Understanding the field of rural health academic research: a national qualitative, interview-based study

Abstract

Introduction: Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. However, to date, there is limited description of this workforce and the field of rural health research. This study aimed to characterise this field to inform how it can be fostered. Methods: Qualitative semi-structured interviews of 50-70 minutes duration were conducted with 17 early career rural health researchers based in Australian rural and remote communities, to explore their professional background, training and research experiences. Results: Six key themes emerged: becoming a rural health researcher; place-based research that has meaning; generalist Rural and Remote Health rrh.org.au

Exploring how to sustain ‘place-based’ rural health academic research for informing rural health systems: a qualitative investigation

“…Such an approach significantly disadvantages the production of research that fits rural settings as well as the community partnerships needed for rural system translation of findings. Using rural researchers as data collectors for city projects or bypassing them altogether by 'fly-in, fly-out' projects is symptomatic of a research culture where skills and resources are owned by cities, and the genuine skills and efforts of trained rural health researchers are devalued [2,14].…”

“…Similarly, another competitive funding mechanism, the Medical Research Future Fund (expected to grow to $20 billion in 2021, based on the 2018-2021 plan) does not include rural health as a specific topic area [61]. It is urgent that major funding streams intended to address the health of all Australians, better targets this field and accommodates its nuance [2]. Given that rural health research supports social and economic growth, rural education and attracts rural clincians, each being major issues for the 'rural' public good, capacity still requires core government funding to supplement geographically targeted competitive grants [2].…”

“…Around half of the global population lives rurally but rural health outcomes continue to significantly lag behind those of metropolitan areas [1]. The field of rural health research, involving trained researchers, based in rural communities and regions, working in trusted partnership with rural stakeholders to inform improvements in rural health, has an important role to play in addressing these disparities [2]. As opposed to 'place-neutral' evidence, rural health research is centred on 'placebased' spheres of influence on health outcomes, including population and culture, distance and isolation, workers and resources, health services, and practice models.…”

“…Moreover, the availability of research opportunities is integral to attracting and retaining rural health workers [12,13]. However, understanding how to sustain rural health academic research is a significant issue given that these researchers may work in different ways to metropolitan-based academics, including working across a generalist skillset, in small teams and distributed sites, and their field is depicted by responding to high levels of community demand with limited funding [2] [14]. Australia, the United States and Canada are all countries that have formally sought to or embed rural health research capacity; however, none has evaluated the sustainability challenges of their models [14][15][16][17].…”

“…Developing doctoral level research-trained staff in any field is a long-term investment of universities and involves supervised training for tertiary qualified candidates over a minimum of 3 full years as they navigate the research process to produce new knowledge. Atop of their doctoral training, other studies suggest that rural health researchers are required to rapidly diversify skills in the post-doctoral period in order to respond to the breadth of community demand with few other academics onsite [2,14]. Further, the field relates to researching within trusted partnerships, applying rich theoretical and contextual knowledge of people and place that takes time to develop.…”