Volume twenty-six, Issue 3

Colorectal cancer is the third-most common cancer diagnosis and the second-most common cause of cancer death worldwide. As access to cancer investigations like colonoscopies are a significant barrier identified by rural primary healthcare providers, novel approaches like colon capsule endoscopy (CCE) – in which a camera is digested and travels through the gut transmitting images to a data recorder for review and diagnosis before elimination – are required to meet the needs of rural and remote populations. This Original Research study examines the experiences and perspectives of staff involved in an innovative CCE service in Scotland.

In Germany, the shortage of rural GPs and the aging population, with older people requiring increasing amounts of medical care, is creating considerable strain on the healthcare system. In addition, the average age of GPs in Germany is climbing steadily. To encourage young doctors into general practice, especially in rural areas, GPs in the rural region of the Bavarian Forest launched the ‘Excellent Project’, which provides medical students with a structured internship program in a rural general practice, combining intensive one-on-one supervision by experienced GPs with an accompanying teaching program. This Original Research study investigates the impact of The Excellent Project.

Cognitive impairment is linked with poor sleep health (eg sleep duration, sleep efficiency, daytime sleepiness) and is more prevalent in rural areas. However, despite independent associations of rurality and sleep with cognitive function in aging adults, their interactive association is unclear. This Original Research study examines whether rurality (non-rural v rural) moderates the associations between self-reported sleep and cognition (including working memory, executive functioning, spatial attentional orienting, and processing speed) in aging adults in the US.

In response to the shortage of healthcare professionals in rural areas in Japan, medical schools across the country have implemented the Chiiki-Waku (regional quota) system, which selects students based on their intention to work in rural health care, often offering scholarships in exchange for a service obligation in specific regions after graduation. Despite the system’s potential, current educational approaches often fail to adequately address the unique expectations, concerns, and aspirations of Chiiki-Waku students, which presents a significant challenge in translating the goals of the Chiiki-Waku system into successful, long-term outcomes for rural health care. This Original Research article explores how Chiiki-Waku students’ learning experiences, educational support, and relationships with educators and peers shape their professional identity formation and anticipated commitment to rural practice.

The maldistribution of the medical workforce is a global phenomenon, and rural physician retention is a critical barrier to achieving universal health coverage. While there are several international strategies, many high-income countries (including Australia, Canada and the US), have invested heavily in regionalised medical education to foster ‘rural intent’ early in the professional pipeline. Evidence from systematic reviews and longitudinal cohort studies indicates that rural career intent during medical training is strongly associated with subsequent rural practice. This Original Research study assesses the rural intent of medical students by examining the prevalence of negative and positive feelings associated with their Rural Clinical School placement, as well as associations with demographic characteristics and placement experiences.

Providing for the healthcare needs of an aging population represents one of the most important challenges of the 21st century. In Peru, frailty syndrome, which becomes more common with age, has been found to be more prevalent in high-altitude Andean communities than elsewhere in Peru. This Original Research article investigates the association between very high altitude and frailty syndrome in rural community residents of the central Peruvian Andes.

In Greece, every public service, private enterprise or organization where large numbers of people gather is obliged to have an automatic external defibrillator (AED), and CPR training is mandatory for sport trainers, lifeguards and employees of large organizations. Despite this, several issues continue to hamper the effectiveness of public access defibrillation (PAD), including lack of awareness and training and inaccessible or out-of-service AEDs. To overcome these issues, an innovative initiative aimed at establishing an effective PAD program was recently launched in Crete. This Project Report describes the establishment of, and results from the first 8 months of implementation for, the first organized PAD program in Greece.

Varicella-zoster virus (VZV) establishes lifelong latency after primary infection and may reactivate as herpes zoster, particularly with increasing age or immunosenescence, sometimes causing neurological complications and, possibly, long-term cognitive changes. Despite this risk, screening and catch-up vaccination policies are inconsistently implemented. Healthcare workers (HCWs) are a priority group for VZV prevention because they may acquire infection from patients and transmit it to vulnerable individuals in healthcare settings. This Original Research study investigates VZV seroprevalence, vaccination coverage and mismatches between self-reported immunity and serostatus, and evaluates the feasibility of brief cognitive screening, in a working-age HCW population serving predominantly rural and regional populations in Greece.

Medication errors (inappropriate medication use or medication causing patient harm) can occur at various stages of the medication process, including prescribing, dispensing, administering, and monitoring, and are estimated to occur in 7–9% of medication orders, with approximately 1% of these errors resulting in patient harm. This Scoping Review explores the application and effectiveness of AI technologies to enhance patient safety and reduce medication errors in rural health settings.

Aging is a complex process associated with the emergence of multiple comorbidities, which can significantly affect functionality, wellbeing, and self-esteem. Despite a range of barriers, Indigenous older adults living in Indigenous communities often maintain higher levels of physical activity through their traditional lifestyle practices compared with people in urban populations. Furthermore, Indigenous older adults hold a distinct and respected position within their communities, where their ancestral knowledge is highly valued, and their experiences serve as a vital resource for preserving traditions, culture, and communal practices. This Original Research study describes the functional capacity of Indigenous older adults in the Peruvian Amazon and analyzes the association between functional capacity and self-esteem in this population.

Healthcare organisations’ engagement in research and investment in enhancing research culture has been linked to improved quality of care, including better patient outcomes and more effective care processes. However, engaging in research may be particularly challenging for rural health services because of a limited number of rural researchers, high workloads, lack of organisational support, and lack of targeted research grants and scholarships for rural researchers. Strategies identified to address some of the challenges to undertaking rural health service research include establishing dedicated research support roles within organisations, and fostering networks and collaborations to enhance research capacity. An additional yet underexplored component of these strategies is hosting student researchers in the health service setting. This Original Research study explores key motivations, barriers, enablers, benefits, and burdens of hosting student researchers from the perspective of rural health service staff, and uses these findings to inform the development of an implementation support tool to assist rural health services in becoming hosting organisations.

Health worker productivity is a core determinant of health system performance, especially in low- and middle-income countries where shortages of skilled professionals constrain service availability and quality. Efficient utilization of available working hours is particularly critical in rural and remote settings, where geographic isolation, limited resources, and staffing shortages intensify system pressures. This Original Research study reports on the results of a multi-site time–motion assessment in public and private hospitals, including rural hospitals, across Ethiopia. By quantifying productive and non-productive time and examining associated factors such as experience, training, supervision, and workload, this study provides context-specific insights crucial for informing workforce optimization in Ethiopia’s rural health system.

Access to effective mental health care remains critically limited in low- and middle-income countries, particularly across Sub-Saharan Africa. The Friendship Bench, in which therapy sessions take place in an informal, confidential, and non-stigmatizing space – like a wooden bench – is a well-documented community-based innovation for delivering mental health care in resource-constrained settings. The Friendship Bench was piloted and adapted in rural parts of Zimbabwe and its success has prompted replication and adaptation across various African contexts, where lay health workers and peer counselors have been trained to provide mental health support in both clinical and community settings. This Review identifies and evaluates the implementation strategies, barriers, and facilitators associated with the Friendship Bench model across different African health systems and explores how practices consistent with person-centered care principles (respect, empathy, shared decision-making, tailoring, holistic support, and confidentiality) are described in Friendship Bench implementation studies.

Musculoskeletal system disorders are one of the leading occupational diseases, and these disorders are mostly observed in factory workers who are likely to do physical labor. The most common causes of these disorders are working with incorrect posture, lifting of heavy objects, and movements that require excessive strength and repetitive loading. Long working hours, insufficient rest hours, depression, and insomnia are among the risk factors that trigger these disorders in workers. This Original Research study evaluates posture disorders, physical activity level, pain, and body awareness in rural factory workers in three provinces of Türkiye.

Sustaining a multidisciplinary allied health workforce of adequate size and skills is a longstanding issue for rural and remote health services, and workforce distribution in Australia remains skewed towards metropolitan areas. Rural Generalist Training Positions (RGTPs) for allied health professions have been trialled in Queensland as a new strategy to improve recruitment, retention and workforce capacity. This Original Research article reports on the largest evaluation of RGTPs in the public sector to date and adds to the emerging body of literature on allied health early-career rural generalist workforce development.

Clinical courage describes an integral part of rural clinical practice in which doctors work at the limits of their scope of practice to provide place-based medical care not routinely available in their specific rural context, based on sound clinical reasoning. However, deviations from conventional best practice that result from rural doctors’ adaptive expertise can potentially be considered poor practice by the city-based professional establishment. To make the practice of clinical courage more explicit, this Commentary proposes the COURAgE mnemonic, which can act as a tool for discussing modifications to conventional care with rural patients, their families and members of the local rural healthcare team as well as with city-based specialist support services.

Strong family networks contribute to health, resilience and support for all people. Building strong emotional support systems and positive family relationships can promote collective healing from stressors that may influence negative dynamics, such as social, environmental and economic pressures. To ensure effectiveness and sustainability of programs promoting health and wellbeing, it is crucial that communities, governments and organisations demonstrate long-term commitment and cultural competency. This article reports on an outcome-based evaluation of the Moordidjabiny Moort (Stronger Families) program's approach to encourage funders to provide support for staff and programs that include Aboriginal participants in developing, implementing and evaluating activities tailored to their individual priorities/needs.

Health practitioners in many rural and remote communities experience inadequate timely professional support because of a shortage of on-site, experienced practitioners and geographic barriers. Research suggests that telehealth technologies can help less-experienced local staff, healthcare providers and patients in such areas access real-time, effective professional support and guidance from experts located elsewhere. This Original Research study evaluates the usability of augmented reality technology for telementorship between central medical specialists and rural junior doctors in Vietnam, assesses the perceived effectiveness of the mentoring relationship, and explores patient acceptability of AR technology during clinical consultations.

In Ghana, diabetes prevalence is estimated at 4–9% and, while diabetic patients possess knowledge about dietary recommendations, significant barriers prevent effective self-care implementation. Diabetes patients in the Wa Municipality have additional challenges because socioeconomic and dietary factors exacerbate these issues. This Original Research study assesses the dietary practices, food preferences, and nutrition-related determinants among type 2 diabetic patients in the Wa Municipality of Ghana.

Mapping the knowledge, perceptions, and existing practices regarding rabies is considered an important milestone in the control and prevention of the disease. Although the magnitude and distribution of rabies exposure in the Tigray region of Ethiopia is high, there has been no coordinated study on the community’s knowledge, attitudes, and practices (KAP) concerning rabies in the Tigray Region. This Original Research study assessed the community's level of KAP towards rabies and retrospectively analyzes human and animal rabies exposure cases over the past 5 years in the project area.

Papua New Guinea (PNG) is the largest Pacific Island country, and the majority of its population lives in rural and remote areas. PNG’s persistent low immunisation coverage of 39% among children between 12 and 23 months is the underlying cause of vaccine-preventable disease outbreaks. This Original Research study investigates the individual, interpersonal, organisational and sociocultural factors that influence the use of immunisation services for children under the age of five in PNG.

Despite being particularly vulnerable due to the wide range of stressors they experience, farmers face ongoing challenges in accessing timely, appropriate, and culturally responsive mental health care. Barriers to help-seeking include stoicism, self-reliance, stigma, limited mental health literacy, and structural constraints such as distance, cost, and long wait times. In response to these barriers, mental healthcare providers have adapted their services to respond to the unique needs and challenges associated with the agricultural lifestyle. This Original Research study explored the perspectives of mental healthcare providers who work with farmers to identify their strategies for fostering trust and therapeutic alliance.

Global population ageing has far-reaching implications, including for public health. Challenges like rising chronic disease burden, increasing disability, caregiving shortages and deficiencies in long-term care are particularly acute in rural and regional areas, where access to health care is constrained by workforce shortages, geographic isolation and socioeconomic disadvantage. Addressing these challenges using participatory co-design approaches that engage older adults in the development and evaluation of services is promising, but the evidence base underpinning such approaches in rural aged care contexts remains underdeveloped. This Scoping Review maps the existing literature on the care needs of community-dwelling older adults in rural areas.