Rural and Remote Health is an open-access international academic journal serving rural and remote communities and publishing articles by rural health practitioners, educators, researchers and policy makers.

Australia’s medical workforce problem is primarily one of maldistribution, with both the geographic distribution of doctors and the relative supply of medical specialities not currently meeting the health needs of Australian rural communities. Recent studies from Australian universities that have prioritised recruiting students from the region in which they are located, rather than just the ASGS-RA or MM classifications, have demonstrated promising results for ‘grow your own’ workforce strategies, with students who grew up and also trained in a region being up to 17 times as likely to work in the same region after graduation. With growing evidence supporting strategic ‘grow your own’ approaches to recruiting, training and retaining health professionals from and for underserviced rural communities, there is a need for sound methodologies by which universities with a social accountability mandate can accurately describe their region of rural focus, or ‘footprint’. This Project Report describes the process, outcomes and lessons learned through a project undertaken to formally describe Deakin University’s rural health activity footprint.

COVID-19 was the leading cause of maternal deaths in Mexico and Colombia during the pandemic and many Latin American countries reported disruptions to maternal and newborn services. In Guatemala, only 10% of the population is vaccinated and there are many misconceptions about COVID-19 and the vaccine. More information is needed about misconceptions patients might still harbor about the virus and the vaccine. Lay midwives attend the majority of births in Guatemala, including most births at home, and are in an optimal position to offer front-line support to pregnant women and newborns regarding COVID-19. Lay midwives are a particularly important source of information inrural and Indigenous Mayan populations, which disproportionately suffer poor health outcomes. This Original Research article reports on a program of study that aimed to dispel myths about COVID-19 and provide culturally relevant educational activities to low-literacy Guatemalan lay midwives in Peten, which is the largest department in Guatemala, but among the most remote regions and where >60% of residents live in poverty and lack access to basic health care. 

In Queensland, Australia, people residing in rural and remote locations have poorer access to health care than urban people and nurses working in these settings play a crucial role, often being the first point of contact for people needing care. Although inadequacies in access to, and choice of, maternity care for women living in rural and remote communities have been highlighted in the past, 43% of rural maternity services have closed over the past two and half decades, and remote area nurses (RANs) have been increasingly relied on to provide care to pregnant and labouring women. This Original Research study provides an in-depth description of the lived experience of RANs who care for pregnant women in their role.

Salmonella spp. is one of the most commonly reported causal agents of bacterial gastroenteritis and a leading cause of foodborne outbreaks globally. It has been estimated that 94% of salmonellosis is transmitted via contaminated food of animal origin, such as poultry and pig meat, eggs and milk. Salmonella  enterica subsp. enterica serovar Give is one of the less frequently isolated serotypes in humans. Between 2007 and 2021, there have been 1874 Salmonella ser. Give cases in European Union and European Economic Area countries. This Original Research study investigates an outbreak of Salmonella ser. Give linked to consumption of a local traditional roast pork recipe in September 2022 in southern Greece.

Household food insecurity (HFI) describes inadequate food access, availability, and utilization due to insufficient financial resources and is an important social determinant of health. Other aspects of food security, such as the availability of, and physical access to, healthy foods, are uniquely challenging to achieve in remote regions. This Scoping Review provides a unique global exploration and comment on the literature surrounding HFI in remote and circumpolar remote communities. Through examining initiatives and outcomes that have been conducted to decrease HFI, and factors that contribute, a fulsome picture of the current evidence is created and critiqued. Suggestions both regarding further research, as well as informing current policy based on work done thus far, are made.

Breast cancer is the most common cause of cancer-related deaths worldwide. Regular screening and early diagnosis are vital for reducing breast cancer deaths but, in Turkey, despite a screening program that includes mammography every 2 years for women aged 40–69, 75% of women are unaware of the need for mammography. International studies have found that health literacy is a crucial component in predicting knowledge, awareness and decision-making for breast cancer screening, but there is little knowledge of this issue in rural Turkey, where there are particularly low rates of health service access. This Original Research study uses a survey and face-to-face interviews to investigate health literacy levels and breast cancer screening behaviors in a rural area of Turkey.

Despite its high-achieving health system, universal health coverage and having the world’s highest life expectancy, Japan faces challenges in providing equitable health care to rural and remote populations. Approximately 10% of Japan's population of over 100 million people live in rural and remote areas (mountains, small islands and peninsulas) and its healthcare system is experiencing increasing healthcare costs, physician maldistribution and an entrenched workforce and training culture in which primary care has lacked formal recognition (until recently) as a specialty medical workforce. The Rural Generalist Program Japan (RGPJ) was established in 2017 to support medical training in rural and remote areas. The program is certified by the Australian College of Rural and Remote Medicine (ACRRM) and registrars who complete training and assessment are awarded the Certificate of Completion of Training jointly by ACRRM and RGPJ. This Original Research article presents the views of RGPJ participants, academics and government officials on the future role of rural generalist medicine in contributing to solutions for rural and island health in Japan.

Rural and remote health services face challenges recruiting and retaining allied health (AH) professionals, despite increasing demand for AH services with the expansion of disability and aged care services, increasingly complex health needs and ageing populations. Postgraduate training is one strategy that can be used to develop skills relevant to rural AH roles. The Allied Health Rural Generalist Pathway (AHRGP) is a postgraduate program that includes coursework and work-based projects throughout a program of study with the aim of growing and sustaining the rural and remote AH workforce. Regional Local Health Networks in South Australia introduced the AHRGP in 2019 as a workforce strategy. This Original Research article presents the first evaluation of the resources and outcomes of the AHRGP using a cost consequence analysis approach.

Globally, rural and remote areas are impacted by limited access to highly skilled physicians. Addressing these shortages requires concerted efforts by medical schools to place medical students on rotation within these communities and for medical students to have a positive experience. Positive experiences within rural rotations has previously been found to be an important factor in medical students’ career intentions. This Original Research study, set in Northern Ontario, Canada, explores what rural preceptors believe contributes to positive rural placements for medical students.

Despite educational and policy efforts, the projected healthcare professional shortage in the USA is expected to increase in the coming years, with rural and underserved communities among those that will be most affected. For newly graduated clinicians, the juncture between the conclusion of formal training and initial practice in a rural community is a critical time that influences retention. Particular challenges for new healthcare professionals in rural areas include isolation, inexperience, purpose, and community integration. To that end, Mountain Area Health Education Center developed a Rural Fellowship program with the intention of facilitating both the placement and continued development of recent graduates from family medicine and one clinical pharmacy residency program in rural western North Carolina. This Original Research article outlines promising results from the Rural Fellowship program.

Cultural disruption appears to be particularly important in determining refugee health outcomes. Given that culture can influence pain experience and expression, Western pain management programs may not be meeting the needs of migrant peoples. Nepali-speaking Bhutanese (Lhotshampa) refugees have a multigenerational history of displacement from their homeland and subsequent countries, separation from their families, persecution and torture, malnutrition and poor health. This accumulation of trauma places Nepali-speaking Bhutanese refugees at significant risk of mental and physical ill-health and it is estimated that up to 56% of Nepali-speaking Bhutanese refugees experience chronic pain. This Original Research article reports the results of a qualitative study exploring conceptualisations and beliefs about pain held by the Nepali-speaking Bhutanese community in rural and regional Australia.

Inequitable distribution of allied health professionals (AHPs) affects the delivery of rural healthcare services and the retention of rural healthcare professionals. Models of future supply and demand for rural and urban allied healthcare services predict continued widening of the gap between the number of available AHPs and health care needs in the USA. This Review article identifies literature related to the rural AHP workforce, specifically that assessing demographics and predicted trends, the person factors (cognitive, physical, and psychosocial), and recruitment and retention.

Machado-Joseph Disease (MJD) is the most common spinocerebellar ataxia worldwide and has the highest estimated prevalence in affected Aboriginal communities of the Top End of Australia. MJD, or spinocerebellar ataxia 3 (SCA3), is a genetic disease that leads to loss of coordination of all motor functions, for which there is no cure. Within 5 to 10 years of symptoms first emerging, individuals typically become wheelchair dependent and require full assistance for all activities of daily living and have a mean life expectancy of 20 years from symptom onset. Physical activity programs responsive to the culture and lifestyle of families with MJD, and those with degenerative ataxias more broadly, are scarce in Australia and internationally, despite calls for person-centred rehabilitation programs. For Aboriginal people, and other first Nations people internationally, programs are found to fail when views, lifestyle and concepts of cultural and traditional practices are not taken into account. The ‘Staying Strong Toolbox’ is a physical activity and lifestyle program co-designed by Aboriginal families living in Groote Eylandt and Ngukurr, the MJD Foundation and university researchers. This Original Research article presents the results of a mixed-method multiple case study design to determine the feasibility and impact of the ‘Staying Strong Toolbox’ program on walking and moving around for Aboriginal families with MJD in the Top End of Australia.