Are Rural People Getting HeartSmart?

Characterizing Dietary Intakes in Rural Australian Adults: A Systematic Literature Review

Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians. A systematic literature review aimed to synthesize the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention, and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes. Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available and a lack of consistency between dietary outcomes collected in research to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities.

Limited dietary interventions in rural Australian communities: A systematic review

AIM

This review aimed to synthesise the evidence on the effectiveness of dietary interventions targeting adolescents (>13 years) and adults living in rural or remote Australia.

METHODS

Six electronic databases were searched to identify dietary interventions undertaken in rural or remote communities. Studies were included if they utilised intervention and control comparisons or pre and post assessment of diet-related outcomes. If studies included metropolitan populations, dietary outcome measures had to be provided separately for rural data.

RESULTS

In total, 14 articles from 12 unique studies met the criteria for inclusion and together provided incomplete coverage across all states of Australia, included intervention studies targeted diet to address obesity, cardiovascular disease, and high blood pressure or diabetes. No studies were focussed on reducing community malnutrition. All studies, with one exception, focussed specifically on rural adults, no interventions specifically targeted adolescents in rural areas. Only two studies documented the involvement of a dietitian in intervention development or delivery. All studies produced a significant outcome for either dietary intake, body mass index, waist circumference, or diet related biomedical risk factors for individuals located in rural or remote areas of Australia.

CONCLUSION

Dietary interventions in rural Australia are under-studied, especially among the adolescent population. This is despite the high level of preventable diet-related disease burden in rural and remote Australia. Existing evidence shows promise in improving dietary intakes, but further, large scale intervention research, with the involvement of dietitians, is urgently needed to improve the health of rural communities.

Understanding the impact of rural weight loss interventions: A systematic review and meta-analysis

Rural adults have a higher risk of developing obesity than urban adults. Several evidence-based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE-AIM-related data were abstracted from each article. We performed a meta-analysis to examine effectiveness. Sixty-four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta-analyses revealed the interventions achieved a significant weight reduction, and longer-duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.

A systematic review of published interventions for primary and secondary prevention of ischaemic heart disease (IHD) in rural populations of Australia

BACKGROUND

Rural Australians are known to experience a higher burden of ischaemic heart disease (IHD) than their metropolitan counterparts and the reasons for this appear to be highly complex and not well understood. It is not clear what interventions and prevention efforts have occurred specifically in rural Australia in terms of IHD. A summary of this evidence could have implications for future action and research in improving the health of rural communities. The aim of this study was to review all published interventions conducted in rural Australia that were aimed at the primary and/or secondary prevention of ischaemic heart disease (IHD) in adults.

METHODS

Systematic review of the peer-reviewed literature published between January 1990 and December 2015. Search terms were derived from four major topics: (1) rural; (2) ischaemic heart disease; (3) Australia and; (4) intervention/prevention. Terms were adapted for six databases and three independent researchers screened results. Studies were included if the published work described an intervention focussed on the prevention or reduction of IHD or risk factors, specifically in a rural population of Australia, with outcomes specific to participants including, but not limited to, changes in diet, exercise, cholesterol or blood pressure levels.

RESULTS

Of 791 papers identified in the search, seven studies met the inclusion criteria, and one further study was retrieved from searching reference lists of screened abstracts. Typically, excluded studies focused on cardiovascular diseases without specific reference to IHD, or presented intervention results without stratification by rurality. Larger trials that included metropolitan residents without stratification were excluded due to differences in the specific needs, characteristics and health service access challenges of rural populations. Six interventions were primary prevention studies, one was secondary prevention only and one included both primary and secondary intervention strategies. Two interventions were focussed exclusively on Aboriginal and Torres Strait Islander (Australian Indigenous) populations.

CONCLUSIONS

Few interventions were identified that exclusively focussed on IHD prevention in rural communities, despite these populations being at increased risk of IHD in Australia, and this is consistent with comparable countries, internationally. Although limited, available evidence shows that primary and secondary interventions targeted at IHD and related risk factors can be effective in a rural setting.

Understanding the landscape: promoting health for rural individuals after tertiary level cardiac revascularization

PURPOSE

The purpose of this pilot study was to describe the needs and experiences of rural individuals commuting to an urban center for percutaneous coronary intervention (PCI).

METHODS

Data were analyzed from a "Patient Adherence and Satisfaction Survey" conducted by telephone as part of a quality improvement focus, and supplemented with in-depth semi-structured interviews with rural patients following PCI.

FINDINGS

Both urban and rural patients after PCI experienced few complications, had made some attempts to reduce tobacco usage, and were highly satisfied with explanations of their treatment and their overall treatment experience. Patients in rural settings were more likely to experience chest pain at least rarely following their surgery than people in urban settings (P < .05). Data on participation in cardiac rehabilitation (CR) showed no significant differences between urban and rural dwellers. Four themes emerged from the interviews: standards of care during treatment; transportation; local resources and community support; and lifestyle changes. Although patients were highly satisfied with standards of care during acute treatment, there were unmet needs in relation to transportation and lifestyle changes.

CONCLUSION

Transitions between rural communities and urban centers and rural adaptations of secondary prevention programs require more attention in health service delivery. Further research is required to better understand potential variations in chest pain patterns between urban and rural residents.