The Journal of Rural Health (J RURAL HEALTH )

Publisher: American Rural Health Association; National Rural Health Care Association (U.S.), Blackwell Publishing

Journal description

The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.

Current impact factor: 1.77

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.771
2012 Impact Factor 1.444
2011 Impact Factor 1.429
2010 Impact Factor 1.41
2009 Impact Factor 1.105
2008 Impact Factor 1.05
2007 Impact Factor 1.108
2006 Impact Factor 1.038
2005 Impact Factor 0.866
2004 Impact Factor 0.673
2003 Impact Factor 0.537
2002 Impact Factor 0.782

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.68
Cited half-life 6.40
Immediacy index 0.25
Eigenfactor 0.00
Article influence 0.50
Website Journal of Rural Health, The website
Other titles The Journal of rural health, JRH
ISSN 0890-765X
OCLC 12020952
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
  • Conditions
    • See Wiley-Blackwell entry for articles after February 2007
    • Publisher's version/PDF cannot be used
    • On author's server, institutional server or subject-based server
    • Server must be non-commercial
    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: As part of the Patient Protection and Affordable Care Act (Affordable Care Act) of 2010, 2 new opportunities for health care coverage were established for many uninsured individuals beginning on January 1, 2014. The first opportunity was through Medicaid expansion where states had the opportunity to expand Medicaid coverage to individuals with household incomes up to 133% of the federal poverty level. The second opportunity was through the establishment of Health Insurance Marketplaces where individuals could purchase private health plans and potentially qualify for financial assistance in paying for their plans. The Office of Rural Health Policy (ORHP) provided supplemental grant awards to help stimulate Affordable Care Act outreach and education efforts in rural communities that were being served by the Rural Health Care Services Outreach (Outreach) Grant Program. As a result, Outreach grantees enrolled 9,300 rural Americans during the initial Open Enrollment period. Valuable outreach and enrollment lessons were learned from rural communities based on discussions with the Outreach grantees who received the supplemental funding. These lessons will help rural communities prepare for the next Open Enrollment period. © 2014 National Rural Health Association.
    The Journal of Rural Health 12/2014; 31(1).
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    ABSTRACT: PurposeTo explore the perceived barriers, resources, and training needs of rural primary care providers in relation to implementing the American Medical Association Expert Committee recommendations for assessment, treatment, and prevention of childhood obesity.Methods In‐depth interviews were conducted with 13 rural primary care providers in Oregon. Transcribed interviews were thematically coded.ResultsBarriers to addressing childhood obesity fell into 5 categories: barriers related to the practice (time constraints, lack of reimbursement, few opportunities to detect obesity), the clinician (limited knowledge), the family/patient (family lifestyle and lack of parent motivation to change, low family income and lack of health insurance, sensitivity of the issue), the community (lack of pediatric subspecialists and multidisciplinary/tertiary care services, few community resources), and the broader sociocultural environment (sociocultural influences, high prevalence of childhood obesity). There were very few clinic and community resources to assist clinicians in addressing weight issues. Clinicians had received little previous training relevant to childhood obesity, and they expressed an interest in several topics.Conclusions Rural primary care providers face extensive barriers in relation to implementing recommended practices for assessment, treatment, and prevention of childhood obesity. Particularly problematic is the lack of local and regional resources. Employing nurses to provide case management and behavior counseling, group visits, and telehealth and other technological communications are strategies that could improve the management of childhood obesity in rural primary care settings.
    The Journal of Rural Health 08/2013; 29.
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    ABSTRACT: PurposeObservation care is used to evaluate patients prior to admission or discharge. Often beneficial, such care also imposes greater financial liability on Medicare beneficiaries. While the use of observation care has increased recently, critical access hospitals (CAHs) face different policies than prospective payment (PPS) hospitals, which may influence their observation care use.Methods We used 100% Medicare inpatient and outpatient claims files and enrollment data for years 2007 to 2009, and the 2007 American Hospital Association data to compare trends in the likelihood, prevalence and duration of observation stays between CAHs and PPS hospitals in metro and non‐metro areas among fee‐for‐service Medicare beneficiaries over age 65.FindingsWhile PPS hospitals are more likely to provide any observation care, the 3‐year increase in the proportion of CAHs providing any observation care is approximately 5 times as great as the increase among PPS hospitals. Among hospitals providing any observation care in 2007, the prevalence at CAHs was 35.7% higher than at non‐metro PPS hospitals and 72.8% higher than at metro PPS hospitals. By 2009, these respective figures had increased to 63.1% and 111%. Average stay duration increased more slowly for CAHs than for PPS hospitals.Conclusions These data suggest that a growing proportion of CAHs are providing observation care and that CAHs provide relatively more observation care than PPS hospitals, but they have shorter average stays. This may have important financial implications for Medicare beneficiaries.
    The Journal of Rural Health 08/2013; 29.
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    ABSTRACT: PurposeTo examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age.Methods All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists. Rurality of primary office location, categorized using Rural‐Urban Commuting Area codes, served as the outcome variable. Chi‐square tests and multivariable logistic regression were used to explain associations between rural practice location and dentist characteristics.FindingsFifteen percent of the state's population resided in isolated small rural towns, but only 8% of general dentists practiced here. Approximately 17% of dentists in isolated small rural towns were age 40 or younger, compared to 32% of dentists in urban areas. Among male dentists, those who were born in Iowa (P = .002) were older (P = .020), and graduated from dental schools other than the University of Iowa (P = .009) were more likely to practice in rural areas than were their counterparts. Conversely, among female dentists, solo practice (P = .016) was the only variable significantly associated with rural practice location.Conclusions The dentist workforce in rural areas of Iowa is dominated by older males who were born in Iowa. As this generation retires and increasing numbers of women enter the profession, state policy makers and planners will need to monitor changing trends in the rural workforce.
    The Journal of Rural Health 08/2013; 29(Suppl 1):89-95.
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    ABSTRACT: PurposeWith its population rapidly aging, China needs prompt action to facilitate the middle‐aged and senior citizens' utilization of health care. The New Rural Cooperative Medical Scheme (NCMS), a health care reform initiative started in 2003, is currently China's primary insurance program for the rural population.Methods With a 2‐province pilot sample (Gansu, the poorest province, and Zhejiang, one of the richest) of people over age 45 from the China Health and Retirement Longitudinal Study (CHARLS), this paper used logistic regressions to examine the association between the coverage of New Rural Cooperative Medical Scheme and the underutilization of medical care.FindingsAmong those who had a need to visit a health care provider during the previous month, people covered by NCMS were more likely to underutilize outpatient care than the uninsured (Odds Ratio = 5.610, 2.035‐15.466). As for those who had a need to be hospitalized in the past year, the association between NCMS coverage and the underutilization of inpatient care was not statistically significant (Odds Ratio = 1.907, 0.335‐10.862). Low total household expenditure per capita, living in the inland province of Gansu, and being an urban resident were also associated with underutilizing outpatient care.Conclusion Further research is needed to understand the negative association between NCMS coverage and outpatient care utilization.
    The Journal of Rural Health 08/2013; 29.
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    ABSTRACT: PurposeLittle is known about access to care for hematological cancer patients. This study explored patient experiences of barriers to accessing care and associated financial and social impacts of the disease. Metropolitan versus nonmetropolitan experiences were compared. MethodsA state‐based Australian cancer registry identified adult survivors of hematological cancers (including lymphoma, leukemia and myeloma) diagnosed in the previous 3 years. Survivors were mailed a self‐report pen and paper survey. FindingsOf the 732 eligible survivors, 268 (37%) completed a survey. Forty percent of participants reported at least one locational barrier which limited access to care. Only 2% reported cancer‐related expenses had restricted their treatment choices. Almost two‐thirds (64%) reported at least one financial or social impact on their daily lives related to cancer. The most frequently reported impacts were the need to take time off work (44%) and difficulty paying bills (21%). Survivors living in a nonmetropolitan location had 17 times the odds of reporting locational or financial barriers compared with those in metropolitan areas. Preferred potential solutions to alleviate the financial and social impacts of the disease were: free parking for tests or treatment (37%), free medications or treatments (29%), and being able to get treatment in their local region (20%). Conclusions Providing more equitable access to care for hematological cancer patients in Australia requires addressing distances traveled to attend treatment and their associated financial and social impacts on nonmetropolitan patients. Greater flexibility in service delivery is also needed for patients still in the workforce.
    The Journal of Rural Health 08/2013; 29.
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    ABSTRACT: PurposeThis study investigates health disparities for adults residing in a mountaintop coal mining area of Appalachian Kentucky. Mountaintop mining areas are characterized by severe economic disadvantage and by mining‐related environmental hazards. MethodsA community‐based participatory research study was implemented to collect information from residents on health conditions and symptoms for themselves and other household members in a rural mountaintop mining area compared to a rural nonmining area of eastern Kentucky. A door‐to‐door health interview collected data from 952 adults. Data were analyzed using prevalence rate ratio models. FindingsAdjusting for covariates, significantly poorer health conditions were observed in the mountaintop mining community on: self‐rated health status, illness symptoms across multiple organ systems, lifetime and current asthma, chronic obstructive pulmonary disease, and hypertension. Respondents in mountaintop mining communities were also significantly more likely to report that household members had experienced serious illness, or had died from cancer in the past 5 years. Significant differences were not observed for self‐reported cancer, angina, or stroke, although differences in cardiovascular symptoms and household cancer were reported. Conclusions Efforts to reduce longstanding health problems in Appalachia must focus on mountaintop mining portions of the region, and should seek to eliminate socioeconomic and environmental disparities.
    The Journal of Rural Health 08/2013; 29.
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    ABSTRACT: PurposeExtensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary‐related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents.Methods During 8 focus groups (N = 99) and 6 group key informant interviews (N = 20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others.FindingsParticipants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental, and society‐level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extraindividual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents' recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening.Conclusions We discuss the implications of these findings for programmatic development in the Appalachian context.
    The Journal of Rural Health 08/2013; 29.
  • The Journal of Rural Health 01/2012; 28(1).
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    ABSTRACT: Purpose: To determine the association between sleep duration and depressive symptoms in a rural setting. Methods: We conducted a cross-sectional study using data from Wave 3 of the Walk the Ozarks to Wellness Project including 12 rural communities in Missouri, Arkansas, and Tennessee (N = 1,204). Sleep duration was defined based on average weeknight and weekend hours per day: short (<7), optimal (7-8), and long (>8). The primary outcome was self-reported elevated depressive symptoms. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (95% CI). Findings: Elevated depressive symptoms were common in this rural population (17%). Depressive symptoms were more prevalent among subjects with short (26.1%) and long (24%) sleep duration compared to those with optimal (11.8%) sleep duration. After adjusting for age, gender, race, education, employment status, income, and BMI, short sleep duration was associated with increased odds of elevated depressive symptoms (aPOR = 2.12, 95% CI: 1.49, 3.01), compared to optimal sleep duration. Conversely, the association between long sleep duration and depressive symptoms was not statistically significant after covariate adjustment. Similar findings were observed when we excluded individuals with insomnia symptoms for analysis. Conclusions: This study suggests that short sleep duration (<7 hours per night) and depressive symptoms are common among rural populations. Short sleep duration is positively associated with elevated depressive symptoms. The economic and health care burden of depression may be more overwhelming among rural populations, necessitating the need to target modifiable behaviors such as sleep habits to improve mental health.
    The Journal of Rural Health 10/2011;
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    ABSTRACT: Medicare beneficiaries incur 27%-30% of lifetime charges in the last year of life; most charges occur in the last quarter. Factors associated with high end-of-life Medicare charges include less advanced age, non-white race, absence of advance directive, and urban residence. We analyzed Medicare hospital charges in the last year of life for nursing home residents with severe cognitive impairment, focusing on rural-urban differences. The study population consisted of 3,703 nursing home residents (1,882 rural, 1,821 urban) in Minnesota and Texas who died in 2000-2001. Data on Medicare hospital charges were obtained from 1998-2001 Centers for Medicare and Medicaid Services MedPAR files. During the last year of life, unadjusted charges averaged $12,448 for rural subjects; $31,780 for urban. The charges were distributed across the last 4 quarters similarly for the 2 populations, with 15%-20% of charges incurred in each of the first 3 quarters, and 47% (rural) and 52% (urban) in the last quarter. At the individual level, a higher percentage of hospital charges were incurred in the last 90 days by urban than by rural residents (P < .001). A larger proportion of urban (43%) than rural (37%) residents were hospitalized in the final quarter. The charges for hospitalized residents (N = 1,994) were distributed similarly to those of the entire study population. Medicare hospital charges during the last year of life were lower for rural nursing home residents with cognitive impairment than for their urban counterparts. Charges tend to be more concentrated in the last 90 days of life for urban residents.
    The Journal of Rural Health 03/2008; 24(2):154-60.
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    ABSTRACT: Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings. To examine rural-urban differences in physician work effort, physician characteristics, and practice characteristics, and to determine whether, after adjusting for any observed differences, rural primary care physicians' incomes were lower than those of urban primary care physicians. Using survey data from actively practicing office-based general practitioners (1,157), family physicians (1,378), general internists (2,811), or pediatricians (1,752) who responded to the American Medical Association's annual survey of physicians between 1992 and 2002, we used linear regression modeling to determine the association between practicing in a rural (nonmetropolitan) or urban (standard metropolitan statistical area) setting and physicians' annual incomes after controlling for specialty, work effort, provider characteristics, and practice characteristics. Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients. After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts (95% confidence intervals: -$14,569, -$4,602, P < .001). In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts. Addressing rural physicians' lower incomes, longer work hours, and greater dependence on Medicaid reimbursement may improve the ability to ensure that an adequate supply of primary care physicians practice in rural settings.
    The Journal of Rural Health 03/2008; 24(2):161-70.
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    ABSTRACT: Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences. To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations. We conducted a cross-sectional analysis of the Healthcare Cost and Utilization Project's National Inpatient Sample representing a total of 37,804,021 hospital discharges, with 4.9% of them generated by uninsured persons in 2002. We compared demographic and clinical characteristics and the proportion of frequent and costly diagnoses by rural and urban hospitals. We used multiple logistic regression models to examine the relationship between preventable conditions and rural and urban hospitals among uninsured hospitalizations. Uninsured persons discharged from rural hospitals were more likely than their urban counterparts to be working-age adults (82% vs 79%) and to reside in a ZIP code area with a median household income of less than $35,000 per year (56% vs 26%). Rural uninsured hospitalizations were more likely to be for preventable conditions than were urban uninsured hospitalizations (P < .001). The proportion of total hospital charges related to preventable hospitalizations was 15.5% in rural hospitals versus 10.0% in urban hospitals. The patterns of uninsured hospitalizations in rural and urban hospitals were different in many ways. Providing adequate access to primary care could result in potential savings related to preventable hospitalizations for the uninsured, especially for rural hospitals.
    The Journal of Rural Health 03/2008; 24(2):194-202.
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    ABSTRACT: A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers' compensation system was implemented in 2004 (SHB 1691), amid concern about disparities in access to health care for injured workers in rural areas. SHB 1691 authorized NPs to independently perform most functions of an attending physician. The aims of this study were to (1) describe the contribution by NPs to Washington's workers' compensation provider workforce, (2) evaluate change in provider availability attributable to SHB 1691, and (3) evaluate the effect of SHB 1691 on timely accident report filing. Administrative data were used to evaluate this natural experiment, using a pre-post design with primary care physicians (PCPs) as a nonequivalent comparison group. NPs served injured workers with characteristics similar to those served by PCPs, but 22.0% of NPs were rural, compared with 17.3% of PCPs. Of claimants with NPs as their attending provider, 53.3% were injured in a rural county, compared with 24.7% for those with PCP attending providers. The number of NPs participating in the workers' compensation system rose after SHB 1691 implementation, more so in rural areas. SHB 1691 implementation was associated with a 16 percentage point improvement in timely accident report filing by NPs in both rural and urban areas. Authorizing NPs to function as attending providers for injured workers may improve provider availability (especially in rural areas) and timely accident report filing, which in turn may improve worker outcomes and system costs.
    The Journal of Rural Health 02/2008; 24(2):171-8.
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    ABSTRACT: Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts. To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess whether rural-urban differences exist. PubMed, Ageline, Cinahl, PsycInfo, International Pharmaceutical Abstracts, Agricola, and Institute for Scientific Information Web of Science - Social Science Index were searched. English-language articles through May 2005 involving a sample of rural, noninstitutionalized older adults and analyses of overall medication prevalence and/or intensity were included. Review articles, conference abstracts, dissertations, books, and articles targeting nonprescription or specific therapeutic categories were excluded. A total of 206 citations were identified and 26 met the inclusion criteria. Reported prevalence of prescription medication use by rural older adults varied between 62% and 96%, with 2-6 prescriptions per person. Multivariate analyses results were equally inconsistent. Controlling for insurance, most US studies suggest there is no rural-urban difference in access to prescribed medications. However, this finding may not be generalizable across all regions in the United States or other countries. Geographic location may not be as important a variable for medication usage as for other health services utilization.
    The Journal of Rural Health 02/2008; 24(2):203-9.