Black Queer Being/Knowing/Feeling: Storytelling of Barriers to Reproductive Healthcare.

Anti-Blackness and heteronormativity are the driving forces that determine access to reproductive healthcare and services in the United States, and the rate of Black birthing-related deaths continue to skyrocket. Still, there is a dearth of literature that includes the reproductive experiences of Black birthing people and their interactions with the healthcare system. This current study builds power with 10 Black Queer birthing people (or Partners) by centering on their gestation-based storytelling within discourse about reproduction. By blending these Partners' self-examination of their lived experiences with gestation with health research, Black feminism, and researcher interpretation of their stories, this study reveals the unparalleled truths of Black Queer reproduction. Six thematic areas within the healthcare system as experienced by Partners are explored. Additionally, through this disruptive approach, this study identifies the lived and material needs that necessitate reproductive justice for all.

Parents' Behaviors and Experiences Associated with Four Vaccination Behavior Groups for Childhood Vaccine Hesitancy.

OBJECTIVES: Increasing vaccine hesitancy and decreasing acceptance of the Centers for Disease Control and Prevention's (CDC) recommended schedule for childhood vaccines represent a crucial public health issue. The present study directly compares vaccine acceptance behavior across four different groups: those who are fully accepting of the CDC-recommended schedule, those who are accepting but on a delayed schedule, those who only partially vaccinate, and those who do not vaccinate at all. METHODS: A total of 779 adults residing in the United States with at least one child under the age of 18 years participated in an online survey. RESULTS: Logistic and Ordinary Least Squares regression analyses revealed clear differences between the vaccination behavior groups on a variety of demographic, psychographic, and behavioral metrics. Results suggest financial and insurance-related barriers still hinder full vaccination, and there are differences by race, ethnicity, and educational attainment. Sources of information about vaccines also differed by vaccination behavior group, with those who never vaccinate more likely to rely on friends and family for information. Finally, those whose child experienced what the parent interpreted as an adverse reaction to a previous vaccine, even if that reaction was within the bounds of "normal", were more likely to report they delay or partially vaccinate. CONCLUSIONS FOR PRACTICE: These results have implications for public health policy and intervention campaigns, in particular that two-step flow campaigns and increased knowledge of normal vaccine side effects may ameliorate some vaccine hesitancy.

A Qualitative Content Analysis of Caregiver Reports of Conversations with Their Children about Vaccinations.

Low childhood vaccination rates are associated with recent outbreaks of serious preventable diseases. However, prior research suggests that parent-physician communication may not be sufficient for increasing caregivers' intentions to follow the recommended vaccination schedule. Children sometimes play a role in the health decisions caregivers make on their behalf. Yet there is little research on the communication between caregivers and children about vaccinations and their influence on caregivers' vaccine decisions. The objectives of this study were to explore caregivers' conversations with their children about vaccinations and to examine how these conversations differed by child's vaccination status. 376 caregivers provided open-ended descriptions of a memorable conversation they'd had with their child about vaccinations. Qualitative content analysis revealed five key themes and four sub-themes mentioned by caregivers when discussing these conversations. Results suggest that most caregivers are discussing vaccines with their children. However, the topics discussed by caregivers who choose not to vaccinate and who vaccinate on a delayed schedule were quite different from those who fully or partially vaccinate their children. Understanding these different patterns of conversation themes can provide valuable insight for targeted intervention campaigns and messaging strategies.

A method for assessing links between objectively measured food store scores and store & neighborhood favorability.

Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.

If Everyone Is Doing It, It Must Be Safe: College Students' Development of Attitudes toward Poly-Substance Use.

Background: While binge drinking on college campuses has been a topic of concern for decades, especially among fraternity and sorority members, recreational drug use is on the rise and mixing alcohol and drugs is now more of a concern than ever. Objective: Social learning theory was used as a framework for understanding how students develop attitudes regarding the possible risks and rewards of various behaviors such as binge drinking and drug use. Method: This research reports the results of 13 focus group discussions with 63 college students. A thematic approach was used and revealed several themes: participating in college culture, experimenting is expected, ignoring risk-taking, and resisting peer pressure. Findings: Participants felt as if it was expected that college students would experiment with alcohol and drugs, and that it was just "part of going away to college." Students reported ignoring the known risks of mixing alcohol and drugs use despite prior education efforts. Conclusions: The findings of this study suggest that alcohol and drug use on college campuses is, at least in part, driven by a perception of college culture and a poor balancing of the risks and rewards associated with these behaviors.

Becoming a clinician researcher in allied health.

Objective Combining research with clinical practice has benefits for health services and practitioners. There is limited information available on strategies used by health professionals to balance research with high clinical service demands. The aims of the present study were to examine how research is initiated and to identify the factors that influence the successful integration of research into a clinical work role. Methods Semistructured recursive-style interviews were conducted with 15 research-active allied health professionals at regional health services using a combination of criterion and purposive sampling. Interviews were recorded, transcribed and analysed using constant comparative techniques to identify dominant themes, which were integrated to create a conceptual model. Results Becoming a clinician researcher involved four phases: (1) a research debut; (2) building momentum; (3) developing a track record; and (4) becoming an established clinician researcher. A research debut was enabled by pre-entry exposure to research or through quality activities, predisposing personal characteristics and research opportunities at work. Quarantined time for research, a research-friendly workplace culture and supportive research relationships enabled a clinician to thrive as a researcher despite the challenges. Conclusion The clinician researcher career trajectory contributes to a better understanding of how a research career commences and develops in clinical settings. It may assist to develop strategies to support research capacity building. What is known about the topic? There are potential benefits for clinicians and health services that flow from incorporating research into clinical roles. Factors that motivate, enable and constrain allied health research in clinical settings have been identified, but little is known about how a research career is initiated and progresses over time. What does this paper add? The present study contributes an important career path understanding to the successful development of research capacity from a clinician perspective. The clinician researcher career trajectory delineates four phases and identifies enabling and constraining factors. The study highlights the combination of factors that can initiate a research debut and lead clinicians to thrive as researchers. What are the implications for practitioners? Conducting research can provide an opportunity for a professional challenge and increased job satisfaction. A research-friendly environment, supportive research relationships and quarantined time for research contribute to research output in clinical settings.

Towards understanding the availability of physiotherapy services in rural Australia.

INTRODUCTION: A recent exploration of factors affecting rural physiotherapy service provision revealed considerable variation in services available between communities of the study. Multiple factors combined to influence local service provision, including macro level policy and funding decisions, service priorities and fiscal constraints of regional health services and capacity and capabilities at the physiotherapy service level. The aim of this article is to describe the variation in local service provision, the factors influencing service provision and the impact on availability of physiotherapy services. METHODS: A priority-sequence mixed methods design structured the collection and integration of qualitative and quantitative data. The investigation area, a large part of one Australian state, was selected for the number of physiotherapy services and feasibility of conducting site visits. Stratified purposive sampling permitted exploration of rural physiotherapy with subgroups of interest, including physiotherapists, their colleagues, managers, and other key decision makers. Participant recruitment commenced with public sector physiotherapists and progressed to include private practitioners, team colleagues and managers. Surveys were mailed to key physiotherapy contacts in each public sector service in the area for distribution to physiotherapists, their colleagues and managers within their facility. Private physiotherapist principals working in the same communities were invited by the researcher to complete the physiotherapy survey. The survey collected demographic data, rural experience, work setting and number of colleagues, services provided, perspectives on factors influencing service provision and decisions about service provision. Semi-structured interviews were conducted with consenting physiotherapists and other key decision makers identified by local physiotherapists. Quantitative survey data were recorded in spreadsheets and analysed using descriptive statistics. Interviews were recorded and transcribed verbatim, with transcripts provided to participants for review. Open-ended survey questions and interview transcripts were analysed thematically. RESULTS: Surveys were received from 11/25 (44%) of facilities in the investigation area, with a response rate of 29.4% (16/54) from public sector physiotherapists. A further 18 surveys were received: five from principals of private physiotherapy practices and 13 from colleagues and managers. Nineteen interviews were conducted: with 14 physiotherapists (nine public, five private), four other decision makers and one colleague. Three decision makers declined an interview. The variation in physiotherapy service availability between the 11 communities of this study prompted the researchers to consider how such variation could be reflected. The influential factors that emerged from participant comments included rurality and population, size and funding model of public hospitals, the number of public sector physiotherapists and private practices, and the availability of specialised paediatric and rehabilitation services. The factors described by participants were used to develop a conceptual framework or index of rural physiotherapy availability. CONCLUSIONS: It is important to make explicit the link between workforce maldistribution, the resultant rural workforce shortages and the implications for local service availability. This study sought to do so by investigating physiotherapy service provision within the rural communities of the investigation area. In doing so, varying levels of availability emerged within local communities. A conceptual framework combining key influencing factors is offered as a way to reflect the availability of physiotherapy services.

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

BACKGROUND: Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. METHODS: A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. RESULTS: Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. CONCLUSIONS: The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

Utilising a collective case study system theory mixed methods approach: a rural health example.

BACKGROUND: Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. METHOD: A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. RESULTS: 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. CONCLUSIONS: The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research.

What factors influence physiotherapy service provision in rural communities? A pilot study.

OBJECTIVE: To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. DESIGN: Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. SETTING: A rural centre and its regional referral centre formed the pilot sites. PARTICIPANTS: Nine participant perspectives were obtained on rural physiotherapy services. MAIN OUTCOME MEASURES: Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. RESULTS: Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. CONCLUSION: Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery.

Preventive behavior intention for a viral outbreak among college students: The case of Mpox.

OBJECTIVE: Examine college students' behavior intention to reduce viral outbreak transmission in the context of Mpox, and what preventive messaging strategies would be most effective in future transmissible disease outbreaks based on the Reasoned Action Approach (RAA). PARTICIPANTS: Undergraduates at a mid-Atlantic U.S. University. METHODS: An online survey (n = 266) conducted at the height of the recent Mpox outbreak in the U.S., asked about five target behaviors to reduce Mpox transmission, including RAA determinants for each behavior. RESULTS: Highest intention was safe sex practices, lowest were vaccination and sexual abstinence, and sharing dishes and fabrics were in between. RAA determinants differed by target behavior, although attitudes were significantly positively associated with intention for all five behaviors. CONCLUSIONS: College students are potentially open to preventative behaviors to reduce viral transmission during an outbreak. However, specific target behavior matters and messaging should focus on differing RAA determinants depending on target behavior.

Sociodemographics, behaviour and knowledge of first South African HPV-vaccine recipients.

BACKGROUND:  Infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer and is one of the most prevalent sexually transmitted infections worldwide. Primary prevention strategies target reducing HPV acquisition through vaccination, limiting exposure (e.g. delayed sexual debut, barrier contraception) and health education focusing on sexual behaviour and tobacco use. METHODS:  The ImmunoVACCS study, conducted from 2019 to 2022 in two provinces in South Africa, examined sociodemographic characteristics, sexual practices, and knowledge of cervical cancer and the HPV vaccine among young female vaccine recipients. It encompassed participants from the previously conducted vaccine implementation trials, VACCS 1 and VACCS 2 (2011-2014). Recruitment involved telephonic contact with eligible potential participants. Data were collected through self-administered questionnaires. RESULTS:  One hundred and eleven participants took part in the current study (median age: 20 years; age range: 16-22 years). Most sexually active participants had their first engagement in secondary school (96.2%), and 77.2% used contraception during their last sexual activity. Knowledge gaps were evident, with only 13.5% recognising cervical cancer's cervix origin and 3.6% attributing it to a virus. Despite this, 70.3% had heard of a vaccine for cervical cancer. Less than half knew about the importance of regular Pap smears (49.5%), vaccine protection (44.1%) or condom use (20.7%) against HPV and cervical cancer. CONCLUSION:  The current study demonstrates that young women still lack complete information on cervical cancer and its risk factors even after receiving health education linked with vaccination.Contribution: This study underscores the necessity of ongoing education about HPV, its risks and preventive measures among young women to combat cervical cancer.

Embedding Nursing Ethics Within Teaching Strategies in Nurse Residency Programs.

Exposing new nurses to theoretical teaching strategies that help them to navigate the ethical challenges in clinical practice is essential for retention and long-term job satisfaction. This article explores the rationale for teaching ethics content in nurse residency programs and ways to navigate ethical decision-making in the clinical setting. Examples of evidence-informed teaching strategies that enhance knowledge retention and reduce the gap between ethical theory and practice are included.

Looking ahead: Caregivers' COVID-19 vaccination intention for children 5 years old and younger using the health belief model.

COVID-19 vaccine hesitancy is a significant public health issue. While vaccines are not yet available for children, clinical trials are underway, and children will likely be an important factor in the U.S. reaching herd immunity. However, little research has been conducted to examine parents' intention to vaccinate their young children for COVID-19. METHOD: An online survey with a national U.S. sample of 682 primary caregivers of children under age six assessed variables associated with intention to accept the COVID-19 vaccine for their children from November 13, 2020, to December 8, 2020. RESULTS: Caregivers whose child received a recent influenza vaccine, as well as those with previous experience COVID-19, were more likely to express COVID-19 vaccination intention for their young child. Identifying as female was associated with lower COVID-19 vaccination intention, while identifying as Hispanic or Latino was associated with higher intention. Health Belief Model variables of perceived severity of COVID-19 for their child, as well as vaccine confidence, were positive predictors of COVID-19 vaccine intention and mediated the relationship between prior behavior, demographic variables, and intention. CONCLUSIONS: The findings highlight the importance of early, proactive COVID-19 vaccination education efforts directed at caregivers, including those with young children. Vaccines for young children will likely become a necessary part of ending the pandemic's impact in school settings. Operationally, COVID-19 vaccination may also become a part of childhood vaccination schedules. Understanding the beliefs and intentions of caregivers of young children before vaccinations are recommended for children will enable public health officials and medical practitioners to prepare in advance.

Informed Consent for Online Research-Is Anybody Reading?: Assessing Comprehension and Individual Differences in Readings of Digital Consent Forms.

Informed consent is an important part of the research process; however, some participants either do not read or skim the consent form. When participants do not read or comprehend informed consent, then they may not understand the potential benefits, risks, or details of the study before participating. This study used previous research to develop experimentally manipulated online consent forms utilizing various presentations of the consent form and interactive elements. Participants (n = 576) were randomly exposed to one of six form variations. Results found that the highly interactive condition was significantly better for comprehension than any of the other conditions. The highly interactive condition also performed better for readability, though not significantly. Further research should explore the effects of interactive elements to combat habituation and to engage participants with the parts of the consent form unique to the study.

Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States.

Research on the social determinants of vaccine uptake often occur between racial/ethnic groups and not within groups. Though minoritized individuals face inequalities across the board, these are also not evenly distributed amongst minoritized individuals within groups. Using the National Health Interview Survey data, we examined disparities in flu vaccine uptake across racial/ethnic groups in the United States (US). We examined (a) NH (non-Hispanic) White (n = 32,655), (b) NH Asian (n = 2335), (c) NH African American (n = 5137), and (d) Hispanic (n = 5718) respondents who lived in the United States using the combined 2017 and 2018. We used multivariable logistic regression to predict flu vaccination (yes/no) both in models comparing racial/ethnic groups and within groups. Less than 50% of any of the four major racial/ethnic groups in the US received a flu vaccination in 2017-18. Flu vaccine uptake varied within racial and ethnic groups. These results suggest that increasing vaccination may require a complex, multi-faceted perspective that considers subgroups more directly.

Barriers for Telemedicine Use Among Nonusers at the Beginning of the Pandemic.

Telemedicine has garnered considerably more attention during the COVID-19 pandemic than in any time previously. However, before the beginning of the pandemic, many individuals had not accessed care in this manner. The purpose of this study was to understand the central reasons that individuals had not used telemedicine before the pandemic. Therefore, we conducted a convenience sample survey in March-April 2020, and 539 participants living in the United States answered questions about exploring their reasons for not having used telemedicine. Descriptive statistics and correlations were conducted to analyze the data. Two themes emerged from these data, including the importance of the patient-provider relationship and that access to technology was not the issue for this particular population. Although technology was not a barrier, many, specifically older participants, had concerns over privacy and security. As the world gains some control over the COVID-19 pandemic and medical appointments begin to return to a new normal, the implication for the continued use of telemedicine is still important to address as this will become a standard of care.

Returning to physiotherapy practice: the perspective of returners, potential returners and clinical supervisors.

The experience of returning to physiotherapy practice needs to be understood from the perspective of those who have returned to practice, those thinking of returning, and clinical supervisors who have worked with people that have returned to practice. A qualitative methodology using an interpretivist theoretical framework was utilised. Participants were selected using a combination of purposive and snowballing sampling techniques. Semi-structured interviews were conducted to determine the opinions of participants on returning to physiotherapy. Maternity and child-care were the main reason returners and potential returners took a break from physiotherapy. The main reason for returning to physiotherapy was because the returner wanted to rather than external factors such as financial hardship. Overall, the experience of returning to physiotherapy has been rewarding for returners and clinical supervisors. Returners and potential returners were highly motivated, keen to learn, and are willing to undertake a period of training to help them return to practice. However, there is only one programme available for returners to re-register as a physiotherapist and no refresher programmes are available. Returners, potential returners, and clinical supervisors thought that a structured re-registration or re-entry programme would need to be flexible to allow for returners' current needs, commitments, and career directions.

The Chaplain Family Project: Development, Feasibility, and Acceptability of an Intervention to Improve Spiritual Care of Family Surrogates.

In the Intensive Care Unit (ICU), family members experience psychological and spiritual distress as they cope with fear, grief, and medical decisions for patients. The study team developed and pilot tested a semistructured chaplain intervention that included proactive contact and spiritual assessment, interventions, and documentation. An interdisciplinary team developed the intervention, the Spiritual Care Assessment and Intervention (SCAI) Framework. Three chaplains delivered the intervention to surrogates in two ICUs. There were 25 of 73 eligible patient/surrogate dyads enrolled. Surrogates had a mean age of 57.6, were 84% female and 32% African American. The majority (84%) were Protestant. All received at least one chaplain visit and 19 received three visits. All agreed they felt supported by the chaplains, and qualitative comments showed spiritual and emotional support were valued. A semistructured spiritual care intervention for ICU surrogates is feasible and acceptable. Future work is needed to demonstrate the intervention improves outcomes for surrogates and patients.

Service Level Decision-making in Rural Physiotherapy: Development of Conceptual Models.

BACKGROUND: Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. METHOD: A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. RESULTS: Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. CONCLUSIONS: Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd.