Original Research

Exploring the ideas of young healthcare professionals from selected countries regarding rural proofing


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Ian Couper
1 MFamMed, FCFP(SA), Professor and Director, Ukwanda Centre for Rural Health * ORCID logo

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Manoko Innocentia Lediga
2 MPhil, Research Assistant and Public Health Student ORCID logo

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Ndivhuho Beauty Takalani
3 Msc Medical Sciences, PhD Candidate ORCID logo

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Mayara Floss
4 MD MFamMed, PhD Candidate ORCID logo

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Alexandra E Yeoh
5 Medical Student ORCID logo

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Alexandra Ferrara
6 MPH, Medical Student ORCID logo

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Amber Wheatley
7 MRCGP, Family Physician ORCID logo

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Lara Feasby
8 Resident Family Physician

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Marcela A de Oliveira Santana
9 MD, Generalist Physician ORCID logo

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Mercy N Wanjala
10 MFamMed, MBA-HCM, Family Physician ORCID logo

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Mustapha A Tukur
11 Medical Student

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Sneha P Kotian
12 MD, MSc, PhD Researcher ORCID logo

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Veronika Rasic
13 MD, RCGP, General Practitioner ORCID logo

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Vuthlarhi Shirindza
14 BMedSci(Hons), Medical Student ORCID logo

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#Alan Bruce Chater

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#Theadora Swift Koller
16 MA, Senior Technical Lead/Unit Head ORCID logo

#Contributed equally


1, 2 Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa

3 Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa; and Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa

4 Department of Pathology, University of São Paulo, São Paulo, Brazil

5 Rural Seeds; and Institute for Evidence-Based Healthcare, Bond University, Robina, Qld, Australia

6, 8 Rural Seeds; and School of Medicine, University of Limerick, Limerick, Ireland

7 Rural Seeds; and British Virgin Islands Health Service Authority, Tortola, British Virgin Islands

9 Rural Seeds; and Health Service, Uberaba, Minas Gerais, Brazil

10 Rural Seeds; and Health Service, County Government of Embu, Kenya

11 Rural Seeds; and College of Medicine, Ahmadu Bello University, Zaria, Nigeria

12 Rural Seeds; and Amsterdam Institute for Global Health, and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands

13 Rural Seeds; and Health Service, Bristol, United Kingdom

14 Rural Seeds; and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

15 Working Party on Rural Practice, World Organisation of Family Doctors (WONCA), Theodore, Qld, Australia

16 Department for Gender, Equity and Human Rights, Director-General’s Office, WHO Headquarters, Geneva, Switzerland

ACCEPTED: 4 September 2023

early abstract:

Introduction: Globally, most countries struggle to meet the health needs of rural communities. This has resulted in rural areas performing poorly when compared to urban areas in terms of a range of health indicators. There have been few coherent, or systematic strategies that target rural communities and address their needs within the rural context. Rural proofing, defined as the systematic application of a rural lens across policies and guidelines to ensure that they speak to these health needs, seeks to address this gap. The healthcare professionals (HCPs) who will be called upon to advocate for and lead the implementation of rural proofing efforts are those currently in training or early career stages. We thus sought to understand the perspectives of young HCPs regarding the concept of rural proofing.
Methods: The study adopted an interpretivist paradigm. Data were collected using semi-structured individual interviews and focus group discussions (FGDs). Selected HCPs who are in leadership in Rural Seeds, a movement for young HCPs, participated in the study. FGDs in the form of Rural Seeds Cafés were led by some Rural Seeds leaders who participated in the interviews and who showed interest in organising the discussions. Eleven exploratory interviews and six FGDs were conducted using Zoom. HCPs where from the following regions: Australia, Europe, Africa, North America, South America, and Asia. Interviews and FGDs were conducted in English, recorded, and transcribed verbatim. Thematic analysis was then undertaken.
Findings: Participants perceived the state of rural healthcare globally to be problematic. Access to care was seen as the most significant issue in rural healthcare, associated with the challenges of lack of equity in access, and limited funding and support for healthcare professionals and their career pathways. Despite varying understanding of the concept, rural proofing was seen to be of great value in improving rural healthcare. A number of ideas for applying rural proofing, with examples, were proposed from their perspectives as frontline healthcare providers. They particularly recognised the importance of addressing the local needs of rural communities and the needs of present and future HCPs. Implementation of rural proofing was seen to require the involvement of key stakeholders from a range of sectors at multiple levels.
Conclusions: Given the state of rural health, young rural HCPs suggest that rural proofing strategies are needed as they have the potential to bring about equity in the delivery of healthcare in rural and remote communities. These strategies will assist in creating a more positive future for rural healthcare worldwide and motivate young HCPs to become involved in rural healthcare, as well as to increase their motivation to take an interest in health policy development. These strategies need to be applied at multiple levels, from the national government to local contexts. It is also seen to be critically important to involve multiple levels of stakeholders, from politicians to healthcare providers and community members, in the process of rural proofing.