Preparing occupational therapy students for practice in rural areas: a scoping review protocol

Abstract

Introduction

Despite greater needs in rural areas, occupational therapists are maldistributed to urban spaces which limits service access and health outcomes for rural people and communities. Preparation of students for rural practice may improve rural workforce recruitment and retention; however, the range and scope of preparation strategies employed by education providers are unclear. This scoping review aims to understand and describe the range of strategies education services use to prepare occupational therapy students for rural practice across the globe.

Methods and analysis

The study will include all publications about strategies used to prepare occupational therapy students for future rural practice, prior to enrolment, during the programme or on graduation. MEDLINE (Ovid), Emcare (Ovid), APA PsychInfo (Ovid), CINAHL (EBSCOhost), Health Source: Nursing/Academic (EBSCOHost), Educational Resources Information Centre (ERIC), Open Access Theses and Dissertations (OATD), and Scientific Electronic Library Online (SciELO) databases will be systematically searched in English, Spanish, French and Portuguese languages. Citations will be screened by two or more independent researchers against inclusion criteria and data extracted from included publications using a customised extraction tool. Frequency counts will be provided for study type, student location and sociodemographics, and the timing/educational strategy. The extracted data will be analysed using a matrix framework and presented in diagrammatic/tabular form and accompanied by a narrative summary which will describe how the results relate to the reviews’ questions.

Ethics and dissemination

This study will not involve human/animal subjects and does not require ethics approval. Results will be disseminated to relevant groups in peer-reviewed journal(s) and at relevant occupational therapy, higher education and/or rural health conferences. Results will also be translated and shared in blogs/social media to support access for non-research audiences and shared with other regional universities to influence curriculum design.

Correspondence to Ms Karen Hayes; [email protected]

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The review will use the rigorous Joanna Briggs Institute scoping review methodology²⁷ to ensure trustworthiness of results.

• Examination of literature in four languages, using multiple databases from both the Global North and Global South, will provide more diverse results than English alone.

• Alignment of Medical Subject Headings with multilingual and structured vocabulary Health Sciences Descriptors for database searches will increase likely identification of manuscripts published in languages other than English.

• The quality of the publications will not be assessed as this is a scoping, not a systematic review, and therefore will not demonstrate the effectiveness or otherwise of the strategies identified.

Introduction

In most countries across the globe, health professionals are maldistributed, with a significant majority located in cities.¹ Consequently, two billion rurally located people are estimated to have no or extremely limited access to health workers.¹ Those who have access to health workers often experience longer wait times and significantly higher costs to access healthcare than urban people.^{1 2} This maldistribution persists regardless of the level of development of a country and tends to enhance other intersectional disadvantages such as race, gender and disability.^{3 4} Poor access to health, education and social care experience by rural people has been linked to the population level poorer health, income and social outcomes in rural spaces.¹ A shift of rural populations to urban places over the past 50 years is projected to continue into 2050, and for many countries has resulted in ageing rural populations, reduction in rural services and an increasing risk of rural poverty.² These changes have left many rural people behind with poor health outcomes including markedly different life expectancies between rural and urban people living in the same country.³

The occupational therapy profession also demonstrates this rural/urban workforce maldistribution. Countries with published statistics consistently report occupational therapy workforce maldistribution where 77% or more of a nation’s occupational therapists live and work in urban areas.^5–8 Occupational therapy’s stated aim includes working with people who are marginalised to engage in daily activities that are important to them. A core tenant of the profession is that being able to engage in activities allows people to develop physical, mental and social health⁹ yet, occupational therapists are so rarely found within marginalised rural populations.^5–8

Multiple reasons for health worker maldistribution have been proposed including limited workforce supply, attraction and retention challenges, social stability (perceived or real), poor living conditions, limited infrastructure and poor remuneration.¹ However, a recent scoping review of global occupational therapy service publications identified a common approach to rural occupational therapy services, particularly in the Global North, was to transplant urban-style services to rural places and staff these services with urban-based therapists in outreach models.¹⁰ It was suggested that poor understanding of the rural context by the service designers and urban-based therapists may contribute to poor health outcomes and experiences in rural places.¹⁰ Further thematic analysis of these publications identified a hegemonic approach to rural occupational therapy services in the publications, which problematised the people and geography in rural places for not fitting within urban norms under which these services were initially developed and causing inconvenience and costs for service providers.¹¹ Tacit suggestions that rural practice is both difficult and less prestigious have been noted in the medical literature as a hidden curriculum in undergraduate education which, while not overtly stating it, may contribute to rural practice being perceived as less desirable.¹² However, evidence suggests that rural practitioners who report feeling prepared for rural practice^{6 13} and rural cultures/ways of living¹⁴ are more likely to be recruited to and retained in rural practice. Thus, considering how rural practice is described and included in occupational therapy education may support increased interest and participation in rural practice.

Multiple strategies to prepare health professional students for rural practice have been noted in the literature including supporting urban students to experience rural practice during workplace learning placements,^15–17 remote learning opportunities for selected students in specified rural areas,^{18 19} immersive ‘road trips’ or camps to rural areas,²⁰ telehealth training,²¹ outreach programmes^{22 23} and building satellite education campuses in rural areas.^24–26 However, there is no synthesis of preparatory strategies used to develop occupational therapy students for future rural practice. Understanding the strategies being described in the literature will support future analysis of the success or otherwise of these strategies in developing a rural workforce.

A preliminary search of MEDLINE (Ovid), the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted and no current or underway scoping reviews on the topic were identified. Thus, the objective of this review is to understand and synthesise current approaches to preparing occupational therapy students for practice outside of urban places.

Review question

Across the globe, what strategies are used by educational institutions to prepare occupational therapy students for practice in rural locations?

Methods and analysis

The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.²⁷

Publication inclusion criteria

Participants

All publications will be included which discuss occupational therapy students from any country, who are being prepared for professional practice by educational institutions of any qualification level (diploma, degree or professional masters’ degree, postgraduate clinical training) relevant to the qualification requirements of the country in which the student is learning. No exclusion criteria related to age, ethnicity, gender and health status will be applied. Postprofessional qualification research degrees (eg, by research, Doctor of Philosophy) will be excluded as these programmes are non-qualifying and not specifically preparing students for professional practice.

Concept

All publications that discuss strategies related to the preparation of occupational therapy students for rural and remote practice will be included. This will include strategies implemented: (1) prior to enrolment such as targeting rural-based people for enrolment or locating programmes in rural areas, (2) during the programme such as inclusion of rural content in subjects/curriculum, rural workplace learning programmes/support or (3) postgraduation such as bonded service in a rural area for a period following graduation. The strategy can be targeting occupational therapy students alone or as part of a wider strategy for multiple student cohorts such as health students or other disciplines.

Context

The review will consider publications targeting future practice outside of urban spaces. The location of the education provider itself, and most of the study time may be in urban or non-urban areas. As no globally agreed definition of urban/non-urban exists,²⁸ the review will rely on each publication to define itself as non-urban within the context of that country.

Types of sources

To ensure wide catchment and consideration of strategies in use across the globe, all information types will be included in the review (eg, primary research studies, systematic reviews, meta-analyses, commentary, programme descriptions and conference presentations)

Literature published in English, Spanish, French and Portuguese will be included. Where English translations are provided by the publisher, the paper will be reviewed in English as the common language of all reviewers. Portuguese is the first language of one of the research team members, and articles published in Spanish and French will be read by a team member also proficient in those languages. Any available publications from any time frame will be included.

Search strategy

An initial limited search of MEDLINE (Ovid) and CINAHL (EBSCOhost) was undertaken to identify articles on the topic. The citations were collated and uploaded into EndNote V.20 (Clarivate Analytics, Philadelphia, Pennsylvania, USA) and duplicates were removed. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy using keywords and Medical Subject Headings (MeSH) for each database.

Text mining was completed using MeSH on Demand to identify relevant MeSH (National Library of Medicine, 2020). Relevant articles were identified from the initial search and the introduction and/or literature review text from each was copied into MeSH on Demand to generate MeSH. Once MeSH on Demand (National Library of Medicine) started to repeat keywords (12 articles), no further MeSH analysis was undertaken. The generated MeSH terms were copied into a Microsoft Excel spreadsheet, duplicates were removed and relevant keywords were included in the search strategy.

Non-English search terms were identified using multilingual Health Sciences Descriptors (DeCS). DeCS terms are aligned with MeSH but include an additional 4402 descriptors and qualifiers which reflect linguistic nuances between English, Portuguese, Spanish and French.²⁹ These terms were identified and included in a spreadsheet and tested for efficacy in the MEDLINE (Ovid) and Scientific Electronic Library Online (SciELO)³⁰ databases. SciELO is an online electronic library commonly used in Global South countries which may provide a more balanced collection of publications not available from Global North databases.

A second search using the identified keywords/MeSH terms will be conducted across six academic databases MEDLINE (Ovid), Emcare (Ovid), APA PsychInfo (Ovid), CINAHL Plus with Full Text (EBSCOhost), Health Source: Nursing/Academic (EBSCOHost) and the Educational Resources Information Centre (ERIC). These databases have been selected as MEDLINE (Ovid) covers 23 million citations from more than 5600 journals including published allied health content and linked to MeSH.³¹ Emcare provides access to allied health articles including 1800 journals not available on other databases.³² APA PsychInfo provides access to approximately 2300 journals and 500 000 books focused on mental health,³³ which is a common practice area for occupational therapists. CINAHL Complete Plus with Full Text (EBSCOHost) publishes 4000+ nursing and allied health journals including conference proceedings for major occupational therapy conferences,³⁴ while Health Source: Nursing/Academic (EBSCOHost) includes a diverse mix of allied health research and other grey literature, including dissertations.³⁵ ERIC (EBSCOHost) is the largest education database and includes adult and higher education content which will likely be relevant to the review.³⁶ The search strategy, including all identified keywords and index terms, will be adapted for each included information source. The searches will be conducted using keywords in English, Portuguese, Spanish and French. A full MEDLINE search strategy is presented in online supplemental appendix 1.

A focused grey literature search will be conducted seeking unpublished theses and dissertations, reports, newsletters, media releases and news articles. Unpublished theses and dissertations will be sourced from Open Access Theses and Dissertations (OATD)³⁷ and ProQuest Dissertations & Theses Global³⁸ and will also emerge in the above search of Health Source: Nursing/Academic (EBSCOHost).³⁵ Limited Google searches will be completed for grey literature across specified sites including the World Federation of Occupational Therapists, WHO and the United Nations. These sites were chosen for their relevance to the subject area. A full Google grey literature search strategy is included in online supplemental appendix 2.

Following screening and selection, the reference list of all studies included in the review will be screened to identify any additional publications and the Scopus database will be used to review citing studies and identify additional relevant resources.

Source of evidence selection

Following the search, all identified citations will be collated and uploaded into Covidence systematic review software.³⁹ As data from Google grey literature searches cannot be downloaded as reference files, data about relevant results will be manually entered into an Excel spreadsheet before being uploaded into the Covidence system. The number of files examined and the number of relevant files will be managed in a spreadsheet. Following a pilot test, titles and abstracts will be screened by two or more independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant sources will be retrieved in full text and stored in Covidence. The full text of selected citations will be assessed in detail against the inclusion criteria by two or more independent reviewers. Existing English language translations provided by the relevant journal will be sought for any papers written in Spanish, Portuguese or French, and if this is not available, non-English language papers will be reviewed and discussed within the team led by an author who is fluent in the relevant language. Reasons for exclusion of sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion or with an additional reviewer.

Subquestions

To examine the review question, What strategies are used by education institutions to prepare occupational therapy students for practice in rural locations? we will consider the following subquestions:

What type of strategy was implemented?

The WHO¹ recommended 17 strategies to improve recruitment and retention of rural workforce following an extensive literature review. The review identified nine strategies related to student education, most with low to moderate levels of evidence to support their likely success. These strategies were (1) raising the profile of rural health workers to encourage students to consider working in rural healthcare. (2) Targeting admission policies to enrol students with a rural background, as there was moderate evidence that rural origin students were more likely to practice rurally on completion of their studies. Tied to this recommendation was (3) locating health education facilities closer to rural areas to allow better access for rural students. For students not learning in rural areas, it was recommended that they be (4) exposed students to rural communities and clinical practices and that (5) rural content be included as mainstream education for students. WHO also recommended (6) return for service grants where scholarships, bursaries or other education subsidies were provided to students while studying in return for rural service on graduation. WHO acknowledged that many countries had (7) compulsory bonded service where all students were required to work in a rural area on graduation, and rather than recommending this as a strategy, suggested ensuring the needs of health workers in this situation were prioritised. WHO also recommended (8) introducing and regulating enhanced scope of practice in rural and remote areas and ensuring that there were (9) support networks available for workers (and we extended this to include students) in rural areas. We will use these recommendations to examine the breadth of strategies described in the literature.

All the strategies recommended by the WHO¹ can be analysed by considering who the strategy is targeting and when the strategy occurs. That is, the WHO¹ recommends multifaceted strategies in building a rural workforce, targeting all levels from individuals (eg, potential or existing students), to groups (eg, communities of need and rural students) and industries (eg, universities and rural employers). Understanding the areas in which the literature is focused will support the identification of potential gaps. The WHO guidelines¹ also recommend that strategies occur across multiple time frames from prior to enrolment, during time as a student and on graduation. Considering how the strategies are used over time may identify patterns and gaps that offer opportunities for further research and changes in practice. Understanding when strategies are implemented in occupational therapy will demonstrate patterns and potential areas for future research and change. This allows for the types of strategies to then be examined in a matrix comparing who is being targeted, with when they are targeted. Understanding the scope and spread of the types of strategies being used over target groups and timeframes relative to student enrolment will provide clarity about the strategies currently described in the literature and potential gaps.

How was rurality defined?

A global definition of rurality has not yet been accepted, with most countries having their own definitions.²⁸ The United Nations proposed a method for harmonising the analysis of areas, rural or urban in 2021,⁴⁰ but this has yet to be adopted in most countries and relies on geographical concepts which may or may not have social meaning to the people living in the spaces.⁴¹ Examining how rurality was defined by the authors will provide a clearer understanding about how occupational therapy related literature defines the concept or if the concept is defined at all.

Where was the strategy designed and implemented?

A previous scoping review of occupational therapy services provided for people in rural areas¹¹ found a theme, particularly in the Global North of transplanting service models from urban areas into rural areas without necessarily considering appropriateness for the rural context. It was also identified that there was a problematisation of rural people and places which normalised urban living and considered rural ways of living as inferior. Countries in the Global South and projects using codesign methodology were more likely to accept rural ways of living as an alternative reality and design services to meet needs. Potentially, this issue may be present in occupational therapy education programmes designed to prepare rural workforce.

What were the characteristics of the students who participated?

Understanding the sociodemographic variables of students who participated in the strategies may demonstrate patterns of the types of students participating in rural preparation strategies.⁴² Alternatively, like recent findings, sociodemographic variables may be underreported, limiting generalisability.^{42 43} Therefore, examining student characteristics will provide information about how effectively demographics are reported and who is most likely to be participating in rural preparation strategies.

How were outcomes measured?

The WHO identified that there was very limited research evidence to support the recommendations made in their guidelines, yet there were many strategies being tried across the globe.¹ The New World Kirkpatrick Model for education strategy evaluation⁴⁴ is an outcome-focused model widely used in health education.⁴⁵ The model presents four levels of evidence of success from participant satisfaction, to learning, behaviour change and real-world results.⁴⁵ Medical research has identified that most strategy evaluation stops at satisfaction and learning, without attempting to measure if the strategy has impacted behaviour or results in the wider world.⁴⁵ Understanding how success has been measured will identify if future research is required to evaluate strategy success. This approach will also more effectively account for strategies which did not use standardised research methodologies, rather they used evaluation to examine the success of the programmes (eg, government strategies).

Data extraction

Data will be extracted from included papers, by independent reviewers using a data extraction tool developed by the reviewers and presented in online supplemental appendix 3. Aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR),⁴⁶ data will be extracted regarding the sources of evidence including, citation details, language of publication and publication type. Other details will be extracted in alignment with the subquestions.

What type of strategy was implemented?

• Target individuals, groups and/or institutions? (categorical and free text)

• Timing relative to student enrolment? (categorical and free text)

• Aim (categorical and free text)

• Choice in participation—voluntary or required (categorical)

• Completed in a rural or urban area? (categorical)

• Alignment to WHO recommended educational strategies (categorical)

• Strategy description (free text)

How was rurality defined by the authors?

• Rurality definition provided (yes/no categorical)

• Authors’ definition (free text)

Where was the strategy designed and implemented?

• Country of implementation (categorical and other)

• Socioeconomic/political location (categorical)

• Urban or rural location (categorical)

• Inclusion of rural people in design (yes/no categorical and free text)

What were the characteristics of the students who participated?

• Qualification level aiming to achieve (categorical)

• Count and percentage of total cohort of enrolled students

• Age (range)

• Gender (categorical male/female/non-binary)

• Socioeconomic status (categorical high/middle/low)

• Race (categorical dominant/minority)

• Disability status (categorical disabled/able-bodied)

How were outcomes measured?

• Outcomes measured (Kirkpatrick levels categorical)

• Description of outcomes measured (free text)

• Strategy successful (yes/no categorical)

• Description of results (free text)

The draft data extraction tool will be modified and revised during the process of extracting data from each included evidence source. The extraction tool will be piloted with at least 10% or n=5 of the included articles (whichever is higher) to ensure team consistency and to identify any issues with the data extraction tool. Modifications will be detailed in the scoping review publication. Any disagreements that arise between the reviewers will be resolved through discussion or with an additional reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required.

Data analysis and presentation

Data will be analysed using a combination of deductive and inductive approaches relevant to each subquestion. While the categories in the extraction tool reflect current literature and the preliminary search results, to the best of our knowledge this is the first study of its kind, so an inductive approach will be used where necessary to expand and further categorise any factors. Analysis will be conducted by all team members.

What type of strategy was implemented?

Analysis of strategy types will use a framework. Each data source will be mapped to a 3×3 matrix comparing strategy targets with the timing of the strategy (see table 1). This will result in nine categories from which to identify patterns and gaps in approaches to preparing occupational therapy students for rural practice.

Table 1

A matrix framework will be used to arrange data related to the strategy focused on who is targeted and when

Time\Target	Individual(s)	Group(s)	Institution(s)
Pre-enrolment
During enrolment
Postenrolment

Further, categorical data for each variable (aim; choice in participation; rural or urban location; alignment to WHO recommendations) will be developed from existing lists in the extraction data and thematic analysis of free text content to identify any additional categories. This categorical data will be reported using the nine categories of the matrix to identify patterns and gaps.

How was rurality defined by the authors?

The total number of papers (count) and percentage of total papers that defined rurality will be recorded and reported. The definition provided within the included papers will be thematically analysed in an inductive process and reported in diagrammatic and/or tabular form.

Where was the strategy designed and implemented?

The country of implementation will be mapped to a world map using ArcGIS software and the Brandt Line will be used to identify the Global North and Global South countries. The map will be presented with the number of sources from each country marked. Strategy types from the Global North and the Global South will be compared with all other variables to identify if there are differences in approach. Differences will be reported using tables.

Count and percentage of urban and rural strategy locations will be analysed and presented, and the inclusion of rural people in design will be analysed using the matrix outlined in table 1 and mapped to Global North or South strategies. How rural people were included in design will be thematically analysed using an inductive process and reported in diagrammatic and/or tabular form.

What were the characteristics of the students who participated?

The overall number of papers which report the characteristics of samples used (qualification; age; gender; socioeconomic status; race and disability status) will be counted and the percentage of the total will be reported in a table. If sufficient studies provide these data, the overall characteristics of students will be presented as counts and percentages and compared across the nine categories in the matrix outlined in table 1.

How were outcomes measured?

The overall number of papers reporting outcomes at each Kirkpatrick level will be calculated and reported in a table against the framework in table 1. The description of the outcomes measured and results will be thematically analysed to identify any other relevant considerations about success, including alignment with stated aims.

The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a PRISMA-ScR flow diagram and follow the PRISMA-ScR extension for reporting results.⁴⁶ A narrative summary will accompany all tabulated and/or charted results and will describe how the results relate to the review objectives and question(s).

Ethics and dissemination

This study will not involve human or animal subjects and therefore does not require ethics approval.

The results of this study will be disseminated to relevant groups including the 107 World Federation of Occupational Therapists Member Organisations,⁴⁷ and rural workforce researchers as the most relevant audience for the results. The research team will submit research papers in English in peer-reviewed journal(s) and disseminate the results at conferences, including at least one conference where English is not the lingua franca, both nationally and internationally.

As researchers from a rurally located university committed to the development of rural professionals, the results will also be disseminated within the university and with other rural/regional universities via professional networks to support the preparation of the future rural workforce. We will also share the final publication with the leading/corresponding author of all articles in the review to promote conversation.

Patient and public involvement

It is not relevant or possible to involve patients/the public in the design, or conduct, or reporting, of our research.

The authors would like to thank Tricia Bowman, Senior Client Services Librarian, Charles Sturt University, for her invaluable support in critiquing and improving the search strategy for this protocol.

Ethics statements

Patient consent for publication

Not applicable.

Ethics approval

Not applicable.

Footnote

Contributors The initial concept for this work was developed by KH and VDS, while the design, method and approach were collaboratively developed by KH and VDS, NB, BC and KL. Data acquisition, critical analysis of approach and development of final search strategies were completed by KH and VDS, NB, BC and KL. The work was initially drafted by KH and critically reviewed for important intellectual content by VDS, NB, BC and KL. KH, VDS, NB, BC and KL have approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding Funding for open accessing publishing of this article was provided by the Charles Sturt University Tri-Faculty Open Access Publishing scheme.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

References

¹ World Health Organisation. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. 2021.

² Scheil-Adlung X. Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries. In: International Labour Office, Social Protection Dept. 2015.

³ Taylor MM. Rural health disparities: Public health, policy, and planning approaches. Cham: Springer Books, 2019. doi:10.1007/978-3-030-11467-1

⁴ O’Connor C, Bright LK, Bruner JP. The emergence of Intersectional disadvantage. Social Epistemology 2019; 33: 23–41. doi:10.1080/02691728.2018.1555870

⁵ Ned L, Tiwari R, Buchanan H, et al. Changing demographic trends among South African occupational therapists: 2002 to 2018. Hum Resour Health 2020; 18. doi:10.1186/s12960-020-0464-3

⁶ Roots RK, Li LC. Recruitment and retention of occupational therapists and Physiotherapists in rural regions: a meta-synthesis. BMC Health Serv Res 2013; 13: 59. doi:10.1186/1472-6963-13-59

⁷ Mani K, Sundar S. Occupational therapy workforce in India: a national survey. Indian J Occup Ther 2019; 51: 45. doi:10.4103/ijoth.ijoth_1_19

⁸ Australian government Department of health, 2019 occupational therapist fact sheet; 2020.

⁹ World Federation of occupational therapists, definitions of occupational therapy from member organisations; 2013.

¹⁰ Hayes K, Dos Santos V, Costigan M, et al. Profile of occupational therapy services in non-urban settings: A global Scoping review. Aust Occup Ther J 2023; 70: 119–41. doi:10.1111/1440-1630.12835

¹¹ Hayes K, Dos Santos V, Costigan M, et al. Extension, austerity, and emergence: themes identified from a global Scoping review of non-urban occupational therapy services. Aust Occup Ther J 2023; 70: 142–56. doi:10.1111/1440-1630.12844

¹² Malatzky C, Bourke L. Re-producing rural health: challenging dominant discourses and the manifestation of power. Journal of Rural Studies 2016; 45: 157–64. doi:10.1016/j.jrurstud.2016.03.005

¹³ Playford D, Puddey IB. Interest in rural clinical school is not enough: participation is necessary to predict an ultimate rural practice location. Aust J Rural Health 2017; 25: 210–8. doi:10.1111/ajr.12324

¹⁴ Cosgrave C, Malatzky C, Gillespie J. Social determinants of rural health workforce retention: A Scoping review. Int J Environ Res Public Health 2019; 16. doi:10.3390/ijerph16030314

¹⁵ Barraclough FL, Pit S. Preparing the future workforce to address the health needs of small rural Australian towns through non-traditional Allied health student placements. Int J Integr Care 2018; 18: 65. doi:10.5334/ijic.s2065

¹⁶ Khalil H, Leversha A, Walker J. Evaluation of Pharmacy students' rural placement program: preparation for Interprofessional practice. Aust Health Review 2015; 39: 85. doi:10.1071/AH14121

¹⁷ Bolte K, Bourke L. Rural health workforce development: student placement project. Australian Nursing & Midwifery Journal 2017; 25.

¹⁸ Bell E. 'Creating 'the rural pathway: Australia’s University departments of rural health and rural clinical schools'. International Journal of Child Health & Human Development 2011; 4: 135–44.

¹⁹ Johnston C, Wakely L. Delivering introductory Physiotherapy clinical placements incorporating simulated learning experiences in rural settings. Aust J Rural Health 2021; 29: 172–80. doi:10.1111/ajr.12715

²⁰ Page AT, Hamilton SJ, Hall M, et al. Gaining a 'proper sense' of what happens out there: an ' academic Bush camp' to promote rural placements for students. Aust J Rural Health 2016; 24: 41–7. doi:10.1111/ajr.12199

²¹ McIvor L, Karnes M. Role-play as an effective way to teach relationship building with Telehealth. The Open Journal of Occupational Therapy 2019; 7: 1–10. doi:10.15453/2168-6408.1527

²² Bowman PJ. Ergonomics work assessment in rural industrial settings: A student occupational therapy project. Work 2012; 43: 323–9. doi:10.3233/WOR-2012-1367

²³ Brandt LC. From collaboration to cause: breaking rural poverty cycles through educational partnerships. Am J Occup Ther 2014; 68 Suppl 2 (Supplement_2): S45–50. doi:10.5014/ajot.2014.685S01

²⁴ Eley DS, Synnott R, Baker P, et al. A decade of Australian rural clinical school graduates - where are they and why RRH 2012; 12: 1–12. doi:10.22605/RRH1937

²⁵ Farmer J, Kenny A, McKinstry C, et al. A Scoping review of the association between rural medical education and rural practice location. Hum Resour Health 2015; 13. doi:10.1186/s12960-015-0017-3

²⁶ Hays C, Devine S, Wongtongkam N, et al. Studying nursing at Australian satellite University campuses: A review of teaching, learning and support. Aust J Rural Health 2021; 29: 226–35. doi:10.1111/ajr.12741

²⁷ Peters M, et al. Chapter 11: Scoping reviews (2020 version). In: Munn Z, ed. Joanna Briggs Institute Reviewer’s Manual. 2020. doi:10.46658/JBIRM-190-01

²⁸ Carson D, et al. Perspectives on Demography at the edge, in Demography at the Edge Remote Human Populations in Developed Nations. Burlington, Vt: Ashgate, 2011.

²⁹ Virtual health library. Decs - health science Descriptors. 2022. Available: https://decs2020.bvsalud.org/cgi-bin/wxis1660.exe/decsserver/?IsisScript=../cgi-bin/decsserver/decsserver.xis&interface_language=i&previous_page=homepage&previous_task=NULL&task=start

³⁰ SciELO. Scielo.org. 2023. Available: https://scielo.org/en

³¹ Ovid. Ovid MEDLINE. 2022. Available: https://www.ovid.com/product-details.901.html

³² Ovid. Ovid Emcare. 2022.

³³ Ovid. APA Psychinfo Factsheet. 2022. Available: https://www.apa.org/pubs/databases/psycinfo/fact-sheet.pdf

³⁴ EBSCOhost. CINAHL. 2022.

³⁵ ProQuest. Nursing and allied health database. 2022.

³⁶ Institute of Educational Sciences. Eric. 2023. Available: https://eric.ed.gov/?faq

³⁷ OATD.org. Open access theses and dissertations. 2023. Available: https://oatd.org

³⁸ ProQuest. About Proquest dissertations & theses global. 2023. Available: https://www.proquest.com/pqdtglobal/productfulldescdetail

³⁹ Covidence. Covidence - better systematic review management. 2022. Available: https://www.covidence.org

⁴⁰ Dijkstra L, Florczyk AJ, Freire S, et al. Applying the degree of Urbanisation to the globe: A new Harmonised definition reveals a different picture of global Urbanisation. Journal of Urban Economics 2021; 125. doi:10.1016/j.jue.2020.103312

⁴¹ Bennett KJ, Borders TF, Holmes GM, et al. What is rural? challenges and implications of definitions that inadequately encompass rural people and places. Health Affairs 2019; 38: 1985–92. doi:10.1377/hlthaff.2019.00910

⁴² Jones SH, St Peter CC, Ruckle MM. Reporting of demographic variables in the Journal of applied behavior analysis. J Appl Behav Anal 2020; 53: 1304–15. doi:10.1002/jaba.722

⁴³ Nastasi JA, Crowe A, Gravina NE. Reporting demographic variables in JOBM and JAP: a comparison and call to action. J Organ Behav Manage 2023; 43: 50–63. doi:10.1080/01608061.2022.2082624

⁴⁴ Kirkpatrick J. An introduction to the new world Kirkpatrick model. Kirkpatrick Partners 2015. doi:10.1515/9781580468619

⁴⁵ Moreau KA. Has the new Kirkpatrick generation built a better hammer for our evaluation Toolbox Med Teach 2017; 39: 999–1001. doi:10.1080/0142159X.2017.1337874

⁴⁶ Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for Scoping reviews (PRISMA-SCR): checklist and explanation. Ann Intern Med 2018; 169: 467–73. doi:10.7326/M18-0850

⁴⁷ World Federation of Occupational Therapists. Member organisations profiles. 2021. Available: https://www.wfot.org/membership/member-organisations/member-organisations-profiles