Medicine and Health Sciences Commons^™

Finding A Good Fit: Tips On Hiring Rural Personal Assistants, Rayna A. Sage, Krys Standley

Health and Wellness

Living in rural areas means being part of close communities. For people with disabilities in these areas, Personal Assistance Services (PAS) help them live on their own. But finding good PAS workers in rural places can be hard. To help you pick the right PAS worker, we explored what traits make them a good fit.

Project Dig Summary Report, Tracy Boehm Barrett, University Of Montana Rural Institute

Health and Wellness

People with intellectual and developmental disabilities (IDD) are commonly overlooked in society because of a combination of social, economic, political, and cultural barriers. Due to such constraints, they also experience a wide range of health and community disparities that result in negative impact on their quality of life and well-being (Mpofu et al., 2020; Akyurek & Bumin, 2017). While many community-based organizations provide a variety of supports for people with disabilities, far less common are those providing therapeutic horticulture (TH) programs within the scope of their services. This report provides information about and recommendations for TH as an increased practice …

Self-Efficacy, Grit, And Rural Career Aspirations Among Early Career Nurses: A Repeated Cross-Sectional Study, Daniel Terry, Blake Peck, Ed Baker, David Schmitz

Public Health and Population Science Faculty Publications and Presentations

Background Global nursing workforce shortage represents an impediment to the delivery of safe, evidence-based healthcare. Despite collective efforts, a consistent stream of nurses leaving the profession remains, particularly within the first five years of practice, which is exacerbated in rural communities. The aim of the study was to compare self-efficacy, grit, and rural career aspirations among nursing graduates between their second and fourth year of their nursing profession.

Methods As part of a longitudinal investigation, a repeated cross-sectional design was utilised. Participants included, 117 (response rate 52.2%) who completed an online questionnaire 18–24 months after graduating, and 32 participants (response …

Factors Associated With Physical Activity Increases And Decreases Among A Sample Of Appalachian Residents During The Covid-19 Pandemic: A Cross-Sectional Study, Christiaan G. Abildso, Angela M. Dyer, Shay M. Daily, Christa Lilly, Emily A. Sarkees, Samantha I. Moyers, Thomas K. Bias

Journal of Appalachian Health

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic.

Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia.

Methods: Surveys were collected from a convenience sample of adults from eight …

Family Caregivers Of Older Adults With Physical Disabilities In Rural Thailand, Denis Tuttle, Jiranan Griffiths, Anuchart Kaunnil

The Qualitative Report

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers …

A Descriptive And Visual Analysis Of The North Coast Fall Prevention Survey Data, Mishell Lopez

Cal Poly Humboldt theses and projects

Older adults over 65 will double from 52.4 million in 2018 to 94.7 million in 2060. Among this aging group, falls affect one out of four older adults and are a critical economic concern for our American society, with yearly costs of $50 billion. In older adults, falling can result in negative consequences such as fear of falling, injuries, mobility restrictions, and loss of independence. California has one of the highest costs per fall ($4 billion annually) and a high percentage of adults who have fallen (30.6%) compared to the nation. Moreover, two of California’s northwest rural counties, Del Norte, …

Comparing The Impact Of Food Insecurity, Access To Exercise Opportunities, And County Classification On Obesity Rates In Ohio, Ankur Parekh, Deborah Lee

Scholarship in Medicine - All Papers

Objective: We completed a study to determine how food insecurity, access to exercise opportunities, and county classification (rural or urban) impacted obesity rates in Ohio. We hypothesized that the county classification impacted obesity the most followed by food insecurity and access to exercise opportunities.

Methods: We obtained data on food insecurity, access to exercise opportunities, and obesity from County Health Rankings and county classification data from the United States Department of Agriculture Census. We analyzed correlations between obesity and food insecurity and obesity and access to exercise opportunities in both county types. We also analyzed changes in obesity rates in …

Evaluating How Physical Activity Affects The Perception Of Resilience In Box Butte County, Nebraska, Eric Pulver

Capstone Experience

Physical activity is one of the modern hallmarks for good health in individuals and the public, in general. Resiliency is a growing concentration in all levels of disaster preparedness where the focus is on how to deal with the growing number of disasters stemming from global climate change. This research project’s aim is to look at the possible relationships between physical activity and resiliency in a rural Nebraska population. This was done with the use of a cross-sectional study utilizing a fifteen-question survey to gather demographics, assess the amount of physical activity, and then apply a perception of resilience tool …

Telemedicine And Healthcare Implications For Central Virginia: A Systematic Review Of The Literature, Patricia A. Lynch, Charletta H. Barringer-Brown, Daniel N. Brown, Taneisha D. Brown

Journal of Research Initiatives

Background: Uncertainties and challenges associated with COVID-19 have affected the efficient delivery of health care in Central Virginia. Integrating and redesigning health systems could boost the quality and efficiency of care delivery. Telemedicine has been suggested as a viable solution to increase virtual access to patient advocacy healthcare education and training programs and has the potential to help facilitate the delivery of health services to rural and remote areas. It is projected that access to quality telehealth services can minimize the need for in-person hospital visitation amid the pandemic. The innovation also facilitates remote assessment of patients and monitoring of …

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …

Creating Rural Community Outreach Materials Related To Covid-19 And Disability, University Of Montana Rural Institute

Health and Wellness

RTC:Rural researchers led by Andrew Myers present best practices in rural COVID-19 outreach based on feedback from regional rural disability leaders.

They Built My Soul: A Qualitative Analysis Of The Impacts Of Home Repairs In Rural Tennessee, Bethesda O'Connell, Ada Sloop, Nicole Intagliata, Melisa Miller, Megan Quinn

Journal of Appalachian Health

Background: Housing is an important social determinant of health and substandard housing is linked to physical, mental, and social health problems.

Purpose: The purpose of the study was to qualitatively assess the impacts of repairs to substandard housing in rural East Tennessee through twenty-eight interviews.

Methods: Zoom was utilized for recording phone interviews in January– February 2021 and NVivo software was used for thematic analysis in May–July 2021.

Results: Themes that emerged included environmental risk reduction, impacts on physical health, impacts on mental health, impacts on financial well-being, and willingness to receive future assistance from service organizations.

Implications: Further …

Perception Of Health Care Access In Rural Georgia: Findings From A Community Health Needs Assessment Survey, Elisa M. Childs, Tiffany R. Washington

Journal of the Georgia Public Health Association

Background: Limited access to health care services has been cited as a barrier to care for individuals who live in rural areas, contributing to significant health disparities in this population. While perception of services has been cited as a determinant of utilization of health services, it is unknown how perception of services influences health care access in rural areas. The paucity of studies specific to areas in the United States that are medically underserved, necessitated this study and its quantification of the issues that are relevant to individuals living in rural Georgia.

Methods: This study examined the perception of health …

Identifying Factors Associated With Syringe Reuse Among People Who Inject Drugs (Pwid) In Appalachia Kentucky, Grayson Keith Fuller

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: Syringe reuse contributes to the spread of infectious diseases. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs (PWID) in Kentucky.

Methods: PWID (n=238) completed interviewer-administered questionnaires to collect data on syringe reuse and demographic, behavioral, and clinical characteristics. Negative log binomial regression was used to model the associations.

Results: On average, people reused each syringe 9.3 times (median: 3; IQR: 2-10, range 1-95). Syringe reuse was higher among men [aOR=1.386; 95% CI: 1.041-1.845] and those who injected methamphetamine [aOR=2.122; 95% CI: 1.445-3.116]. Reuse was also higher among those who …

Parental Status As A Modifying Factor In Covid-19 Vaccination Status: A Mixed Methods Approach, Mackenzie Carter

All Master's Theses

Introduction: Vaccines are the best protection against COVID-19 and have been proven to be safe and effective. Parental efforts to protect their children by complying with or refusing pediatric vaccinations have previously been studied. However, the author found little research on how parental status affects the vaccination decisions for the parents. Using an explanatory sequential mixed-methods approach and the Health Belief Model, this study examines how parental status influences parental COVID-19 vaccination status. Methods: A local health department conducted a quantitative survey on COVID-19 vaccination attitudes and beliefs from September to October 2021. The COVID-19 vaccination status of parents of …

Improving Access To Medication Assisted Treatment For Opioid Use Disorder In A Rural Emergency Department, Warren Grunvald

Family Medicine Clerkship Student Projects

Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.

Policy Implications Of The Covid-19 Pandemic On Food Security In Rural America: Evidence From Appalachia, Kathryn M. Cardarelli, Emily M. Dewitt, Rachel Gillespie, Rachel Hogg-Graham, Heather Norman-Burgdolf, Janet T. Mullins

Dietetics and Human Nutrition Faculty Publications

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; …

Research Report: Social Isolation And Loneliness Experiences Among People With Disabilities Before And During Covid-19, University Of Montana Rural Institute

Health and Wellness

Increased risk and fear of exposure to COVID-19 may impact social isolation and loneliness among vulnerable populations who are disproportionately at risk of COVID-19 complications, like people with disabilities. In a previous report, research findings showed people with disabilities experienced more than double the rates of social isolation and loneliness compared to those without disabilities before the COVID-19 pandemic. While recent data indicates rates of social isolation and loneliness have increased for the general population with the onset of the COVID-19 pandemic, less is known how rates of social isolation and loneliness have shifted for people with disabilities. Data in …

Social Isolation And Loneliness Among Rural And Urban People With Disabilities, University Of Montana Rural Institute

Health and Wellness

Social connection is the experience of interacting with and feeling connected to other people. A lack of social connections can lead to social isolation and loneliness. Social isolation is an objective measure based on a limited number of social connections. Loneliness is the perception of being isolated or feeling alone. Both social isolation and loneliness are associated with adverse physical and mental health outcomes. Researchers used data from two national surveys to understand the experiences of social isolation and loneliness among people with disabilities. Findings indicate people with disabilities report higher rates of social isolation and loneliness than people without …

Overcoming The Challenges Of Community-Engaged Emergency Referrals In A Rural District Of Pakistan, Imran Naeem Abbasi, Sameen Siddiqi

Community Health Sciences

A functional referral system for addressing health emergencies requires coordinated efforts by health system's stakeholders and the community. Using the Rural Health Programme (RHP) Thatta as a platform provided by an academic institution, district health system stakeholders and the community of Mirpur Sakro, taluka of Thatta, were engaged to strengthen the referral system for health emergencies through active community engagement. Through consultations with stakeholders, a referral system plan was developed with community volunteers from each village as focal persons for transportation, referring patients to health facilities and maintaining referral documentation. The stakeholders' experience and perceptions about the referral system were …

Process Evaluation Of The Early Implementation Stages Of The National Diabetes Prevention Program Through Kentucky Cooperative Extension: Perceptions Of Adopters And Potential Adopters, Nicole Breazeale, Heather Norman-Burgdolf, Katherine Counts, Lovoria B. Williams

Dietetics and Human Nutrition Faculty Publications

With the growing demand for lifestyle change programs that prevent or delay Type 2 diabetes onset, community organizations with broad reach should be explored for national dissemination of the National Diabetes Prevention Program (NDPP). This study evaluates the early implementation of the NDPP through Cooperative Extension in four Kentucky counties and explores the feasibility of scaling up the program to additional counties. Using a qualitative approach, semi-structured telephone interviews were conducted with 12 Family and Consumer Sciences (FCS) Agents – four who were participating in the pilot (adopters) and eight who had no experience with the NDPP (potential adopters). Five …

Use Of Telehealth In Home-Based End-Of-Life Care For Children In Rural Regions, Meaghann S. Weaver

Theses & Dissertations

A national shortage in pediatric-trained providers results in certain geographies, primarily rural, where children with special needs are not able to access home-based care at their end-of-life. Advances in technology have made the use of telemedicine a potential modality for palliative care subspecialty clinicians to provide clinical care and support for adult-trained hospice teams. This dissertation utilizes four approaches to consider telehealth as an unexplored opportunity in care delivery: (1) a systematic review of telehealth measures and instruments to select the Technology Acceptance Model as a validated metric of telehealth acceptance uniquely now applied to pediatric care; (b) a pilot …

People With Disabilities Still At Risk In Congregate Care Settings, University Of Montana Rural Institute

Health and Wellness

This report provides an analysis of data to better understand where cases and deaths are rising in nursing homes as of August 8 2021. We hope this analysis can help support local community planning and networking among rural partners to improve outcomes.

• COVID-19 cases among residents and staff are on the rise in nursing homes with the steepest increases in urban areas and in the South and Midwest.
• Disabled people are disproportionately overrepresented in the resident populations of unsafe congregate settings, such as nursing homes.
• Vaccination rates across both residents and staff in nursing homes have stagnated.
• Policy priorities should …

Exploring Provider Perspectives To Understand How To Best Inform Patients In South Dakota, Isabelle M. Lehman

Honors Thesis

Patients in rural areas are more likely to experience worse health outcomes than patients in urban or suburban areas. The reasons for this discrepancy are multi-faceted, including inequities in resources and access, as well as differences in the environment. Rural providers understand what education and resources patients are missing as they often interact with patients in multiple contexts. We interviewed rural providers and performed an inductive thematic content analysis of the interviews to shed some insight into what information rural patients would need to be better healthcare advocates for themselves. Three themes emerged from the interview data: health education, access, …

Comparison Of Mortality Data From Nebraska’S Rural & Metropolitan Health Districts, Claire Figi

Theses/Capstones/Creative Projects

As there has been minimal research done on the correlation between communities identified as rural or metropolitan and their mortality rates, this research aims to provide baseline evidence that mortality rates associated with non-infectious and infectious diseases are connected to an area’s rural or metropolitan classification. This study analyzed public data from the Nebraska Department of Health and Human Services and the Center for Disease Control to compare mortality rates related to the top two causes of death in both rural and metropolitan health districts of the state of Nebraska, United States. This data was then compared to mortality rates …

America At A Glance: Covid-19 Vaccination Among People With Disabilities, University Of Montana Rural Institute

Health and Wellness

There is a lack of foucs on how people with disabilities are experiencing COVID-19 vaccination efforts. Addressing this knowledge gap is critical to ensuring that people with disabilities are considered as vaccination efforts progress during the ongoing pandemic and future health crises. Overall, 19% of our sample of people with disabilities reported already being vaccinated, 56% wanted to get vaccinated, 10% were unsure, and 15% did not want to be vaccinated. Rural residents with disabilities reported higher rates of current vaccination, but higher rates of overall hesitancy, and more barriers to vaccination than urban residents with disabilities. Political party affiliation …

Patient Recommendations For Providers To Avoid Stigmatizing Weight In Rural-Based Women With Low Income, Declan Watson, Katherine Hughes, Emma Robinson, Jacqueline Billette, Andrea E. Bombak

Journal of Patient-Centered Research and Reviews

Purpose: Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations.

Methods: In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants’ recommendations for …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Development Of A Web-Based Agriculture Health Risk Assessment Tool For Military Veteran Farmers And Ranchers, Alyssa Damke

Capstone Experience

In the U.S., significant health disparities exist among rural populations compared to their urban counterparts. These disparities can be compounded in agricultural workers due to the dangerous and unpredictable nature of their work. Agricultural producers who are also military Veterans may experience additional health pressures that are often overlooked in the healthcare setting. Over 2.5 million Veteran Health Administration (VHA) patients reside in rural areas and the healthcare infrastructure to care for these Veterans may not include an agricultural occupational approach. To address healthcare disparities in Veteran farmers and ranchers, this study, in collaboration with AgriSafe Network, will be used …

Creating Educational Opportunities For Independent Living Through Participatory Curriculum Development: A Toolkit For Centers For Independent Living, University Of Montana Rural Institute

Health and Wellness

This toolkit is an introduction for staff at centers for independent living (CILs) and their community partners who are interested in developing curriculums or trainings that meet the unique needs and goals of Independent Living. It provides instructions and guidance on how to use Participatory Curriculum Development (PCD) to create new ways of supporting Independent Living skills education and development.

This toolkit is for those who can commit to working collaboratively with consumers and other stakeholders to address an Independent Living service gap or training need.