Fisher K, Hussain R. Rural and Remote Health ; Although there have been great strides in the prevention, care and treatment of sexually transmitted infections STIs, including HIV in Australia, the increasing trend towards higher rates of some STIs is of concern, especially reports of higher rates of chlamydia in inner regional areas.
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Reasons for these changes are unclear but suggest there is an inconsistent use of prevention measures and ambivalence towards acting responsibly around sexual
Understanding sexually transmitted infections stis in rural communities. Understanding an individual's response to the circumstances or contexts in which knowledge about STIs are operationalised in rural communities becomes central to recognising how individuals experience health and illness, especially for developing interventions to prevent the transmission of STIs.
The aim of this research is to understand how individuals in rural communities make sense of their experiences in
Understanding sexually transmitted infections stis in rural communities to STIs and how rurality influences discussion about STIs and health-seeking behaviours. In-depth interviews with 24 participants, 18 females and 6 males, aged between 19 and 65 years provide the data for the study. Methodological principles of 'grounded theory' underpin the analysis.
An eclectic approach to grounded theory was used in the current study that was derived from a number of authors. The findings revealed that a number of contexts shape the actions and reactions of rural individuals towards STIs. These include 'public and private world of individuals', 'forms of talking in rural communities' and 'managing information and use of health services'. Factors that shape social life in rural communities such as the social bonds that are present, the relationships developed, and the way in which people behave influence the public and private aspects of rural life.
Different forms of talk were identified that indicate that sexual issues are discussed in a number of informal ways and encompass distinct experiences of conveying information with regard to sex and STIs. Managing information and use of health services occurs when individuals assess and identify the need to access services for STIs. The strength of this research lies in the identification of a number of contexts such as the private-public divide and types of talk where informal mechanisms encourage individuals to conform and comply with community rules and values.
Using informal talk as a health promotion and or prevention strategy in rural locations can provide an alternative approach to potentially changing social norms.
It would be possible to extend the idea of positive informal talk to include symbols and imagery that encourage individuals to seek treatment and provide a more positive view of 'reputation'. Engaging rural individuals in positive talk about sexual risk, access to treatment for STIs, and provision of accurate knowledge can help to build new 'social norms' that encourage new interpretations. Although there have been great strides in the prevention, care and treatment of sexually transmitted infections STIs, including HIV in Australia, the increasing trend towards higher rates of some STIs is of concern 1especially reports of higher rates of chlamydia within inner regional areas 23.
Within rural communities, a number of circumstances or contexts, such as the overlap between public and private aspects, shape their experiences and thus influence behaviours. Underpinning these experiences and behaviours are formal and informal modes of control and regulation of sexuality.
According to Weeks 4the formal level involves the influence of the church and state, for example marriage, divorce, sexual unorthodoxy that affect the patterns of sexual behaviour.
The informal level includes factors such as symbols that associate sex with danger and risk 5the notion of self-responsibility and regulation of moral behaviour 6. These informal modes of control and regulation intersect with the way in which society perceives and understands STIs and may affect the reaction of others, for example fear, sympathy or disapproval 7.
Through interactions the meanings that individuals attach to things influence the way in which they act or the way in which they manage situations 8. What is implied is that individuals construct divergent meanings about sex, sexuality and STIs through the process of interaction.
understandings of sexually transmitted infections...
Thus, the creation of shared meanings through these interactions becomes an individual's social reality where meaning constantly changes 9.
Shared meanings about STIs in rural communities are thus subject to change through interactions with the self and others. However, difficulties with stigma, confidentiality and anonymity in rural communities also pose problems 1011as can talking about STIs, because of the tendency towards conservative beliefs and values 12stoicism and silence around STI testing Compounding the issues of stigma, confidentiality and anonymity are a number of conditions that shape the way in which rural communities understand STIs, and these can
Understanding sexually transmitted infections stis in rural communities influence decisions about health care access in rural communities.
These include deficiencies in health resources and infrastructure in rural areasand cultural and social norms such as individual values and beliefs 19 This article aims to contribute to explanations of how rurality affects an individual's constructed notions of STIs. Driving the research discussed in this article is the need to understand how individuals in rural communities make sense of their experiences in relation to STIs and how rurality influences discussion about STIs and health-seeking behaviours.
The selected study region covers a large geographic area km 2. The study region represents There is a comparatively large proportion The overall representation of Indigenous population in the state-wide statistics is persons or 2.
Health services in the region are provided by medical practitioners, public hospitals, multipurpose health services, community health centres, Aboriginal community controlled organisations and two sexual health clinics.
There is a mix of specialist services provided either from the major referral hospitals or through formal networking arrangements with other health areas. Importantly, as far as the delivery of health services in the region is concerned, the issue of transport is an important one for rural residents. The driving time from smaller towns to larger regional centres for services takes approximately hours one way.
This is similar to other regional areas in NSW. Sampling for this study was initially undertaken using a theoretical sampling frame that
Understanding sexually transmitted infections stis in rural communities the selection of participants. The topics in the sampling frame were based on relevant issues, categories and themes that were identified in the literature as well as state-wide health surveillance data This initially included age, gender, Aboriginality, STI experience, socioeconomic status and sexual orientation.
For greater contrast and clarity, these categories broadened as the research progressed and included individuals who may not have had any experiences with an STI.
The development of conceptual categories directed the sampling and continued until no new data, concepts or further variation was identified within the categories.
Participants provided contrasts based on the following categories: Some difficulties were experienced accessing Aboriginal, male participants and non-heterosexual participants. For example, only four of the 24 participants identified themselves as Aboriginal and of these one was a male. Similarly, the entire study sample comprised of participants who reported their sexual orientation as heterosexual Table 1.
Demographic characteristics of participants The participants were 24 rural residents recruited using a variety of approaches which included the use of posters, pamphlets, and advertisements via the internet, radio, print media, word of mouth and snowballing. Participants gave written informed consent and were free to use a pseudonym.
talk: shaping understandings of sexually...
One researcher the first author undertook the interviews, which varied in length between 30 min and 2 hours. Telephone interviews with three participants took place when face-to-face interviews were not practical.
Community health education played a...
A digital voice recorder recorded all interviews except one telephone interview when it was not practicable to record. The interviews took place in both public and private locations that ensured privacy and safety for the researcher and participants. Topics in the interview guide were based on the literature as well as those that emerged from analysis of the interviews.
These included descriptions of sexual
Understanding sexually transmitted infections stis in rural communities, what factors and strategies were important when the accessing services, what was known about STIs, what factors were important to understanding the link between sex and STIs, their sexuality, culture, and the way health care was approached.
The places of residence have intentionally been withheld within this article to maintain participant's confidentiality and privacy. An eclectic approach to grounded theory was used in this study One of the major differences between grounded theory and other approaches to qualitative inquiry, according to Strauss and Corbin 25is its emphasis on theory development. A grounded theory approach focuses on the development of a theory that comprises an integrated set of concepts that show relationships Simultaneous data collection and analysis occurs in a spiral mode with each informing the other 25 Analysis begins early in the process to allow further data collection to become increasingly focused and refined 25 As the analysis proceeds, creativity in the development of abstract ideas and new connections between conceptual ideas results in analytic interpretations of the participants' worlds and processes 28 The researcher's background assumptions and perspectives shape his or her conceptual sensitivity towards certain processes in the data Browne 37 argues that scrutinising the extent to which the researcher's experiences and interpretations influence the inquiry is an important aspect in the assessment of rigour in the research process.
Consequently, attention to issues of reflexivity throughout the research process can help to evaluate the impact of the researcher on the research process and fosters creativity In this study, movement back and forth between data collection and analysis facilitated integration of analysis with data collection. The data were analysed by the first author, then revised by the co-author and other study supervisors.
Several iterations of the analysis were undertaken until there was consensus among the study team. Words, sentences or paragraphs were coded using constant comparison 26then subsequently organised into concepts and categories. Through the next stage of analysis, focused coding and synthesis of codes 33a comparison of codes and data ensured the consolidation of data and refinement of the main themes.
For instance, a comparison of situations led to the following propositions: STIs are invisible, hidden, and become public when a person has to disclose information to their doctor or tells others, but public disclosure is limited to those who are perceived to be able to provide support. Following on from focused coding, axial coding 25 was undertaken, which involved linking categories with subcategories.
The subcategories explained the category by elaborating the relationships according to their properties and dimensions. They also had the dimension 'distance', such as close or distant relationship. As the research progressed, the proposition became even more refined as negative cases emerged in the data.
Negative cases represented extreme points on the dimensional range of concepts and provided alternative explanations for the developing analysis 25 In the present study, a negative case represented someone who had not had any sexual or STI experiences, thus had nothing to conceal or disclose. Selective coding 25 and theoretical coding 29 followed axial coding and involved the development of a core category and the systematic connection to other categories 25 According to Glaser, theoretical coding refers to the relationships between categories and their analytical presentation 27 Glaser presents over 18 coding families that allow variability, precision and clarity in the analysis and presentation of data.
The coding families provide a logical and broad way in which to integrate the analysis in a conceptual direction. For example, the forms of talk were
Understanding sexually transmitted infections stis in rural communities dimension of the larger category of public versus private life of rural individuals.
Each form of talk was a combination of categories with a set of properties that reflected interaction processes and different degrees of control in information about STIs. Data collection ceased when the categories and dimensions were saturated.
“But people living in medically...
To ensure rigor and trustworthiness of the study, concepts such as credibility, originality, resonance usefulness 33 and reflexivity 9 were used. All attempts were made to present a true reflection and richness of the participants' experiences
Understanding sexually transmitted infections stis in rural communities the findings by including excerpts in the participants' own words. Full copies of the transcripts were shared with colleagues to ascertain alignment of the coding schema with the accounts of the participants and to establish validation of the study findings.
Throughout the study, reflexivity provided a mechanism to address the underlying assumptions of the first author who worked in the area of Sexual Health and lived in the area. These reflections are reported elsewhere Twenty-four rural residents, 18 females and 6 males, aged between 19 and 65 years of age median age of 42 were recruited to the study.
Place of residence varied from a regional centre to small villages. The specific places of residence have intentionally been withheld within this article to maintain participants' confidentiality and privacy.
Rurality was measured using percent...
All participants identified themselves as Australian and as heterosexuals. The findings revealed that a number of contexts shape the actions and reactions of rural individuals in relation to the management of private information and access to services for STIs.
Risk Factors for Sexually Transmitted Disease Among Rural-to-Urban Migrants in are advocated to reduce the risk and stigma among the special population. Community health education played a major role in a study of sexually transmitted diseases (STDs) and other reproductive tract infections which we study and to raise their awareness of the transmission, treatment, and prevention of STDs.
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“But people living in medically underserved, rural areas are at higher “I think it's complicated to really understand why,” Renton said. “We do not have STD clinics and some of the local public health units do not offer STD services. reduce the risk of gonorrhea and other sexually transmitted diseases.
COMMUNITY HEALTH EDUCATION PLAYED A MAJOR ROLE IN A STUDY OF SEXUALLY TRANSMITTED DISEASES (STDS) AND... DRAMATIC INCREASE IN RURAL STDS ALARMS STATE HEALTH OFFICIALS | RHQ INFORMAL TALK: SHAPING UNDERSTANDINGS OF SEXUALLY TRANSMITTED INFECTIONS (STIS) IN RURAL AUSTRALIA.
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Rurality was measured using percent rural and rural-urban commuting area of sexually transmitted infections (STIs; (1)) to include geographical core areas (2). were mapped to understand the spatial distribution and patterns of infection. understandings of sexually transmitted infections (STIs) in rural of this research is to understand how individuals in rural communities make. Abstract. Objectives: To conduct a knowledge, attitude, and practice (KAP) study and to determine the prevalence of sexually transmitted diseases (STDs). “But people living in medically underserved, rural areas are at higher “I think it's complicated to really understand why,” Renton said. “We do not have STD clinics and some of the local public health units do not offer STD services. reduce the risk of gonorrhea and other sexually transmitted diseases. Local health departments (LHDs) are an important source for screening and treating sexually transmitted diseases (STDs) in rural communities. Yet, they. Fisher K, Hussain R. Community health education played a major role in a study of sexually transmitted diseases STDs and other reproductive tract infections which we conducted in rural and periurban communities of the Asaro Valley near Goroka in the Eastern Highlands Province of Papua New Guinea. Risk Factors for Sexually Transmitted Disease Among Rural-to-Urban Migrants in are advocated to reduce the risk and stigma among the special population. Preventing HIV/AIDS and sexually transmitted diseases in rural areas requires Increasing the awareness of HIV and STDs and encouraging. talk: shaping understandings of sexually transmitted infections (STIs) in rural Factors that shape social life in rural communities such as the social bonds that.
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Can gays be converted to heterosexuals? Risk Factors for Sexually Transmitted Disease Among Rural-to-Urban Migrants in are advocated to reduce the risk and stigma among the special population. Abstract. Objectives: To conduct a knowledge, attitude, and practice (KAP) study and to determine the prevalence of sexually transmitted diseases (STDs)..
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