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Conlin M, McLaren D, Spelten E, MacDermott S. Cultivating participatory approaches in health promotion planning, delivery, and evaluation: A case study of an academic-health service partnership in rural Victoria. Health Promot J Austr 2024; 35:804-812. [PMID: 37816340 DOI: 10.1002/hpja.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
ISSUE ADDRESSED Community participation in planning, delivery, and evaluation of health promotion (HP) programs is a poorly explored topic. However, this approach has the potential to improve health outcomes and reduce health inequities, particularly for residents of rural and remote areas. METHODS This case study describes the outputs of an academic-health service partnership in rural Victoria. The collaboration has led to the implementation and ongoing evaluation of a microgrant program for HP which integrates community participation principles in the foundations of the program and its evaluation. RESULTS To date, 10 funded projects have been brought to completion, with COVID-19 having disturbed both grant distribution and funded activity implementation. Semi-structured interviews with health service officers served to clarify conceptualisation and operationalization of HP principles. Focus groups with health service management and officers contributed to building an overarching evaluation framework for the HP team's activities. Finally, the specific methodological evaluation framework for the microgrant program was developed through a collaborative workshop with the HP team and grantees. CONCLUSIONS Fostering community participation in HP planning, delivery, and evaluation, especially in rural areas, is feasible as evidenced by the experience described in this case study. The forthcoming evaluation results will help clarify the impact of community participation on health-related outcomes. SO WHAT?: Documentation and dissemination of processes used to increase community participation in HP programs is essential to grow the knowledge base around what works and what doesn't, and for whom.
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Affiliation(s)
- Michèle Conlin
- La Trobe Rural Health School, La Trobe University, Mildura, Victoria, Australia
| | | | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Mildura, Victoria, Australia
| | - Sean MacDermott
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Mildura, Victoria, Australia
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Sheridan N, Love T, Kenealy T. Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study. Int J Equity Health 2023; 22:79. [PMID: 37143152 PMCID: PMC10157126 DOI: 10.1186/s12939-023-01893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/11/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. METHODS We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. RESULTS The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. CONCLUSIONS Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care.
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Grants
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- HRC 18/788 Health Research Council of New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
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Affiliation(s)
| | - Tom Love
- Sapere Research Group, Wellington, Aotearoa, New Zealand
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Rowe A, Crawford-Williams F, Goodwin BC, Myers L, Stiller A, Dunn J, Aitken JF, March S. Survivorship care plans and information for rural cancer survivors. J Cancer Surviv 2023; 17:441-448. [PMID: 35334076 PMCID: PMC10036447 DOI: 10.1007/s11764-022-01204-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to investigate the amount and type of survivorship care information received by cancer survivors living in rural Australia and whether this varies according to demographic factors or cancer type. METHODS Self-reported receipt of a survivorship care plan (SCP) and information on various aspects of survivorship care (e.g., managing side effects, healthy lifestyles, psychosocial advice and monitoring for recurrence) were collected from 215 cancer survivors who had returned home to a rural area in Queensland Australia after receiving cancer treatment in a major city within the previous 5 years (72% in the previous 12 months). Logistic regression was used to assess for differences across demographic factors and cancer type. RESULTS Only 35% of participants reported receiving a SCP and proportions of those reporting the receipt of specific information varied from 74% for information on short-term side effects to less than 30% for information on finances, chemoprevention and monitoring for signs of recurrence. No significant differences were found in the receipt of survivorship care information across demographic factors or cancer type. CONCLUSIONS Findings suggest that cancer survivors living in rural areas are not consistently provided with adequate survivorship care information, particularly that pertaining to long-term health and recovery. IMPLICATIONS FOR CANCER SURVIVORS Without improved systems for delivering survivorship care information to patients returning home to rural communities after treatment, these cancer survivors risk missing out on necessary information and advice to maintain their health, wellbeing and long-term recovery.
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Affiliation(s)
- Arlen Rowe
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
| | - Fiona Crawford-Williams
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Belinda C Goodwin
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia.
- Cancer Council Queensland, Fortitude Valley, QLD, Australia.
| | - Larry Myers
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Anna Stiller
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
- Prostate Cancer Foundation of Australia, St Leonards, Sydney, NSW, Australia
| | - Joanne F Aitken
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
- School of Public Health, The University of Queensland, Springfield, QLD, 4300, Australia
| | - Sonja March
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
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Duke SM, Otárula KAG, Canales T, Lu E, Stout A, Ghearing GR, Sajatovic M. A systematic literature review of health disparities among rural people with epilepsy (RPWE) in the United States and Canada. Epilepsy Behav 2021; 122:108181. [PMID: 34252832 PMCID: PMC8429139 DOI: 10.1016/j.yebeh.2021.108181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Epilepsy is a leading cause of global disease burden, with people with epilepsy (PWE) experiencing adverse health outcomes related to the psychiatric comorbidities and socioeconomic consequences of the disorder. Rural populations are more likely to be impoverished or uninsured, which could impact health outcomes for rural-dwelling PWE (RPWE). AIMS This systematic literature review identified original research studying health disparities and outcomes among RPWE in the United States and Canada to (1) characterize the disparities faced by RPWE and (2) elucidate the effects of these disparities upon clinical outcomes. METHODS We performed a systematic search of six electronic databases: Pubmed, Cochrane, PsychInfo, Web of Science, Scopus, and Ovid. Articles considered were original research reports conducted in Canada or the United States before August 2020. A modified Newcastle Ottawa Scale was used to assess the quality of the included studies. RESULTS Our search returned 2093 articles that examined the health disparities of RPWE, of which six met criteria for this review. Outcome measures of health disparity included in these papers were mortality (2; 33%), use of health resources (2; 33%), and epilepsy prevalence (2; 33%). Only one paper (16%) concluded that RPWE experienced worse health outcomes relative to urban-dwelling PWE, while 5 (84%) found no difference. CONCLUSION Our study did not find sufficient evidence that RPWE in the US and Canada experience significant health disparities compared to similar urban populations of PWE. More research using prospective studies and datasets allowing better characterization of rurality is required.
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Affiliation(s)
- Sean M. Duke
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Karina A. González Otárula
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Thomas Canales
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Elaine Lu
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Amber Stout
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Gena R. Ghearing
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Martha Sajatovic
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
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Aljassim N, Ostini R. Health literacy in rural and urban populations: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2142-2154. [PMID: 32601042 DOI: 10.1016/j.pec.2020.06.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/09/2020] [Accepted: 06/05/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant. METHODS Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies. RESULTS Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy. CONCLUSION Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles. PRACTICE IMPLICATIONS These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.
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Affiliation(s)
- Noor Aljassim
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
| | - Remo Ostini
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
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Groenewegen PP, Bosmans MWG, Boerma WGW, Spreeuwenberg P. The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011. Eur J Public Health 2020; 30:iv12-iv17. [PMID: 32875316 PMCID: PMC7526766 DOI: 10.1093/eurpub/ckaa125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rural areas have problems in attracting and retaining primary care workforce. This might have consequences for the existing workforce. We studied whether general practitioners (GPs) in rural practices differ by age, sex, practice population and workload from those in less rural locations and whether their practices differ in resources and service profiles. We used data from 2 studies: QUALICOPC study collected data from 34 countries, including 7183 GPs in 2011, and Profiles of General Practice in Europe study collected data from 32 countries among 7895 GPs in 1993. Data were analyzed using multilevel analysis. Results show that the share of female GPs has increased in rural areas but is still lower than in urban areas. In rural areas, GPs work more hours and provide more medical procedures to their patients. Apart from these differences between locations, overall ageing of the GP population is evident. Higher workload in rural areas may be related to increased demand for care. Rural practices seem to cope by offering a broad range of services, such as medical procedures. Dedicated human resource policies for rural areas are required with a view to an ageing GP population, to the individual preferences and needs of the GPs, and to decreasing attractiveness of rural areas.
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Affiliation(s)
- Peter P Groenewegen
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Mark W G Bosmans
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wienke G W Boerma
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Nivel – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Terashima M, Rainham DGC, Levy AR. A small-area analysis of inequalities in chronic disease prevalence across urban and non-urban communities in the Province of Nova Scotia, Canada, 2007-2011. BMJ Open 2014; 4:e004459. [PMID: 24823673 PMCID: PMC4025452 DOI: 10.1136/bmjopen-2013-004459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Small-area studies of health inequalities often have an urban focus, and may be limited in their translatability to non-urban settings. Using small-area units representing communities, this study assessed the influence of living in different settlement types (urban, town and rural) on the prevalence of four chronic diseases (heart disease, cancer, diabetes and stroke) and compared the degrees of associations with individual-level and community-level factors among the settlement types. METHODS The associations between community-level and individual-level characteristics and prevalence of the chronic diseases were assessed using logistic regression (multilevel and non-multilevel) models. Individual-level data were extracted from the Canadian Community Health Survey (2007-2011). Indices of material deprivation and social isolation and the settlement type classification were created using the Canadian Census. RESULTS Respondents living in towns were 21% more likely to report one of the diseases than respondents living in urban communities even after accounting for individual-level and community-level characteristics. Having dependent children appeared to have protective effects in towns, especially for males (OR: 0.49 (95% CI 0.27 to 0.90)). Unemployment had a strong association for all types of communities, but being unemployed appeared to be particularly damaging to health of males in urban communities (OR: 2.48 (95% CI 1.43 to 4.30)). CONCLUSIONS The study showed that those living in non-urban settings, particularly towns, experience extra challenges in maintaining health above and beyond the socioeconomic condition and social isolation of the communities, and individual demographic, behavioural and socioeconomic attributes. Our findings also suggest that health inequality studies based on urban-only settings may underestimate the risks by some factors. Ways to devise meaningful small-area units comparable in all settlement types are necessary to help plan effective provision of chronic disease-related health services and programmes on a regional scale.
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Affiliation(s)
- Mikiko Terashima
- Environmental Science Program, Dalhousie University, Halifax, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | | | - Adrian R Levy
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
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Terashima M, Read Guernsey J, Andreou P. What type of rural? Assessing the variations in life expectancy at birth at small area-level for a small population province using classes of locally defined settlement types. BMC Public Health 2014; 14:162. [PMID: 24524307 PMCID: PMC3925774 DOI: 10.1186/1471-2458-14-162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 02/07/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although efforts have been made to articulate rural-urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. Small-area level investigations of health inequalities will likely show more detailed pictures of health inequalities among diverse rural communities, but they are difficult to conduct, particularly in a small population region. The objectives of this study were: 1) to compare life expectancy at birth for females and males across small-areas classified by locally defined settlement types for a small province in Canada; 2) to assess whether any of the settlement types explains variations in life expectancy over and above the extent of socioeconomic disadvantage and social isolation; and 3) to examine variations in life expectancies within a (larger) area unit used as the basis of health inequality investigations in previous studies. METHODS Seven settlement types were determined for the 'community' units based on population per-kilometre-road density and settlement forms. Mean life expectancies at birth for both genders were compared by settlement type, both for the entire province and within the Halifax Regional Municipality--the province's only census designated metropolitan area, but also contains rural settlements. Linear regression analyses were conducted to assess the statistical associations between life expectancy and the settlement types, adjusting for indicators of community-level deprivation. RESULTS While types of communities considered as 'rural' generally had lower life expectancy for both genders, the effects of living in any settlement type were attenuated once adjusted for socioeconomic deprivation and social isolation. An exception was the village and settlement cluster type, which had additionally negative effects on health for females. There were some variations observed within the Halifax Regional Municipality, suggesting the importance of further investigating a variety of health and disease outcomes at smaller area-levels than those employed in previous studies. CONCLUSIONS This paper highlighted the importance of further articulating the differences in the characteristics of rural at finer area-levels and the differential influence they may have on health. Further efforts are desirable to overcome various data challenges in order to extend the investigation of health inequalities to hard-to-study provinces.
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Affiliation(s)
- Mikiko Terashima
- Department of Community Health & Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada
| | - Judith Read Guernsey
- Department of Community Health & Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada
| | - Pantelis Andreou
- Department of Community Health & Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada
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