Yonder: working rurally, pain-related distress, access and experience, tailored public health messaging

Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature

Working rurally

Rural medical workforce shortages contribute to geographic health inequities. In Australia, government-funded initiatives to address this have included increasing enrolment of medical students from rural backgrounds and offering extended rural training, both of which have shown positive results. This study at University of Adelaide examined how rural placements during medical school are related to working rurally after graduation.¹ Those from a rural background were almost 4 times more likely to be working rurally after graduation, as were students who had spent longer on rural placements at university (Year 5 36-week rural placement only OR -Odds Ratio- 1.97, combined with Year 4 or 6 short rural placement OR 3.11, rural placement in Year 4, 5 & 6 OR 5.57). However, short 4- or 8-week placements alone showed no association with rural practice location. The authors therefore conclude that the immersion gained from longer term placements “plays an important role in converting interest into actual rural practice.”

Pain-related distress

Depression is a common co-morbidity in patients with persistent musculoskeletal (MSK) pain. Distinguishing between pain-related distress – where pain is acting as a stressor which people are struggling to manage – and depressive disorders can be difficult but is crucial to enable appropriate and effective treatment. This mixed-methods UK study aimed to explore the key factors that differentiate between pain-related distress and depression in people with persistent MSK pain.² Qualitatively, the key distinction was that distress could be alleviated if pain was resolved whereas depression was pervasive. Pain-related distress mainly stemmed from the impact on physical function and daily activities. Quantitatively, higher levels of stress, lower levels of positive outlook and sleep interference significantly predicted depression and distress compared to distress only. The 4-Dimensional Symptom Questionnaire (4DSQ) was useful for this as it provided scores which separated distress from depression.

Access and experience

The 10-year Health Plan for England is focused on patient experience with access, the ability to contact and receive care from general practice, being a key focus. Recent contractual changes requiring practices to provide online access during core working hours are controversial and whether this makes it easier to see or speak to a GP is up for debate. This study aimed to determine whether inequalities in patient experience differ by access mode using data from the 2023 GP Patient Survey.³ When comparing online vs traditional (in-person or telephone) methods of making an appointment, overall patients were 14% more likely to report a good experience using online methods after adjustment for patient and practice characteristics but this was not the case for older patients or those with non-binary, other, or prefer not to say gender identities. This highlights the risk of digital exclusion and a potential lack of inclusive gender options in online systems.

Tailored public health messaging

An early framework for delivering public health messaging is Lasswell’s 5W model: 1. Who? 2. Says What? 3. In Which channel? 4. To Whom? 5. With What effect?⁴ For example, a politician delivering a public health message during COVID-19 can be broadcast online and on television and be delivered cheaply and quickly, but the message may not be heard due to mistrust of politicians, particularly amongst vulnerable groups. This Australian study used videos delivering information on COVID-safe behaviour to six vulnerable groups to investigate the impact of who delivers health messaging and visual stimulus.⁵ There was no clear preference for animated vs talking head videos, or whether the talking head was a GP or a community representative except amongst Aboriginal and Torres Strait Islander and street-based sex worker groups, whose intent to carry out COVID-safe behaviour was higher following messages from community representatives.

References

1. Williams S, Gonzalez-Chica D, Morgan K, White L, Walters L. Time Spent in Rural Placements and Working Rurally After Graduation: A Retrospective Cohort Study of University of Adelaide Medical Graduates, 2010-2021. Aust J Rural Health. 2026 Apr;34(2):e70174. DOI: 10.1111/ajr.7017
2. Birkinshaw H, Pincus T, Hughes S, Stuart B, Chew-Graham C, Little P, Moore M, Shivji N, Geraghty AWA. Differentiating pain-related distress from depression in people with persistent musculoskeletal pain: a mixed methods study. Pain. 2026 Mar 13. DOI: 10.1097/j.pain.0000000000003926
3. Marks T, Ge X, Opie-Martin S, Clarke JM, Xu Y, Brine R, Bakhai M, Clarke GM. Sociodemographic variation in the association between modes of access and patient experience of primary care: a retrospective cross-sectional patient-level analysis of the General Practice Patient Survey in England in 2023. BMJ Open Qual. 2026 Mar 26;15(1):e003616. DOI: 10.1136/bmjoq-2025-003616
4. H.D. Lasswell. The structure and function of communication in society. Commun Idea, 37 (1) (1948), pp. 136-139. Available from: https://marketing-course.ru/wp-content/uploads/2018/11/Lasswell.pdf
5. D’Atri M, Williams N, Robins LM, Long KM, Wiloughby L, Callaway L, Williams C, Russell G, Hill K, Hlavac J, Prain M, Bonnici R, Wilkinson N, Aslangul S, Macindoe R, Danby H, Pearce D, Loads M, Nazarentian S, McMurtie S, Ireland P, Hayes-Brown P, Haines TP. Effectiveness of tailored public health messages for vulnerable populations: A randomised controlled trial. Public Health. 2026 Mar 24;255:106251. DOI: 10.1016/j.puhe.2026.106251. Epub ahead of print.

Featured photo by George Hiles on Unsplash.