Rural Health Commons^™

Pharmacy Access Is Out Of Reach For One In Six South Carolinians, Bryan L. Love Pharm.D., Tessa J. Hastings Phd, Abby Davies

CORE Research Briefs

A cross-sectional geospatial analysis mapped active South Carolina community pharmacies and used 2020 Census tract data to estimate the population residing within and beyond five-mile pharmacy service areas. About one in six South Carolinians lives more than five miles from an active community pharmacy, with limited access disproportionately affecting rural communities.

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 …

Addressing Food Pantry Capacity To Offer Medically Tailored Groceries For Food Insecure Individuals With Chronic Disease In Rural South Carolina, Anna G. Taylor

All Theses

This study examines the feasibility of implementing medically tailored grocery (MTG) programs within rural food pantries in South Carolina to better serve food-insecure individuals living with chronic diseases. Using a mixed-methods design, the study aimed to assess current pantry capacity, identify barriers and facilitators to MTG implementation, and evaluate strategies to strengthen MTG delivery.

The intervention was guided by three implementation science frameworks: the Six-Step Knowledge Sharing Model, the Consolidated Framework for Implementation Research (CFIR), and the RE-AIM evaluation framework. Data collection occurred in two phases. In Phase 1, statewide focus groups, capacity surveys, and inventory assessments were conducted to …

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 …

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).

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.

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 …

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 …

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: …

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 …

Key Predictors Of Postpartum Depression And Anxiety Symptoms Among Mothers In Kilifi, Kenya: A Machine Learning Approach, Faith Benson, Rachel Odhiambo, Willie Brink, Anthony Ngugi, Akbar Waljee, Eileen Weinheimer-Haus, Cheryl Moyer, Ji Zhu, Amina Abubakar

Institute for Human Development, East Africa

Background:

The burden of maternal postpartum depression and anxiety is disproportionately high in sub-Saharan Africa (SSA), yet the use of advanced analytical methods to capture the complex interplay of variables influencing these conditions remains underexplored.

Objective:

To apply machine learning (ML) methods to predict depressive and anxiety symptoms in postpartum mothers and to identify key and actionable predictors.

Methods:

This cross-sectional study included 1,995 biological mothers of singleton infants aged 0–6 months, using survey data collected between March 2023 and March 2024 in Kaloleni and Rabai sub-counties, Kilifi County, Kenya, within the Kaloleni–Rabai Health and Demographic Surveillance …

Social, Environmental And Policy Contexts Affecting The Feasibility And Acceptability Of Improving Household Flooring For Better Health In Rural Kenya, Ulrike Fillinger, Victoria Ochwal, Hugo Legge, Sharon Muli, Karisa Kazungu, Carlos Mcharo, Jacinta Mwongeli, Charles Mwandawiro, Katherine Halliday, Doris Njomo

Institute for Human Development, East Africa

Background Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens.

Methods Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and …

Sexually Transmitted Infections And Screening: An Educational, Evidence-Based, Quality Improvement Bundle, Misty D. White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: With sexually transmitted diseases on the rise in central Texas, advance practice providers were not following evidence-based practice recommendations for sexually transmitted infection screening, treatment, and follow-up. Screening for sexually transmitted diseases occurred at a rate of less than one patient every 7.75 days.

Objective: The objective of this project was to develop and implement an advanced practice provider training tool to educate the clinic providers on sexually transmitted infections, collect pre- and post-data for the educational sexually transmitted infection bundle, and collect sexually transmitted infection screening, identification, treatment, and follow-up data generated by the clinic advanced practice providers …

Child Poverty And Nutritional Health In Rural And Non-Rural Ohio Counties, Viraj Chegu, Macy Puthoff

Scholarship in Medicine - All Papers

Child poverty is an ongoing issue in the United States, placing children at a risk of nutritional deficits. While community interventions and reduced price school lunch programs have improved food insecurity outcomes for children, there is limited knowledge of how these programs can alleviate potential health problems in rural versus urban areas. Thus, this project aims to compare various variables such as food environment index, food insecurity, and enrollment in reduced price school lunch among counties in Ohio of different poverty levels as well as whether the counties are rural or nonrural. Methods: Factors such as food insecurity, food environment …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

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

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Understanding The Impacts Of Food Insecurity On Education Outcomes In Ohio, Maria El Biri, Sreya Tummalapalli

Scholarship in Medicine - All Papers

Background: Food insecurity has been a growing concern in the United States, and prior research has shown how food insecurity in youth can correspond to negative psychosocial outcomes. Additionally, there are known disparities with access to food based on living in rural or urban counties. Objective: The goal of this study was to determine how differences in food security can impact youth educational outcomes in Ohio. Methods: Data from County Health Rankings & Roadmaps were obtained on variables such as access to healthy foods, food insecurity, high school graduation rates, average grade performance, and percentage of the population living in …

Infant Mortality In Ohio, Isabella Bacon, Alexis Jackson

Scholarship in Medicine - All Papers

Introduction: Infant mortality continues to occur at alarming rates that differ among various groups and states. Despite this, there has been a lack of intersectional examination of risk- and protective-factors. Methods: We examine how smoking status, education level, primary care to population ratio, teen birth rates, and urban vs rural status impact infant mortality rates in Ohio, Kentucky, Michigan, and Indiana using County Health Rankings data. Results: Ohio was shown to have no significant difference between urban and rural infant mortality rates; however,  risk-and-protective factors did differ. In urban counties, high school completion, teen birth rates, and primary care ratios …

Primary Care Access And Preventable Hospitalizations: A Multi-Variable Analysis Of Medicare Populations In California (2022–2025), Mariam Shenouda, Suchetha Shashi

Scholarship in Medicine - All Papers

Background: Based on prior literature, limited access to primary care has been linked to higher preventable hospitalization rate. Particularly, rural communities often face physician shortages, contributing to disparities in health outcomes. Objective: To understand the relationship between primary care access and preventable hospitalization rates among medicare populations in California. Methods: The data was gathered from County Health Rankings & Roadmaps for 56 California counties, excluding Sierra and Alpine. This study used unpaired t-tests to determine the difference in the PCP ratio and preventable hospitalization rate between rural and urban counties in California in 2025. A paired t-test was performed to …