Rural Healthcare Workers' Well-Being: A Systematic Review of Support Interventions

Abstract Introduction: COVID-19 has amplified existing challenges to healthcare in rural areas, including a lack of access to care, increased staff turnover, and poor staff morale. Although there was increased awareness about healthcare workers’ stress and burnout during the COVID-19 pandemic, most of the support interventions tended to be in urban healthcare centers. Given the unique challenges rural healthcare workers face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of healthcare workers practicing in rural settings. Methods: We conducted a comprehensive search of the literature through electronic databases (Medline, Embase, PsycINFO, Web of Science, CINAHL, Emerald, SCOPUS databases, Google Scholar, ProQuest Dissertations and Theses Global, American Doctoral Dissertations, Open Access Theses and Dissertations) to identify quantitative, qualitative, and mixed methods studies describing supportive interventions for rural healthcare workers with well-being-related outcomes. We used the Effective Public Health Practice Project (EPHPP), Mixed Methods Assessment Tool (MMAT) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist to evaluate the study quality. Results: Out of 1583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized, and only six included controls. The included interventions had high acceptance by rural healthcare workers. Quantitative and qualitative themes identified shared decision-making, effective supervision, and proactive cultural change as the most fruitful interventions. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. Conclusions: Support interventions for healthcare workers, especially second-victim support programs, are underutilized in rural settings.