Browsing by Subject "Rural"
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Item Art Therapy Treatment Model for Rural LGBTQ+ Emerging Adults(2020) Kimbrough, Libby; Leigh, HeatherLGBTQ+ individuals living in rural areas who are aging into adulthood face specific challenges, such as isolation, discrimination, bullying, and hate crimes, leading to mental health issues that often go untreated due to lack of services, stigma, fear of being outed, as well as distrust of mental health clinicians. Art therapy is an emerging treatment modality that may help to address these barriers to treatment. An integrative literature-based review was conducted to study the treatment needs of LGBTQ+ rural emerging adults in order to design a model for an art therapy program for queer emerging adults in rural communities. Created from an antioppressive perspective, the model focuses on using art therapy with clients to assist them in building and exploring their identity, empowering them in the face of discrimination, and decreasing isolation through a therapeutic group experience. The model may also serve to train and educate clinicians to treat this population ethically.Item Assessing the acceptability and feasibility of remote spirometric monitoring for rural patients with interstitial lung disease: a multimethod approach(Springer Nature, 2024-02-20) Boente, Ryan D.; Schacht, Sydney; Borton, Rebecca; Vincent, Joseph; Golzarri‑Arroyo, Lilian; Rattray, Nicholas; Medicine, School of MedicineIntroduction: Interstitial lung disease encompasses a group of rare lung conditions causing inflammation and scarring of lung tissue. The typical method of monitoring disease activity is through pulmonary function tests performed in a hospital setting. However, accessing care can be difficult for rural patients due to numerous barriers. This study assesses the feasibility and acceptability of home spirometry telemonitoring using MIR-Spirometers and the patientMpower home-monitoring platform for rural patients with interstitial lung disease. Methods: Unblinded, uncontrolled, prospective, multiple-methods study of the feasibility and utility of remote monitoring of 20 rural subjects with interstitial lung disease. Study assessments include adherence to twice weekly spirometry for 3 months in addition to mMRC dyspnea and EQ-5D-5L health-related quality of life questionnaires with each spirometry maneuver. Upon completion, subjects were encouraged to complete an 11-question satisfaction survey and participate in semi-structured qualitative interviews to further explore expectations and perceptions of rural patients to telehealth and remote patient monitoring. Results: 19 subjects completed the 3-month study period. Adherence to twice weekly spirometry was mean 53% ± 38%, with participants on average performing 2.26 ± 1.69 maneuvers per week. The median (Range) number of maneuvers per week was 2.0 (0.0, 7.0). The majority of participants responded favorably to the patient satisfaction survey questions. Themes regarding barriers to access included: lack of local specialty care, distance to center with expertise, and time, distance, and high cost associated with travel. Remote monitoring was well perceived amongst subjects as a way to improve access and overcome barriers. Conclusions: Remote spirometry monitoring through web-based telehealth is acceptable and feasible for rural patients. Perceived benefits include overcoming access barriers like time, distance, and travel costs. However, cost, reimbursement, and internet access must be addressed before implementing it widely. Future studies are needed to ensure long-term feasibility and to compare outcomes with usual care.Item Clinical Features and Outcomes of Patients with Idiopathic Inflammatory Myositis-Associated Interstitial Lung Disease in Rural Appalachia: A Cross-Sectional Study(MDPI, 2024-02-25) Deepak, Vishal; Buragamadagu, Bhanusowmya; Ul Jannat, Fnu Rida; Salyer, Rachel; Landis, Ty; Kaur, Sayanika; Balakrishnan, Bathmapriya; Medicine, School of MedicineBackground: Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders often complicated by interstitial lung disease (ILD). The clinical characteristics and outcomes of IIM-associated ILD have been reported variably, but the literature on rural populations is scarce. Methods: A retrospective cross-sectional study was conducted at a rural tertiary academic medical center. Twenty-nine patients met the final inclusion criteria. The primary outcome was to assess the disease state and immunological and radiographic features of IIM-associated ILD. Secondary outcomes included disease progression, ILD exacerbation, mortality rate, and factors associated with poor outcome. Results: Dermatomyositis (n = 15, 51.72%) followed by polymyositis (n = 8, 27.58%) were predominant myopathies. The most common autoantibodies were anti-Jo1 antibodies (n = 11, 37.93%). Indeterminate usual interstitial pneumonitis (41.30%, n = 12) was the most common radiographic pattern followed by non-specific interstitial pneumonia (n = 5, 17.24%). ILD exacerbation (n = 14, 66.66%) and mortality rate (n = 6, 20.69%) were high. Albumin levels were significantly lower in patients who died. Conclusions: The clinical characteristics of patients with IIM-associated ILD in rural Appalachia exhibit notable distinctions, and outcomes are worse compared to other populations. Larger studies are needed to investigate other prognostics factors and longitudinal trends of clinical characteristics and outcomes of IIM-associated ILD in rural populations.Item Closing the Gap: Increasing Community Mental Health Services in Rural Indiana(Springer Nature, 2021) Schultz, Kristi; Farmer, Sara; Harrell, Sam; Hostetter, Carol; Medicine, School of MedicineDue to the significant need for mental health services in rural Martin County, IN and lack of providers, this study examined the current strengths of the community as well as the barriers preventing mental health service delivery. The goal of the study was to propose community-specific solutions to overcoming the barriers. Using a strengths-based approach (Saleeby in The strengths perspective in social work practice, Longman, White Plains, NY, 1992), the authors first sought to understand Martin County residents’ current experiences with mental health services. Second, the authors sought to understand Martin County residents’ opinions about church/mental health partnerships. As a result of this analysis, the authors comprised a list of feasible and sustainable recommendations for Martin County and similar rural areas that incorporate the strengths in the community, address their identified challenges, and thus created a model for mental health service provision that can be replicated in other rural communities with similar strengths as well as similar challenges.Item Creative Placemaking: Building Partnerships to Create Change(Midwest Public Affairs Conference, 2019) Levine Daniel, Jamie; Kim, Mirae; School of Public and Environmental AffairsArts, artists, and creative strategies can be critical vehicles for planning to achieve social, economic, and community goals. Creative placemaking is one type of arts-led planning that incorporates both stakeholder participation and community goals. Yet, questions exist around who participates in the creative placemaking process and to what end. Our study discusses a case where a state-sponsored workshop brings people from diverse backgrounds together to facilitate community development and engagement through creative placemaking. In particular, the event discussed in this study highlights how a one-shot intervention can reshape perceptions of creative placemaking held by planners, non-planners, artists, and non-artists. Our study also shows that while pre-workshop participants tended to identify resource-based challenges, post-workshop participants focused more on initiating collaborations and being responsive to community needs. The different attitudes before and after the state-sponsored workshop demonstrate the importance of facilitating stakeholder understanding and engagement for successful creative placemaking.Item Examining Rural-Urban Differences in Fatalism and Information Overload: Data from Twelve NCI-designated Cancer Centers(American Association for Cancer Research, 2022) Jensen, Jakob D.; Shannon, Jackilen; Iachan, Ronaldo; Deng, Yangyang; Kim, Sunny Jung; Demark-Wahnefried, Wendy; Faseru, Babalola; Paskett, Electra D.; Hu, Jinxiang; Vanderpool, Robin C.; Lazovich, DeAnn; Mendoza, Jason A.; Shete, Sanjay; Robertson, Linda B.; Balkrishnan, Rajesh; Briant, Katherine J.; Haaland, Benjamin; Haggstrom, David A.; Rural Workgroup of the Population Health Assessment in Cancer Center Catchment Areas Consortium; Medicine, School of MedicineBackground: Rural populations experience a disproportionate cancer burden relative to urban populations. One possibility is that rural populations are more likely to hold counterproductive cancer beliefs such as fatalism and information overload that undermine prevention and screening behaviors. Methods: Between 2016 and 2020, 12 U.S. cancer centers surveyed adults in their service areas using online and in-person survey instruments. Participants (N = 10,362) were designated as rural (n = 3,821) or urban (n = 6,541). All participants were 18 and older (M = 56.97, SD = 16.55), predominately non-Hispanic White (81%), and female (57%). Participants completed three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death") and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow"). Results: Compared with urban residents, rural residents were more likely to believe that (i) everything causes cancer (OR = 1.29; 95% CI, 1.17-1.43); (ii) prevention is not possible (OR = 1.34; 95% CI, 1.19-1.51); and (iii) there are too many different recommendations about cancer prevention (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33). Conclusions: Compared with their urban counterparts, rural populations exhibited higher levels of cancer fatalism and cancer information overload. Impact: Future interventions targeting rural populations should account for higher levels of fatalism and information overload.Item Listening to the community: identifying obesity prevention strategies for rural preschool-aged children(Frontiers Media, 2024-05-31) Pope, Katherine Jochim; Lightfoot, Alexandra F.; Harrison, Lisa Macon; Getz, Deborah; Gittelsohn, Joel; Ward, Dianne; Hannon, Tamara S.; Erinosho, Temitope; Pediatrics, School of MedicineMulti-level interventions promoting healthy weight in rural preschool children aged 2–5 years are limited. With the goal of developing a community-informed obesity prevention intervention for rural preschool-aged children, the purpose of this descriptive study was to identify: (1) community settings and intervention strategies to prioritize for an intervention; (2) potential implementation challenges and solutions; and (3) immediate interventions the study team and community partners could collaboratively implement. Workshops occurred in two rural communities in Indiana (2 workshops) and North Carolina (2 workshops), with high obesity rates. A guide was developed to moderate discussions and participants voted to rank community settings and intervention strategies. There were 9–15 participants per workshop, including parents, childcare providers, and representatives of community organizations. Community settings identified as priorities for child obesity prevention included the home, educational settings (preschools), food outlets, recreational facilities, and social media. Priority intervention strategies included providing nutrition and physical activity education, increasing access to healthy foods and physical activity in the built environment, and enhancing food security. Potential intervention implementation challenges centered on poor parental engagement; using personalized invitations and providing transportation support to families were proffered solutions. Immediate interventions to collaboratively implement focused on making playgrounds esthetically pleasing for physical activity using game stencils, and nutrition education for families via quarterly newsletters. This participatory approach with community partners provided insight into two rural communities’ needs for child obesity prevention, community assets (settings) to leverage, and potential intervention strategies to prioritize. Findings will guide the development of a multi-level community-based intervention.Item Political Elements of Recognition for Micropolitan Areas(2019-12) Nieto, Suani I.; Blomquist, William A.; Ferguson, Margaret R.; Bandele, Ramla M.The U.S. Office of Management and Budget’s designation of Micropolitan Statistical Areas brought to light communities with quasi-rural characteristics that had previously been ignored or hidden between their metro and non-metro category. The present study analyzes three recognition elements: political atmosphere, geography, and population characteristics of the state to analyze their effects on micropolitan areas’ economic strength.Item Prehospital Time Disparities for Rural Patients with Suspected STEMI(Taylor & Francis, 2023) Stopyra, Jason P.; Crowe, Remle P.; Snavely, Anna C.; Supples, Michael W.; Page, Nathan; Smith, Zachary; Ashburn, Nicklaus P.; Foley, Kristie; Miller, Chadwick D.; Mahler, Simon A.; Emergency Medicine, School of MedicineBackground: Rural patients with ST-elevation myocardial infarction (STEMI) may be less likely to receive prompt reperfusion therapy. This study's primary objective was to compare rural versus urban time intervals among a national cohort of prehospital patients with STEMI. Methods: The ESO Data Collaborative (Austin, TX), containing records from 1,366 emergency medical services agencies, was queried for adult 9-1-1 responses with suspected STEMI from 1/1/2018-12/31/2019. The scene address for each encounter was classified as either urban or rural using the 2010 US Census Urban Area Zip Code Tabulation Area relationship. The primary outcome was total EMS interval (9-1-1 call to hospital arrival); a key secondary outcome was the proportion of responses that had EMS intervals under 60 minutes. Generalized estimating equations were used to determine whether rural versus urban differences in interval outcomes occurred when adjusting for loaded mileage (distance from scene to hospital) and patient and clinical encounter characteristics. Results: Of 15,915,027 adult 9-1-1 transports, 23,655 records with suspected STEMI were included in the analysis. Most responses (91.6%, n = 21,661) occurred in urban settings. Median EMS interval was 37.6 minutes (IQR 30.0-48.0) in urban settings compared to 57.0 minutes (IQR 46.5-70.7) in rural settings (p < 0.01). Urban responses more frequently had EMS intervals <60 minutes (89.5%, n = 19,130), compared to rural responses (55.5%, n = 1,100, p < 0.01). After adjusting for loaded mileage, age, sex, race/ethnicity, abnormal vital signs, pain assessment, aspirin administration, and IV/IO attempt, rural location was associated with a 5.8 (95%CI 4.2-7.4) minute longer EMS interval than urban, and rural location was associated with a reduced chance of achieving EMS interval < 60 minutes (OR 0.40; 95%CI 0.33-0.49) as compared to urban location. Conclusion: In this large national sample, rural location was associated with significantly longer EMS interval for patients with suspected STEMI, even after accounting for loaded mileage.Item Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes(Hindawi, 2015-08) de Grogg, Mary; Shubrook, Jay; Schwartz, Frank; Hornsby Jr., W. Guyton; Pillay, Yegan; Saha, Chandan; Department of Medicine, IU School of MedicineOBJECTIVE: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. METHODS: The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. CONCLUSIONS: This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.