This post offers a curated list of articles toolkits, white papers, and other resources that offer how cultural adaptations for rural populations of evidence-based practices is critical to ensure relevance and effectiveness across marginalized populations. Click on the toggle for any reference to view a brief summary of the document, its source, and an active link for access.
2021-2024
Office of National Drug Policy (ONDCP). (n.d.). Rural Community Action Guide: Building stronger, healthy, drug-free rural communities
Overview: This Action Guide includes background information, data, and resources to help local leaders build an effective response to the opioid crisis. It is designed to help rural communities find ways to tackle a wide range of issues related to drug addiction including stigma, economic challenges, health needs, and recovery.
Office of National Drug Policy (ONDCP). (n.d.). Rural Community Action Guide: Building stronger, healthy, drug-free rural communities. https://www.usda.gov/sites/default/files/documents/rural-community-action-guide.pdf
Palomin, A., Takishima-Lacasa, J., Selby-Nelson, E., & Mercado, A. (2023). Challenges and ethical implications in rural community mental health: The role of mental health providers
Abstract: This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications.
Palomin, A., Takishima-Lacasa, J., Selby-Nelson, E., & Mercado, A. (2023). Challenges and ethical implications in rural community mental health: The role of mental health providers. Community Mental Health Journal, 59(8), 1442-1451. https://doi.org/10.1007/s10597-023-01151-9
Rural Health Information Hub. Rural Community Health Toolkit
Overview: This toolkit compiles evidence-based and promising models and resources to support organizations implementing mental health programs in rural communities across the United States, with a primary focus on adult mental health. The modules contain resources and information useful in developing, implementing, evaluating, and sustaining rural mental health programs.
Rural Health Information Hub. Rural Community Health Toolkit. https://www.ruralhealthinfo.org/toolkits/rural-toolkit
Selby-Nelson, E. M., Layh, M. C., Brumbaugh, J. T., & McNeil, D. W. (2022). Mental health and treatment considerations for rural communities
Abstract: Delivery of mental health and psychological services to clientele in the diverse rural areas of the United States requires a unique knowledge base and skill set from clinicians. Depression, suicidality, trauma, and substance use disorders are particular concerns in rural areas. Generalist training and an awareness of special ethical issues is needed, along with a sensitivity to social and other environmental influences in rural settings. Working with limited resources, the demands on rural clinicians are great, but so are the professional satisfactions and opportunities of rural practice. While efforts to expand and evolve rural practice have been advancing, rural areas continue to be underserved in terms of mental health services. As health and healthcare inequities are omnipresent in rural areas, a “call to action” is aimed at including rural mental healthcare competencies in training. Further development and testing of mental healthcare delivery models for rural areas and advancing recruitment and retention of rural psychologists through system-based supports are encouraged to address workforce shortages.
Selby-Nelson, E. M., Layh, M. C., Brumbaugh, J. T., & McNeil, D. W. (2022). Mental health and treatment considerations for rural communities. In G. J. G. Asmundson (Ed.), Comprehensive Clinical Psychology (2nd ed., Vol. 9, pp.270-290). Elsevier. https://doi.org/10.1016/B978-0-12-818697-8.00194-1
Thompson, J. R., Risser, L. R., Dunfee, M. N., Schoenberg, N. E., & Burke, J. G. (2021). Place, power, and premature mortality: A rapid scoping review on the health of women in Appalachia
Abstract – Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. Data source: We searched bibliographic databases (e.g., PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia. Study inclusion and exclusion criteria: Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. Data extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. Data synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (e.g., 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.
Thompson, J. R., Risser, L. R., Dunfee, M. N., Schoenberg, N. E., & Burke, J. G. (2021). Place, power, and premature mortality: A rapid scoping review on the health of women in Appalachia. American Journal of Health Promotion, 35(7), 1015–1027. https://doi.org/10.1177/08901171211011388
Prior to 2021
American Psychological Association Division 31 (State, Provincial and Territorial Psychological Association Affairs), Rural Health Section
Overview: This section of Division 31 was created to serve the unique needs of state, provincial, and territorial psychological associations in rural regions.
American Psychological Association Division 31 (State, Provincial and Territorial Psychological Association Affairs), Rural Health Section. https://www.apadivisions.org/division-31/about/rural-health
Center for Medicare and Medicaid Services. (2019). Improving access to maternal health care in rural communities
Overview: Issue brief provides background information on maternal health care with a focus on the need for national, state, and community-based organizations to jointly develop an action plan that facilitates access to care and improves outcomes for rural women and their babies.
Center for Medicare and Medicaid Services. (2019). Improving access to maternal health care in rural communities. Issue brief. https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf
Gessert, C., Waring, S., Bailey-Davis, L,, Conway, P., Roberts ,M., & VanWormer, J. (2015). Rural definition of health: A systematic literature review
Abstract – Background: The advent of patient-centered care challenges policy makers, health care administrators, clinicians, and patient advocates to understand the factors that contribute to effective patient activation. Improved understanding of how patients think about and define their health is needed to more effectively “activate” patients, and to nurture and support patients’ efforts to improve their health. Researchers have intimated for over 25 years that rural populations approach health in a distinct fashion that may differ from their non-rural counterparts. Methods: We conducted a systematic review of the literature to assess the extent and strength of evidence for rural definition of health. Studies were eligible for inclusion if they were published in English, reported on original research and presented findings or commentary relevant to rural definition of health, were published over the last 40 years, and were based on observations of rural U.S., Canadian, or Australian populations. Two reviewers were assigned to each selected article and blinded to the other reviewer’s comments. For discordant reviews, a third blinded review was performed. Results: Of the 125 published articles identified from the literature, 34 included commentary or findings relevant to a rural definition of health. Of these studies, 6 included an urban comparison group. Few studies compared rural and urban definitions of health directly. Findings relevant to rural definition of health covered a broad range; however, good health was commonly characterized as being able to work, reciprocate in social relationships, and maintain independence. This review largely confirmed many general characteristics on rural views of health, but also documented the extensive methodological limitations, both in terms of quantity and quality, of studies that empirically compare rural vs. urban samples. Most notably, the evidence base in this area is weakened by the frequent absence of parallel comparison groups and standardized assessment tools. Conclusions: To engage and activate rural patients in their own healthcare, a better understanding of the health beliefs in rural populations is needed. This review suggests that rural residents may indeed hold distinct views on how to define health, but more rigorous studies are needed to confirm these findings.
Gessert, C., Waring, S., Bailey-Davis, L,, Conway, P., Roberts ,M., & VanWormer, J. (2015). Rural definition of health: A systematic literature review. BMC Public Health, 15, 378. https://doi.org/10.1186/s12889-015-1658-9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406172/pdf/12889_2015_Article_1658.pdf
Miller, B. F., Petterson, S., Brown Levey, S. M. , Payne-Murphy, J. C., Moore, M., & Bazemore, A. (2014). Primary care, behavioral health, provider colocation, and rurality
Abstract – Purpose: The purpose of this study was to characterize the proximity of primary care and behavioral health service delivery sites in the United States and factors influencing their colocation. Methods: We geocoded the practice addresses of primary care and behavioral health providers found in the Centers for Medicare & Medicaid Services’ National Plan and Provider Enumeration System Downloadable File to report where colocation is occurring throughout the country. Results: The extent to which primary care physicians are colocated with behavioral health providers is strongly associated with rurality. Specifically, 40.2% of primary care physicians in urban areas are colocated with behavioral health providers compared with 22.8% in isolated rural areas and 26.5% in frontier areas. However, when controlling for number of primary care physicians at a location, the odds of colocation actually are greater for physicians in a frontier area than those in urban areas (odds ratio, 1.289; P < .01). Conclusions: Our findings offer new insights into the overlap of the behavioral health and primary care workforce, where opportunities for integration may be limited because of practice size and the proximity of providers, and where new possibilities for integration exist.
Miller, B. F., Petterson, S., Brown Levey, S. M. , Payne-Murphy, J. C., Moore, M., & Bazemore, A. (2014). Primary care, behavioral health, provider colocation, and rurality. Journal of the American Board of Family Medicine, 27(3), 367-374. https://doi.org/10.3122/jabfm.2014.03.130260