Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings. A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases. A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign. Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and community research, as well as interventions and policy efforts.

Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review.

Beyond fatalism: Information overload as a mechanism to understand health disparities.

Taking Care of Caregivers

Depression in a depressed area: Deservingness, mental illness, and treatment in the contemporary rural U.S.

The goal of this study was to compare the odds of meeting physical activity (PA) guidelines among adults living in rural and urban areas of Canada. Data from the 2017 cycle of the Canadian Community Health Survey were analyzed using binomial logistic regression with a sample of 47,266 adults representing a survey-weighted total of 25,669,018. The odds of meeting PA guidelines were determined based on self-reported moderate-to-vigorous PA (<150 min per week or ≥150 min per week). Communities were categorized as urban or rural based on population size and density. Individual-level correlates included in the model were self-identified sex, age, body mass index, highest level of education, household income, perceived health, and sense of belonging to community. Approximately 56.6% of rural and 59.3% of urban adults reported meeting recommended PA levels when location was examined as a sole predictor. The best-fit model adjusted for all individual-level factors showed a significant sex × location interaction. Males in rural communities were more likely to report meeting PA guidelines (odds = 0.90 or 47.4%) than males in urban areas (odds = 0.78 or 43.8%), whereas females living in rural communities (odds = 0.58 or 36.7%) were less likely to report meeting PA guidelines than females in urban areas (odds = 0.65 or 39.4%). The association between rural-urban residence and meeting PA guidelines appears to be contingent on self-identified sex differences. Future work should explore how gender- and location-related variables interact to influence self-reported PA engagement.

Likelihood of meeting physical activity guidelines in rural and urban adults: cross-sectional analysis of the Canadian Community Health Survey

Background. Rural populations in the U.S. face numerous barriers to health care access. The Patient Protection and Affordable Care Act (PPACA) was developed in part to reduce health care access barriers. We report rural women’s access barriers and the PPACA elements that address these barriers as well as potential gaps. Methods. For this qualitative study, we analyzed two datasets using a common framework. We used content analysis to understand rural, focus group participants’ access barriers prior to PPACA implementation. Subsequently, we analyzed the PPACA text. Results. Participants described health care access barriers in two domains: availability and eligibility. The PPACA proposes solutions within each domain, including health care workforce training, Medicaid expansion, and employer-based health care provisions. However, in rural settings, access barriers likely persist. Discussion. While elements of the PPACA address some health care access barriers, additional research and policy development are needed to comprehensively and equitably address persistent access barriers for rural women.

Health care eligibility and availability and health care reform: Are we addressing rural women's barriers to accessing care?

Rural cancer disparities are increasingly documented in the USA. Research has identified and begun to address rural residents' cancer knowledge and behaviors, especially among women. Little, however, is known about rural female residents' awareness of cancer inequities and perceived contributing factors affecting them and their families. The purpose of this study was to address these gaps in the literature via a secondary analysis of qualitative needs assessment in Illinois' rural southernmost seven counties, a geographic region with relatively high rates of cancer incidence, morbidity, and mortality. A convenience sample of 202 rural adult female residents was recruited and participated in 26 focus groups, with 3-13 women per group. Inductive content analysis, guided by the principle of constant comparison, was used to analyze the qualitative data. Most respondents indicated their awareness of disproportionate cancer burden in their communities. Individual-level behaviors and environmental toxins were identified as contributing factors. Interestingly, however, environmental toxins were more often discussed as factors contributing to geographic differences, whereas individual-level behaviors were noted as important for overall cancer prevention and control. This study provides important insight into female rural residents' perspectives and offers novel venues for educational programs and research in the context of communication to eliminate disparities.

/pdf/rural-women-s-perceptions-about-cancer-disparities-and-1bqsmde31t.pdf

Rural Women's Perceptions About Cancer Disparities and Contributing Factors: a Call to Communication.

The majority of rural US men fail to meet physical activity (PA) guidelines and are at risk for chronic diseases. This study sought to understand rural men's perceptions about PA and PA engagement and the influence of masculinity and social norms. From 2011 to 2014, 12 focus groups were conducted with men prior to a church-based health promotion intervention. Men were recruited from Illinois' rural, southernmost seven counties, where 40% of men report no exercise in the past 30 days. We used inductive content analysis methods to identify PA-related themes, and subsequently used elements of the Health, Illness, Men, and Masculinities framework as a lens to explore subthemes. We identified four themes: (i) knowledge of the positive impact of PA on health, (ii) perceptions of appropriate types of PA for men, (iii) the importance of purposeful PA and (iv) the desire to remain strong and active, particularly during aging. These findings can inform strategies for messaging and interventions to promote PA among rural men. Health promotion efforts should consider the intersections between rurality and masculinity as it relates to rural men's perceptions of PA, include information about purposeful PA and encourage them to engage in PA with a support person.

/pdf/physical-activity-and-masculinity-in-rural-men-a-qualitative-1irz7wkl1a.pdf

Physical activity and masculinity in rural men: a qualitative study of men recruited from churches.

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Health care eligibility and availability and health care reform: Are we addressing rural women's barriers to accessing care?

Rural Women's Perceptions About Cancer Disparities and Contributing Factors: a Call to Communication.

Physical activity and masculinity in rural men: a qualitative study of men recruited from churches.