Background: People from rural communities are not spared from COVID-19. But implementing preventive measures and strategies can be made to control the spread. Objective: This study was conducted to describe the epidemiologic situation and the healthcare capacity of the locality, determine the responses and strategies implemented in the control of COVID-19, and explain the activities performed in relation to the epidemiologic situation in Tarangnan, Samar – a low-income class municipality in the Philippines. Methods: A mixed qualitative–quantitative design was employed in this study. Descriptive documentary research design through review of records from March to October 2020 was utilized. For the qualitative context, a case study design was employed whereby focus group discussions and key informant interviews using open-ended questions were performed. Results: A total of 66 individuals were recorded as having COVID-19 in the municipality from March to October 2020. The first recorded confirmed cases of COVID-19 in Eastern Visayas were two adults in Tarangnan, Samar, in March 2020. Since then, additional confirmed cases have been recorded every month, but confirmed COVID-19 dramatically reduced from August to October 2020. Qualitative analysis revealed stringent COVID-19 preventive measures reflected in the confirmed case numbers. The tailwinds of the COVID-19 response include: the SARS pandemic precedent, coordination and communication, outpouring of support from other government and nongovernment partners, and innovative community-based approaches. The headwinds of COVID-19 response were challenges in imposing minimum health and safety precautions, stigmatization, and discrimination. Conclusion Even if challenges have arisen in implementing measures against the spread of the disease, good outcomes have been achieved through persistent good practice, positive modifications, and community-based innovations.
Community Participation ; Community Health Services ; COVID-19 ; Rural Health ; Philippines

Introduction: Despite policy actions and strategic efforts for improving the reproductive and sexual health of adolescents by promoting the uptake of adolescent reproductive and sexual health (ARSH) services, the utilisation rate remains significantly low, especially in rural areas of India. This study aimed to assess the utilisation of these services by adolescents in rural West Bengal and its associated determinants. Methods: This mixed-method study was conducted from May to September 2021 in the Gosaba rural block of South 24 Parganas, West Bengal. Quantitative data were collected from 326 adolescents using a pre-tested structured questionnaire. Qualitative data were collected via four focus group discussions among 30 adolescents and key-informant interviews among six healthcare workers. Quantitative data were analysed using SPSS, while qualitative data were analysed thematically. Results: Ninety-six (29.4%) adolescents had utilised ARSH services at least once during adolescence. The factors associated with non-utilisation of ARSH services were younger age, female sex, increasing reproductive health stigma and decreasing parent–adolescent communication related to sexual health. Qualitative exploration revealed that unawareness regarding services, perceived lack of privacy and confidentiality at healthcare facilities and disruption of services post-emergence of the COVID-19 pandemic were some major barriers to ARSH service utilisation. Conclusion A multi-component strategy, including promotion of adolescent-friendly health clinics, community support interventions associated with motivation and counselling of parents regarding the importance of adolescent reproductive health, is needed to improve the utilisation of ARSH services. Necessary steps to correct the deficiencies at the facility level should also be prioritised.
Adolescent ; Reproductive Health Services ; Sexual Health ; Qualitative Research ; Rural Population

COVID-19 ; Humans ; Rural Health Services ; Rural Population

OBJECTIVES: The Fourth Plenary Session of the 19th Central Committee of the Communist Party of China put forward the idea of "promoting the equalization of basic public services". The utilization of basic public health services by the floating population is an important indicator to measure the equalization of basic public health services. This study aims to understand the intergenerational differences in the utilization of basic public health services between the older generation and the new generation of floating population, and to analyze the influential factors. METHODS: We employed the personal questionnaire (A) of the national health and family planning dynamic monitoring survey on floating population in 2017. Pearson Chi-square test, bi-grouping logistic regression, and Poisson regression were applied to analyze the basic situation of the floating population and the intergenerational differences in the use of basic public health services between the new and old generations. RESULTS: The proportions of the new generation and the old generation who had established the residents' health records in the inflow area were 36.42% and 34.96%, respectively, with the significant difference ( CONCLUSIONS Although the coverage of basic public health services for the two generations of floating population is obviously different, the utilization of basic public health services of the floating population is still at a low level both in the new generation and in the old generation. There is an urgent need to improve the utilization of public health services for the whole floating population according to the characteristics of generations.
China/epidemiology* ; Educational Status ; Health Services ; Humans ; Rural Population ; Urban Population

Objectives: To determine the beliefs and attitudes towards diabetes of rural health care providers in Aklan, Philippines using the Diabetes Attitude Scale 3 (DAS-3) and to determine factors associated with it. Methodology: This is a cross-sectional analytic survey. A total of 339 health care providers were given self-administered DAS-3 questionnaires. Additional data gathered included their age, highest educational attainment, position, municipality class, diabetes as a co-morbidity, attendance to diabetes classes, and family history of diabetes. Results: Rural health care providers showed an overall mean positive attitude score of 3.5 using the DAS-3 questionnaire. In decreasing order, mean scores of participants according to subscale is as follows: “Need for Special Training in Education” (4.13) >“Autonomy of diabetes for patients” (3.70) >“Psychosocial Impact of Diabetes” (3.60) >“Value of Tight Glucose Control” (3.14) and “Seriousness of Type 2 Diabetes” (3.09). Physicians have the highest mean scores consistently in all subscales compared to other health care providers. Among the different factors considered, educational attainment (p=0.005) and work position (p=<0.001) were found out to affect attitude score of health care providers. Conclusions This study has shown that the majority of the rural health care providers believe in the need for special training of healthcare providers, psychosocial impact of diabetes and patient autonomy in diabetes self-care. However, the majority still do not strongly believe in the seriousness of diabetes and the benefits of tight sugar control. Educational attainment and work position are the consistent factors that impact diabetes-related attitude; therefore, the need to strengthen continuous medical education among health care providers
Diabetes Mellitus, Type 2 ; Attitude ; Rural Health Services

To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors.
 Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS).
 Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well.
 Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.
Adolescent ; Ambulatory Care ; economics ; statistics & numerical data ; China ; Healthcare Disparities ; economics ; statistics & numerical data ; Humans ; Hypertension ; therapy ; Insurance, Health ; economics ; statistics & numerical data ; Outpatients ; statistics & numerical data ; Rural Health Services ; economics ; statistics & numerical data ; Socioeconomic Factors ; Urban Health Services ; economics ; statistics & numerical data

BACKGROUND: Despite increasing the number of newly licensed nurses across Korea, shortages caused by geographical imbalances remains a significant concern. Therefore, understanding nursing students' attitudes to working and living, factors influencing where they first choose to work after graduation is useful in formulating appropriate interventions to retain nurses in regional areas. METHODS: A total of 329 senior nursing students from areas outside Metropolitan Seoul completed self-report questionnaires. Data were analyzed using t-test, chi-square test and multiple logistic regression analysis. RESULTS: Of the respondents, 57.8% reported that they planned to work in the region in which their school was located. The three factors ranked as having the greatest influence on their decision to work in non-metropolitan regions were: the cost of living, housing costs, and the proximity to family. Enjoyable aspects of rural life contributed positively to students' intentions to work in non-metropolitan regions, whereas isolation and socialization problems negatively affected their intentions to work in such areas. CONCLUSIONS: Greater consideration should be given to improving working conditions and housing environments in non-metropolitan regions.
Employment ; Hospitals, Rural ; Housing ; Humans ; Intention ; Korea ; Logistic Models ; Nursing ; Seoul ; Socialization ; Students, Nursing ; Surveys and Questionnaires

OBJECTIVE: To explore the influencing factors of elderly outpatient visits and to provide evidence for poverty reduction in health in the poor rural areas. METHODS: Through stratified sampling, a total of 1 271 aged people in four poverty Qi/County of Ulanqabcity were surveyed, including Qahar Right Wing Front Banner, Qahar Right Wing Middle Banner, Qahar Right Wing Rear Banner and Liangcheng County. Their socioeconomic and demographic characteristics, daily consumption, EuroQol five dimensions questionnaire(EQ-5D) and visual analogue scale (VAS),social support, health service needs and utilization were collected through cross-sectional household questionnaires. 1 039 aged people who had experienced physical discomfort in the past 30 days were selected as subjects for the study. The differences between the groups were analyzed by chi-square test. A Logistic regression equation and a decision tree of elderly visits were built to find factors influencing decisionmaking of the aged. RESULTS: The average age of the research subjects was 71.8 years, with 52.2% being illiterate and 85.8% with middle social support. 58.5% of the subjects living with their spouses, mostly living in 15 min medical circle and without any financial support from their children. The 30-day visiting rate when having physical discomfort was 31.0%. The chi-square test showed that the differences in visit rates among age, ethnic, residence patterns, daily consumption index, housing types, social support scores, grown children's economic assistance, travel time to medical institutions, and health self-assessment scores were statistically significant. Compared with Logistic analysis, the decision tree showed lower error rate of classification. Logistic regression model's error rate of classification was 31.4%, showing that the differences in visit rates among age, ethnic, residence patterns, daily consumption index, social support scores, travel time to medical institutions, and health self-assessment scores were statistically significant. The decision tree model's error rate of classification was 28.6%, showing six main influencing factors, including the travel time to medical institutions, cohabitants, education level, age, whether adult children provide economic support and social support score. The importance of these predictors were 0.42, 0.21, 0.13, 0.11, 0.07 and 0.06, respectively. CONCLUSION In poor rural areas, medical resources, economic affordability, family and individual socio-demographic characteristics are the key factors affecting decision-making for the aged. It is necessary to integrate the improvement of the health care of the aged into the overall development of the society. And comprehensive interventions should be adopted to improve the outpatient utilization for aged in poor rural areas.
Aged ; Cross-Sectional Studies ; Decision Trees ; Ethnicity ; Health Services ; Humans ; Logistic Models ; Rural Population ; Social Support ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study is to investigate the influencing factor of the quality of life of the elderly with mild dementia in rural community. METHODS: A total of 123 elderly who were managed by public health center participated. They were diagnosed as mild dementia by MMSE-DS and CDR. Data were collected during the period from May to September in 2017 by a structured questionnaire that included general characteristics, depression, dependence, comorbidity, sleep scale. Data were analyzed by t-test, ANOVA, Pearson's correlation analysis, and multiple regression analysis. RESULTS: The quality of life was correlated significantly with depression. Depression was the factor affecting the quality of life of the elderly with mild dementia in rural community. Depression accounted for 54.0% as a variable of quality of life. CONCLUSION: This study was meaningful in that it directly measured the quality of life of the elderly with mild dementia is known to be difficult to measure and found meaningful results. it is necessary to identify the cause of depression and establish a linkage system between public health centers and health related organizations in the community. We suggest the need for individualized preventive intervention program and integrated psychological health service considering depression.
Aged* ; Comorbidity ; Dementia* ; Depression ; Health Services ; Humans ; Korea* ; Public Health ; Quality of Life* ; Rural Population*

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.
Asian Continental Ancestry Group* ; China ; Cross-Sectional Studies ; Dronabinol ; Education ; Emergency Medicine ; General Practice ; Health Occupations ; Health Policy ; Hospitals, County ; Hospitals, Urban ; Humans ; Models, Theoretical ; Needs Assessment ; Rural Nursing ; Surveys and Questionnaires