Public perspectives on health improvement within a remote‐rural island community

Abstract

Background Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health. Objective To identify and describe shared perspectives within a remote‐rural community on how to improve rural health. Method Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews. Results Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services. Discussion and conclusions Factors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice. Public Contribution Members of the public were involved in the development and piloting of the statement set.

Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action

“…Preferred solutions also echo broader public perspectives, with young people in our study consistently emphasising the need to improve living and working conditions, echoing the findings of citizens' juries with adults in Glasgow, Liverpool and Manchester 10 . Likewise, our participants called for structural, long‐term solutions (and not individual‐level behavioural interventions) aligning with participants in a Q‐methodology study of remote and rural communities 9 . The young participants in our study also broadly agreed on the importance of addressing poverty (e.g., through increasing wages and improving safety nets) with considerable (though more contested) support for reducing income and wealth inequalities.…”

“…As previously noted, variations in existing research suggest that the specific questions and approaches taken to exploring public perspectives on addressing health inequalities influence the accounts generated. Politically innovative proposals suggested by our young participants, including increasing participatory governance, are notably absent from existing studies, 8–10 although these ideas have recently been emphasised by researchers 34,36 . That young people developed these proposals and positioned them as key to reducing social inequalities via reducing inequalities in power relations as well as through enabling policy choices that are likely to reduce inequalities, seems a testament to both the sophistication of young people's insights and the potential of engaging with notions of utopia 23 in conversations about tackling health inequalities 24 .…”

“…However, perhaps unsurprisingly given the range of communities and methods involved, there are no consistent preferred solutions across these studies. There does, however, appear to be some consensus across studies that poverty and public services require greater policy attention 8–10 . Smith et al found that public support was greatest for proposals to reduce health inequalities via improvements to living and working conditions and more redistributive economic policies, and noted that support for these kinds of ‘upstream’ policies increased when participants worked collectively in citizens' juries 10 .…”

Community stakeholder‐driven technology solutions towards rural health equity: A concept mapping study in Western Canada

“…Yet, geographical place shapes how technology is used or not used, 17 and the rural context is diverse and an especially important consideration with the expedited need for technology across jurisdictions as a result of COVID‐19. Participatory community‐driven research is ideally suited to identify acceptable and relevant user‐driven solutions to pragmatic real‐life issues 18,19 . Community‐engaged research is a people‐centred approach building from community strengths and priorities.…”

“…Participatory community‐driven research is ideally suited to identify acceptable and relevant user‐driven solutions to pragmatic real‐life issues. 18 , 19 Community‐engaged research is a people‐centred approach building from community strengths and priorities. It is crucial to promoting health equity by integrating diverse voices including those of marginalized groups 20 , 21 and aligned with the direction of this study.…”