Addressing Rural Health Access Inequity by Assessing Potential and Organizational Readiness for Antifragile Electronic Health Project Design in Rural Communities

Abstract

There is a rural health access equity gap (especially for specialist care) within Canadian and international universal healthcare systems. Electronic health (eHealth) can address that gap, but pilot projects rarely scale to other contexts, or sustain in their original settings. Antifragile design and complexity informed principles can improve pilot project lifespans. Antifragile entities gain stability from uncertainty, rather than lose integrity. Antifragile operators include Chapter 1: Impact of the Novel Coronavirus (COVID-19) Pandemic on Doctoral Research ActivitiesSome problems are so complex that you must be highly intelligent and well informed just to be undecided about them.~Laurence J. PeterIn the winter of 2020, my research was following closely to the timelines outlined in the Carleton Health Sciences PhD stream table. Partnerships were being built with organizations who had interest in both electronic health (eHealth) and implementation. Chief among those institutional partners was the IWK health centre in Halifax, specializing in pediatrics and critical care. Through a CIHR funded health systems impact fellowship, I would have been embeddedwithin their organization for a year to assess the readiness of adopting a clinical information system at multiple sites across the province of Nova Scotia. Instead, that partnership, as well as a partnership with the Ontario Telehealth Network (OTN) and a local initiative out of the Ottawa Civic emergency department, were cut short as goals and resources shifted to combat the global COVID-19 pandemic.This has had a profound effect on my research, both positively and negatively, and has required adjustments regarding how I collected my data, the context of previously collected data, and how I should rectify my recommendations with the realities of a COVID-19 encumbered health system. Adverse effects of the pandemic are chiefly the break down of personal

Access Barriers to Healthcare Services by Young Women in Rural Areas: A Qualitative Study in Australia, Canada, and Sweden

“…This study uses a qualitative research method to provide a broader perspective on the issue of its incorporation of formal theories through the use of a "Dirt Research" methodology, which guided this study throughout. This approach prioritizes the researcher's firsthand experiences by utilizing ethnographic research residencies (23). The researchers not only live in these places, but they also shop, socialize, and conduct research in them, by fully immersing in the environment where one is acquiring knowledge, researchers can begin to understand connections and relationships that would be difficult to grasp through statistical analysis and published materials alone (119,120).…”

“…(2022) identify the declining ability to attract and retain healthcare professionals as a defining characteristic of healthcare in a rural context (14). In South Australia, the "undersupply and maldistribution of health workers" is a persistent barrier to healthcare access (23). Moreover, in the absence of resources and staff, rural residents must frequently travel long distances to access the care they need (24,25).…”

“…(2017) completed a quantitative analysis of youth (aged [16][17][18][19][20][21][22][23][24][25] health inequities and found that lower socio-economic status and household income was strongly correlated with healthcare utilization. Consequently, finding opportunities to increase youth's perception of the healthcare system and their utilization is important.…”

“…Studies consistently demonstrate that place of residence plays a dramatic role in people's access to healthcare, but particularly in small communities that tend to be rural and/or remote areas (1, 3,[20][21][22][23][24]. This study defines rural areas as constructed areas with relatively few inhabitants compared with metropolitan areas; consequently, they tend to have fewer resources, reduced accessibility to healthcare services, and-as a result-a more vulnerable and at-risk population for acute and chronic health issues (25).…”

“…Appendix D provides a schematic depiction of this theoretical framework. The Andersen Behavioral Model of Health Services Use proposes that healthcare utilization is influenced by three factors: predisposing factors, enabling factors, and need factors(4,23). Predisposing factors include personal characteristics like age, gender, education, and culture, which may affect healthcare needs and experiences, particularly for rural women in their youth.…”