How can rural community-engaged health services planning affect sustainable health care system changes? - A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project
Authors: Johnston C Stuart , Belanger Erika , Wong Krystal , Snadden David 
Published: November 2020

Objectives

The objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community health care issues to help modify existing rural health care programs and inform government rural health care policy.

Design

An adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, and community representatives. Qualitative data was gathered using a semi-structured interview guide. Major themes were identified through content analysis, and this information was fed back to the government and interviewees in reports every six months.

Setting

The 107 communities visited thus far have health care services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care.

Participants

Participants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling.

Primary and secondary outcome measures

A successful process was developed to engage rural communities in identifying their health care priorities, whilst simultaneously building and strengthening relationships. The qualitative data was analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels.

Results

36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed.

Conclusion

The SV Project appears to be unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped support system change.

Article Summary

This study process has adapted Boelen’s health partnership model and is unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis.

A successful method of engaging with rural communities and building relationships and trust across multiple stakeholder groups is described that contributed to influencing positive health care system changes.

As all communities in one province are being visited a picture of rural health care initiatives and challenges is highly comprehensive and therefore able to influence policy.

One of the main limitations in this study is that because the interviewers were experienced health care providers, power differentials may have existed which may have introduced bias in the discussions.

A potential limitation is the enormous amount of data to handle and analyze in a rigorous way, which was mitigated by having two full time analysts working together to ensure consistency with frequent meeting with the research team to consider and agree emerging themes.

How can rural community-engaged health services planning affect sustainable health care system changes? – A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project