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1.
JMIR Public Health Surveill ; 8(2): e30063, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-2197941

ABSTRACT

BACKGROUND: The COVID-19 pandemic exacerbated the need for urgent improvements in access to health care for rural, remote, and underserviced communities. The Renfrew County Virtual Triage and Assessment Centre (VTAC) was designed to provide access to COVID-19 testing and assessment with a family physician. The goal was to protect emergency departments and 911 paramedics while ensuring that nobody was left at home, suffering in silence. Residents were encouraged to call their own family physician for any urgent health needs. If they did not have a family physician or could not access their usual primary care provider, then they could call VTAC. This study reports on the output of a service model offering access to assessment and COVID-19 testing through a blend of virtual and in-person care options by a multidisciplinary team. OBJECTIVE: The purpose of this study was to assess the ability of VTAC to provide access to COVID-19 assessment and testing across rural, remote, and underserviced communities. METHODS: We conducted a cross-sectional analysis of the data derived from the cases handled by VTAC between March 27, 2020 (launch day), and September 30, 2020. RESULTS: Residents from all 19 census subdivisions and municipalities of Renfrew County accessed VTAC. A total of 10,086 family physician assessments were completed (average 64 per day). Of these, 8535 (84.6%) assessments were to unique patient users. Thirty physicians provided care. Using digital equipment setup in the patients' home, 31 patients were monitored remotely. VTAC community paramedics completed 14,378 COVID-19 tests and 3875 home visits. CONCLUSIONS: Renfrew County's experience suggests that there is tremendous synergy between family physicians and community paramedics in providing access to COVID-19 assessment and COVID-19 testing. The blended model of virtual and in-person care is well suited to provide improved access to other aspects of health care post pandemic, particularly for patients without a family physician.


Subject(s)
COVID-19 , Telemedicine , COVID-19 Testing , Cross-Sectional Studies , Humans , Pandemics , Rural Population , SARS-CoV-2
2.
Rural Remote Health ; 22(4): 7231, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2164502

ABSTRACT

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic has caused unprecedented social and economic disruption, accompanied by the enactment of a multitude of public health measures to restrain disease transmission. These public health and social measures have had a considerable impact on lifestyle and mental wellbeing, which has been well studied with metropolitan populations. However, limited literature concerning such effects on a selectively rural population is presently available. Additionally, the use of a standardised scoring system for lifestyle may be valuable for an overall assessment of lifestyle that may be incorporated into clinical practice. METHODS: This study examined the associations between psychological distress and changes in SNAPS health behaviours (smoking, nutrition, alcohol, physical activity, sleep) since the onset of COVID-19 in Australia. A cross-sectional anonymous survey was distributed online to adults in the Western New South Wales Primary Health Network in August 2020 and included measures of psychological distress, income, disposition and lifestyle factors during the pandemic as well as changes to lifestyle due to COVID-19. A novel Global Lifestyle Score (GLS) was generated as a holistic assessment of lifestyle across multiple domains. RESULTS: The survey was completed by 304 individuals (modal age group 45-54 years, 86.8% female). High distress on the Kessler-5 scale was present in over one-third of participants (n=95, 33.7%). Detrimental change was reported for sleep (22.7%), nutrition (14.5%), alcohol (16.7%), physical exercise (34.0%) and smoking (24.7%) since the onset of the pandemic. Changes in sleep, nutrition, physical activity and smoking were associated with distress. Participants with a poor lifestyle (GLS) during the pandemic were significantly more distressed. Perceived COVID-19 impact was associated with high distress, drought impact and loss of income. Participants who reported negative impact from both COVID-19 and drought were significantly more distressed than those reporting a negative impact from drought alone or neither event. CONCLUSION: High rates of distress among rural Australians during the COVID-19 pandemic was linked to low GLS, worsening lifestyles and loss of income. Healthy lifestyle strategies should be considered by health professionals for the management of crisis-related distress. Further research may explore the impact of COVID-19 on a larger study population with a greater proportion of male participants and to examine the effect of modifying lifestyle factors in reducing distress in the context of a stressor such as this pandemic.


Subject(s)
COVID-19 , Adult , Australia/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Droughts , Female , Humans , Life Style , Male , Middle Aged , Pandemics , Rural Population , SARS-CoV-2
3.
Patient Educ Couns ; 105(7): 2371-2381, 2022 07.
Article in English | MEDLINE | ID: covidwho-2150394

ABSTRACT

OBJECTIVE: To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS: 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS: 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION: Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS: Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.


Subject(s)
Obesity , Weight Loss , Counseling/methods , Humans , Obesity/psychology , Obesity/therapy , Primary Health Care/methods , Rural Population , Weight Loss/physiology
4.
Rural Remote Health ; 22(3): 6751, 2022 07.
Article in English | MEDLINE | ID: covidwho-2146087

ABSTRACT

INTRODUCTION: Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious global health threat. Many countries including Greece have seen a two-wave pattern of reported cases, with a first wave in spring and a second in autumn of 2020. METHODS: A cross-sectional seroprevalence study was designed to measure the prevalence of IgG antibodies with a quantitative SARS-CoV-2 IgG lab-based serology test, chemiluminescent microparticle immunoassay, against novel coronavirus in rural areas in Greece after the second pandemic wave. The study was conducted on 29 January 2021 in a rural semi-closed area, the municipality of Deskati, prefecture of western Macedonia in Greece after the second pandemic wave. RESULTS: Sixty-nine participants were included in this study. The present study demonstrated a high prevalence of COVID-19 infection (31 of 69 total participants; 45%) and those who were working in the public sector were at higher risk of COVID-19 infection in comparison to their counterparts in private sector (p=0.05364), (relative risk 2.64; 95% confidence interval 1.001-7.086). CONCLUSION: The study presents data showing a high prevalence of herd immunity for COVID-19 in a semi-closed area in Greece. These findings might help to understand the characteristics of this second wave, the behaviour and danger of SARS-CoV-2 in rural areas in Greece and Europe generally.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cross-Sectional Studies , Greece/epidemiology , Humans , Immunoglobulin G , Prevalence , Rural Population , SARS-CoV-2 , Seroepidemiologic Studies , Workplace
5.
Healthc Pap ; 20(4): 77-81, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-2145320

ABSTRACT

The constraints of the COVID-19 pandemic accelerated the adoption of virtual care. The role of virtual care in the mix of healthcare services is being re-examined as the pandemic evolves. For many diverse Indigenous communities (rural, remote, urban), virtual care has the potential to increase access to healthcare and improv health outcomes, or to worsen existing inequities. Thoughtful co-design of virtual care programs, attention to user experience and enabling policy decisions can unlock the potential of virtual care for Indigenous individuals and communities.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Rural Population , Canada/epidemiology
6.
Int J Environ Res Public Health ; 19(12)2022 06 10.
Article in English | MEDLINE | ID: covidwho-2142774

ABSTRACT

Much of the differences in health care outcomes can be attributed to the differential rates of primary health care utilization and resource allocation across population subgroups [...].


Subject(s)
Patient Acceptance of Health Care , Rural Population , Healthcare Disparities , Humans , Primary Health Care , Urban Population
7.
BMC Geriatr ; 22(1): 808, 2022 10 20.
Article in English | MEDLINE | ID: covidwho-2139159

ABSTRACT

BACKGROUND: Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults. METHODS: Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction. RESULTS: Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations. CONCLUSIONS: The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. 15 after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind.


Subject(s)
Disabled Persons , Health Equity , Humans , Aged , Delivery of Health Care , Rural Population
9.
Prev Chronic Dis ; 19: E74, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2119217

ABSTRACT

INTRODUCTION: During the COVID-19 pandemic, measures implemented to protect community health may have influenced how and where people engaged in physical activity. In rural communities, access to resources, the environment, and socioeconomic status could play a role in how adults are physically active. Our study examined locations where rural residents of a county in western North Carolina engaged in physical activity early in the COVID-19 pandemic, their reasons for being physically active, and their perceptions of benefits and barriers related to engaging in physical activity. METHODS: Rural adults (N =297) completed an online survey from August 3 through September 15, 2020, describing their physical activity during the summer of 2020. Data were analyzed using nonparametric measures. RESULTS: Survey respondents frequently engaged in physical activity in the home (57.8%), at parks or on trails (45.3%), and around their neighborhood (39.4%). The most common types of physical activities at parks or on trails were walking and hiking (99.5%). Across all locations, the most frequently reported reasons for engaging in physical activity were getting out of the house, maintaining fitness and mental health, and exercising. CONCLUSION: Our study showed many locations where rural residents were physically active and their reasons for participating in physical activity during the pandemic. Data about perceived benefits of and barriers to physical activity during the pandemic can assist in meeting the current need to increase physical activity levels in rural communities.


Subject(s)
COVID-19 , Rural Population , Adult , Humans , Pandemics , COVID-19/epidemiology , North Carolina/epidemiology , Exercise
10.
Indian J Med Res ; 155(5&6): 485-490, 2022.
Article in English | MEDLINE | ID: covidwho-2110463

ABSTRACT

Background & objectives: Studying vaccine hesitancy is important for helping improve vaccine coverage against COVID-19. The objective of this study was to assess the prevalence and correlates of COVID-19 vaccine hesitancy in a rural community in India. Methods: A cross-sectional study of all adults aged over 18 yr was undertaken during July-August 2021, in a village outside Bengaluru city in southern India. Results: In our study, 68.7 per cent of the eligible 297 adult population accepted vaccination immediately, another 9.4 per cent hesitated but accepted vaccination without delay, a further 10.4 per cent delayed their vaccination and the remaining 11.5 per cent refused vaccination. The prevalence (95% confidence interval) of vaccine hesitancy was 21.9±4.8 per cent. Full vaccination was higher among males (76%) compared to females (58%, P <0.001). Those who hesitated and delayed vaccination (converts) were more likely to be from a nuclear family, whereas those who refused the vaccine were from a joint/three-generation family. Those who refused vaccination were adversely influenced by social media predominantly as also their religious/cultural beliefs and distrust on the pharmaceutical industry. Those who delayed but accepted vaccination were positively influenced by healthcare professionals and others who had accepted the vaccine recently. Geographic factors, cost of vaccine, and mode of administration were not the major concerns. Interpretation & conclusions: Vaccine uptake is a continuum. Our study helped identify the characteristics of those who delayed vaccination versus those who refused vaccination. This will help policymakers, programme managers and healthcare professionals to focus priority action on population subgroups for improving individual- and population-level protection.


Subject(s)
COVID-19 Vaccines , COVID-19 , Male , Adult , Female , Humans , Adolescent , COVID-19 Vaccines/therapeutic use , Rural Population , Cross-Sectional Studies , Prevalence , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination Hesitancy , Vaccination
12.
JAMA Netw Open ; 5(11): e2241144, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2103438

ABSTRACT

This cross-sectional study explores geographic disparities in antiviral access by quantifying the accessibility of COVID-19 Test to Treat sites for subpopulations by race, ethnicity, age, and rurality.


Subject(s)
COVID-19 , Ethnicity , Humans , Rural Population , Healthcare Disparities
13.
Int J Environ Res Public Health ; 19(20)2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2099493

ABSTRACT

Older people's help-seeking behaviors (HSBs) may be limited because of various factors and are essential in improving healthcare in aging societies. This cross-sectional study investigated the association between perception of HSBs, concrete HSBs, quality of life (QOL), and other variables among people over 65 in rural Japan using standardized questionnaires. Participants were divided into high or low health status index score groups based on a median split. Logistic regression was used to assess the association between perception of HSBs and high QOL while controlling for age, sex, living conditions, annual health checks, having chronic diseases, regular clinic visits, smoking, habitual alcohol consumption, education, living conditions, social support, social capital, socioeconomic status (SES), and health literacy. Participants in the high QOL group were younger (p < 0.001), and had fewer chronic diseases and regular clinic visits than those in the low QOL group (p < 0.001). The multivariate logistic regression model revealed that age, chronic diseases, tobacco usage, family consultation, and consulting primary care physicians negatively predicted QOL. High SES, social capital and support, and HSB intention positively predicted QOL. Self-efficacy and intention regarding HSBs should be investigated to improve health among older rural people.


Subject(s)
Help-Seeking Behavior , Quality of Life , Humans , Aged , Cross-Sectional Studies , Rural Population , Surveys and Questionnaires , Chronic Disease , Perception
15.
BMJ Open ; 12(10): e062987, 2022 10 27.
Article in English | MEDLINE | ID: covidwho-2088812

ABSTRACT

OBJECTIVES: To examine differences in rural community children's moderate-to-vigorous physical activity (MVPA) and participation in out-of-school activities from fall 2019 to fall 2020 and explore enacted PA opportunity modifications post initial COVID-19 disruption. DESIGN: Mixed methods study using the validated Youth Activity Profile (YAP), administrator reports and stakeholder surveys and semistructured interviews. SETTING: Children and community stakeholders from one rural US Great Plains community in the state of Nebraska were recruited. PARTICIPANTS: Third through fifth graders in fall 2019 (n=144) and fall 2020 (n=174) reported MVPA and participation in out-of-school activities using the YAP. School administrators reported weekly physical education (PE) and recess minutes. Community stakeholders reported pandemic-related changes in community social structures in semistructured interviews (n=4) and surveys (n=19). RESULTS: Average daily MVPA minutes increased from 2019 to 2020 (75.0 vs 81.3, SE=1.6, p<0.05). Minutes of MVPA increased during: school hours (MD=2.7, SE=0.5, p<0.5); out-of-school time on weekdays (MD=3.9, SE=1.3, p<0.5); and on weekends (MD=5.5, SE=2.4, p<0.5). On average, fewer children participated in youth sport (42.5% vs 47.2%), youth clubs (10.3% vs 16.0%) and other out-of-school activities (24.1% vs 38.2%) in 2020, compared with 2019. Weekly PE/recess minutes increased from 208.3 to 241.7 from 2019 to 2020. Stakeholder surveys revealed community-driven modifications to PA opportunities, and interviews suggested children played outside more frequently, especially when school was closed and out-of-school activities were shut down. CONCLUSIONS: Increased minutes of PE and recess, and decreased out-of-school activity participation may have increased children's overall free play and MVPA during the pandemic. Free play was an important contributor to children's PA during the pandemic and should be prioritised by educators, coaches and other leaders of child PA opportunities. TRIAL REGISTRATION NUMBER: NCT03380143.


Subject(s)
COVID-19 , Child , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Exercise , Pandemics/prevention & control , Physical Education and Training , Rural Population , Schools
16.
NCHS Data Brief ; (447): 1-8, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2083525

ABSTRACT

Death rates in the United States are higher in rural than urban areas, and the difference has grown over the last 2 decades (1). Death rates for all of the 10 leading causes of death in 2019 were higher in rural than urban areas (1). In 2020, deaths due to COVID-19 became the third leading cause of death in the United States (2). This report presents COVID-19 death rates for rural and urban areas in 2020 by sex and age group (under age 65 and 65 and over). Rates are presented for the six categories of urbanicity according to the decedent's county of residence (3). Urban areas include large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan; rural areas include micropolitan and noncore (nonmetropolitan).


Subject(s)
COVID-19 , United States/epidemiology , Humans , Aged , Urban Population , Rural Population
17.
Int J Environ Res Public Health ; 19(20)2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2082237

ABSTRACT

The qualitative data presented in this paper was part of a larger concurrent mixed methods study evaluating the effectiveness of a transportation program (Project TRIP) for low-income residents in rural eastern North Carolina. Twenty stakeholders involved in TRIP were interviewed, including riders (n = 12) of which 83% were over 50 years old, program staff including the program coordinator and 5 case managers (n = 6), and transportation providers (n = 2). Due to the COVID-19 pandemic, interviews were completed by phone with each participant. Themes from the qualitative data included the: (1) Emotional, health, & financial impacts of TRIP, (2) Changes that should be implemented into TRIP when replicating the program, and (3) Unique aspects of how TRIP operates that could inform other rural transportation programs. Thematic analysis was used to analyze the transcript data. The findings are couched in the context of how TRIP potentially defrays the impacts of cumulative disadvantage that residents experience over the life course by increasing access to healthcare.


Subject(s)
COVID-19 , Pandemics , Humans , Middle Aged , COVID-19/epidemiology , Rural Population , Poverty , Health Services Accessibility
18.
BMC Public Health ; 22(1): 1920, 2022 10 14.
Article in English | MEDLINE | ID: covidwho-2079410

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused the loss of millions of lives and economic breakdowns in many countries across the globe. Despite the limited availability of vaccines and the challenges of poor health infrastructure, few interventions have been developed and implemented for those who live in rural areas, particularly in sub-Saharan Africa. In response, Cocoa360, a global health nonprofit in rural Ghana designed an intervention called Cocoa360's COVID-19 Preparedness and Outbreak Prevention Plan (CoCoPOPP). This paper aimed to examine the extent to which CoCoPOPP's design aligned with the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS: We reviewed documents influencing CoCoPOPP's design between March and June 2021. A total of 11 documents were identified for analysis. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a guide, thematic analysis was done to analyze the extracted data. RESULTS: Overall, CoCoPOPP's design aligned with the evidence, context, and facilitation domains of the PARIHS framework. It positioned CoCoPOPP as an intervention that considered the unique context of a rural Ghanaian setting. It was guided by robust and high-quality published and non-published evidence and engaged external and internal stakeholders during its implementation. CoCoPOPP's context-dependent nature positions it for potential replication in sub-Saharan Africa's rural communities with similar farming contexts. Specific areas that were less well and/or not addressed were the unintended negative consequences of community engagement, the absence of primary data in the guiding evidence, and the lack of a facilitation continuum coupled with the role of power during the facilitation process. CONCLUSION: CoCoPOPP, Cocoa360's response to the COVID-19 pandemic in rural Ghana, is an evidence-driven, context-dependent public health intervention that has been designed to reduce COVID-19 infections and prevent potential deaths. This study underscores the importance of considering the unique community and cultural contexts, employing evidence, and engaging local and external actors as facilitators when designing interventions to respond to global health pandemics.


Subject(s)
COVID-19 , COVID-19/prevention & control , Ghana/epidemiology , Health Services Research , Humans , Pandemics/prevention & control , Rural Population
19.
Biomed Res Int ; 2022: 2545830, 2022.
Article in English | MEDLINE | ID: covidwho-2079082

ABSTRACT

The global malaria morbidity and mortality witnessed an increase from 2019 to 2020 partly due to disruptions in control programs' activities imposed by the COVID-19 pandemic. Therefore, there is still a significant burden of malaria in Cameroon which needs attention from all fronts to attain elimination goals. It is normally expected that a typical forest ecology that has undergone urbanization and subjected to high rates of ecological instabilities should also have a shift from characteristic perennial malaria transmission and a shift in the type of malaria endemicity plaguing such distorted forest ecology. In this observational comparative study, we randomly enrolled participants from rural and urban settings of a forest zone during a low malaria transmission period, which coincided with the onset of COVID-19 pandemic. An optimized structured questionnaire was employed, to collect socio-demographic data and associated risk factors. The CareStart™ Malaria HRP2 antigen test was performed on participants from both settings to determine the prevalence of community asymptomatic malaria. Of 307 participants, 188 (61.0%) were from the rural, while 119 (38.8%) from the urban community. The overall prevalence of asymptomatic malaria (27.0%) detected Plasmodium falciparum antigen in 83 participants. The urban community's prevalence was 4.2% (5 positives) while the rural community's was 41.5% (78 positives). In simple logistic regression models, rural forest community and farm around the house were statistically significant predictors of testing positive (coefficient 2.8, 95% CI 1.8-3.7, p value<0.001) and (coefficient 3.1, 95% CI 1.1-5.1, p value =0.003), respectively. In the multivariate model, the strongest predictor of testing positive was living in a rural community, with p < 0.001 and odds ratio of 10.9 (95% CI, 3.8-31.8). These results indicate that during a low transmission period, the prevalence of asymptomatic malaria differs between depleted urban and rural forested settings, suggesting a need for strategic target intervention for the control of asymptomatic malaria.


Subject(s)
COVID-19 , Malaria, Falciparum , Malaria , Humans , Rural Population , Plasmodium falciparum , COVID-19/epidemiology , Pandemics , Malaria/epidemiology , Forests , Prevalence , Malaria, Falciparum/epidemiology
20.
Aust J Rural Health ; 30(5): 702-704, 2022 10.
Article in English | MEDLINE | ID: covidwho-2078313
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