, respectively, and the mean difference using a two-sample t-test with equal variance, with statistical significance set at 0.05. Descriptive analysis was performed to evaluate education and promotion outcomes. Retention and promotion of employees in RGTPs ('trainees') were compared with a group of allied health professionals in standard base-grade rural or remote clinical positions. A cost analysis calculated the additional cost of implementing an RGTP compared to a standard early-career allied health position from the perspective of the employing health service.Results: Forty-five allied health professionals employed in an RGTP ('trainees') and 53 non-trainees were eligible for analysis. Participants' professions were nutrition and dietetics, occupational therapy, pharmacy, physiotherapy, podiatry, speech pathology and social work. Compared to non-trainees, trainees were retained significantly longer in their original rural or remote location prior to relocation (mean difference 153 days, 95%CI 55-252 days, p=0.003); in any Modified Monash (MM) Model category 4-7 (MM 4 to MM 7) location until moving to an MM 1 to MM 3 location (mean difference 172 days, 95%CI 62-277 days, p=0.003) and in any MM 2 to MM 7 location until moving to an MM 1 location (mean difference 139 days, 95%CI 11-266 days, p=0.035). The trainee group had a total of 51 enrolments across two approved postgraduate rural generalist education courses, including six participants who undertook both courses. There were 22 (43.1%) course completions, 16 (31.4%) withdrawals, and 13 (25.5%) were continuing studies at the conclusion of data collection. More trainees were promoted above base grade Health Practitioner Level 3 (39%) than employees in the non-trainee group (29%). The total average annual cost for a health service to implement an early-career allied health position as an RGTP was between $10,730 and $15,718, which was fully covered by organisation funding grants of a minimum $25,000 per annum.Conclusion: RGTPs showed favourable outcomes for retention, education and promotion of early-career allied health professionals in rural and remote public health services compared to similar employees in standard positions. Implementation costs for a rural or remote work unit were manageable. The RGTPs provide good value for the health services through focusing training and development investment on early-career allied health professionals who are retained for longer in rural or remote communities.
Introduction: Strong family networks or kinships are integral for overall health and wellbeing, and it is important for families to have the opportunity to build positive and supportive relationships together. In Australia, culturally safe and appropriate programs have the potential to help Aboriginal families to strengthen connections and improve overall physical, social and emotional health and wellbeing. The Moordidjabiny Moort (Stronger Families) program was a place-based, culturally appropriate, family-determined health and wellbeing program, where families chose, planned, undertook and evaluated an activity with the aim of creating positive outcomes for their family. The program was delivered by the South West Aboriginal Medical Service, an Aboriginal Community Controlled Health Organisation that delivers a range of comprehensive primary healthcare services throughout the South West region of Western Australia. Central to this program was a holistic approach to support families and community by providing culturally responsive, community-led health promotion and prevention programs. However, Aboriginal Community Controlled Health Organisations are often limited due to funding constraints and reporting requirements that often do not cover outcome-based program evaluations. Thus, in addition to examining the impacts of the Moordidjabiny Moort (Stronger Families) program, the evaluation reported here also seeks to provide evidence to advocate for funding for similar programs in the future.Methods: Conducted as part of an internal program evaluation and culturally safe research-capacity-building learning experience for staff, the study implemented an evaluation design with embedded participatory action research and Aboriginal Data Sovereignty principles. Evaluation data included family activity grant application information and participant activity reports. Yarning circles and individual yarns were conducted with available program participants and staff and thematically analysed. A program logic model guided the development of outcome measures.Results: The activities provided healing, connection, and improved social and emotional wellbeing, and highlighted the importance of self-determination and cultural ways of working. Findings also show the value of a program logic that connects purposes and outcomes in program planning and evaluation. Added costs, organisation stresses and limited planning lead time are potential barriers to the implementation of this type of program.Conclusion: Both the organisation and the families involved in the project were able to determine how the project would be implemented and therefore ensured the needs and priorities of those involved were identified and met. Allowing families to determine their own outcome measures demonstrates on a small scale the empowering value of applying Aboriginal Data Sovereignty principles. Connecting purpose, planning and evaluation highlighted the value of self-determination, and the application of Aboriginal Data Sovereignty 'governance of data' principles. Comprehensive primary healthcare services that provide a holistic range of services in a culturally sensitive manner are particularly valued by Aboriginal people living in regional, rural and remote areas who would otherwise have been difficult to access. Aligned with the principle of 'data for governance' it is hoped that the learnings from this evaluation will inform funding models to allow Aboriginal Community Controlled Health Organisations greater determination regarding ways to deliver and evaluate programs using the methods and measures they choose.
Introduction: A collaborative research project between the University of Tasmania, Australia, and a Vietnamese central hospital, funded by the Commonwealth Scientific and Industrial Research Organisation Australia, evaluated the usability of augmented reality (AR) technology for telementorship between central medical specialists and rural junior doctors in Vietnam. Mentorship effectiveness and patient acceptability during consultations were explored.Methods: The AR system included a mentor station at a central hospital and eight mentee stations in rural and regional areas in Vietnam. Medical specialists and rural junior doctors formed mentor-mentee pairs to conduct consultations with patients recruited from local health facilities. Participants underwent seven training sessions to gain hands-on experience with HoloLens devices and the Remote Assist app. Mentees used HoloLens in patient rooms to connect with mentors via the Remote Assist app and Microsoft Teams for real-time discussions and remote assistance tailored to patient examinations and treatments.Results: Four mentors, 18 mentees, and four technical staff participated in 41 consultations involving 94 patients. Usability scores were positive across all groups (mentees 3.8±0.6, mentors 3.1±0.2, technical staff 4.1±0.2). Mentorship effectiveness was rated highly by mentors (3.8±0.3) and mentees (4.2±1.1). Most patients (66.3%) were satisfied, and 75% were willing to be consulted again using AR technology.Conclusion: This study demonstrates the potential of AR technology to support junior doctors in patient care in rural clinical settings. The implications for practice and policy are as follows. Doctors in rural areas could enhance health services by using AR to obtain guidance and advice from medical specialists elsewhere. End users require training and ongoing support for the effective implementation and use of AR technology. Guidelines for using AR in remote consultations should be developed by practitioners and policymakers. Further studies conducted with various healthcare professionals would generate additional understanding of the use of AR technology in telementorship.
Introduction: Type 2 diabetes poses a growing global health challenge, with dietary behaviours and food choices playing a critical role in its management. This study assessed dietary practices, food preferences, and nutrition-related determinants among patients with type 2 diabetes in the Wa Municipality of Ghana, and further evaluated overall dietary behaviour using a dietary behaviour index derived from key dietary behavioural indicators.Methods: A cross-sectional survey was conducted among 208 adult respondents selected from diabetes clinics in the municipality using structured interviewer-administered questionnaires and 24-hour dietary recalls. Descriptive statistics were used to summarize demographics, food-choice determinants, dietary practices, and 24-hour food-group consumption. A total dietary behaviour score was computed from 10 dietary behaviour indicators, classified into a dietary behaviour index. Independent samples t-tests and one-way analysis of variance were used to examine differences in dietary behaviour score across selected participant characteristics at a significance level of p<0.05.Results: Most participants were female (69.2%), aged 45-64 years (49.0%), married (73.6%), had no family history of diabetes (48.1%), and had no formal education (39.4%). Major influences on food choices included food availability (79.8%), financial constraints (76.0%), appetite (71.6%), and nutrition advice from healthcare providers (72.1%). In the previous 24 hours, a high proportion of participants reported consuming meat, poultry, and fish (90.4%), whereas fewer reported consuming eggs (17.8%), fruits other than those rich in vitamin A (26.9%), and healthy fats (38.5%); 67.3% reported consuming foods containing trans fats. Participants had limited nutrition knowledge - 53.4% did not understand the glycaemic index, 60.6% did not know which carbohydrates raise blood sugar levels, and 63.9% never read nutrition labels. Most participants indicated moderate dietary behaviour (65.4%), while 23.6% had good dietary behaviour and 11.1% had poor dietary behaviour. Total dietary behaviour scores were significantly associated with eating situation (p=0.001), meal decision making (p=0.004), and nutrition label use (p<0.001), but not with gender (p=0.070), religion (p=0.254), or family history of diabetes (p=0.112). Participants demonstrated predominantly moderate dietary behaviour, with important gaps in fruit intake, carbohydrate monitoring, application of glycaemic knowledge, and nutrition label use. Household food arrangements and nutrition literacy were found to be more strongly associated with healthier dietary behaviour than basic sociodemographic characteristics.Conclusion: Context-specific interventions that strengthen practical nutrition education, improve food label literacy, and support household-level dietary decision making may improve diabetes dietary management in this setting.
Introduction: Rabies is a fatal viral disease affecting all endothermic animals, including humans. It predominantly impacts low- and middle-income countries such as Ethiopia. Community awareness plays a vital role in the control of the disease. This study aimed to assess community knowledge, attitudes, and practices (KAP) regarding rabies, and to retrospectively analyze human and animal rabies cases over the previous 5 years in the studied area. Methods: A cross-sectional study was conducted from September 2021 to August 2023 in the rural Raya-Alamata and Ofla/Korem woredas (districts) of the Southern Zone of Tigray Regional State in northern Ethiopia. Data were collected using a structured questionnaire with 20 questions, administered to 375 respondents. Additionally, 5 years of retrospective rabies exposure data were gathered from hospitals and veterinary clinics, and analyzed. Results: Among the respondents, 52.4% had poor knowledge, 54.9% poor attitudes, and 56.1% poor practices. Poor knowledge was significantly associated with living in rural areas (p=0.002), being a woman working at home (p=0.003), a farmer (p=0.022), and not owning a dog (p<0.001). Poor attitudes were linked to being female (p<0.001), rural residence (p<0.001), and not owning a dog (p<0.001). Poor practices were associated with secondary education (p=0.035), not owning a dog (p=0.013), and having poor knowledge (p=0.03) or attitudes (p<0.001). Overall, 53.1% of respondents had poor KAP scores. Being female and living in rural areas were significant predictors of overall poor KAP (p<0.001) as the two groups have poor access to information and health services. Retrospective data showed 375 human and 71 animal rabies cases. Most human cases were male (80.8%), children aged <15 years (43.2%), and rural residents (86.1%). Conclusion: The study highlights poor community KAP regarding rabies and high rates of human exposure. There is a need for an increased public education and awareness creation on rabies. Community-based education regarding rabies should be provided especially for rural residents, women at home, farmers, and those who do not own dogs. Government bodies should provide sufficient human and veterinary health facilities, particularly in rural areas. Regular mass vaccination of owned dogs and elimination of stray dogs are important interventions. Finally, to have successful rabies prevention and control strategies, there should be a strong intersectorial collaboration between public health, veterinary professionals and local authorities in one health approach.
