Rural Remote Health
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Rural Remote Health · Jan 2011
'I am part of the community but...' The changing context of rural living for persons with advanced cancer and their families.
Older rural persons who are receiving palliative care experience multiple co-existing transitions that can be distressing. These transitions do not occur in a vacuum, but occur in a context that reflects the uniqueness of rural living and the complexities of end of life in rural settings. The context or situation (geographical, physical, and social) in which an experience occurs influences the way people view and interpret the world around them; this contextual perspective contributes greatly to perceptions held by rural residents. ⋯ These findings reveal that the rural context has a major impact on the types of community support and healthcare services needed by older persons with advanced disease and their families. With advanced disease, the participants' sense of solitude became one of isolation, and with increasing dependence on others, they needed more connection and support from others. The findings reflected a more complex view of rural aging and dying than has been cited in the literature to date. This study suggests there is a need to renegotiate community supports and the independence available to persons with advanced disease as they undergo multiple transitions near the end of life.
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The prevalence of chronic disease in the US population is increasing. Projections indicate that half the US population will live with at least one chronic disease by the year 2030. Statistics indicate that chronic illnesses account for 70% of all deaths. Developing healthy self-management behaviors can lower the risk of developing chronic disease and also minimize the magnitude of subsequent morbidity and disability. Individuals need access to reliable information in order to learn successful self-management skills. Delivering healthcare information in rural areas is difficult. Geography, distance, inclement weather and/or the lack of financial resources are barriers that can prevent individuals from accessing health care and health education. Likewise, rural health clinics often lack the financial resources to provide the most current patient education materials. However, the internet allows remote and immediate access to this type of information if individuals know how and where to search for it. An internet portal, My Health Education & Resources Online (MyHERO) was created to facilitate locating current, non-commercial, reliable, evidence-based health information. The authors sought to assess the impact of a publically accessible internet information portal on diabetes knowledge, quality of life (QOL) measures, and self-management behaviors in a US rural area. ⋯ Disease knowledge and self-blood glucose monitoring improved with one-on-one education. High attrition and a short study period were limitations of this study. The researchers speculate that the age of the participants and low internet penetration affected satisfaction scores. Future recommendations include a longer data collection period, more widespread publically accessible internet kiosks (grocery stores, malls, churches etc), other chronic disease states, and younger participants.
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Rural Remote Health · Jan 2011
Comparative StudyReceipt of preventive counseling among reproductive-aged women in rural and urban communities.
Preventive health interventions often occur less frequently among rural women compared to urban women. Preventive counseling is an important feature of comprehensive preventive healthcare provision, but geographic disparities in the receipt of preventive counseling services have not been fully described. In this study the framework of the behavioral model of healthcare utilization was employed to investigate the association between rurality and receiving preventive counseling. It was hypothesized that demographic differences in rural and urban communities, as well as differential healthcare resources, explain rural-urban healthcare disparities in preventive counseling. ⋯ Most women do not receive recommended preventive counseling. While rural women are less likely than urban women to receive counseling, rurality generally was not independently associated with receipt of counseling once demographics, access to health care, and health behaviors and indicators were controlled. This suggests that both demographic differences between rural and urban communities as well as aspects of healthcare access govern rural-urban healthcare disparities in preventive counseling. These results speak to important targets for reducing urban-rural healthcare disparities in receiving preventive counseling, improving the health literacy of the rural population, educating rural healthcare providers about the need for preventive counseling, and the expansion of access to obstetrician-gynecologists in rural communities.
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Rural Remote Health · Jan 2011
Biofeedback therapy for faecal incontinence: a rural and regional perspective.
Faecal incontinence is the involuntary loss of liquid or solid stool with or without the patient's awareness. It affects 8-11% of Australian community dwelling adults and up to 72% of nursing home residents with symptoms causing embarrassment, loss of self-respect and possible withdrawal from normal daily activities. Biofeedback, a technique used to increase patient awareness of physiological processes not normally considered to be under voluntary control, is a safe, conservative first-line therapy that has been shown to reduce symptom severity and improve patient quality of life. The Townsville Hospital, a publicly funded regional hospital with a large rural catchment area, offers anorectal biofeedback for patients with faecal incontinence, constipation and chronic pelvic pain. The aim of this report is to describe the effect of the biofeedback treatment on the wellbeing of regional and rural participants in a study of biofeedback treatment for faecal incontinence in the Townsville Hospital clinic. ⋯ For equivalent long term improvement in faecal continence and quality of life to be achieved in both regional and rural participants, an additional follow-up session with the biofeedback therapist, ongoing local support provided by continence advisors, or both, should be investigated for rural patients.