Rural Health Commons^™

Exploring Rural And Non-Rural Disparities In Interpersonal Violence And Help Seeking Barriers Among North Dakota Women, Tahmid Hassan Jeeshan, Ashley K. Fansher

Criminal Justice Posters and Presentations

Interpersonal violence extends beyond physical assault to include psychological and/or emotional abuse that can produce substantial physical and mental health consequences. Unfortunately, rates of violence have not been directly studied among residents of North Dakota. In this study, we compare victimization patterns, treatment seeking behaviors, and barriers to treatment among North Dakotan women. We anticipate that rural victims will report more severe or chronic victimization yet face reduced access to and use of healthcare and victim services. By jointly considering violence type, rural versus non-rural status, and treatment seeking, this project highlights differences between rural and non-rural residents and identifies …

Determinants Of Multimorbidity Among Stroke Patients For Epidemiological Management In Indonesia's Agro-Coastal Communities, Krish Naufal Anugrah Robby, Isa Ma'rufi, Farida Wahyu Ningtyias, Latifatul Izzah, Nurjazuli Nurjazuli, Suhartono Suhartono, Muchlis Achsan Udji Sofro, Ida Srisurani Wiji Astuti, Olivia Listiowati Prawoto, Dedek Sutinbuk, Taufik Kurrohman, Elhoussin Ouassou

Kesmas

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models …

From “Fixer” To “Facilitator”: A Clinical Review Of Shared Medical Appointments As A Strategy For Workforce Sustainability, Barbara A. Slusher

Lynchburg Journal of Medical Science

Clinician burnout remains a significant threat to workforce sustainability, particularly in resource-constrained settings managing complex chronic diseases. While shared medical appointments (SMAs) have demonstrated clear benefits in patient satisfaction and access, their impact on clinician well-being and professional fulfillment is less clearly defined. This review evaluates whether participation in SMAs improves clinician satisfaction and mitigates burnout by facilitating a conceptual transition from isolated “Fixer” to collaborative “Facilitator.”

A targeted literature search of PubMed, the Cochrane Library, and Google Scholar identified peer-reviewed publications examining shared medical appointments and clinician-centered outcomes, including burnout, clinician satisfaction, and workforce sustainability. …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Non-Metropolitan Vs. Metropolitan Variations In Alcohol, Illicit Drug, And Prescription Therapeutic Drug Misuse, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metropolitan (non-metro) than metropolitan (metro) residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.

Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.

Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than …

Sleep Disturbances Affect Sleep Quality Of Hospitalized Adults, Tonjia Hardesty

Dissertations

Abstract

Background: Sleep disturbances affect the quality of sleep hospitalized adults experience, possibly extending patient recovery time. Treatment of insomnia frequently includes pharmacological interventions exposing patients to potential side effects, leading to negative patient outcomes.  The purpose of this project was to determine if a sleep hygiene toolkit including eye masks, earplugs, advocacy cards, and removal of nicotine patches at bedtime would improve patient sleep quality without use of pharmacological interventions.

Methods: A descriptive observational design was used in this quality improvement (QI) project. A convenience sample of 37 (N =37) participants over the age of 18 years and …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Assessing Aflatoxin Knowledge, Perceptions, And Related Practices, In A Rural Coastal Community: A Population-Based Cross-Sectional Survey, Rosebella Iseme, Joseph Abuodha, Anthony Ngugi, Innocent Abayo, Mansoor Saleh

Population Health, East Africa

Background

Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads’ awareness, perceptions, and behaviours related …

Utilizing Remote Patient Monitoring With Dnp Students To Provide Pre-Natal Care, Sara Mccumber

InnovateHER Meeting 2026

This educational project introduced Nurse Practitioners to the use of RPM during pre-natal care for a patient with pre-natal hypertension. Hypertension is a risk factor in 16% of pregnancies and 5-8% of US births are impacted by hypertensive disorders and preeclampsia (CDC, 2023).

Identification and effective management of hypertension in pregnancy recently was an initiative of the Minnesota Perinatal Quality Collaborative (MPQC, 2022).

Exploring Health Insurance’S Role In Chronic Disease Management Among Hispanics, Romelyn Dones

Seton Hall University Dissertations and Theses (ETDs)

This qualitative study examined how insured non-English- and English-speaking Hispanic adults perceive the role of health insurance in the management of chronic disease. Chronic conditions remain a leading cause of morbidity in the United States, and although prior research suggests that insurance coverage improves access to care, it does not always enhance how individuals understand or utilize support for chronic disease management. Limited research has explored how individuals with chronic conditions interpret the role of insurance in their daily self-management practices, particularly among Hispanic populations. Guided by Andersen’s Behavioral Model of Health Services Use, this study explored how contextual, enabling, …

A Quality Improvement Project To Increase Identification And Treatment Of Obstructive Sleep Apnea In Patients With Type 2 Diabetes In A Rural Clinic, Paige Spence

Evidence-Based Practice Project Reports

No abstract provided.

What You Don't Hear About Barriers To Healthcare In The Deaf Community: Analyzing Interpreter Experiences In The Deep South, Ryan Augustine

Honors Theses

Deaf and hard-of-hearing individuals experience significant health disparities in the United States, yet the perspective of the ASL interpreter has remained largely absent regarding the barriers documented in existing literature. This pilot case study examined the barriers Deaf individuals face when seeking healthcare through the unique vantage point of eight ASL interpreters across the Deep South: Alabama, Georgia, Louisiana, and Mississippi. Guided by grounded theory methodology, eight semi-structured interviews were conducted and analyzed to find recurring themes. Findings confirmed and revealed barriers that would not have surfaced without the perspective of the interpreter. Four themes emerged from this study: healthcare …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Evaluating Headache Treatment Efficacy Across Rural And Urban Emergency Departments, Logan Stacey, Alan Sazama, Benjamin Aaker

Scholarship Pathways Program

Evaluating Headache Treatment Efficacy Across Rural and Urban Emergency Departments

Logan Stacey, MD | Alan Sazama, MD, Benjamin Aaker, MD

Introduction: Headaches are a common chief complaint in emergency departments (EDs), with rural patients facing unique challenges such as geographic isolation and limited access to care. This study aims to compare treatment efficacy for this top five ED chief complaints between rural and urban EDs.

Methods: Patients treated for headaches from 2020-2023 were identified using diagnosis codes and electronic health records. Treatment plans and patient demographics were abstracted from identified charts. EDs were categorized as rural (populations under 50,000) or …

Challenges For Older Veterans In Disaster-Prone Rural Areas, Umayma Saifuddin, Joshua Ehrenberg, Elizabeth Tran Phung

Rowan-Virtua Research Day

Purpose: To describe a case in which an elderly veteran was unable to receive necessary health services due to environmental factors and routine natural disaster in his rural coastal town. Methods: A case report is presented. Results: A 95 year-old WWII veteran with a complex medical history and numerous disabilities including hearing impairment, visual impairment, and chronic pain struggles to receive proper care as he lives in a small coastal town. The patient’s son lives an hour away and this area is prone to flooding, making accessing health services extremely challenging. In order to respect the patient’s wishes to remain …

Assessing The Utilization Of Emergency Departments For Primary Care Services In Southern New Jersey, Joshua James Novello, Sheila Joazile, Mohammad Isa

Rowan-Virtua Research Day

Background: Primary care (PC) is essential to proactive, comprehensive, and preventative care that can improve patient outcomes. One-third of emergency department (ED) visits are for non-emergency care that can be appropriately treated by a PC provider. In New Jersey, more than $400 million is spent annually on avoidable ED visits. Decreasing the total PC treatable ED visits per year will improve the quality of care and decrease costs. New Jersey’s PC spending, based on total health spending, is one of the lowest in the country. Demographic and socioeconomic factors in the Social Vulnerability Index (SVI) examine potentially preventable ED …

Barriers To Palliative Care Access In Rural South Dakota: A Policy And System-Level Analysis, Harshavardhan Kadarkaraisamy

Honors Thesis

Palliative care improves the quality of life for people living with serious illness. It helps by addressing symptoms, improving communication, and providing mental, physical, and spiritual support. However, in South Dakota access to palliative care is limited in rural areas. These challenges include geographic isolation, workforce shortages, healthcare infrastructure, reimbursement, and misunderstandings about palliative care. This thesis examines the key policy barriers that limit access to palliative care in rural South Dakota. This work involves engaging with South Dakota-specific literature, rural health research, policy sources, community education, telehealth expansion, and policy reform. By focusing on the rural context of South …

Dfend: A Nutrition Education Intervention To Improve Food Budgeting, Shopping, And Meal Preparation Skills Among Adults In Arkansas, Samantha K. Edwards

Human Nutrition and Hospitality Management Undergraduate Honors Theses

Preventive strategies targeting modifiable lifestyle factors related to food, nutrition, and health are needed as chronic health conditions continue to rise. Nutrition literacy refers to having the knowledge and skills needed to obtain, understand, and apply nutrition information to make informed dietary decisions. Without adequate nutrition education and food security, vulnerable populations are at risk of malnutrition and poor dietary behaviors. Educational interventions that increase food literacy can help improve dietary choices and food selection skills.

The purpose of this creative project was to develop a nutrition education toolkit for Extension agents to implement among rural populations with low health …

Determinants Of Hypertension Awareness And Control In Kenya: A Secondary Analysis Of National Survey Data, Alexander K. Davis

Honors Theses

In low- and middle-income countries (LMICs), cardiovascular diseases (CVDs) are prevalent and pose a major concern as the current healthcare systems are oriented primarily towards communicable diseases. The largest contributor to CVDs, hypertension, is a significant issue in Kenya, a model LMIC. Based on previous studies in this lab, high rates of hypertension are present in the region of Kasigau, Kenya. Kasigau is a small region within Taita-Taveta County, Kenya. Traditional risk factors are not necessarily predictive of hypertension in all regions of Kenya. This study aims to address the lack of tested risk factors for hypertension in Kenya and …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Improving Glp-1 Ra Initiation In Primary Care Through A Paper-Based Clinical Decision Support Tool, Carissa R. Bowery, Karen Carver

Epsilon Sigma at-Large Research Conference

Title: Improving GLP-1 RA Initiation in Primary Care Through a Paper-Based Clinical Decision Support Tool

Authors: Carissa R. Bowery, MSN, FNP-C; East Tennessee State University College of Nursing. Karen M. Carver, PhD, APRN, FNP-C; East Tennessee State University College of Nursing

This quality improvement project focuses on improving evidence-based pharmacologic management of adults with type 2 diabetes mellitus (T2DM) and obesity through implementation of a paper-based clinical decision support (CDS) tool in primary care. The aim is to increase initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among eligible patients and improve provider adherence to current clinical guidelines.

Processes: This …

Medication Nonadherence And Social Participation For African American Adults With Low Vision, Shakeda Mcghee, Mary Jan Greer Phd, Otr, Jaimee Fielder

Spring 2026 OTD Capstone Symposium

The concept of this capstone is to analyze how quality of life (social participation, health management) is affected in adults ages 18-55 with low vision/blindness with conditions to include diabetic retinopathy, glaucoma, and cataracts.

Facilitators And Barriers To Mobile Health Unit Implementation: A Qualitative-Dominant Mixed Methods Study Exploring Staff Perspectives And Service Outreach, Kelsey Hardin

MUSC Theses and Dissertations

Background: Health disparities are linked to rising healthcare costs in the United States, particularly related to healthcare accessibility. Mobile Health Units (MHUs) have proven to be an effective intervention in reducing barriers to healthcare services, for example, providing early access to prenatal care, thus reducing infant mortality rates. This study focused on the facilitators and barriers to implementing an MHU program, based on staff perspectives and service outreach, to improve maternal and infant health outcomes.

Methods: This study employed a qualitative-dominant mixed-methods research design. Data was collected through interviews to assess staff perspectives. Secondary data analysis of quantitative data was …

Healthcare Systems & Policy Implications For The Impact Of State Medicaid Reimbursement Rates On Access To Primary Care Services In Rural Communities: Turning Knowledge Into Action, Miriam Martinez

Posters - 2026

• Where a child lives can determine whether they receive care or go without it. • Access to primary care is essential for prevention, early diagnosis, and treatment, but rural areas face persistent challenges such as provider shortages and geographic isolation. • Medicaid serves as the primary source of health coverage for low-income children; however, reimbursement rates vary by state and are often lower than other forms of insurance. • This study examines how Medicaid reimbursement policy contributes to disparities in access to care for rural children and reflects broader structural inequalities within the healthcare system.

Rural Health In Pike County: A Richard & Magnolia Community Health Needs Assessment, Victoria Bracey

Honors Theses

Rural communities across the United States suffer from poor health outcomes due to lack of resources and other compounding factors that make access to quality healthcare difficult. Mississippi is a predominantly rural state, and in the southwestern region of Mississippi lies the community of Magnolia and the community of Richard within Pike County. To better understand the health needs of Pike County, a community health needs assessment was conducted. This study aimed to assess the needs of Pike County in southwest Mississippi through the use of a community health needs assessment using focus groups. Two focus groups, with a total …

Overcoming Challenges With Rural-Related Health Data: Lessons Learned From Published Studies, Casey P. Balio, Margaret M. Francisco, Nicole Galler, Olivia A. Sullivan, Kate E. Beatty, Michael E. Meit, Chyanne Morrison, Christiana Keinath, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Victimization, Health, And Help Seeking In North Dakota: How Interpersonal Violence Shapes Physical And Mental Health, Tahmid Hassan Jeeshan

Graduate Research Achievement Day Posters

Interpersonal violence extends beyond physical assault to include psychological and/or emotional abuse that can produce substantial physical and mental health consequences. This study examines how multiple forms of interpersonal violence relate to health outcomes among North Dakotan women, focusing on differences between rural and non rural residents. We compare victimization patterns, physical and mental health status, and treatment seeking behaviors. We anticipate that rural victims will report more severe or chronic victimization yet face reduced access to and use of healthcare and victim services. By jointly considering violence type, rural versus non-rural status, health outcomes, and treatment seeking, this project …