Rural health care providers’ experiences of providing care to children and youth with disabilities: a scoping review

Health care providers face many challenges with delivering care in rural areas. However, little is known about their experiences of providing care to marginalized populations, such as children with disabilities. The purpose of this study was to explore the experiences of health care providers serving rural children with disabilities. We conducted a scoping review following the Joanna Briggs Institute methodology and an inductive thematic approach involving eight international databases (Embase, CINAHL, JBI EBP, Healthstar, Ovid Medline, PsycINFO, Scopus, Web of Science). Of the 2631 screened articles, 31 met the inclusion criteria. The studies spanned across seven countries over a 24-year period. Our findings involved the following themes: (1) training and knowledge of childhood-onset disabilities (i.e., lack of training; adequate training); (2) communication (i.e., communication concerns; effective communication and rapport building with local communities); and (3) lack of resources, services and supports (i.e., staff shortages; travel and accessibility issues; challenges of intersectional needs of rural patients). Our findings emphasize the extent of the challenges that rural health care providers encounter in delivering care to children with disabilities. There is a critical need for further supports, resources and targeted interventions to recruit and retain rural health care providers. Clinicians providing services to children with disabilities in rural areas face many challenges.More training in childhood-onset disabilities and access to ongoing professional development is needed for rural clinicians.More efforts are necessary to recruit and retain rural health care providers serving youth with disabilities.Additional services, supports and resources are required to address gaps in care and to help optimize health outcomes for children and youth with disabilities. Clinicians providing services to children with disabilities in rural areas face many challenges. More training in childhood-onset disabilities and access to ongoing professional development is needed for rural clinicians. More efforts are necessary to recruit and retain rural health care providers serving youth with disabilities. Additional services, supports and resources are required to address gaps in care and to help optimize health outcomes for children and youth with disabilities.

医疗服务提供者在乡村地区开展诊疗服务时面临诸多挑战，但目前学界对其为弱势人群（如残疾儿童）提供照护的实际体验仍知之甚少。本研究旨在探索医疗服务提供者为乡村残疾儿童提供照护的体验。本研究遵循乔安娜·布里格斯研究所（Joanna Briggs Institute）方法论，采用归纳式主题分析法开展范围综述，检索了Embase、CINAHL、JBI EBP、Healthstar、Ovid Medline、PsycINFO、Scopus、Web of Science共8个国际数据库。本次研究共筛选出2631篇文献，其中31篇符合纳入标准，相关研究覆盖7个国家，时间跨度达24年。本研究的核心主题包括以下三类：（1）儿童起病性残疾相关培训与认知（即培训缺失、充足培训）；（2）沟通协作（即沟通顾虑、与当地社区建立有效沟通与信任关系）；（3）资源、服务与支持体系匮乏（即医护人员短缺、出行与可及性问题、乡村患者交叉性需求面临的挑战）。研究结果凸显了乡村医疗服务提供者为残疾儿童提供照护时所遭遇的各类挑战。当前亟需进一步完善支持体系、补充相关资源，并制定针对性干预措施，以招募并留住乡村医疗服务从业者。为乡村残疾儿童及青少年提供服务的临床医师面临诸多挑战，亟需针对儿童起病性残疾开展更多培训，并为乡村临床医师提供持续职业发展路径；需投入更多精力招募并留住为残疾青少年服务的乡村医疗从业者；还需补充更多服务、支持与资源，以填补照护缺口，助力残疾儿童与青少年获得更佳健康结局。