An Ethnographic Meta‐Synthesis of Three Southwestern Rural Studies

Abstract

Objectives The objectives were to synthesize cumulative findings across three critical ethnographic, community-partnered studies in the southwestern United States and to describe the process of meta-ethnography for that analysis. Design The meta-ethnography followed the design of Noblit and Hare for constructing an analysis of composite data, informed by community-based participatory research and Stringer’s ethnographic strategies of Look-Think-Act. Sample The three studies occurred in rural settings of Colorado and New Mexico, engaging 129 total participants, along with community organizations and agencies as partners. Methods Methods consisted of detailed review of each original study, mapping of major concepts and themes, and general analysis, interpretation, and synthesis across the studies. Results Overall themes were: health is the capacity to care for oneself and do work, meaningful relationships are key in health care interactions, patterns of discrimination persist in rural settings, poor literacy and health literacy are barriers, and food insecurity is a growing concern for older rural adults. Conclusions Resolutions involve practice, policy and research and must incorporate all stakeholder groups in rural settings; a participatory approach is critical to prioritize and impact existing inequities; and work is needed to extend education and understanding of multiple cultures, groups, customs, and rural contexts.

Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature

“…Reviews contained quantitative and qualitative studies, while the most reviewed approach was Community-Based Participatory Research (32%). 20 , 22 , 26 , 30 , 43 , 46–49 , 53–55 , 57 , 60–62 Multiple geographical settings were covered, but 36% of reviews had a specific US focus 18–20 , 22 , 26 , 28 , 38 , 41–44 , 48 , 53–55 , 57 , 60 , 61 ( Supplementary Material 3 ).…”

“…The most common process element was to ‘focus on equality, empowerment and measures of power-sharing’ (54%). 4 , 21 , 22 , 28 , 29 , 32–36 , 38–41 , 44 , 45 , 47–51 , 53 , 56 , 58 , 59 , 61 , 63 There were seven outcomes, with ‘health literacy promotion and behaviour change’ the most frequently reported (56%). 4 , 17 , 19–21 , 27–30 , 32 , 34–37 , 40 , 42–44 , 48 , 52–56 , 58 , 59 , 61 , 63 However, the vast majority of reviews did not provide sufficient access to quantifiable data to enable meaningful assessments and pooling of effects.…”

Use of Comprehensive Participatory Planning and Evaluation in Rural Patient Engagement

“…These included technology and miles/ time. However, anticipated elements such as rurality as a social determinant of health (CDC, 2017;National Rural Health Policy Association, 2013;Singh et al, 2017) and differences in health attitudes (Averill, 2016;Gessert et al, 2015) are decidedly absent in the causal map. Further use and study may provide insight as to the value (or lack thereof) provided by further consideration of these concepts.…”

“…Rural and urban differences exist in identified definitions of health and experienced health outcomes. For those who live in rural communities, being able to work (Averill, 2016), reciprocate in social relationships, and to maintain independence were characterized as "good health." Within this definition, rural residents tended to seek a physician's care only when physical functioning was impaired, and they tended to accept ill-health with stoicism when compared to urban residents (Gessert et al, 2015).…”

Consecuencias Clínicas De Caries Dentales No Tratadas en Escolares De Zonas Rurales en Perú

“…La OMS recomienda edades para investigaciones epidemiológicas 6 y 12 años para establecer comparaciones diagnosticas estandarizadas. 16,17 La prevalencia de caries dental encontrada en este estudio fue de 95.6 % para dentición permanente, mayor a lo reportado por Villena R et al 18 (62.3 %), Monse B et al 19 (85 % y 56 % en niños de 6 y 12 años de edad), Grund Respecto al indicador (PUFA/pufa), presentaron una media de 0.6 (DS 0.9) y de 0.9 (DS 1.3) para dentición permanente y decidua respectivamente, en relación al sexo de los escolares, siendo inferior a lo reportado por Monse B et al 29 Esto permite evidenciar la alta morbilidad dentaria sumado al bajo nivel económico, al nulo o escaso acceso a los servicios de salud bucodental, falta de recurso humano en zonas rurales, la falta de conocimientos en medidas preventivo y promocionales por parte de esta población, estas características usuales en zonas rurales, acrecientan el daño a la salud bucal de sus pobladores incrementando las brechas de prestaciones de servicios de salud bucal en relación a pobladores del ámbito urbano. La necesidad de contar con programas escolares de salud pública odontológica en los cuales no sólo se contemple un aspecto preventivo y promocional, en consecuencia mejorar las condiciones de salud de la población rural va más allá de mejorar la asistencia en salud y la atención de la enfermedad; implica profundas transformaciones de orden económico, político y social que permitan superar las desigualdades existentes entre lo urbano y lo rural sobre todo en países sudamericanos 31…”