Secondary Analysis Assesses Dietary Diversity Changes among Maya Guatemalan Women Post-Nutrition Interventions.

OBJECTIVES: This study aimed to evaluate the change in the Dietary Diversity (DD) Index of Maya women of reproductive age living in rural areas of the Western Highlands of Guatemala after nutrition, health, and agroecology interventions. METHODS: This is a secondary analysis study on DD from two matched groups from three villages in the Lake Atitlan area in the department of Sololá. The first cohort was recruited in 2017 (sample of n = 77). The second cohort was recruited in 2020 (sample of n = 61). Both were followed until 2021. The program provided various resources for assistance for food production and home improvements (sessions from 2018 to 2022). Agroecology sessions were conducted in the test farm. Due to the COVID-19, adjustments were made to continue the education and training sessions. RESULTS: Both cohort samples had a statistically significant increase in participants who consumed at least 15 g from five groups of foods (2017: p = .00002; 2020: p = .045). There was a statistically significant increase in mean food groups consumed daily (2017: p < .00001; 2020: p = .005). CONCLUSIONS FOR PRACTICE: Implementing interventions that include nutrition, health, and agroecology practices in the long term has demonstrated a statistically significant increase in the Dietary Diversity Index of Maya women in their reproductive years living in rural villages in the Western Highlands.

Effects of recalling place memory on promoting cooperative behaviors in local communities.

AIMS: The present study aimed to develop a theoretical model that explores the influence of recalling place memory on cooperative behaviors in local communities. METHODS: Five hundred ninety-five Japanese residents (mean age = 49.75 years) participated in an online survey, in which they received one of the three interventions: (1) positive memory; (2) neutral memory and (3) negative memory. Participants were instructed to recall their place memories within their living areas and provide ratings for their place attachment, emotional valence, perceived self-interest, and willingness to engage in cooperative behaviors. RESULTS: The results revealed that individuals who recalled positive-valenced place memories exhibited a higher willingness to engage in cooperative behaviors. Additionally, this study reveals the previously unreported mediating role of place attachment and perceived self-interest in promoting cooperative behaviors. CONCLUSION: The findings hold significance in elucidating the relationship between place memory and cooperative behaviors, offering novel insights for community management.

"I Couldn't Leave the Farm": Rural Women's Experiences of Intimate Partner Violence and Coercive Control.

Intimate partner violence (IPV) and coercive control are prevalent across Canada; these experiences are exacerbated by regionality with women in rural areas disproportionately affected. This study explores rural women's experiences of IPV and coercive control, drawing on qualitative interviews with rural women in Saskatchewan who experienced IPV and focus groups with service providers who work with survivors. Our findings suggest rurality magnifies conditions of coercive control through physical elements of normative rurality, such as isolation that restrict women's space for action. Our participants' experiences of coercive control were exacerbated by the geographic reality of living in a rural/remote location.

Enhancing rural community engagement through palliative care networks: A scoping review.

Palliative care is a crucial discipline that alleviates suffering and enhances the quality of life for patients with life-limiting illnesses and their families. However, there is gap globally between the need for and availability of these services. Integrated health service networks offer a promising solution to address this gap in rural areas, by coordinating care across different levels and sectors. This scoping review aimed at identifying the key characteristics of palliative care networks in rural communities. A broad search without time limits was conducted in four databases. Analysis and synthesis were conducted using Latent Dirichlet Allocation topic modeling. Sixteen studies were included, revealing four key themes regarding the development of palliative care networks in rural areas: community engagement is essential to secure the reach of rural networks, tailored approaches acknowledging diversity enrich these networks, team-centric efforts involving stakeholder coordination ensure successful implementation, and a multifaceted approach-empowering non-traditional stakeholders and incorporating technology resources into primary health services-dynamizes palliative care delivery in rural areas. These findings underscore the potential of collaborative and innovative approaches to enhance the accessibility and effectiveness of palliative care in underserved rural communities. Further cost-effectiveness studies are warranted to better understand the impact these strategies can have on health systems.

AI-enabled sports-system peer-to-peer energy exchange network for remote areas in the digital economy.

In remote areas, particularly in developing countries, there is a growing interest in off-grid solar PV systems for their ability to provide clean and affordable electricity. However, these systems often face limitations in powering essential amenities, including sports facilities, due to restricted capabilities and inadequate battery storage. To address these challenges and promote energy independence, this paper proposes an AI-enabled sports-system peer-to-peer (P2P) energy exchange network within the digital economy. This innovative system leverages AI to optimize energy distribution specifically for sports-related infrastructures, ensuring efficient use of solar power and improved energy availability for both recreational and community needs. The proposed P2P network operates on a three-part Internet of Things (IoT) framework, facilitating automatic energy sharing among interconnected systems. This approach not only enhances the performance of existing solar power setups but also ensures that energy demands for sports facilities are met effectively. Feasibility studies of this system reveal promising outcomes, including a 13.67% increase in community energy independence and a 12.20% reduction in overall energy consumption. The AI-powered sports-system network demonstrates its potential to support sustainable development and improve the quality of life in remote areas by integrating sports and energy needs within the digital economy context.

Blood glucose control among type 2 diabetic farmers in Chinese resettlement areas: a mixed methods study.

BACKGROUND: Due to China's rapid urbanization, many farmers have relocated to urban resettlement regions. There is limited research on the glycemic control of Type 2 diabetes mellitus (T2DM) farmers in these areas. This study examined their blood glucose control and its determinants. METHODS: This study took place from March 2021 to January 2022 in a resettlement community in Yiwu, Zhejiang Province, China. In the first phase, a quantitative survey of 181 T2DM farmers was conducted using a questionnaire to gather demographic data, blood glucose control status, disease cognition levels, and treatment compliance. Inclusion criteria were migrant workers with ≥ 3 months of residence and local household registration and T2DM patients who met the diagnostic criteria of the Chinese guidelines. In the second phase, qualitative research involved face-to-face, semi-structured interviews with 15 patients with varying blood glucose control levels to analyze their experiences. RESULTS: The blood glucose control rate in this particular group was 27.62%, and the average disease cognition score was 2.5 ± 0.75. Many patients (67.96%) had inadequate treatment compliance, specifically in monitoring compliance (4.45 ± 1.92) and regular review compliance (3.58 ± 1.74). CONCLUSION: There is a need for tailored programs to improve glycemic control among resettled farmers. Enhancing disease awareness and treatment compliance through targeted education and support is crucial. Further studies are needed to evaluate different treatment regimens' impact on glycemic control. CLINICAL TRIAL NUMBER: Not applicable.

A Mixed-Method Study of the Utilization and Determinants of Private Health Insurance Schemes in the Residents of Rural Communities in Central India: A Study Protocol.

Background Private health insurance plays a critical role in healthcare financing, yet its utilization and determinants in rural settings still need to be studied, particularly in Central India. This study aims to address this gap by investigating the utilization and determinants of private health insurance schemes among residents of rural communities in Central India. Materials and methods A convergent parallel mixed-method study design, consisting of quantitative and qualitative approaches, will be employed. Quantitative data will be collected through structured questionnaires administered to residents aged 18 and above within the field practice area of a tertiary medical college hospital. Qualitative data will be gathered through in-depth interviews with key stakeholders. Statistical analysis will include descriptive and inferential statistics, while thematic analysis will be employed for qualitative data (CTRI Number CTRI/2024/06/069155). Conclusion The findings of this study will provide valuable insights into the utilization and determinants of private health insurance schemes in rural communities of Central India. By identifying barriers and facilitators to insurance uptake, policymakers and healthcare providers can develop targeted interventions to improve healthcare access and affordability in rural areas. In addition, the study will contribute to the existing literature on private health insurance utilization in India, informing future research endeavors and policy initiatives.

What exacerbates and what eases Chinese rural residents' depression during the COVID-19?

During the COVID-19 pandemic, there has been a growing prevalence of mental disorders, particularly in China, where anti-epidemic measures have been more stringent compared to other countries. This has resulted in a heightened psychological burden on individuals. However, the actual psychological impacts of COVID-19 on Chinese residents have not been clearly established. In this study, we aimed to investigate the effects of various factors, including personal and household characteristics, social networks, and epidemic-related variables (such as rural residents' knowledge of COVID-19 virus transmission and prevention), on rural residents' depression. Using a two-year balanced panel dataset encompassing 152 villages and 676 samples in both 2019 and 2020, we employed the Ordinary Least Squares (OLS) model to estimate the influence of these factors and compare their coefficients to examine the changes in rural residents' depression between the pre-epidemic and during-epidemic periods. Our study highlights significant factors contributing to rural residents' depression during the COVID-19 pandemic, including isolation (2.063, p < 0.01) and concern about COVID-19 infection (0.128, p < 0.05). Conversely, factors such as health status (-0.714, p < 0.01) and the number of friends (-0.017, p < 0.01) were found to significantly alleviate depression among rural residents. Moreover, we identify key moderators that mitigate the negative impact of infection concerns on mental health. Specifically, the health status of rural residents (-0.166, p < 0.01), the size of their family network (-0.036, p < 0.05), and their knowledge of COVID-19 transmission and prevention (-0.184, p < 0.05) significantly moderated the relationship between infection concerns and depression. These findings contribute to a better understanding of the psychological implications of the pandemic and provide valuable insights for the development of targeted interventions to address mental health challenges in rural populations.

Distribution of host-specific Bacteriodales marker genes in water sources of selected rural areas of Vhembe District, South Africa.

Access to safe drinking water sources and appropriate sanitation facilities remains a dream in low and middle-income countries including South Africa. This study identified the origin of faecal pollution by using quantitative polymerase chain reaction (qPCR) targeting host-specific Bacteroidales genetic markers to track the distribution of human-specific (BacHum) and animal-specific (cattle-BacCow, chicken-Cytb, pig-Pig-2-Bac, dog-BacCan) markers in water sources used by rural communities of the Vhembe District Municipality (VDM). Results revealed the prevalence of BacHum, BacCow, and BacCan in all surface water sources in Thulamela Local Municipality (TLM) and Collins Chabane Local Municipality (CLM) during wet (100%) and dry seasons (50-75%). Cytb was not detected in untreated spring water in TLM and CLM, and Pig-2-Bac was not detected in untreated hand-dug well water in TLM during both seasons. Household-level analysis detected Cytb (28.8% wet, 17.5% dry), BacHum (34.4% wet, 25% dry for Pig-2-Bac) in stored untreated spring water in CLM, and Cytb (42.9% wet, 28.5% dry) in untreated hand-dug well water in TLM. Despite differences in detection frequencies of host-specific Bacteroidales, the study highlights the public health concern of faecal pollution in rural VDM households.

Analysis of the Contribution of Home Gardens to Household Food Security in Limpopo Province, South Africa.

Addressing food security is one of the national priorities in South Africa, enshrined under the country's constitution, yet there is a growing percentage of households struggling to meet their food requirements. Food insecurity and malnutrition remain severe problems in rural communities and can be addressed through home gardening. This study aimed to assess the contributions of home gardens to food security in Limpopo Province. This study employed a quantitative research methodology. A total of 2043 rural households were selected using multistage stratified random sampling. The Household Food Insecurity Access Scale (HFIAS) was used to measure household food insecurity levels of home garden participants. Results showed that 46% of participants were food secure, 24% were severely food insecure, 17% were moderately food insecure and 13% were mildly food insecure. The results from the endogenous switching Poisson regression model showed that gender, household size, wage/salary, access to land, agriculture-related assistance and market distance had a positive influence on household food security of home garden participants. On the other hand, employment status and receiving any social relief had a negative association with household food security of home garden participants. The results also showed that employment status had a positive influence on the food security of home garden non-participants, while education, access to land, wage/salary and age had a negative influence. The results from average treatment effects (ATEs) showed that households that participated in home garden production had a negative and significant (p-value < 0.05) impact on household food insecurity. This study concludes that involvement in home gardening improves food security. Household food security can be enhanced through agricultural training and skills enhancement directed at increasing participation in home gardening in rural areas, thus addressing income and food security challenges. Agricultural education needs to be introduced and facilitated at school levels so that an understanding of food systems, nutrition and food security can be attained from younger age groups.

Improving access to cancer care among rural populations in India: Development of a validated tool for health system capacity assessment.

BACKGROUND: Cancer burden in India is rapidly growing, with oral, breast, and uterine cervix being the three most commonly affected sites. It has a catastrophic epidemiological and financial impact on rural communities, the vast majority of whom are socio-economically disadvantaged. Strengthening the health system is necessary to address challenges in the access and provision of cancer services, thus improving outcomes among vulnerable populations. OBJECTIVE: To develop, test, and validate a health system capacity assessment (HSCA) tool that evaluates the capacity and readiness for cancer services provision in rural India. METHODS: A multi-method process was pursued to develop a cancer-specific HSCA tool. Firstly, item generation entailed both a nominal group technique (to identify the health system dimensions to capture) and a rapid review of published and gray literature (to generate items within each of the selected dimensions). Secondly, tool development included the pre-testing of questionnaires through healthcare facility visits, and item reduction through a series of in-depth interviews (IDIs) with key local stakeholders. Thirdly, tool validation was performed through expert consensus. RESULTS: A three-step HSCA multi-method tool was developed comprising: (a) desk review template, investigating policies and protocols at the state level, (b) facility assessment protocol and checklist, catering to the Indian public healthcare system, and (c) IDI topic guide, targeting policymakers, healthcare workforce, and other relevant stakeholders. CONCLUSIONS: The resulting HSCA tool assesses health system capacity, thus contributing to the planning and implementation of context-appropriate, sustainable, equity-focused, and integrated early detection interventions for cancer control, especially toward vulnerable populations in rural India and other low-resource settings.

The impact of Zika emergence in remote communities in northwestern Ecuador.

The Zika virus (ZIKV) epidemic in Latin America (2015-2016) has primarily been studied in urban centers, with less understanding of its impact on smaller rural communities. To address this gap, we analyzed ZIKV sero-epidemiology in six rural Ecuadorian communities (2018-2019) with varying access to a commercial hub. Seroprevalence ranged from 19% to 54% measured by NS1 blockade of binding ELISA. We observed a decline in ZIKV seroprevalence between 2018 and 2019 that was greater among younger populations, suggesting that the attack rates in the 2015-16 epidemic were significantly higher than our 2018 observations. These data indicate that the 2015-16 epidemic included significant transmission in rural and more remote settings. Our observations of high seroprevalence in our area of study highlights the importance of surveillance and research in rural areas lacking robust health systems to manage future Zika outbreaks and vaccine initiatives.

Implementation outcomes from a pilot study of training probation officers to deliver contingency management for emerging adults with substance use disorders.

INTRODUCTION: Emerging adults (EAs) in the criminal legal system are at high risk for substance use and related negative outcomes. EAs also have low levels of engagement in treatment services, a pattern exacerbated for those living in rural communities. This pilot study investigated implementation outcomes of task-shifting an evidence-based substance use intervention, via a developmentally targeted program, provided by probation officers (POs) to selected EA clients. METHODS: Ten POs recruited from two counties in Oregon who provide services to rural clients were trained and supported in delivering contingency management for EAs (CM-EA) to 17 EAs on their current caseloads. The pilot took place entirely during the COVID-19 pandemic. POs submitted session audiotapes and checklists from meetings with participating EA clients and participated in focus groups. EA clients completed baseline interviews and agreed to have their adult criminal records collected. Ten semi-structured interviews were completed with probation/parole administration and staff from four rural counties across three states highly impacted by the opioid epidemic about the barriers and facilitators for delivering a program like CM-EA in their offices. RESULTS: Based on self-reports and observational coding, POs demonstrated fidelity and adoption as they delivered all CM-EA components and engaged in CM-EA quality assurance protocols. Penetration was demonstrated by the selection of EAs reflecting the demographics of their local offices (i.e., White, non-Hispanic, balanced across sex), struggling with polysubstance use, and primarily holding felony convictions. Emerging themes from focus groups and interviews revealed feasibility, acceptability, and appropriateness of CM-EA, including use with clients not currently in the research program and reported intentions to continue CM-EA use. Barriers for future use include those found for the delivery of other programs in rural areas such as resource limitations. CONCLUSIONS: There is initial support for the implementation outcomes related to task-shifting a program like CM-EA to POs, particularly those serving rural clients, to increase access to evidence-based substance use services for EAs. Future research with larger samples and multiple follow-ups will allow for effectiveness testing and further program refinement for this high-priority population.

Indigenous agricultural practices employed by the Vhavenda community in the Musina local municipality to promote sustainable environmental management.

Indigenous knowledge offers insights into preserving natural resources and further contributes towards improving rural livelihoods. Incorporating this knowledge into agriculture can therefore increase acceptance and innovation of sustainable technologies. In support of this argument, rural small-scale farmers have globally proven the significance of indigenous knowledge in the agricultural sector by incorporating their local strategies and practices for both commercial and subsistence agriculture. This article demonstrates the various indigenous farming practices employed by the Vhavenda Community and how these practices promote sustainable environmental management. It reflects the essential aspects crucial to indicating the value of indigenous agriculture. Using a mixed-methods approach, we administered face-to-face structured questionnaires to elderly villagers aged 50 years and above from the study area. Our results revealed various agricultural practices such as crop rotations, polyculture, intercropping, livestock farming, ploughing rituals, water harvesting, and seasonal agriculture. The Vhavenda community incorporates local knowledge, which is unique to these agricultural practices, and uses various strategies which contribute to a sustainable environment within their area. This has, in turn, allowed them to improve their livelihoods, reduce poverty, and provide life sustenance. The study's findings demonstrate the significance of indigenous knowledge in the agricultural sector and rural peoples' efforts towards supportable environmental management. The article therefore suggests that local indigenous knowledge should be understood as a collaborative concept within the agricultural industry. Furthermore, it proposes that stakeholders who influence decision-making and progress in rural communities should consider this knowledge and work together with local inhabitants. Additionally, it advocates for acknowledging the understanding of local indigenous peoples in pursuing sustainable environmental management.

Descriptive analyses of knowledge, attitudes, and practices regarding rabies transmission and prevention in rural communities near wildlife reserves in Uganda: a One Health cross-sectional study.

BACKGROUND: Despite urban (domestic dog) rabies cycles being the main target for rabies elimination by 2030, sylvatic (wildlife) rabies cycles can act as rabies spillovers especially in settlements contiguous to wildlife reserves. Rural communities next to wildlife reserves are characterized by unique socio-demographic and cultural practices including bat consumption, hunting for bushmeat, and non-vaccination of hunting dogs against rabies among others. This study aimed to compare the knowledge, attitudes, and practices (KAPs) related to rabies transmission and prevention in the three districts of Uganda; (1) Nwoya, neighboring Murchison Falls National Park (MFNP) in the north, (2) Kamwenge neighboring Kibaale National Park (KNP), Queen Elizabeth National Park (QENP) and Katonga Game Reserve (KGR) in the west, and (3) Bukedea, neighboring Pian Upe Game Reserve (PUGR) in the east of Uganda. METHODS: A community-based cross-sectional survey was conducted in settlements contiguous to these wildlife reserves. Using a semi-structured questionnaire, data were collected from 843 households owning dogs and livestock. Data were collected between the months of January and April 2023. Stratified univariate analyses by district were carried out using the Chi-square test for independence and Fisher's exact test to compare KAPs in the three study districts. RESULTS: The median age of study participants was 42 years (Q1, Q3 = 30, 52) with males comprising the majority (67%, n = 562). The key findings revealed that participants from the Nwoya district in the north (MFNP) had little knowledge about rabies epidemiology (8.5%, n = 25), only 64% (n = 187) of them knew its signs and symptoms such as a rabid dog presenting with aggressiveness and showed negative attitudes towards prevention measures (15.3%, n = 45). Participants in the Kamwenge district-west (KNP, QENP, and KGR) had little knowledge and negative attitude towards wildlife-human interaction pertaining to rabies transmission and prevention especially those with no or primary level of education (20.9%, n = 27) while participants from Bukedea in the east (PUGR) had remarkedly poor practices towards rabies transmission, prevention, and control (37.8%, n = 114). CONCLUSIONS: Rabies from sylvatic cycles remains a neglected public health threat in rural communities surrounding national parks and game reserves in Uganda. Our study findings highlight key gaps in knowledge, attitudes, and practices related to rabies transmission and prevention among such communities. Communication and action between veterinary services, wildlife authority, public health teams, social science and community leaders through available community platforms is key in addressing rabies among the sympatric at-risk communities in Uganda.

Overdose responses among rural people who use drugs: A multi-regional qualitative study.

BACKGROUND: Efforts to distribute naloxone have equipped more people with the ability to reverse opioid overdoses but people who use drugs are often reluctant to call 911 due to concerns for legal repercussions. Rural communities face unique challenges in reducing overdose deaths compared to urban communities, including limited access to harm reduction services as well as greater concerns about stigma and privacy. METHODS: The Rural Opioid Initiative was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural US communities and consists of eight studies spanning ten states and 65 counties. Each study conducted semi-structured qualitative interviews with people who use drugs to understand contextual factors influencing drug use and health behaviors. We analyzed qualitative data from seven studies with data available at the time of analysis to understand peer response to overdose. RESULTS: Of the 304 participants interviewed, 55% were men, 70% were white, 80% reported current injection drug use, and 60% reported methamphetamine use. Similar to what has been found in studies focused on urban settings, people who use drugs in rural communities use a range of strategies to reverse overdoses, including non-evidence-based approaches. Several reported that multiple doses of naloxone are needed to reverse overdose. Three themes emerged around the willingness to call 911, including (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement. CONCLUSION: People who use drugs employ multiple strategies to attempt overdose reversal, including non-evidence-based approaches. Greater education about the most effective and least harmful strategies is needed. Reluctance to call 911 is rooted in concerns about potential legal consequences as well as perceptions about law enforcement officers, which may be heightened in rural communities where people who use drugs are more easily identified by law enforcement. People who use drugs will go to great strides to connect their peers to needed medical services, suggesting that comprehensive interventions to reduce interactions with law enforcement officers and eliminate legal consequences for reporting overdoses are critical.

Confined within a sugarcane monoculture: A participatory assessment of water pollution and potential health risks in the community of El Tiple, Colombia.

Communities neighboring monoculture plantations are vulnerable to different forms of pollution associated with agro-industrial operations. Herein, we examine the case of El Tiple, a rural Afro descendant community embedded within one of the largest sugarcane plantations in the Americas. We implemented a participatory approach to assess water pollution, exposure via water ingestion, and non-carcinogenic health risks associated with the use of local water sources available to the community. We conducted household surveys to unveil demographic characteristics and family dynamics linked to water consumption. Additionally, we measured water quality parameters and assessed the concentration glyphosate, its major metabolite (aminomethylphosphonic acid) and metals and metalloids. Drinking water El Tiple households is sourced from three primary sources: the local aqueduct system, water delivery trucks, and private deep wells. Tests on water samples from both the local aqueduct and delivery trucks showed no traces of pesticides, metals, or metalloids surpassing regulatory limits set by Colombian or EPA standards. However, we found concentration of contaminants of primary concern, including mercury (up to 0.0052 ppm) and lead (up to 0.0375 ppm) that exceed the permissible regulatory thresholds in water from groundwater wells. Residents of the peripheric subdivisions of El Tiple are four times more reliant on well water extraction than residents of the central area of the town due to lack of access to public drinking water and sanitation infrastructure. Finally, adult women and school-age children have a higher health risk associated with exposure to local pollutants than adult men due to their constant presence in the town. We conclude that expanding the coverage of clean water and sanitation infrastructure to include all households of the community would be the most recommended measure to minimize exposure and risk via ingestion of water pollutants.

Exploring rehabilitation providers' perspectives of assistive technology access after the implementation of a paediatric AT provision program in rural South India.

A paediatric Assistive Technology (AT) Provision Program was implemented by a non-governmental rehabilitation facility in rural South India to support rehabilitation providers in providing needed AT access for children with disabilities. Capacity-building measures for providers and other supports based on the AT needs, barriers, and facilitators to AT access were implemented that aligned with the AT global report for low-middle income countries (LMIC). This study explores how the initiatives from the AT Provision Program have influenced the perspectives of rehabilitation providers on AT access.Using a qualitative design eight paediatric rehabilitation providers were purposively sampled for virtual semi-structured interviews. Findings were analysed using thematic analysis.Six overarching themes were identified: (1) Stigma associated with AT use, (2) Organisational response to changing needs, (3) Financial factors related to family socioeconomic status and the organisation providing AT services, (4) Inequity of AT service access in rural areas, (5) Provider AT awareness and confidence and, (6) Quality assurance. Rehabilitation providers' experiences informed future AT capacity-building strategies within a low-resource context. Our findings provide valuable insights for the development of comprehensive AT Provision Program initiatives to provide AT access for children with disabilities in LMIC settings.

The perspectives of rehabilitation providers in low- and middle-income countries are important to expand the limited research in understanding Assistive Technology (AT) provision in these countries to advance program development and planning.Organized access to AT in rural communities, particularly in developing countries such as India, enables children with disabilities to improve their participation in social, recreational, and educational opportunities.Exploring rehabilitation providers' perspectives gives insight into barriers and opportunities surrounding AT access within their cultural context, and how it influences their clinical practice.Integrating the AT Access Principle framework from the 2022 WHO-UNICEF Global Report on AT, this study evaluates the current AT systems in rural south India and can further inform strategic planning in low-middle income countries to mitigate access barriers encountered along the AT access pathway.

Medical mistrust, discrimination and healthcare experiences in a rural Namibian community.

Substantial evidence indicates that medical mistrust, resulting from experiences with discrimination and marginalisation, is a determinant of health disparities in minority populations. However, this research is largely limited to the US and other industrialised countries. To broaden our understanding of the role of medical mistrust on health-care decision making, we conducted a study on healthcare experiences and perceptions in a rural, underserved indigenous community in northwest Namibia (n = 86). Mixing semi-structured interview questions with the medical mistrust index (MMI), we aim to determine the relevance of the MMI in a non-industrialised population and compare index scores with reports of healthcare experiences. We find that medical mistrust is a salient concept in this community, mapping onto negative healthcare experiences and perceptions of discrimination. Reported healthcare experiences indicate that perceived incompetence, maltreatment and discrimination drive mistrust of medical personnel. However, reporting of recent healthcare experiences are generally positive. Our results indicate that the concept of medical mistrust can be usefully applied to communities in the Global South. These populations, like minority communities in the US, translate experiences of discrimination and marginalisation into medical mistrust. Understanding these processes can help address health disparities and aid in effective public health outreach in underserved populations.

Revealing rural motivations in pharmacy students pursuing a graduate certificate program.

INTRODUCTION: To assist recruitment and retention efforts and influence the need for an increased supply of future rural pharmacists, this study examines perceptions and key motivators of pharmacy students who chose to participate in the Rural Pharmacy Health Certificate (RPHC) program and pursue pathways to rural practice. METHODS: We interviewed six RPHC students prior to or shortly after beginning their first semester in the RPHC program. Interview questions assessed applicants' reasons for pursuing the RPHC, perceptions of living in and providing healthcare in rural and small communities, awareness of barriers and health disparities in rural areas, and qualities needed to be a successful rural pharmacist. We analyzed data with the Sort and Sift, Think and Shift method, a common approach to qualitative data analysis. RESULTS: Interest in pursuing rural pharmacy grew out of growing up in a rural area, as well as a desire to serve and help others. Students expected that completing the RPHC would strengthen their skillsets to provide the best care by addressing barriers such as difficulty accessing care and health literacy. Being a learner of one's community was the primary quality identified as necessary to be a successful rural pharmacist. CONCLUSION: This study identified primary motivators and perceptions that led students to pursue a rural health program at one US pharmacy school. The results can be used to identify and train good candidates for rural pharmacy practice, strengthening the rural pharmacy workforce to better meet communities' needs.