Multiskilling: What Does It Mean For Rural Allied Health?

ABSTRACT: The apparent negativity of allied health professionals towards the term 'multiskilling' can be explained by examining its emotive connotations. Many allied health professionals fear that multiskilling implies one of the following: extension of an already overutilised allied health professional's duties and allied health skills are subsumed and performed at an unsatisfactory level by other health workers; or proposals to train substandard multipurpose practitioners. Allied health professionals need to establish a personally relevant, positive definition of multiskilling which is cognisant of acceptable service delivery models and the advanced competencies required for effective rural practice. Appropriate training must advance alongside continuing agitation for an improved, integrated infrastructure of personnel and services.     

Midwives' Cell Phone Use and Health Knowledge in Rural Communities

This study developed and tested a theoretical model that explains the underlying process through which the use of cell phones can facilitate the capacity of community health care workers in developing regions. On the basis of a study conducted on 223 midwives in rural regions of Indonesia, the results showed that cell phone use was positively associated with midwives’ access to institutional and peer information resources. Access to institutional resources was positively associated with midwives’ health knowledge. Further, access to peer resources was associated with higher self-efficacy, which was positively associated with health knowledge. The study provides implications for technology intervention strategies targeted to community health workers in rural communities.     

Understanding the Business Case for Telemental Health in Rural Communities

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment.     

自我依靠策略在农村社区妇幼健康教育中的应用

云南是一个边疆少数民族聚居的省份 ,在这里聚居着 52个少数民族 ,云南独有民族就有 2 5个。山区、半山区占全省面积的 94% ,贫困县占全省总县数的 57%。山多、民族多、贫困面大、交通不便、经济文化落后是云南的现状。 1 997年中国与加拿大国际开发署合作的妇幼卫生保健项目正式启动 ,确定了少数民族聚居的边远而闭塞的 1 0县为项目县。据调查 ,这几个县孕产妇儿童死亡的原因主要包括 :产科出血、小儿肺炎、腹泻、营养不良等引起的感染 ,而这些则是可以通过及早预防或是及时的救治的。由此可见 ,农村群众不仅仅是经济贫困 ,更贫困的是缺乏…     

Recruiting and Retaining Mental Health Professionals to Rural Communities: An Interdisciplinary Course In Appalachia

CONTEXT: Faculty from 5 disciplines (health administration, nursing, psychology, social work, and special education) collaborated to develop and teach a distance-learning course designed to encourage undergraduate and graduate students to seek mental health services employment in rural areas and to provide the skills, experience, and knowledge necessary for successful rural practice. METHODS: The primary objectives of the course, developed after thorough review of the rural retention and recruitment literature, were to (1) enhance interdisciplinary team skills, (2) employ technology as a tool for mental health practitioners, and (3) enhance student understanding of Appalachian culture and rural mental health. Didactic instruction emphasized Appalachian culture, rural mental health, teamwork and communication, professional ethics, and technology. Students were introduced to videoconferencing, asynchronous and synchronous communication, and Internet search tools. Working in teams of 3 or 4, students grappled with professional and cultural issues plus team process as they worked through a hypothetical case of a sexually abused youngster. The course required participants to engage in a nontraditional manner by immersing students in Web-based teams. FINDINGS: Student evaluations suggested that teaching facts or "content" about rural mental health and Appalachian culture was much easier than the "process" of using new technologies or working in teams. CONCLUSIONS: Given that the delivery of mental health care demands collaboration and teamwork and that rural practice relies increasingly more on the use of technology, our experience suggests that more team-based, technology-driven courses are needed to better prepare students for clinical practice.     

Family Perspectives on Pathways to Mental Health Care for Children and Youth in Rural Communities

CONTEXT: There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem. PURPOSE: This study examines issues of access to mental health care for children and youth in rural communities from the family perspective. METHODS: In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders. FINDINGS: Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-à-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews. CONCLUSIONS: The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.     

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

CONTEXT: Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. PURPOSE: This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services. METHODS: Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities. FINDINGS: Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P =.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P =.014). CONCLUSIONS: The introduction of telemedicine into rural communities is associated with increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.