Past research advocates the need for long-term care (LTC) facilities to adopt a person-centred model of care to optimize residents quality of life. The construct of quality of life in LTC has been defined by satisfaction with a set of domains identified by Kane and colleagues (2003). One goal of this study was to determine which domain is the most predictive of overall well-being among LTC residents in a rural setting. Based on past research and on Deci and Ryans (1985; 1991) self-determination theory, satisfaction with autonomy was predicted to emerge as most predictive of overall well-being. The present study also examined the relation between resident quality of life and well-being, and the degree of routinization (i.e., adherence to a rigid, inflexible daily schedule) within the LTC environment. Routinization is conceptually at odds with a person-centred model of care, yet its relation to the well-being of care recipients had not been examined prior. One hundred and ninety-eight residents from 15 LTC facilities in rural Saskatchewan participated in individual interviews to measure their satisfaction with 11 quality of life domains (Kane et al., 2003), and their overall well-being (using the Memorial University of Newfoundland Scale of Happiness; MUNSH; Kozma & Stones, 1980). One hundred and thirty-one staff from the 15 facilities completed a questionnaire designed to assess routinization within the LTC environment. Contrary to predictions, autonomy failed to emerge as a significant predictor of overall well-being among sample residents. The domain of meaningful activity received residents lowest satisfaction rating of the 11 domains, and also accounted for the most unique variance in overall well-being. Routinization was negatively related to resident quality of life, with staff rating routinization higher in facilities which residents reported lower satisfaction with quality of life. Results provide focus for improving the quality of life of LTC residents, and point to areas for further study.

Immunization has been used as an upstream, protective measure in public health for decades. Although immunization programs have been introduced in Pakistan, new and emerging infectious disease remains a concern in the country. The province of Sindh, Pakistan is of special concern because of its large rural population.<p>The purpose of this study was to: 1) determine and compare complete and age-appropriate immunization uptake in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1994 and 1997; and 2) determine the correlates of complete and age-appropriate immunization in children 12 to 36 months and birth to 9 months, respectively living in Sindh, Pakistan in 1997.<p>This study reviewed data that was collected as part of the School Nutrition Program (SNP) and Family Health Project (FHP) in 1994 and 1997, respectively. Analyses included immunization data on 1877 children from the SNP survey and 1694 children from the FHP survey.<p>Females were found to have higher statistically significantly age-appropriate uptake than males in 1997 (p=0.015). Complete immunization status was also found to vary significantly by district of residence in 1994 and 1997 (p<0.001). Both complete and age-appropriate immunization status was found to decrease from 1994 to 1997.<p>Multivariable logistic regression revealed that not owning a radio, electricity, or bicycle was indicative of lower odds of complete immunization uptake (OR<1, p<0.05). Other correlates predictive of lower odds of complete immunization included owning a water pump (OR=0.360), not having a Lady Health Worker (LHW) visit the home (OR=0.489), living in a kucha house (OR=0.637), and living in Tharparkar (OR=0.290), Badin (OR=0.599), or Mirpur Khas (OR=0.271).<p>A similar regression analysis revealed childs sex, ownership of a refrigerator, and having heard of contraception to be correlates of age-appropriate immunization (p<0.05). Females had higher odds of age-appropriate immunization (OR=1.851) compared to males. Not having a refrigerator was indicative of lower odds (OR=0.079). Not having heard of at least one type of contraception was a predictor age-appropriate immunization (OR=1.925).

In recent years there has been a renewed focus on reducing the harms of addictive substances such as alcohol while at the same time restraining or reducing health care costs. To address these issues, and many of the existing limitations in the literature, the purpose of this dissertation was to improve our understanding of the geography of alcohol-related harm, and use of primary health care services for alcohol-attributed diseases in British Columbia (BC). To achieve this purpose, there were three research objectives that guided the research that comprises this dissertation: Objective 1: Measure regional variations and trends in primary health care utilization in BC for alcohol-attributed diseases across time (2001-2011) and space (Health Service Delivery Areas) (Studies A & D); Objective 2: Describe primary health care physician experiences treating persons with alcohol-attributed diseases in rural communities that are isolated and sparsely populated with minimal access to secondary or tertiary level services (Study B), and Objective 3: Develop a methodology to describe the geography of alcohol-related harm in BC to identify regions that have populations who may have elevated risk for the development of alcohol-attributed diseases (Study C). Administrative health data were used in Studies A and D to examine trends in health care utilization by persons with alcohol-attributed diseases from 2001-2011 based on disease type and geography (Health Services Delivery Areas). Building on these results, Study B examines family physician experiences treating persons with alcohol-related issues in rural places. To further understand regional variations in alcohol-related issues, an index of alcohol-related harm (Study C) was created using a variety of data that are correlated to alcohol-related problems at the population level, including morbidity, mortality, and alcohol consumption data. The results of this dissertation research highlight regional variations in alcohol-related harm and primary health care use for alcohol-related illnesses – as well as significant growth in alcohol-attributed disease cases in BC since 2001. These findings demonstrate the importance of where we live to risk of developing alcohol-attributed diseases and access to treatment. The results of this dissertation suggest that less populated areas of BC are disproportionately affected by alcohol-related problems and there are additional barriers to care for persons from rural areas. Based on the increasing number of alcohol-attributed disease cases, and the large regional variations in alcohol-related harm found in this project, alcohol-related health problems are an emerging and significant population health challenge for BC. / Graduate

The conceptual orientation of this study was informed by social ecology theory coupled with the concept of rural place, to investigate social processes embedded within the physical, social and symbolic environment affecting the health of rural grandmothers raising grandchildren. A modified grounded theory methodology was used to generate a middle range theory explicating the basic social process of rural grandmother-mothering. The Rural Grandmother-Mothering as Cushioning model explains how the rural place experience of the physical, social and perceptual environmental context influences the health of rural grandmothers raising grandchildren.This research has significance for the scientific community by demonstrating how place is fused with human experiences. Results can inform nursing interventions tailored to the unique social processes in rural settings and designed to promote the health of the increasing numbers of women engaged in grandmother-mothering.

The first twelve months operation of a five-bed rehydration unit at Osindisweni Hospital is described and data related to admissions presented. Osindisweni hospital is situated in a rural area north of Durban and has approximately 300 general beds with 60 000 outpatient attendances per year. A profile of children admitted to this unit was obtained and results are analysed according to the objectives of this study. The main findings of the study showed that 269 children were admitted to the unit during the study year and the majority of children were black African children, below three years of age, coming from rural areas. The children presented with acute diarrhoeal dehydration mostly of mild to moderate degree and were normally managed by oral rehydration therapy. Eighty-four percent of these children were successfully managed on the rehydration unit and only 13,7% received IV fluids. The majority of children requiring transfer to the ward had either persistent dehydrating diarrhoea or other complications such as malnutrition or septicaemia. No child died on the unit and no child died as a result of dehydration but 4 children died later as inpatients on the children's ward. The mortality of children admitted to the unit was therefore 1,5%. One hundred and nine patients were followed up (41,6% of questionnaires) and of these only 76 (69,7%) actually came for review the others presenting for other illnesses or else interviewed on the wards after transfer. However, most of these children had either no or minor complaints on follow up. Seventeen and a half percent of children were below the 3rd centile for age on discharge. Children with marasmus and/or kwashiorkor were not admitted to the unit. The availability of health care was poorly assessed but indicated a general lack of facilities for the rural population served. Also it was noted that the principles of G.O.B.I. had been poorly taught at Osindisweni in the past, particularly growth . charts. Mothers received health education on the unit and were found to have a good understanding of G.O.B.I. after their stay on the unit. On the whole the unit was well accepted by the mothers. It is thought that this short-stay oral rehydration unit offers a more appropriate and more cost effective alternative to previous methods of in-patient management of children with diarrhoeal dehydration and that it offers an excellent opportunity for health education. / Thesis (MMed)-University of Natal, Durban, 1988.

It’s not easy being a pregnant woman in rural British Columbia. With 10–20% annual attrition of family physicians in rural BC, and 17 rural hospitals having ceased maternity care services since 2000, many women lose the ability to deliver in their own community even if local hospitals exist. What are the causes and consequences? We investigated rural maternity care from the perspective of parturient women and care providers. Through a series of interviews and focus groups in 14 communities across BC, we learned about the current state of maternity care in rural BC and investigated how the reduction in maternity care services has impacted women’s lives, physician’s confidence, and community ethos.

This study assesses environmental factors in the exercise and food environment, demographic factors, physical activity behavior, and fruit and vegetable consumption in 26 rural Georgia counties. The purpose of the study is to identify environmental indicators of physical activity and fruit and vegetable consumption; to see what agencies in Georgia, if any, are collecting these types of data systematically throughout the state; and, to analyze potential relationships between environmental factors and health behaviors. Physical activity and fruit and vegetable consumption were derived from the Georgia Behavioral Risk Factor Surveillance System (2001, 2002, 2003, and 2005). Demographic data were from the U.S. Census (2000). Environmental data were collected using Reference USA. Analysis was conducted using Pearson’s correlation (one-tailed). No statistically significant associations were found between the food environment and fruit and vegetable consumption nor the exercise environment and physical activity; suggesting associations found in urban areas may not exist in rural areas. Fruit and vegetable consumption was positively associated with travel time to work (P < .05). Physical activity was positively related to travel time to work (P < .01) and education (P < .05) and negatively related to federal spending per person (P < .05). Findings should improve understanding of the relationship between the environment and physical activity and fruit and vegetable consumption in rural GA. Recommendations for improved data collection and interdepartmental cooperation are made.

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This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice. / Doctor of Philosophy

It is well documented that rural and remote Australian residents have poorer access to medical services than their counterparts in capital cities. According to the Australian Institute of Health and Welfare in 1998 there were 75.3 vocationally registered general practitioners per 100,000 population in rural and remote areas, compared with 103.0 per 100,000 in metropolitan areas. In 1998 28.7% of the Australian population lived in rural and remote areas, so a substantial proportion of the Australian population is adversely affected by the unequal distribution of general practitioners. Australian country communities highly regard the services of general practitioners and they continue to demand residential medical services. Demand is driven by need for access to health services, but also by the intimate inter-relationships between the general practice and community sustainability. For example, the general practice contributes to the viability of the local hospital which is often a major employer in the district. Consequently, many country communities strive to keep their general practice by contributing to practice infrastructure, providing governance, raising funds for medical equipment, and actively helping recruitment. / Thesis (PhDHealthSciences)--University of South Australia, 2004.