Last mile research: a conceptual map

Abstract

Background:The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization. Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile? Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting. Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity. Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.

Maternal Mortality and Last Mile Challenges: Improved Perspective for Leapfrogging

“…Considering the challenges at the bottom level in catering to maternal healthcare services and ensuring progress toward global commitments last-mile challenges are critical to have full attention. Being informed from the work of Davison et al (2021) in addressing the last-mile dilemma in the research can be also extended in the case of maternal mortality. The extension of the knowledge can further be stressed with the following framework in the maternal mortality last mile challenged areas.…”

“…Reflexive thinking, empowering people and communities, building capacity and knowledge, and breaking pedagogical limitations will be better articulated and translated into action if the research is concentrated on the ‘how’ part concerning the last mile populations (Davison et al, 2021). In this regard operational research for assessing and designing health interventions and policies for better service delivery is tantamount.…”

“…Systemic, structural, and environmental determinants of health or of being among last mile populations also merits the in-depth investigation in mitigating last mile challenges. Intensive clarification of upstream and downstream factors inclusive of the systemic biases and processes that contribute to individuals or groups being ‘last mile is also instrumental (Davison et al, 2021).…”

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“…Over the past decades, the United Nation's Sustainable Development Goals have focused on international intervention, research, and evaluation efforts and have produced much positive change in global health towards healthy aging [24]. The lack of physical activity and a sedentary lifestyle results in one of the most significant public health problems of the 21 st century; the sedentary lifestyle has a strong effect on the frailty of the older people, reveals Spanish Healthy Aging research [25].…”

Pressure Injury Prevention and Management

“…Using evidence-based items identified from the literature appraisal, the Council organized the items using the Donabedian domains (structure, process, and outcome) 14 and developed a concept map (see Figure 1 ) to inform the development of the Pressure Injury Prevention Gap Analysis Instrument (PIPGAI). A concept map was used to identify essential components and to visually depict conceptual relationships 23 for the Council to discuss and better understand interrelationships.…”