IDENTIFYING AND PRIORITISING RURAL HEALTH CARE ISSUES –
INVOLVING CONSUMERS, HEALTH PROFESSIONALS AND RESEARCHERS
A/Prof A Wong Shee1,2, Dr R Clapham1, 2, Dr J Aitken3, Dr A Donaldson4, J Ananthapavan2, A/Prof K McNamara2, Dr A Ugalde2, A/Prof V Versace2 1.Ballarat Health Services 2.Deakin University 3.Rural Northwest Health, 4.La Trobe University
This study was funded by the Western Alliance Academic Health Science Centre
BACKGROUND
Health inequities exist for people living in rural areas and
research needs to meet their needs
There is a gap between health research and rural health
practice
A mismatch exists between academic research and the
needs and priorities of communities and clinicians
Limited communities and clinician involvement in health
research decision-making
AIM
To identify and prioritise health issues in the Grampians region, Victoria, from the perspective of community members,
health professionals and researchers
Identify local health issues
Surveys and community forums with community members and health professionals
Identify values for prioritising health issues
Focus groups with community members and health professionals
PHASE 1
PHASE 2
PHASE 3
Sorting and ranking health issues
Modified Delphi with community members, health professionals and academic researchers
Dissemination
Share findings with key stakeholders and decision-makers
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
74% and 83% female, respectively, 1% identified as indigenous, 18 to 60+ years
• Three rural community forums
• 400 health issue statements collected
→ 72 unique statements
Note: Consent was obtained for taking photographs and their use in presentations
PRIORITISING HEALTH ISSUES
Who should be involved in priority setting?
Limited involvement of community members and health professionals
How should these decisions be made?
Implicit vs explicit
What criteria should be used?
Recognition of need for judgement
IDENTIFYING VALUES FOR PRIORITISING HEALTH ISSUES
Health equity (equal access for
equal need )
Health burden (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
Identify local health issues
Surveys and community forums involving community members and health professionals
Identify values for prioritising health issues
Focus groups involving community members and health professionals
PHASE 1
PHASE 2
PHASE 3
Sort and rank health issues
Modified Delphi involving community members, health professionals and academic researchers
Dissemination
Share findings with key stakeholders and decision-makers
SORTING AND RANKING ISSUES
Modified Delphi¹ (2 rounds)
48 participants sorted the 72 unique statements into groups of similar issues (17 community members, 19 health professionals, 12 researchers)
42 participants used five-point scales (1 = least, 5 = most) to rate each statement for the three priority-setting criteria
1. Okoli, C., & Pawlowski, S. (2004). The Delphi method as a research tool: an example, design considerations and applications. Information and management, 42(1), 15-29.
SORTING AND RANKING ISSUES
Concept mapping²
• Point map - individual statements in two-dimensional (x, y) space with more similar statements located nearer each other
• Cluster map - multidimensional scaling and hierarchical cluster analysis used to group sorted statements into clusters
• Go zones - mean ranking values of statements for the priority-setting criteria used to generate four-quadrant ‘go-zone’ graphs
2. Trochim, W., & McLinden, D. (2017). Introduction to a special issue on concept mapping. Evaluation and Program Planning, 60, 166-175.
POINT MAP
Local hospitals do not birth babies
Specialist services are limited
High suicide rates in the region
POINT MAP
CLUSTER MAP
Cluster Example health issue (statement number) Capacity1 Equity2 Burden3 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 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
Social issues High incidence of family violence in the region (55) 3.60 3.77 3.52
Cancer and respiratory health High rates of smoking in the region (27) 3.60 3.77 3.52 Health behaviours People delay getting tested for cancer symptoms (18) 3.55 3.53 3.23 Cost of health care People in some rural areas have to pay for emergency care
(20) 3.28 3.53 3.12
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
Mental health Poor discharge planning and follow up for mental health
(21) 3.96 3.86 3.48
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
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
NEXT STEPS
Share results with consumers and health professionals
Present results to health service executive and management Work with academic researchers to address evidence gaps for identified health priorities
Thank you
Anna Wong Shee
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 https://www.westernalliance.org.au/
