The conducting and reporting of rural health research: rurality and rural population issues

Rurality and rural population issues require consideration when conducting and reporting on rural health research. A first article focused on the planning stage of the research. The objective of this article is to explore conducting and reporting issues that require attention when undertaking rural health research. The privacy of participants, the collection of data, the cultural traditions of Indigenous communities, the dissemination of results, and giving something back to the community, are all aspects of conducting and reporting rural health research that require attention. Procedures such as identifying the characteristics of the population, attention to safety issues when collecting data, the use of local liaison persons and acknowledging the ownership of intellectual property, increase the quality of the research outcomes. They are issues that are relevant to both qualitative and quantitative research methods. Procedures are available to address issues of particular concern in developing appropriate methods for rural health research. While we have concentrated on Australian issues, and possible solutions, rural localities in many other countries may face similar issues. In any rural setting, paying attention to issues that may affect the conducting and reporting of rural health research will hopefully result in studies that support the continued improvement of health in rural communities.     

Introductory statement: methodologic issues in population planning

The methodologies used in policy formation, program planning and implementation in the field of population are limited. It is, therefore, difficult to critically analyze the issues in population policy. The inability to develop adequate methodologies is probably due to the inability to rationally define the problem. Nevertheless, until nations consider population planning as a means of controlling the size and distribution of the population, (rather than as a means of accomodating it) methodologies will be of limited use.     

The Australian Rural Health Research Collaboration: building collaborative population health research in rural and remote NSW

The health problems faced by rural and remote communities are complex and not amenable to simple or short-term solutions. The Australian Rural Health Research Collaboration, which comprises rural research centres, area health services and policy makers in NSW, investigates these problems. Founded in 2002, it has grown to become the leading rural research collaboration in Australia. It aims to: conduct high quality research; build the capacity of researchers and clinicians; and encourage the translation of research evidence into practice for the benefit of rural and remote communities. The success of the Collaboration is illustrated by the increase in research outputs, funds generated, the strength of the relationships between partners and the ability to address complex research problems such as the mental health of rural and remote communities often deemed too difficult or expensive to include in metropolitan-based research. Keys to success have been the inclusive public health ethos, the participation of senior researchers and service managers, the critical mass of researchers achieved through collaboration and effective leadership and governance. This demonstrates the value of supporting cooperative research and capacity building in rural and remote areas where the size of research groups is small and where effective multi-disciplinary and co-operative research can pay dividends.     

农村健康问题的文献计量学分析

目的使用文献计量方法,从宏观层面定量分析农村健康主题研究的研究特点,并分析该领域中主要环境危险因素和健康危害的热点研究主题。方法在MEDLINE/Pubmed文献数据库中使用Me SH词"rural health"进行检索,获取农村健康主题的相关文献,下载并定量分析其题录信息和主题词信息。对论文发表年份、发表国家进行词频分析以获得农村健康主题研究的研究特点。选取词频排序前10%的主题词(总计词频占全部主题词词频的85.05%)分析归类至环境危险因素和健康危害。使用主题词共现分析法提炼高频主题词类簇,采用词频标化分析法和回归分析法研究高频主题词的词频分布及变化趋势,以此分析农村环境中主要健康危险因素和健康危害。结果 1948—2013年期间,农村健康研究领域共发表论文20 839篇,发表量呈逐年上升趋势。美国论文发表量占12.16%(2 534篇),我国仅发表相关论文468篇,占2.25%。农村环境危险因素的研究热点为饮水卫生、食品营养、厕所卫生、虫媒暴露、土壤污染、空气污染以及家畜暴露等7方面,主题词水供应、饮食、排泄物、昆虫媒介以及农药等的平均标化频次(NF)较高,依次为2.25%,1.35%,0.78%,0.61%,0.41%,其中饮食、排泄物、昆虫媒介和农药的NF有显著升高趋势(b=0.21,0.16,0.13,0.06,P=0.00)。农村健康危害疾病的研究热点为寄生虫病、呼吸系统疾病、循环系统疾病、精神障碍、性传播疾病、肿瘤、病毒性疾病、妊娠和围产期疾病、口腔疾病、伤害、代谢疾病及营养疾病等12方面,主题词寄生虫病、呼吸道疾病、心血管疾病、精神障碍以及HIV感染等的NF值较高,依次为6.21%,4.47%,2.96%,2.46%,2.33%,其中寄生虫病、心血管疾病、精神障碍以及HIV感染的NF呈显著升高趋势(b=0.97、0.24、0.27、0.79,P=0.00)。结论农村健康问题依旧是全球关注的热点研究领域,我国相关的研究较为薄弱。农村环境危险因素的研究热点集中在饮水卫生、食品营养、厕所卫生等7个方面,健康危害相关的研究热点集中在寄生虫病、呼吸系统疾病、循环系统疾病等12个方面。     

The effects of rurality on mental and physical health

The effects of rurality on physical and mental health are examined in analyses of a national dataset, the Community Tracking Survey, 2000–2001, that includes individual level observations from household interviews. We merge it with county level data reflecting community resources and use econometric methods to analyze this multi-level data. The statistical analysis of the impact of the choice of definition on outcomes and on the estimates and significance of explanatory variables in the model is presented using modern econometric methods, and differences in results for mental health and physical health are evaluated.     

人群健康的城乡差距

该文从横向和纵向两方面考察了人群健康的城乡差距,结果表明,在期望寿命、婴儿死亡率、5岁以下儿童死亡率和孕产妇死亡率等死亡性健康指标上,人群健康存在着持续而显著的城乡差距,但婴儿死亡率和5岁以下儿童死亡率的城乡差距呈现逐渐缩小的趋势。城乡之间的死因顺位出现“趋同”现象,以及患病率城乡差距与主要死亡性健康指标城乡差距之间的“趋异”现象既说明了城乡健康差距的复杂性,也提示了在卫生信息系统中引入人群健康综合评价指标的重要性。     

Being rural in rural health research

This paper explores ways that being from a rural background might influence the health research process and why this might occur. It draws on the research experiences of three 'generations' of rural health researchers to suggest rural background affects how researchers approach and conduct study, and how they interpret findings. Concepts of positionality, habitus, performance and 'othering' are explored to suggest how existing sociological and philosophical ideas can explain why rural researchers possess a particular worldview that may influence their research outputs.     

Recent rural health research

Recent rural health research may be examined in two ways: needs and solutions. A definition of needs requires an evaluation of the social factors that affect the expectations and the behavior of both the provider and the consumer. Three types of solutions should be considered: the appropriate utilization of manpower, including the efforts to influence physician location and specialty distribution, new health practitioners, and team approaches; the new technology for transportation and communication; and the organization of new delivery systems.Two areas of rural health research that need more attention are program evaluation and financial planning.Dr. Wright is a Resident in Community Medicine in the Department of Family and Community Medicine, University of Utah College of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84132.     

Methodological issues of health research

This work aims at presenting a reflection on the method of research in the health field. Some questions are presented which involve the use of the method of natural sciences and that of social sciences in an attempt at understanding some methodological problems concerning the former and the latter. Problems related to the methodological issues in the elaboration of investigation projects in this field and the need for continuous discussion are pointed out as to: the differentiation of the nature of the object of investigation; the context in which a determined problem is identified; the type of question which is asked when it is problematized; technical procedures, the theory and the interpretative scheme on which it is founded; the dichotomy concerning the subject/object of knowledge; the researcher's neutrality; the concept of casualty.     

Strengthening government health and family planning programs: findings from an action research project in rural Bangladesh

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.     

The emergence of rural health research in Australia

ABSTRACT: The late 1980s saw a renewed interest in rural health in its own right with State jurisdictions establishing defined rural health units. There was recognition that health professionals in rural communities often needed training to fulfil their roles in rural and remote communities. Simultaneously, the number of regional universities increased. A number of such universities grouped to form a consortium and were funded through the Australian Health Ministers' Advisory Council (AHMAC) to form the Australian Rural Health Research Institute. Consequently, a series of conferences specifically addressing rural health research needs occurred, and the Australian Journal of Rural Health was established. Through both of these avenues a trend towards more research presentations and publications can be seen. The National Health and Medical Research Council, under the auspices of AHMAC, has provided an overview of the state of rural health research in Australia and developed recommendations, which form the framework for a future strategy for rural health research. These recommendations have been endorsed by AHMAC, which has now funded the initiation of the implementation of the strategy.     

Emerging health issues: the widening challenge for population health promotion

The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability--maintenance of the Earth's ecological and geophysical systems--is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the development, human rights and environmental movements. The big task is to promote sustainable environmental and social conditions that bring enduring and equitable health gains.     

我国农村三级医疗预防保健网的历史沿革和存在问题

通过对我国三级医疗预防保健网的历史沿革分析,三级网存在诸多问题,但国内的各类研究尚缺乏系统性和针对性,对三级网焦点问题把握欠缺,实践探索多于和早于理论研究,存在实践推动理论研究趋向。研究显示县乡村三级医疗防保机构的财政投入呈逐年递减趋势,卫生人力总量不低,但运作效率欠佳,且素质有待提高,农村三级网组织体系呈现网络协调运作功能不佳,趋于解体状况,对于三级网的管理体制改革动向主要有股份合作制和乡村一体化。