Rural definition of health: a systematic literature review

Abstract

BackgroundThe advent of patient-centered care challenges policy makers, health care administrators, clinicians, and patient advocates to understand the factors that contribute to effective patient activation. Improved understanding of how patients think about and define their health is needed to more effectively “activate” patients, and to nurture and support patients’ efforts to improve their health. Researchers have intimated for over 25 years that rural populations approach health in a distinct fashion that may differ from their non-rural counterparts.MethodsWe conducted a systematic review of the literature to assess the extent and strength of evidence for rural definition of health. Studies were eligible for inclusion if they were published in English, reported on original research and presented findings or commentary relevant to rural definition of health, were published over the last 40 years, and were based on observations of rural U.S., Canadian, or Australian populations. Two reviewers were assigned to each selected article and blinded to the other reviewer’s comments. For discordant reviews, a third blinded review was performed.ResultsOf the 125 published articles identified from the literature, 34 included commentary or findings relevant to a rural definition of health. Of these studies, 6 included an urban comparison group. Few studies compared rural and urban definitions of health directly. Findings relevant to rural definition of health covered a broad range; however, good health was commonly characterized as being able to work, reciprocate in social relationships, and maintain independence.This review largely confirmed many general characteristics on rural views of health, but also documented the extensive methodological limitations, both in terms of quantity and quality, of studies that empirically compare rural vs. urban samples. Most notably, the evidence base in this area is weakened by the frequent absence of parallel comparison groups and standardized assessment tools.ConclusionsTo engage and activate rural patients in their own healthcare, a better understanding of the health beliefs in rural populations is needed. This review suggests that rural residents may indeed hold distinct views on how to define health, but more rigorous studies are needed to confirm these findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1658-9) contains supplementary material, which is available to authorized users.

Health profile of family caregivers of the elderly and its association with variables of care: a rural study

“…The lack of methodological rigor, especially in terms of standardized evaluation tools, coupled with the lack of studies in the rural context and in remote areas, has affected the number of studies with greater power and level of evidence 16 . Therefore, the present study aimed to analyze the profile of the health complaints of family caregivers of elderly people and to identify the characteristics of the context of care provided by caregivers of the rural elderly.…”

How rural and urban patients in Australia with colorectal or breast cancer experience choice of treatment provider: A qualitative study

“…Another Australian study showed that rural patients have 'implicit faith' in the healthcare system and little input into decisions about the location of care (McConigley et al, 2011). None of these studies explicitly compared rural to urban patient experiences, a common limitation of existing research of the experiences of rural populations (Bettencourt, Schlegel, Talley, & Molix, 2007;Gessert et al, 2015). None of these studies explicitly compared rural to urban patient experiences, a common limitation of existing research of the experiences of rural populations (Bettencourt, Schlegel, Talley, & Molix, 2007;Gessert et al, 2015).…”

“…Work from Canada also suggests that most rural patients with rectal cancer have limited choice of treatment provider, but surgical and hospital service reputation, skill and personal relationships were important in considering treatment location (Nostedt et al, 2014). None of these studies explicitly compared rural to urban patient experiences, a common limitation of existing research of the experiences of rural populations (Bettencourt, Schlegel, Talley, & Molix, 2007;Gessert et al, 2015).…”

Exploring the perspectives of community members as research partners in rural and remote areas

“…To engage meaningfully with these groups, it is necessary to bring research to the communities where people live, dedicate time for personal relationship building, and establish trust between community members and researchers [15,17]. The conceptualization of health differs between urban and rural communities [18], suggesting that researchers should not assume that what has worked in urban centres should be applied in engagement initiatives, research development, or health promotion interventions in rural communities.…”