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Sebong PH, Pardosi J, Goldman RE, Suryo AP, Susianto IA, Meliala A. Identifying Physician Public Health Competencies to Address Healthcare Needs in Underserved, Border, and Outer Island Areas of Indonesia: A Rapid Assessment. TEACHING AND LEARNING IN MEDICINE 2024:1-12. [PMID: 38743583 DOI: 10.1080/10401334.2024.2353573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
Phenomenon: Most medical schools in Indonesia have developed innovations to integrate public health content into the curricula. However, ensuring that all schools meet appropriate standards regarding the quality of subjects, content relevancy, and course delivery takes time and effort. Approach: This study employed a rapid assessment procedure to identify the current knowledge and competencies required to practice medicine effectively in underserved, border, and outer island areas of Indonesia. Ninety-three participants from six remote districts were involved in 12 focus group discussions. Qualitative data were analyzed using content analysis using the social determinants of health as a guiding framework. Findings: Under decentralized health system governance, the local socio-geographical context is critical to understanding the current public health landscape. Medical education with respect to public health must emphasize physicians' ability to advocate and encourage the coordination of healthcare services in responding to disasters, as well as community-based surveillance and other relevant data for synergistic disease control. As part of a healthcare facility management team, prospective doctors should be able to apply systems thinking and provide critical input to improve service delivery at local health facilities. Also, recognizing underlying factors is essential to realizing effective interprofessional collaboration practices and aligning them with leadership skills. Insights: This study outlines recommendations for medical schools and relevant colleges in formulating compulsory block or integrated public health curricula. It also provides a public health learning topic that may aid medical schools in training their students to be competent for practice in underserved, border, and outer island areas. Medical schools should offer initiatives for students to acquire the necessary public health competencies merited by the population's health needs.
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Affiliation(s)
- Perigrinus Hermin Sebong
- Department of Public Health, Faculty of Medicine, Soegijapranata Catholic University, Semarang, Indonesia
| | - Jerico Pardosi
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Roberta Ellen Goldman
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, Massachusetts
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Indra Adi Susianto
- Faculty of Medicine, Soegijapranata Catholic University, Semarang, Indonesia
| | - Andreasta Meliala
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Audet C, Zerriouh M, Nguena Nguefack HL, Julien N, Pagé MG, Guénette L, Blais L, Lacasse A. Where we live matters: a comparison of chronic pain treatment between remote and non-remote regions of Quebec, Canada. FRONTIERS IN PAIN RESEARCH 2024; 5:1291101. [PMID: 38468692 PMCID: PMC10925759 DOI: 10.3389/fpain.2024.1291101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Where a person lives is a recognized socioeconomic determinant of health and influences healthcare access. This study aimed to compare the pain treatment profile of persons with chronic pain (CP) living in remote regions to those living in non-remote regions (near or in major urban centers). Methods A cross-sectional study was performed among persons living with CP across Quebec. In a web-based questionnaire, participants were asked to report in which of the 17 administrative regions they were living (six considered "remote"). Pain treatment profile was drawn up using seven variables: use of prescribed pain medications, over-the-counter pain medications, non-pharmacological pain treatments, multimodal approach, access to a trusted healthcare professional for pain management, excessive polypharmacy (≥10 medications), and use of cannabis for pain. Results 1,399 participants completed the questionnaire (women: 83.4%, mean age: 50 years, living in remote regions: 23.8%). As compared to persons living in remote regions, those living in non-remote regions were more likely to report using prescribed pain medications (83.8% vs. 67.4%), a multimodal approach (81.5% vs. 75.5%), experience excessive polypharmacy (28.1% vs. 19.1%), and report using cannabis for pain (33.1% vs. 20.7%) (bivariable p < 0.05). Only the use of prescribed medications as well as cannabis remained significantly associated with the region of residence in the multivariable models. Discussion There are differences in treatment profiles of persons with CP depending on the region they live. Our results highlight the importance of considering remoteness, and not only rurality, when it comes to better understanding the determinants of pain management.
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Affiliation(s)
- Claudie Audet
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Meriem Zerriouh
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Nancy Julien
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Centre de Recherche Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d’Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Axis, Centre de Recherche CHU de Québec—Université Laval, Québec, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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Nelson D, Inghels M, Kenny A, Skinner S, McCranor T, Wyatt S, Phull J, Nanyonjo A, Yusuff O, Gussy M. Mental health professionals and telehealth in a rural setting: a cross sectional survey. BMC Health Serv Res 2023; 23:200. [PMID: 36849933 PMCID: PMC9970689 DOI: 10.1186/s12913-023-09083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/18/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery. METHODS An online cross-sectional survey that explored mental health professional's experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery. RESULTS Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client's access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth. CONCLUSIONS This study addresses three major gaps in knowledge: the experience of delivering local telehealth solutions to address rural mental health needs, the provision of strong rural-specific telehealth recommendations, and the dearth of rural research emanating from the United Kingdom. As the world settles into a living with COVID-19 era, the uniqueness of the rural telehealth context may be forgotten as urban myopia continues to dominate telehealth policy and uptake. It is critical that rural resourcing and digital connectivity are addressed.
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Affiliation(s)
- David Nelson
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Maxime Inghels
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.4399.70000000122879528Centre Population et Développement (UMR 196 Paris Descartes – IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France
| | - Amanda Kenny
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.1018.80000 0001 2342 0938La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Steve Skinner
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Tracy McCranor
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stephen Wyatt
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jaspreet Phull
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Agnes Nanyonjo
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Ojali Yusuff
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK ,grid.464673.40000 0004 0469 8549Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK. .,La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
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Green E, Quilliam C, Sheepway L, Hays CA, Moore L, Rasiah RL, Bailie J, Howard C, Hyde S, Inyang I, Matthews K, Ferns J, Brown LJ, Jones S, Collett M. Identifying features of quality in rural placements for health students: scoping review. BMJ Open 2022; 12:e057074. [PMID: 35396299 PMCID: PMC8995951 DOI: 10.1136/bmjopen-2021-057074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore and synthesise the evidence relating to features of quality in rural health student placements. DESIGN Scoping review. DATA SOURCES MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020). STUDY SELECTION The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas. DATA EXTRACTION Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework. RESULTS Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure. CONCLUSION The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.
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Affiliation(s)
- Elyce Green
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Claire Quilliam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Catherine A Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Leigh Moore
- Rural and Remote Health, Flinders University, Darwin, Northern Territory, Australia
| | - Rohan L Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, Western Australia, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Christine Howard
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sarah Hyde
- Joint Program in Medicine School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia
| | - Imo Inyang
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Kylie Matthews
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame, Broome, Western Australia, Australia
| | - Jane Ferns
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Leanne J Brown
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Sara Jones
- Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia
| | - Marjorie Collett
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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Nursing students admitted through the affirmative action system display similar performance in professional and academic trajectories to those from the regular path in a public school in Brazil. PLoS One 2022; 17:e0264506. [PMID: 35235564 PMCID: PMC8890649 DOI: 10.1371/journal.pone.0264506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 02/12/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Affirmative action providing higher education access for socially vulnerable students has been implemented in several countries. However, these policies remain controversial. This study compares the performance of students admitted through the regular path and social quota systems, during and after completion of nursing education, in a public nursing school in Brazil. Methods This retrospective cohort study included all students admitted to nursing school at the School of Health Sciences (ESCS), Brazil, between 2009 and 2014, who were followed until May 2020. The first phase involved document analysis from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey was conducted among the alumni. The social quota system criterion was public school attendance across all primary and secondary education levels. Results Of the 448 students included in the study, 178 (39.7%) were from the affirmative action and 270 (60.3%) from the regular path systems. Affirmative action students were older at the time of nursing school admission (p < 0.001) and took longer to be admitted to the nursing school (p < 0.001) after completing high school. There were no significant differences in the dropout rates and years to complete nursing school. In the second phase, 108 alumni answered the survey. No significant differences were found in their participation in the undergraduate scientific research program and university extension projects, attending residency programs, getting a master’s degree and doctoral degree, monthly income, teaching activity, joining public service through a government job competition process, participation in management activities in the private and public health sector, and degree of job satisfaction. Conclusion Our results revealed that affirmative action is a policy that contributes to the reduction of inequalities and guarantees the training of nursing professionals with a similar professional qualification received through affirmative action and regular path systems.
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Alatni BS, Abubakar IR, Iqbal SA. COVID-19 and Rapid Course Adaptations in Saudi Arabia: An Experiential Learning and Recommendations for Online Education. Front Psychol 2021; 12:643203. [PMID: 35002820 PMCID: PMC8733659 DOI: 10.3389/fpsyg.2021.643203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 11/19/2021] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 Pandemic has severely impacted educational systems around the globe, necessitating rapid modifications to the educational milieu while safeguarding human health and wellbeing. Following the closure of universities in Saudi Arabia, the instructors of all theory courses were mandated to switch from face-to-face course delivery to remote teaching and learning. This research examines the challenges and impacts of the COVID-19 Pandemic on the mode of teaching and learning and the numerous adaptations in the pedagogical framework of the Landscape Architecture program at Imam Abdulrahman Bin Faisal University, Saudi Arabia. It also explores the opportunities the transition to online education presents to faculty and students moving forward. The data were collected using an online questionnaire survey and focus group discussions. Data analyses consisted of descriptive statistics and thematic content analysis. The research finds that the sudden transition to online teaching and learning disrupted academic activities and had negatively affected the existing teaching and learning framework. Therefore, the research recommends an adaptable and dynamic teaching framework agile enough to cope with sudden disruptions. It concludes with lessons for future teaching and learning frameworks and amendments for upcoming sessions to deal with similar situations.
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Affiliation(s)
- Basim Sulaiman Alatni
- Department of Landscape Architecture, College of Architecture and Planning, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ismaila Rimi Abubakar
- College of Architecture and Planning, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad Arslan Iqbal
- Department of Landscape Architecture, College of Architecture and Planning, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Gingerich A, Van Volkenburg K, Maurice S, Simpson C, Roots R. Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles. MEDICAL EDUCATION 2021; 55:1183-1193. [PMID: 33617663 DOI: 10.1111/medu.14476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non-clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships. METHODS Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships. RESULTS PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well-being and patient welfare. While off-duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on-duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal-professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions. CONCLUSION Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.
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Affiliation(s)
- Andrea Gingerich
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Kevala Van Volkenburg
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Sean Maurice
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Robin Roots
- Physical Therapy, University of British Colombia, Prince George, BC, Canada
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