Prioritising rural authenticity: Community members' use of discourse in rural healthcare participation and why it matters

Abstract

This paper uses discourse analysis to explore individuals' use of two discourses in Scottish rural health community participation. It explores interview texts from a community participation project to design new services. Findings show that some community members employ discourses of rural localness and tradition to augment their credibility and gain influence. In particular, community members employ discourses that prioritise the voices of those perceived as local, and when discussing doctors and nurses, prioritise those who display idealised characteristics associated with local traditional provision. In examining these prominent discourses, the paper suggests that community participation involves more complex power-plays than simply those between health service managers and the public, that tend to be portrayed in health policy. Power-play between community members could affect processes and outcomes of community participation.

Prudence or speed: Health and social care innovation in rural Wales

“…Pressures on communities to find localised solutions is high (Steinerowski and Steinerowska-Streb, 2012) aimed at increasing citizen involvement in service delivery (Hughes et al, 2009), with the concomitant assumption that they (the patient and/or service user) assume some responsibility for that service delivery and for their own health management (Nimegeer and Farmer, 2016). Collective action and multi-stakeholder governance can also support capacity building and sense of community through sustaining social capital and network ties; and improving trust relations across organisational and sector boundaries.…”

The challenges of rural family physician program in Iran: a discourse analysis of the introduction to criticizing power imbalance between rural health and mainstream urban health

“…The purpose of this paper was to understand more about what governs the rural health and rural FPP. Therefore, we started out by presenting the structure of discourses and how they various elements have been articulated through mainstream urban health (Bourke et al 2010(Bourke et al , 2012(Bourke et al , 2013Malatzky and Bourke 2016;Nimegeer and Farmer 2016). Afterward, we demonstrated how these discourses functioned to construct rural practices as deficits and disadvantages, and inferior compared to urban practices (Bourke et al 2013;Malatzky and Bourke 2016); thus, claiming that rural FPP and overall rural health is undermined by discourses.…”

“…Here, the marginalization of rural health status in the medical hierarchy and the normalizing judgments was criticized. A growing body of literature provides details on the power relations and the dominant discourses of the rural health in comparison to its urban counterpart over the recent years (Bourke et al 2010(Bourke et al , 2012(Bourke et al , 2013Malatzky and Bourke 2016;Nimegeer and Farmer 2016); however, there is very little empirical evidence to support this perspective in rural communities (notable exceptions include Bourke et al 2013;Nimegeer and Farmer 2016).…”

Unhealthy lifestyles, environment, well-being and health capability in rural neighbourhoods: a community-based cross-sectional study

“…Our findings are relevant for raising healthy lifestyles awareness and health seeking-skills to improve the selfability to make balanced decisions, for implementing technology-based devices combined with participatory dynamics, as well as for encouraging the active engagement of local representative planners (governments and other stakeholders) in research to enhance the capacity building and thus the capability for improving heath in rural areas. There are specific contexts of marginalized rural areas for whom the (itinerant) health promotion services and support seem to be an important component of cohesion and equity [53][54][55]. The impact of design and intervention with community representatives is planned and further reflexion on follow-up of the healthy lifestyle assessment in rural (and urban) neighbourhoods is required, which is feasible using the tools in a reference site of the collaborative network European innovation partnership on active and healthy ageing (EIP on AHA) [28,[56][57][58].…”