Canadian older adults express interest in maintaining independence and remaining in their homes as they age, a phenomenon known as aging in place. A variety of supports are needed to age in place, and rural older Canadians face barriers. Much of the current literature on aging in place in Canada focuses on urban environments. However, rural-dwelling older Canadians face unique challenges with aging in place.

The purpose of this research is to investigate the factors that influence a rural-dwelling older adult's ability to age in place and identify any unique barriers faced by the older adult.

The socio-ecological model is a theoretical framework that assesses how factors at the intrapersonal, interpersonal, institutional, community, and policy levels influence health. The socioecological model is used as a framework to investigate the older adults’ ability to age in place in rural Canada.

This research noted facilitators to aging in place in rural Canada, such as social support and a culture of self-reliance. Barriers to aging in place in rural Canada, such as transportation and healthcare access, are also shown.

While implementation of the socio-ecological model can be challenging, findings from this research can inform the development and delivery of health promotion interventions by framing the complex interplay of multi-level factors that influence aging in place for rural Canadians.

Emerging evidence describes the experiences of individuals participating in health research, but insights into the barriers and motivations around research participation in rural communities are limited. We developed and administered a human-centered, evidence-informed survey to assess motivators and barriers to research participation among adults in Pennsylvania.

The online survey captured differences between individuals with and without prior research participation and living in rural and urban settings. We hypothesized that individuals with prior research experience would report different motivators and barriers than those who had never participated in research. We also anticipated that rural and urban respondents would differ in their reported motivators and barriers to participation.

Participants (n = 284, 75% female, 63% urban, 73% with prior research) completed the survey in spring of 2025. Overall top motivators to research participation included a willingness to “contribute to knowledge and medicine,” to “help others,” to “make a difference,” “because the research was personally important,” and “financial compensation.” Top barriers included an “inconvenient research site,” “limited transportation access,” and “time/work constraints.” A variety of motivators and barriers differed by prior research experience. There were no significant differences between the proportion of rural and urban prior research participants who endorsed any of the motivators or barriers. Rural, non-research participants drew greater motivation from “family influence” and “volunteering commitment.”

The results of this work can inform the development of targeted strategies to improve research engagement, particularly among rural populations.

National clinical studies improve generalizability when they enroll participants from geographically underserved areas. We assessed representativeness of dentists and patients in the National Dental Practice-Based Research Network (“Network”) by comparing them to national benchmarks for rural/urban and underserved classifications.

Analyses compared rural status using Rural-Urban Continuum Codes and Health Provider Shortage Areas (HPSA), practitioner data from the Network’s Enrollment Questionnaire and the American Community Survey (ACS), and patient data from Network clinical studies and the Behavioral Risk Factor Surveillance System (BRFSS).

The network has similar proportions of dentists in rural areas compared to national estimates from the ACS (8.5% in Network vs. 8.2% nationally) and comparable proportions in HPSA (76.8% in Network vs. 84.0% nationally). The Network’s proportion of patients living in rural areas (33.7%) is much higher than that of Network practitioners (8.5%), and higher than that of the US “dental” population overall from the BRFSS (20.5%).

The Network not only is effective at engaging a broad dentist base but also engages a comparably higher proportion of rural patients, a group that is often underrepresented in clinical research. BRFSS respondents are a more-selective subset of the population because they report a recent dental visit, yet the Network exceeded even this benchmark in rural representation.

To identify key factors associated with varying levels of Medicare’s Chronic Care Management (CCM) programme implementation in rural primary care practices in the United States.

Despite demonstrated benefits for both patients and providers, CCM implementation remains low nationwide. While previous studies have examined payment-related challenges, limited research exists on other implementation factors such as leadership engagement, organizational culture, and provider training, particularly in rural settings.

This mixed-methods study examined CCM implementation across six rural primary care practices in Wyoming. Thirteen healthcare professionals participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Practice performance data collected over three consecutive months were used to categorize sites as high or low implementers based on care coordinator productivity, percentage of care coordinated, and programme sustainability. Interview transcripts were analysed using CFIR constructs to identify factors that distinguished high from low-implementing sites, with each factor rated based on its impact (positive, negative, or neutral) and strength of influence.

Three CFIR constructs strongly distinguished between high and low implementation sites: networks and communication, leadership engagement, and reflecting and evaluating. High-implementing sites demonstrated effective team communication, supportive leadership, and regular programme evaluation practices. In contrast, low-performing sites faced poor communication, minimal leadership support, and weak feedback mechanisms. Further research is needed to examine the effectiveness of targeted interventions designed to strengthen these organizational factors in rural primary care settings, particularly focusing on developing scalable strategies that account for resource limitations and geographic isolation.

Mental health literacy (MHL) is the ability to recognise mental disorders; have knowledge of professional help available, effective self-help and prevention strategies; and have the skills to support others. MHL is linked to better help-seeking behaviours and better management of mental illness. Mental illness prevalence is increasing in Malawi. Assessing MHL in communities crucially helps identify knowledge gaps, informing the development of evidence-based interventions.

This study assessed the MHL levels of young adults (16–30 years old) in rural and urban communities in Malawi.

A cross-sectional national survey was administered to 682 people across 13 districts in Malawi, using a self-reporting Mental Health Literacy questionnaire (MHLq) that assessed knowledge of mental health problems, erroneous beliefs/stereotypes, first aid skills, help-seeking behaviour and self-help strategies.

Most respondents were either unemployed (36%) or enrolled in school (43%). A total of 73% completed primary or secondary education, and 48% knew someone with a mental illness, but only 14% of this group could specify the illness. The mean MHL score was 111.8 (s.d. 13.9). Individuals with primary and secondary school qualifications had significantly lower scores in factor 2 (erroneous beliefs/stereotypes) and factor 3 (first aid skills and assistance-seeking behaviour) of the MHLq than those with higher education.

This research highlights persisting mental health misconceptions, limited knowledge about specific mental illnesses and low help-seeking behaviour among young adult Malawians. Higher education is linked to a better understanding of mental health. Prioritising community education on causes, signs, treatments and prognosis of mental illness is crucial for increased MHL.

The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.

This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.

Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28–0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23–0.42; good: OR: 0.13, 95% CI: 0.09–0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11–0.76; frequently: OR: 0.15, 95% CI: 0.05–0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19–0.42) were significant for urban practitioners.

Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban–rural disparities.

Family caregivers (FCGs) may experience numerous psychosocial and practical challenges with interpersonal relationships, mental health, and finances both before and after their care recipient (CR) dies. The specific challenges affecting rural FCGs who often have limited access to palliative care services, transitional care, and other community resources are not well understood. The purpose of this paper is to quantify the challenges rural FCGs experienced immediately before the death of a CR and continuing into the bereavement period.

A secondary analysis of data from a randomized controlled trial was conducted. The 8-week intervention included video visits between a palliative care research nurse and FCGs caring for someone with a life-limiting illness. Data were from structured interviews during nurse visits with FCGs in the intervention arm whose CR died during the intervention period.

Ninety (41.8%) of the 215 FCGs experienced the death of their CR. The majority of FCGs were female (58.9%), White (97.5%), spouses or partners (55.6%) and lived with the CR (66.7%). Most FCGs (84%) continued with intervention visits by the study nurse after the CR’s death. Visits resumed on average 7.2 days post-death. The majority of FCGs experienced challenges with grief/coping skills (56%) and interpersonal relationships/support systems (52%) both pre- and post-death of the CR. FCGs also experienced practical challenges with income/finance, housing, and communication with community resources both pre-and post-death.

Bereavement support should extend beyond a focus on grief to include practical challenges experienced by FCGs. Because challenges experienced in the bereavement period often begin before a CR’s death, there is benefit in continuity of FCG support provided by a known clinician from pre- to post-death. When given an option, many rural FCGs are open to bereavement support as early as a week after the death of a CR.

Implantable haemodynamic monitors allow remote monitoring of Fontan circulation. We report unique opportunities and challenges related to device use in rural, high-altitude regions.

Assess the performance of implantable haemodynamic monitor in Fontan circulation and identify potential sources of measurement discrepancy defined as non-physiological, negative, or significantly lower reading than baseline.

We performed a retrospective review of patients who underwent implantable haemodynamic monitor implantation from September 2021 to April 2024 (n = 17) at our centre (∼1,000 feet above sea level; ASL) and identified those with sensor discrepancies.

During a mean follow-up duration of 26 months (range 13–44 months), there were no procedure-related complications, thromboembolism, or device displacement. Ten patients lived in rural, higher-altitude regions (average altitude 5100 feet above sea level, average distance from centre ∼160 miles, range = 100–400 miles). Challenges in remote monitoring included unreliable home-internet connection, non-compliance, and difficulty performing device recalibration at patient’s home altitude. Sensor discrepancies were noted in 7 patients (41%), of whom 6 (86%) lived remotely. Manual review of the waveforms identified sources of discrepancy, including misinterpretation of the non-pulsatile pressure waveform (n = 3), offset due to change in hospital-interrogation unit (n = 4), and sensor drift (n = 1). Altitude change did not directly affect sensor performance. We were able to apply corrective interventions in 4/7 sensors, including Fontan-specific settings (overriding pulsatility), and back-end recalibration, which were effective in improving device accuracy.

Implantable haemodynamic monitors are a promising tool for monitoring Fontan circulation but may require modified settings and careful attention to potential interpretation errors. Home monitoring remains challenging for rural, high-altitude residents with limited resources.