Review Article
What role does family medicine play in rural health advocacy – a scoping review
AUTHORS
#Alexandra Ferrara1,2 MPH, Family Medicine Resident Physician * 
#Shagun Tuli1 MGHD, Research Assistant in General Practice
Liam Glynn1,3 MD, Professor of General Practice and General Practitioner
Peter Hayes1 M Med Ed, Professor of Rural General Practice and General Practitioner
Andrew O’Regan1,4 PhD, Associate Professor
Patrick O’Donnell1,4 PhD, Clinical Fellow in Social Inclusion
Finn Mac Ginneá5 MB, Post CSCST Fellow
Monica Casey1,4 MSc (Primary Care), Research Programme Manager
#Contributed equally
AFFILIATIONS
1 School of Medicine, University of Limerick, Limerick, Ireland
2 Present address: Western University, Ontario, Canada
3 North Clare Primary Care Team, Ballyvaughan, Co Clare, Ireland
4 Health Research Institute, University of Limerick, Limerick, Ireland
5 Irish College of General Practice, Ireland
ACCEPTED: 26 June 2026
Early Abstract:
Introduction: An estimated 2 billion people are living in rural areas around the globe that do not have adequate access to essential health services. This can adversely affect their health and is recognised as a significant cause of health inequities experienced by rural populations. Internationally, advocacy for improved access/ has increasingly been recognized as a fundamental responsibility of family medicine practitioners. They often see and are required to respond to gaps in the various social determinants of health affecting their patients and disproportionately affecting marginalised communities. With the existing geographic inequities in access to healthcare and a growing retention and recruitment crisis of the rural healthcare workforce, it is necessary to understand the scope and capacity of advocacy within rural family medicine and address the pressing issues affecting rural populations. The study aims to summarise the role family physicians have played in advocating for rural healthcare enhancement while highlighting strategies and interventions that have allowed for capacity building in the field.
Methods: This scoping review was conducted using Arksey and O’Malley’s methodology. Peer-reviewed and grey literature were searched across several electronic databases. A two-part study selection process was systematically applied by three reviewers using designated inclusion and exclusion criteria. Data from each accepted article were extracted by the principal author and entered in an Excel template.
Results: A total of 1724 articles were initially identified, and ultimately 20 were included . The majority were from high income countries. Most articles were conceived by those involved directly in rural healthcare, and the remainder came from advocacy and poly-stakeholder groups. Five key themes emerged from thematic analysis: 1) the scope of the rural family physician advocacy role, 2) identifying and overcoming sources of inequity, 3) the need for effective collaboration, 4) influencing policy, and 5) developing leaders.
Conclusion: Advocacy, collaborative research, leadership training, and the translation of advocacy efforts into policy are important for the enhancement of rural health. Rural health is not simply a geographic issue, but one of inequity. The best strategies for rural challenges are developed with rural dwellers working in collaboration with advocacy groups to influence policy change. Rural healthcare workers are key advocates for their own communities but often need to be trained to absorb these types of leadership roles. These issues remain underexamined, and the paucity of literature on the topic attests to this.
Keywords: community health workers, family medicine, family physicians, health advocacy, rural general practice, rural health trends, rural primary care.