Social Determinants of Rural Health Workforce Retention: A Scoping Review

Abstract

Residents of rural and remote Australia have poorer health outcomes than their metropolitan counterparts. A major contributor to these health disparities is chronic and severe health workforce shortages outside of metropolitan areas—a global phenomenon. Despite emerging recognition of the important influence of place-based social processes on retention, much of the political attention and research is directed elsewhere. A structured scoping review was undertaken to describe the range of research addressing the influence of place-based social processes on turnover or retention of rural health professionals, to identify current gaps in the literature, and to formulate a guide for future rural health workforce retention research. A systematic search of the literature was performed. In total, 21 articles were included, and a thematic analysis was undertaken. The themes identified were (1) rural familiarity and/or interest, (2) social connection and place integration, (3) community participation and satisfaction, and (4) fulfillment of life aspirations. Findings suggest place-based social processes affect and influence the retention of rural health workforces. However, these processes are not well understood. Thus, research is urgently needed to build robust understandings of the social determinants of rural workforce retention. It is contended that future research needs to identify which place-based social processes are amenable to change.

The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

“…Interestingly, in this mining study, the towns with transient populations were described as being easier to live in and meet people. This supports findings in other studies, including my own, that newcomers generally make friends with other newcomers, not local people [28,55,56]. In my NSW turnover intention study, newcomers described their exchanges with local residents as being friendly but rarely extending beyond surface level exchanges [56].…”

“…This supports findings in other studies, including my own, that newcomers generally make friends with other newcomers, not local people [28,55,56]. In my NSW turnover intention study, newcomers described their exchanges with local residents as being friendly but rarely extending beyond surface level exchanges [56]. Newcomer participants' explanation for this was that locals already had well-formed social connections and thus did not feel any real need to step outside of these.…”

“…Rural health workforce retention studies that focus on 'newcomer' workers argue that it is essential to develop social connection through a family lens [47,56]. In a study investigating the recruitment and retention of physicians in rural Alberta, Canada, which was undertaken from both the physicians' and spouses' perspectives, the authors found that the decision to relocate to a rural community was mutual and couples commonly assessed a prospective town for whether it was a good place to raise a family [57].…”

“…This framework takes a holistic approach to human resources management and includes five components: stakeholder interests, situational factors, human resources policy choices, human resources outcomes-immediate (e.g., retention, cost effectiveness) and human resources outcomes-long-term (individual wellbeing, organisational effectiveness and societal wellbeing) [66]. Similarly, while 'placed-based social processes' have increasingly been recognised as influencing rural health workforce retention, especially for newcomer workers, until fairly recently there was little research undertaken investigating how these operate and influence retention [56]. Research undertaken by Malatzky, Gillespie and myself [10,56] examining the influence of place-based social processes on turnover, argues that operational concepts such as sense of place, place attachment and belonging-in-place offer potential solutions for rural workforce challenges, especially when applied in person-centred approaches [10].…”

Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis

“…Besides, in the hierarchy system in healthcare institutions [12], the younger staff have more time commitment [53] for the simple and repetitive tasks but less work autonomy [52], which may also lead to the reduced personal accomplishment. Moreover, the reward and career advancement opportunities for the young personals in rural areas were less than that in the urban area [14,15,54], increasing their vulnerability to job stress and burnout [52].…”