IDENTIFYING AND PRIORITISING RURAL HEALTH CARE ISSUES – INVOLVING CONSUMERS, HEALTH PROFESSIONALS AND
RESEARCHERS
A/Prof A Wong Shee1,3, Dr R Clapham2, 3, Dr J Aitken4, Dr A Donaldson5, J Ananthapavan3, A/Prof K McNamara3, Dr A Ugalde3, A/Prof V Versace3 1.Grampians Health 2.Ballarat Health Services 3.Deakin University 4.Rural Northwest Health, 5.La Trobe University
This study was funded by the Western Alliance Academic Health Science Centre
BACKGROUN D
There is a gap between health research and rural health practice
A mismatch exists between academic research and the needs and priorities of community
members and health professionals
Limited involvement of community members and health professionals in identifying the key health and healthcare issues
Health inequities exist for people
living in rural areas and research
needs to meet their needs
AIM
To identify and prioritise health
issues in the Grampians region from the perspectives of community
members, health professionals and researchers
Identify local health issues
Identify values for prioritising health issues
Sorting and ranking health issues
Dissemination
PHASE 1
PHASE 2
PHASE 3
1. Kane M, Trochim WM. Concept mapping for planning and evaluation: Sage Publications, Inc; 2007.
IDENTIFYING LOCAL HEALTH ISSUES
What do you think are the key health and
health care issues in your community that need to be addressed?
• 187 survey respondents 117 community members, 70 health professionals
• Three rural community forums
• 400 health issue statements collected → 72 unique statements
Note: Consent was obtained for taking photographs and their use in presentations
IDENTIFYING VALUES FOR PRIORITISING HEALTH ISSUES
Health equity (equal access for
equal need )
Impact (number of people affected)
Capacity to address (capacity to
implement an
effective intervention) Focus groups - 3 community (n=16), 3 health professional (n=16)
Scenario – limited amount of money and three health issues Choose the most important issue
Explain why it was important
Explain why it was more important to address than another issue
SORTING AND RANKING ISSUES
48 participants sorted the 72 unique statements into groups of similar or
related issues
(17 community members, 19 health professionals, 12 researchers)
42 participants used a five-point scale to rate each statement for the three
priority-setting criteria (1 = least, 5 = most)
Capacity - How much can be done about this issue in the Grampians region?
Equity - How much would addressing this issue ensure those with equal health need have equal access to care?
Impact - How many people in the Grampians region does this issue impact?
POINT MAP
Local hospitals do not birth babies
Specialist services are limited
High suicide rates in the region
BUILDING THE CLUSTER
MAP
CLUSTER
MAP
Cluster Example health issue (statement number) Capacit
y1 Equity2 Impact3 Mental health & Disability
services Poor discharge planning and follow up for mental
health (21) 3.96 3.86 3.48
Cost of health care People in some rural areas have to pay for
emergency care (20) 3.28 3.53 3.12
Transport and Technology Technology-based interventions are hard to apply to the community where people don't have internet
(1) 3.51 3.74 3.43
Mental health & related
social issues High incidence of family violence in the region (55) 3.60 3.77 3.52 Social determinants of
health
Health messages are heard and understood but cannot always be acted upon due to financial
pressures (12) 3.51 3.84 3.52
Availability of essential
services Lack of resources for chronic disease management
(26) 3.65 3.67 3.63
Quality & capacity of health
services Lack of and poor coordination of support services in
the community (67) 3.79 3.74 3.40
Health behaviours People delay getting tested for cancer symptoms
(18) 3.55 3.53 3.23
Cancer and respiratory
health High incidence of respiratory diseases among
farmers (52) 3.60 3.77 3.52
CLUSTERS WITH MEAN VALUE RATINGS
1. How much can be done about this issue in the Grampians region?
2. How much would addressing this issue ensure those with equal health need have equal access to care?
3. How many people in the Grampians region does this issue impact?
GO-ZONE GRAPH
Capacity to address (n=47)
Equity (n=43
)
Mental health services
are fragmented
Poor discharge planning
and follow up for mental
health Expensive and at
times
unreasonable cost of
healthcare
Access Determina
nts of health
Health
issues
Acce
• Health costs, inequities in costs, funding models ss
(Affordability)
• Continuity of care and choice of providers
(Acceptability)• After hours services and service coordination
(Accommodation)
• Provision of essential health services
(Availability)• Geographical and technology barriers
(Accessibility)Determinants of health
• Challenges faced by vulnerable groups in navigating the healthcare system
• Need for health promotion and population health programs
Health issues
• High rates and impact of mental health, substance abuse and social issues
• High rates of cancer and respiratory diseases
SUMMARY
Local health issues were identified and prioritised by community members, health professionals and
academic researchers
Priority setting criteria were created based on community and health professional values
Access to healthcare is a key priority
Acknowledgements: Thank you to all the community members, health professionals and researchers who have contributed to this project.
This study was funded by the Western Alliance Academic Health Science Centre
