Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related in？uencing factors

Objective：To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables.Methods：A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities.Results：The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and100.25±22.56,respectively.Both of these scores significantly differed by age,education level,marital status,and income（P 〈 0.05,P 〈 0.01）.Self-care capability was correlated with health value（r=0.521）.A multivariate linear regression analysis showed that health value,marital status,and age predicted selfcare capability.Conclusions：Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities.The self-care capabilities of the elderly can be enhanced by improving their health value using the ＂knowing-trusting-acting＂ model.

Factors affecting access to primary health care services for persons with disabilities in rural areas:a“best-fit”framework synthesis

Background:Access to primary health care(PHC)is a fundamental human right and central in the performance of health care systems,however persons with disabilities(PWDs)generally experience greater barriers in accessing PHC than the general population.These problems are further exacerbated for those with disabilities in rural areas.Understanding PHC access for PWDs is particularly important as such knowledge can inform policies,clinical practice and future research in rural settings.Methods:We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally.Using an adapted keyword search string we searched five databases(CINAHL,EMBASE,Global Health,Medline and Web of Science),key journals and the reference lists of included articles.We imported the articles into NVivo and conducted deductive(framework)analysis by charting the data into a rural PHC access framework.We subsequently conducted inductive(thematic)analysis.Results:We identified 36 studies that met our inclusion criteria.A majority(n=26)of the studies were conducted in low-and middle-income countries.We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors;availability,acceptability,geography and affordability.In particular,limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care.The barrier of geographic distance was worsened by transportation problems.We also observed that where health services were available most people could not afford the cost.Conclusion:Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings.We also made recommendations for policy development,practice consideration and future research that could lead to more equitable access to health care.Importantly,there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions.In terms of practice,the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs.Future research should focus on exploring access in geographical contexts with different health care systems,the perspectives of health care providers and how PWDs respond to access problems in rural settings.

Investigation and Countermeasures on the Health-Promoting Lifestyle of the Disabled Elderly in a Rural Area

Objective： To investigate the level of health-promoting lifestyle in the disabled elderly in a rural area and to provide useful countermeasures for health care workers and the government to improve the elderly＇ s lifestyle behaviors. Methods： A total of 446 disabled elderly people were recruited and examined using the General Questionnaire and Health-Promoting Lifestyle Profile II. Results： The mean score of the health-promoting lifestyle was 109.73（ SD = 16.80）, in which 90.6 percent of the disabled elderly demonstrated unhealthy lifestyle behaviors. The average score for each of the subscales includedthe following： interpersonal relations, stress management, nutrition, self-actualization, health responsibility, and sports activity. Conclusions： The health-promoting lifestyle of the disabled elderly needs to be improved; health care workers and the government should pay more attention to the countermeasures that can improve the lifestyle behaviors and promote the health of the disabled elderly.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Quality assessment of the practice of focused antenatal care (FANC) in rural and urban primary health centres in Ekiti State

Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and challenges to the practice of FANC in urban and rural areas. Design: Cross sectional. Setting: Primary Health Centers Participants: Pregnant women and Heads of health facilities. Methods: Two hundred respondents each from urban and rural areas primary health centres were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package. In-depth Interviews were conducted with the heads of selected facilities. Data was analysed using descriptive statistics and Chi square test and content analysis for indepth interview. Results: More respondents 58 (29.3%) from the urban areas had the minimum contents compared to 41 (20.7%) of the rural respondents (p < 0.05) and 178 (90.8%) of the urban were taught a range of health education topics compared to 177 (88.5%) (p = 0.45). Urban respondents were about 1.6 times more likely to receive the minimum contents than rural respondents. In-depth interview results explicated the facilitating factors and challenges to focused antenatal care in the study areas. Conclusion: The findings of this study is consistent with other studies establishing the fact that better health service is available to urban residents than rural residents;however, this study has succeeded in comparing the documented standard of antenatal care with what was being practiced in the selected PHCs of the state. The basic contents of focused antenatal care in Ekiti state were received by a small proportion of the respondents, suggesting that focused antenatal care had not fully translated into quality service;one major challenge to the delivery of standard antenatal care was inadequate number of skilled health workers especially in the rural areas. The gap between quality and utilisation of antenatal in urban and rural areas is gradually being closed up;this success should be improved upon and maintained.

Impact of Village-based Health Education of Tobacco Control on the Current Smoking Rate in Chinese Rural Areas

The number of smokers in Chinese rural areas is more than 200 million, which is twice that in cities. It is very significant to carry out tobacco control interventions in rural areas. We performed this community intervention study to evaluate the efficacy of village-based health education of tobacco control on the male current smoking rate in rural areas. The population of this study was the males above 15 years old from 6 villages in rural areas. The villages were randomly assigned to intervention group or control group（3 villages in each group）. Self-designed smoking questionnaire was applied. The intervention group received the village-based health education of tobacco control for one year. The primary outcome measurement was the male current smoking rate. In the baseline investigation, completed surveys were returned by 814 male residents from the control group and 831 male residents from the intervention group. The male current smoking rate in the control group and the intervention group was 61.2% and 58.5%, respectively, before intervention. There was no significant difference between these two groups（P〉0.05）. After one-year intervention, the current smoking rate in the intervention group（51.2%） was significantly lower than that in the control group（62.8%）（P〈0.001）. Our study suggested that the village-based health education of tobacco control was effective in lowering the male current smoking rate in rural areas, which could be a suitable and feasible way for tobacco control in the Chinese rural areas.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Health and Environmental Hazards of Residential Coal and Biomass Fuel Burning in Rural Areas

Recent years have witnessed growing concern over regional atmospheric pollution in China. After the introduction of the Environmental Protection Law on January 1, 2015, governments at both central and local levels have begun to enforce a series of stricter control measures. As a result, it is expected that pollution caused by large energy-consuming sectors such as power。

Going the Distance A telemedicine company uses technology to meet Africa’s rural medical needs with prime health care

We have a scarcity of health care professionals in the rural areas and therefore we can offer medical services from a distance to the underserved rural population.

Effects of livestock and poultry breeding pollution on health risks:Evidence from a hog breeding case in rural China

With the rapid development of livestock and poultry breeding industries,pollution problems caused by the discharge of wastewater and manure have become increasingly severe.However,studies on the impacts of this pollution on rural residents'health are lacking.Based on data from the Peking University's China Family Panel Studies in 2010 and 2014,this paper uses a cross-sectional and panel data probit model to estimate the probability of breeding industry development in rural areas increasing the health risks of local villagers.First,the study found that the more households engaged in breeding in the region or the larger the scale of regional breeding,the higher the health risks to local villagers,particularly in areas where pigs are raised.Second,compared with individual farming,the greater the proportion of large-scale farming,the higher the health risks to villagers.Third,the development of the breeding industry seldom includes the ecological recycling of wastes and fails to reduce the use of local pesticides and fertilizers,thereby increasing the health risks to villagers.Therefore,this paper argues that providing technology to process breeding industry waste and establish an organic industrial production chain will be crucial to reducing the impact of breeding industry pollution on human health.

Equity of Accessibility to Health Care Services and Identification of Underserved Areas

Characterizing the availability of opportunities to residents has been a long-term aim in health care geographic investigation.It is important to measure the degree of inequity in health care accessibility and to identify underserved areas, due to the uneven distribution of health care services. In this study, JavaScript was used to calculate travel time based on Amap, as this can provide a more reliable data support to measure the health care accessibility in Xi’an communities, China. Based on the overall equity, herein, an attempt was made to quantify the equity of health care accessibility, and to identify health care underserved areas inside the different communities. Results show that the accessibility to low-level health care services is high in the northern areas and low in the southern areas, while the accessibility to high-level and comprehensive health care services shows a clear core-periphery spatial structure. Moreover, the overall equity of the health care accessibility is relatively low, and the inequity of high-level health care accessibility is further aggravated.Furthermore, the quantified equity of accessibility to high-level and comprehensive health care services in the central urban areas is better;however low-level health care services are relatively inadequate. There are significant differences among health care underserved areas, in particular, for the worst equity and the lowest accessibility areas(A1) and the worse equity and the lowest accessibility areas(B1) in high-level underserved areas. Notably, the sharing of health care services and the reasonable flow of health technical personnel among different levels of health institutions can make the high-level health care services in the central urban areas have a greater trickle effect on the surrounding areas.

Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review

This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: “urban”, “rural”, “comparison of community”, “elderly health”, and “comparison of community health”. A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.

Extension for Community Health Outcomes-hepatitis C:Small steps carve big footprints in the allocation of scarce resources for hepatitis C virus treatment to remote developing areas

Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.

Qualitative Rural Indonesian Study of Diabetes Knowledge, Health Beliefs, and Behaviors in Type 2 Diabetes Patients

This study was aimed at understanding diabetes knowledge, health beliefs, and behaviors among type 2 diabetes patients in Balinese rural areas. The study used the Health Belief Model (HBM) in applied thematic analysis. It involved semi-structured focus groups with 20 patients (M = 49.95 years old, SD 6.7). Three themes formulated: poor diabetes knowledge, diabetes perceived as a life burden, and the factors affecting self-efficacy in practicing healthy lifestyle. The poor diabetes knowledge was due to traditional indigenous beliefs and low health literacy. The perception that diabetes is a life burden was related with physical and psychological condition. The factors affecting the self-efficacy were the perceived barriers and external influence. It is need to understand the traditional indigenous beliefs, burdens, and lacking internal intention as the modifying factors of health beliefs. This study suggests that the development of integrated health promotion of diabetes should consider the HBM’s modifying factors in rural areas.

Role of Community Health Practitioners in National Development: The Nigeria Situation

This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.

Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service:A pilot study

Objectives:Little is known about the differences between urban and rural gamblers in Australia,in terms of comorbidity and treatment outcome.Health disparities exist between urban and rural areas in terms of accessibility,availability,and acceptability of treatment programs for problem gamblers.However,evidence supporting cognitivebehaviour therapy as the main treatment for problem gamblers is strong.This pilot study aimed to assess the outcome of a Cognitive-Behavioural Therapy(CBT)treatment program offered to urban and rural treatment-seeking gamblers.Methods:People who presented for treatment at a nurse-led Cognitive-Behavioural Therapy(CBT)gambling treatment service were invited to take part in this study.A standardised clinical assessment and treatment service was provided to all participants.A series of validated questionnaires were given to all participants at(a)assessment,(b)discharge,(c)at a one-month,and(d)at a 3-month follow-up visit.Results:Differences emerged between urban and rural treatment-seeking gamblers.While overall treatment outcomes were much the same at three months after treatment,rural gamblers appeared to respond more rapidly and to have sustained improvements over time.Conclusion:This study suggests that rural problem gamblers experience different levels of co-morbid anxiety and depression from their urban counterparts,but once in treatment appear to respond quicker.ACBT approach was found to be effective in treating rural gamblers and outcomes were maintained.Ensuring better availability and access to such treatment in rural areas is important.Nurses are in a position as the majority health professional in rural areas to provide such help.

Effects of a Stress Management Program Based on Psychological Risk Factors of Cardiovascular Disease after Retirement in an Underpopulated Area: A Pilot Study

Background: To develop an effective health education program to prevent cardiovascular disease in middle-aged residents after retirement in underpopulated areas, we explored the effects of a stress management program based on the type A behavior pattern. Methods: This study was carried out in a rural city in Japan recognized as underpopulated and participants were civil servants aged 45 - 64 who joined a stress management program offered as part of staff training. Learning materials for the program were developed based on the type A behavior pattern. Measures for the impact evaluation were Bloom’s learning domains and stage of change for stress management practice. Measures for the outcome evaluation were KG’s Daily Life Questionnaire (KG Questionnaire), the Hospital Anxiety and Depression Scale (HADS) and the Framingham 10-year cardiovascular risk score (CVD risk score). We statistically analyzed changes in each item between time points. Results: Eighteen participants completed questionnaire surveys at pre-, post-, and 4 weeks post-program and eleven had complete blood pressure and weight measurements at pre- and post-program. In the impact evaluation, the Friedman test found significant differences between the three time points in all of Bloom’s learning domain scores and stage of change for stress management. In the post hoc analysis, a significant increase was seen between pre- and post-program and between pre- and 4 weeks post-program in cognitive domain score, psychomotor domain score and stage of change for stress management. In the outcome evaluation, a significant decrease in systolic blood pressure was seen between pre- and post-program. Conclusion: The present study suggested that a stress management program using learning materials based on type A behavior could promote stress management practices and reduce the risk of cardiovascular disease. This stress management program is expected to be useful as a health promotion activity for middle-aged residents after retirement in underpopulated areas.