A rural‐urban comparison of self‐management in people living with cancer following primary treatment: A mixed methods study

Abstract

Objective: To investigate and compare self-management in people living with cancer following treatment, from rural and urban areas in the United Kingdom where there is a significant evidence gap. Methods:A cross-sectional explanatory sequential mixed methods design. This involved a self-completion questionnaire that collected data on demographics, self-management using the PAM-13 and rural-urban residence and 34 in-depth interviews that aimed to explore and compare the barriers and facilitators to selfmanagement in rural and urban settings.Results: 227 participants completed the questionnaire: mean age 66.86 (�11.22).Fifty-two percent (n = 119) were female and 48% (n = 108) were male. Fifty-three percent (n = 120) resided in urban areas and 45 % (n = 103) in rural areas. Participants had a range of different types of cancer but the three most common were breast (n = 73), urological (n = 53), upper and lower gastrointestinal (n = 41). Rural respondents (63.31 � 13.66) were significantly (p < 0.05) more activated than those in urban areas (59.59 � 12.75). The barriers and facilitators to self-management identified in the interviews were prevalent in both rural and urban settings but some barriers were more explicit in rural settings. For example, there was a lack of bespoke support in rural areas and participants acknowledged how travelling long distances to urban centres for support groups was problematic. Equally, there were barriers and facilitators that were not necessarily unique to either geographic setting. Conclusion:Whilst the active treatment phase can present considerable challenges for people living with cancer in rural areas the findings suggest that the rural environment has the potential to increase engagement with self-management in the transition to survivorship. The rigorous mixed methods design has led to different and complementary conclusions that would not have been possible had either quantitative or qualitative methods been used in isolation.

A Rapid Systematic Review on the Experiences of Cancer Survivors Residing in Rural Areas during the COVID-19 Pandemic

“…Not surprisingly, the majority of the research that was included in this review was conducted in North America and Australia which is similar to pre-pandemic scholarship on rurality and cancer that has been dominated by these areas for the past decade [ 11 , 12 , 13 , 15 , 16 , 17 , 18 , 31 , 34 ]. Only two of the COVID-19 studies that were included in this rapid review were from the European continent with one of these being from the UK where there is now a small but increasing body of pre-pandemic research that considers the impact of rurality on cancer experiences and outcomes [ 30 , 32 , 33 ]. Future research that looks at cancer and geographic residence, particularly that in the UK, should extend out to include coastal areas which are amongst the most deprived in the country and there is now a shifting policy focus to reduce growing health inequalities in deprived coastal communities [ 60 ].…”

“…It is important to note that there are a range of characteristics belonging to rural communities that can positively influence the experiences of cancer survivors who reside in rural areas [ 25 , 26 , 27 ]. For example, people living in rural communities frequently report more close relationships with family and friends and sometimes have access to greater levels of community support and green spaces which can improve both physical and mental health [ 15 , 28 , 29 , 30 ]. Rural cancer survivors can have unique values and different attitudes to help-seeking as well as maintaining a stronger degree of stoicism [ 31 ].…”

“…Rural cancer survivors can have unique values and different attitudes to help-seeking as well as maintaining a stronger degree of stoicism [ 31 ]. Furthermore, rural cancer survivors have been shown to have greater cancer-related self-efficacy, engagement with self-management and higher self-reported health status when compared to their urban counterparts [ 30 , 32 , 33 ] and are less likely to report higher levels of distress [ 34 ].…”

Urban–rural differences in associations among perceived stress, resilience and self‐care in Chinese older adults with multiple chronic conditions

“…This study found that urban–rural residence and sex were neither barriers nor facilitators to self‐care (Okpalauwaekwe et al., 2022). In contrast, another study in the United Kingdom investigating the urban–rural differences in self‐management in people living with cancer revealed that rural participants were significantly more active in self‐management than their urban counterparts (Nelson et al., 2022). The urban and rural differences in self‐care in Chinese older adults with MCCs remain understudied.…”

Mental health professionals and telehealth in a rural setting: a cross sectional survey

“…Rates of pandemic related anxiety, depression, posttraumatic stress disorder, psychological distress, and stress across the general population [24] [25,26], saw increased mental health service demand. This demand and reductions in service delivery due to COVID-19 controls, forced service providers to pivot rapidly to telehealth to maintain care delivery.…”