Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project

Research indicates that people living in rural and remote areas of Canada face challenges to accessing health services. This article reports on a community-engaged research project conducted by investigators at Memorial University of Newfoundland in collaboration with the Rural Secretariat Regional Councils and Regional Partnership Planners for the Corner Brook–Rocky Harbour and Stephenville–Port aux Basques Rural Secretariat Regions of Newfoundland and Labrador. The aim of this research was to gather information on barriers to accessing health services, to identify solutions to health services’ access issues and to inform policy advice to government on enhancing access to health services. Data was collected through: (1) targeted distribution of a survey to communities throughout the region, and (2) informal ‘kitchen table’ discussions to discuss health services’ access issues. A total of 1049 surveys were collected and 10 kitchen table discussions were held. Overall, the main barriers to care listed in the survey included long wait times, services not available in the area and services not available at time required. Other barriers noted by survey respondents included transportation problems, financial concerns, no medical insurance coverage, distance to travel and weather conditions. Some respondents reported poorer access to maternal/child health and breast and cervical screening services and a lack of access to general practitioners, pharmacy services, dentists and nurse practitioners. Recommendations that emerged from this research included improving the recruitment of rural physicians, exploring the use of nurse practitioners, assisting individuals with travel costs,  developing specialist outreach services, increasing use of telehealth services and initiating additional rural and remote health research.Keywords: rural, remote, healthcare, health services, social determinants of healt

The effects of parental style on narrative production in preschoolers : an intervention study

The overall narrative productivity of economically disadvantaged preschoolers was evaluated prior to and following intervention. Participants were twenty preschool children and their mothers, who were randomly assigned to either an intervention or control group. The study consisted of a preliminary test, 12 months of intervention and a posttest. Fourteen children {7 in each group) also participated in a follow-up assessment that occurred a year after the end of intervention. All children's narratives from both the pretest and posttest were analysed for the quantity and length of propositions, unique units of information, decontextualized information, and simple and complex temporal terms. All narratives produced by the parents in both the pretest and posttest were analysed for the number of utterances, open-ended prompts, yes/no and wh-questions, and back-channelling. It was predicted that following training the intervention group would surpass the control group on all aspects of narrative productivity. Children in the intervention group showed no improvement relative to the control group in the posttest, except on a vocabulary measure, however a year later at the time of follow-up assessment intervention children produced more decontextualized descriptions of where and especially when the described events took place. Such decontextualized language has been emphasized as important for literacy acquisition