Community participation in the recruitment and retention of rural doctors: methodological and logistical considerations

ABSTRACT: Two Queensland rural communities with histories of poor general practitioner (GP) recruitment and retention participated in a process aimed at developing broadly based community action plans to recruit and retain GPs. Despite their very different physical and social characteristics, the two communities developed many similar objectives and strategies, which had the possiblility of being implemented more widely. The community participation process can be both time- and cost-effective if consideration is given to a variety of methodological and logistical issues. The process is a means by which communities, Divisions of General Practice, government, academic institutions and others can work together to recruit and retain medical practitioners.     

Tobacco smoking habits among a cross-section of rural physicians in China

OBJECTIVE: To investigate the prevalence and distribution of tobacco smoking among rural Chinese physicians. DESIGN: A self-reporting survey adapted from previous international studies. Setting: A teaching hospital in Hebei Province, China. SUBJECTS: A complete cross-section of 361 physicians working in all hospital departments. RESULTS: The overall response rate was 79.2%, among whom 15.7% (95% confidence interval (CI) 12.0-20.4) were current smokers and 1.0% ex-smokers (95% CI 0.4-3.1). There were no female smokers when stratified by sex, although the prevalence rate among male physicians was 31.9% (95% CI 24.8-40.0). The prevalence of smoking varied widely by hospital department, ranging from zero in the obstetrics and gynaecology department, to 32.6% in the surgical unit. Smoking rates also varied by age, with physicians younger than 25 years having the lowest prevalence (6.3%). Although they only accounted for 7.1% of the entire group by number, the highest smoking prevalence was seen among physicians aged 50-54 years (31.6%). CONCLUSIONS: Although our study suggests that smoking is an important health issue for rural Chinese physicians, the distribution of risk is not uniform. Future preventive measures will, therefore, need to consider the individual situation of physicians who smoke, particularly those in the older age groups.     

The contribution of occupational therapy to the fabric of Australian rural and remote communities

Social justice has provided a basis for the underlying values of occupational therapy in Australia. In the 1990s, changes in health issues and delivery of services are causing occupational therapists to reconsider their values and the ways they deliver their services. By any measure, the health status of individuals in rural and remote communities of Australia is poorer that their urban counterparts. The issues associated with the poor health status of these communities will best be addressed through a combined strategic approach by governments, organizations and professional groups, including occupational therapy. Identification of some of the key issues affecting the supply of occupational therapists in rural and remote communities and how they might be addressed are discussed. It is proposed that the development of cohesive national strategies and actions aimed at enhancing the contribution of occupational therapy to rural and remote communities ought to include, among other things, adoption of the primary health care approach, fundamental changes in the education and preparation of practitioners for practice, and identification of competencies and standards for effective rural and remote practice.     

Medical students and rural general practitioners: congruent views on the reality of recruitment into rural medicine

OBJECTIVE: In-depth exploration of the perceptions, experiences and expectations of current long-term rural GPs and medical students intent on a rural career, regarding the current and future state of rural medicine. DESIGN: Qualitative study using semistructured interviews. SETTING: Rural and remote towns in Central and Southern Queensland and the School of Medicine, University of Queensland. PARTICIPANTS: Thirteen rural GPs with 10-40 years experience. Medical students (five second- and seven third-year), all of whom are members of a rural students' club and have an intention to pursue rural practice. Interviews were conducted between August and December 2004. MAIN OUTCOME MEASURES: Emergent themes relating to participant perceptions of the current and future state of rural medicine. RESULTS: Despite large differences in generation and experience, medical students and rural GPs hold similar perceptions and expectations regarding the current and future state of rural practice. In particular, they cite a lack of professional support at the systems level. This includes specific support for: continuing medical education to obtain and retain the skills necessary for rural practice; dealing with the higher risks associated with procedural work; and consequences of medico-legal issues and workforce shortage issues such as long hours and availability of locums. CONCLUSIONS: Issues relating to recruitment and retention of the rural health workforce are identified by both cohorts as relating to professional support. Medical schools and institutional support systems need to join forces and work together to make rural practice a viable career in medicine.     

Rural temperament and character: a new perspective on retention of rural doctors

OBJECTIVE: This exploratory study serves as a starting point to establish a psychobiological profile for rural GPs. The overall aim is to describe how individual levels and combinations of temperament (mildly heritable) and character (influenced by sociocultural learning) traits allow GPs to flourish or fail in rural medicine. DESIGN: In a mixed-method study, 13 rural GPs (rural and remote metropolitan areas 5-7, minimum 7 years of experience) from Central/Southern Queensland, Australia completed the Temperament and Character Inventory-R140 to identify the intensity of the seven basic dimensions of temperament and character. These are novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativenes and self-transcendence. Semistructured interviews provided in-depth information on what brought them to and kept them in rural practice. RESULTS: Preliminary results show that our sample of rural GPs are highly self directed, caring, cooperative, objective and persistent. Individual variations occur in the temperament dimensions of harm avoidance, novelty seeking and reward dependence. In particular, GPs who intended to leave rural practice due to dissatisfaction had significantly higher harm avoidance (F = 23.74; P < 0.01) than those GPs intent on staying. CONCLUSION: Although preliminary, triangulation of the data sources provides insight into individual GP profiles regarding which particular combination of traits is most conducive to maintaining a rural career, and might provide a greater understanding of rural doctors. This information could provide a basis for counselling of students with an interest in rural medicine and for informing policy on appropriate initiatives for rural GPs and the communities they serve.     

浙江德清农村社区已婚育龄女性饮茶与贫血的相关研究

目的了解中国浙江农村社区已婚育龄女性贫血状况及饮茶与其关系。方法采用流行病学现况研究设计,整群抽取浙江省德清县4个农村社区,面对面调查上述社区中20～49周岁的社区已婚育龄女性居民1425人。调查内容包括一般情况、健康状况、生活行为方式等。采用氰化高铁法测定血红蛋白。在SPSS11.0中进行数据分析,对于分类变量进行卡方检验;在二分类和多分类Logistic回归模型中检验饮茶与贫血的关联。结果在1425名调查对象中,平均血红蛋白(114.7±17.0)g/L,贫血患病率为63.3%,以轻中度贫血为主,20～30岁组、31～40岁组和41～49岁组的贫血患病率分别为63.5%、63.2%和63.4%,差异无显著性。饮茶者的平均血红蛋白水平高于非饮茶者(t=3.33,P=0.001);饮茶与贫血患病存在统计学关联,饮茶者贫血的校正OR=0.56(95%CI:0.45,0.70),进一步的分析中,饮茶对无论轻度、中度还是重度贫血均有不同程度的保护效应,其校正OR分别为0.57(95%CI:0.43,0.75)、0.57(95%CI:0.43,0.75)和0.28(95%CI:0.11,0.70)。结论转型期的浙江德清农村社区已婚育龄女性的贫血患病率依然较高,饮茶可能与其贫血有一定的关系。     

Going rural but not staying long: Recruitment and retention issues for the rural dietetic workforce in Australia

Aim: To determine the recruitment and retention issues for rural based dietetic services. Methods: A sequential explanatory mixed methods approach was used to examine six case study sites of dietetic practice, in a geographical area covering 30 000 km² in rural New South Wales, Australia. Quantitative data were obtained from document searches of human resource records between 1991 and 2006. Data were tabulated and counts and proportions used. Qualitative data were obtained from in-depth semistructured individual interviews conducted with 40 key informants including past and present dietitians (n = 28), dietetic managers (n = 3), health service managers (n = 6) and other key influencers (n = 3). The interviews were thematically analysed using the NVivo 7 program. Themes were coded into common categories, using a constant comparison inductive approach. Results: Ninety individual dietitians (94% female) were employed across the six sites over 15 years. The majority were new graduates with less than 1 year of experience. Approximately one-third remained in their position for less than 6 months while 32% remained for 2 years or longer. Key themes emerged from the qualitative data around the characteristics of a rural role, line management of dietitians in a rural site and establishing and maintaining rural staff. Conclusion: Recruitment and retention in rural areas may be improved in the future through strategies to reduce perceived professional isolation, improve management support, access to continuing education and the development of career pathways.     

A national survey of adult placement schemes in England: recruitment and retention of adult placement carers

Adult placement (AP) schemes and the carers they support have been, up to now, a largely invisible part of the social care workforce. Carers in particular fail to appear in workforce statistics. They provide a unique form of care to vulnerable people, under-pinned by values of extended family ('kinship') support. Little is known about the range of current activities of AP schemes and the carers they support. This study of AP schemes in England aimed to provide baseline data about the workforce, care provision, qualification levels, training and support issues, and recruitment and retention problems. Questionnaires were sent to all known schemes in England in both statutory and independent sectors. A final database of 130 schemes was compiled and of these, 124 contributed to the survey with complete or partial information. Variables relating to carers, and recruitment and retention problems experienced by schemes were analysed in detail. Age, gender and ethnic profiles of AP carers were described. Anecdotal evidence had suggested that the current regulatory system was leading to a loss of AP carers and/or an increasingly unregulated sector. Results from analyses supported this as the major reason given by schemes for the problems they had experienced in the last 12 months. Estimates of both the current level of registration and the numbers of carers cancelling their registration in the previous 12 months were made. Recently agreed regulatory changes aim to shift the burden of regulation from individual carers to AP schemes, and thereby ensure a consistent standard of assessment, training and support across England. Evidence from the survey provided support for such a move.     

农村育龄妇女避孕套的使用和认知情况调查

目的:弄清农村育龄妇女避孕套的使用和认知情况,为制定有针对性的健康教育提供依据。方法:采用分层-整群抽样抽取农村育龄妇女2 476人,逐人进行问卷调查。结果:农村育龄妇女中1半以上次数性生活时使用避孕套的仅占10.20%,约84.00%的妇女从未使用过避孕套;避孕套相关知识知晓率最高61.26%,最低仅为4.37%,知晓率在有生殖道感染症状者和无症状者之间不存在统计学差异。结论:农村育龄妇女避孕套使用率低,相关知识差,应在进行生殖道感染健康教育内容上重视避孕套的宣传教育。     

Factors affecting the recruitment and retention of pharmacists to practice sites in rural and remote areas of New South Wales: a qualitative study

OBJECTIVE: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). DESIGN: Qualitative semistructured in-depth interviews. SETTING: Primary care--rural/remote community pharmacies. PARTICIPANTS: Purposive sample of 12 community pharmacists. MAIN OUTCOME MEASURES: Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. RESULTS: Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. CONCLUSIONS: This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different individuals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area.     

陪伴者在贫困农村孕产妇健康促进中的效果分析

目的:评价在贫困农村开展妇女孕产期陪伴者活动的效果,探索促进贫困农村孕产妇保健服务的有效方法。方法:采用整群抽样方法抽取云南省祥云县的两个乡,干预乡开展农村孕产妇孕产期营养保健健康教育及陪伴者活动,为每一位孕妇选择1名陪伴者,陪伴者为孕产妇提供孕产期全程支持;对照乡仅开展农村孕产妇孕产期营养保健健康教育。在产后3个月时采用问卷调查及访谈的方式对产妇及陪伴者进行评估,评价健康教育及陪伴者活动开展的效果。结果:干预组产妇的孕产期营养保健知识知晓率高于对照组,产妇孕期营养保健行为较对照组健康;产妇对不同类型陪伴者的满意度评价,婆婆及丈夫最高,母亲次之,村医最低。结论:在贫困农村开展妇女孕产期陪伴者活动,对孕产妇保健起到了一定的健康促进作用,建议将孕产妇陪伴者活动纳入到孕产妇保健管理系统中。     

A scoping review of opioid misuse in the rural United States

Introduction

This study is a scoping review of the original research literature onthe misuse of opioids in the rural United States (US) and maps theliterature of interest to address the question: What does theoriginal research evidence reveal about the misuse of opioids inrural US communities?

2012年新疆农村妇女宫颈癌和乳腺癌筛查项目结果分析

目的：分析2012年度新疆农村妇女宫颈癌和乳腺癌检查结果,探讨新疆“两癌”流行趋势与特点,为在新疆推广筛查工作提供科学依据。方法对筛查项目结果进行描述性分析。结果妇科常见疾病检出患病人数20．1万人（56．10％）,检出率较高依次为塔城地区（74．56％）、阿克苏地区（64．35％）和伊犁州（61．42％）。新疆农村妇女宫颈癌和癌前病变检出率为0．10％,宫颈癌早诊率为85．05％,检出率高的为巴州（0．26％）和博州（0．18％）。妇女乳腺癌检出率为0．05％,检出率高的为吐鲁番地区（0．27％）和克州（0．25％）。结论新疆妇女宫颈癌和乳癌检出率高于全国同期平均水平,加强重点人群“两癌”防治知识健康教育,积极参加“两癌”筛查,是提高“两癌”早诊早治的关键。