Leslie R. Carnahan

Community‐based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana

To report on a rigorous distribution and monitoring plan to track misoprostol for community‐based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana.

What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011

Introduction Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Methods Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women’s health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Results Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Conclusion Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment.

A community-based continuum of care model for the prevention of postpartum hemorrhage in rural Ghana

To report on Phase 1 of an operations research study designed to reduce postpartum hemorrhage (PPH)‐related morbidity and mortality in rural Ghana.

Age-Associated Perceptions of Physical Activity Facilitators and Barriers Among Women in Rural Southernmost Illinois

Introduction Women living in rural areas in the United States experience disproportionately high rates of diseases such as obesity and heart disease and are less likely than women living in urban areas to meet daily physical activity (PA) recommendations. The purpose of our research was to understand age-specific perceptions of barriers and facilitators to rural women engaging in PA and to identify strategies to promote PA among these women. Methods As part of a community health assessment to learn about women’s health issues, 110 adult women participated in 14 focus groups. The women were divided into 4 age groups, and focus groups were held in various community settings. We used qualitative analysis methods to explore themes in the women’s narratives, including themes related to PA knowledge, PA behavior, and access to PA facilities. Results Participants described multiple and often conflicting individual, social, and environmental barriers and facilitators to PA. Several barriers and facilitators were shared across age groups (eg, competing priorities and inadequate knowledge about PA’s role in disease prevention and disease management). Other barriers (eg, illness and injury) and facilitators (eg, PA as a social opportunity) differed by age group. Conclusion Rural women in southernmost Illinois have often contradictory barriers and facilitators to PA, and those barriers and facilitators are different at different points in a woman’s life. Our findings suggest the need for multilevel, multisector approaches to promote PA. Additionally, this research supports the need for tailored PA promotion programs for rural women to address the barriers these women face across their lifespan.

Healthcare providers’ knowledge and practices associated with postpartum hemorrhage during facility delivery in Dar es Salaam, Tanzania

To investigate healthcare providers’ knowledge and practices associated with prevention and management of postpartum hemorrhage (PPH) to improve care in urban settings and reduce maternal morbidity and mortality.

Recommendations for scale-up of community-based misoprostol distribution programs.

Community‐based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource‐poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community‐based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community‐based misoprostol program introduction, expansion, or scale‐up.

Finding paths with the greatest chance of success: enabling and focusing lung cancer screening and cessation in resource-constrained areas

The article by Rojewski et al . is an important contribution to the literature regarding factors influencing smoking cessation and lung cancer but we believe that it also has substantial benefit in other areas of public health and clinical care (1). For many public health and clinical interventions, applicability criteria are insufficiently specific to allow careful targeting of intervention resources to those most likely to experience maximum benefit.

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

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.

Abstract C22: Cancer-related financial burden, employment, and health among rural cancer survivors

Purpose: A growing body of literature has begun to document rural-urban disparities among cancer survivors. Rural survivors report worse mental health, health behaviors (e.g., smoking, physical activity), and self-rated health relative to urban counterparts. There is a need to determine modifiable determinants of these disparities, including work. Only one study of which we are aware has explored financial determinants of health: Weaver and colleagues found rural survivors were more likely to report not being able to work because of health-related reasons than urban counterparts. Little, however, is known about cancer-related financial burden during (e.g., filing for bankruptcy) and after treatment (e.g., not returning to work). Objective: This study seeks to: 1) characterize cancer-related financial burden and employment among rural survivors and 2) examine how these factors pertain to their self-rated health. Methods: We drew from an ongoing larger study that is characterizing the health needs of 600 rural cancer survivors and caregivers of cancer patients throughout Illinois State. Participants were recruited via non-probability based sampling methods, including physical flyers placed in rural community organizations (e.g., churches, hair salons, support groups), public health departments, clinics, hospitals, and cancer centers as well as at cancer-related events (e.g., Relay for Life); word of mouth; and electronic flyers distributed via websites, listservs, and social media. Interested participants contacted staff via the study website or phone number. To be eligible for the study, individuals self-reported: 1) being 18 years or older, 2) identifying as a survivor and/or caregiver, and 3) living in a rural part of Illinois State. After screening and providing informed consent, participants completed surveys by mail, phone, or website. Participants received

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

15 for their time and effort. Results: Since February, we have recruited 72 current survivors, 84% of whom completed the survey online and 27% of whom also self-reported having been caregivers of cancer patients during their lifetime. Our sample was largely female, married, and non-Latino White (NLW). Survivors in the sample are well-educated overall, with 52% holding a bachelor9s degree or above. The median annual household income (AHI) was