Rural hospital contributions to community health: community perspectives from a New Zealand rural hospital
Stephen Ram
1 * , Karen Carlisle 2 , Sarah Larkins 2 , Katharina Blattner 3
1
2
3
Abstract
Rural hospitals provide secondary care for much of the rural New Zealand population. Little is known about community perspectives of the health and social contribution.
This descriptive qualitative study aimed to explore community views on the role of their rural hospital in a low socioeconomic rural district with a high Māori and Pacific population.
Semi-structured individual and focus group interviews were conducted with rural community members about the perceived role of their rural hospital. Iterative thematic analysis was undertaken.
In total, 22 participants were interviewed. Thematic analysis yielded four themes: (i) rural hospitals as a safety net – providing access to emergency care and mitigating limited primary care access; (ii) providing personalised, culturally aware care; (iii) facilitating family/whanau support; and (iv) doing the best with limited resources. The latter included pragmatism about resource constraints, but a preference for the hospital to remain open.
Rural hospitals contribute to community safety by enhancing access to emergency care and mitigating difficulties in access to primary care. The local contextual knowledge of rural hospital providers allows personalised, family-centred and culturally-responsive care. Despite service centralisation, rural hospitals are wanted by their communities. Rural health planners should consider how to maximise the breadth of locally-provided services to reduce the impacts of travel and transfer for care.
Keywords: community participation, community-institutional relations, health services evaluation, Maori health, Pacific health, rural health, rural hospital.
References
1 The Royal New Zealand College of General Practitioners. Rural Hospital Medicine Training Programme Handbook. Wellington, New Zealand: The Royal New Zealand College of General Practitioners; 2020. Available at https://www.rnzcgp.org.nz/GPdocs/New-website/become_a_GP/DRHM_Handbook_2020.pdf [Accessed 2020].
2 Blattner K, Clay L, Nixon G, Richard L, Miller R, Crengle S, Anton R, Stokes T. The place of rural hospitals in New Zealand's health system: an exploratory qualitative study. Rural Remote Health. 2023 Apr; 23(2): 7583. 10.22605/RRH7583
3 Whitehead J, Blattner K, Miller R, et al. Defining catchment boundaries and their populations for Aotearoa New Zealand’s rural hospitals. J Prim Health Care 2023; 15: 14-23.
| Crossref | Google Scholar | PubMed |
4 Crengle S, Davie G, Whitehead J, et al. Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand. Lancet Reg Health West Pac 2022; 28: 100570.
| Crossref | Google Scholar | PubMed |
6 Blattner K, Clay L, Miller R, et al. New Zealand’s rural hospitals in 2021: findings from an exploratory questionnaire survey. J Prim Health Care 2022; 14: 254-8.
| Crossref | Google Scholar | PubMed |
7 Williamson M, Gormley A, Dovey S, et al. Rural hospitals in New Zealand: results from a survey. N Z Med J 2010; 123(1315): 20-9.
| Google Scholar | PubMed |
8 Blattner K, Miller R, Lawrence-Lodge R, et al. New Zealand’s vocational rural hospital medicine training programme: the first ten years. N Z Med J 2021; 134(1529): 57-68.
| Google Scholar | PubMed |
10 Little A. Pae Ora (Healthy Futures) Bill [Government Bill]. Wellington; 2022. Available at https://legislation.govt.nz/bill/government/2021/0085/latest/LMS575405.html
11 Whitehead J, Blattner K, Miller R, et al. Defining catchment boundaries and their populations for Aotearoa New Zealand’s rural hospitals. J Prim Health Care 2023; 15(1): 14-23.
| Crossref | Google Scholar | PubMed |
12 Whitehead J, Davie G, de Graaf B, et al. Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes. N Z Med J 2022; 135(1559): 24-40.
| Google Scholar | PubMed |
13 Hauora Taiwhenua Rural Health Network. Becoming Hauora Taiwhenua Rural Health Network. Our journey: Hauora Taiwhenua. 2023. Available at https://htrhn.org.nz/our-journey/ [updated 2023].
14 Goodyear-Smith F, Ashton T. New Zealand health system: universalism struggles with persisting inequities. Lancet 2019; 394(10196): 432-42.
| Crossref | Google Scholar | PubMed |
15 Houkamau CA. What you can’t see can hurt you: how do stereotyping, implicit bias and stereotype threat affect Maori health. MAI J 2016; 5: 124-36.
| Crossref | Google Scholar |
16 Gauld R, Atmore C, Baxter J, et al. The ‘elephants in the room’ for New Zealand’s health system in its 80th anniversary year: general practice charges and ownership models. N Z Med J 2019; 132(1489): 8-14.
| Google Scholar | PubMed |
17 Koerber A, McMichael L. Qualitative sampling methods: a primer for technical communicators. J Bus Tech Commun 2008; 22(4): 454-73.
| Crossref | Google Scholar |
18 Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. Int J Transgend Health 2023; 24(1): 1-6.
| Crossref | Google Scholar | PubMed |
19 Richards H, Emslie C. The ‘doctor’ or the ‘girl from the University’? Considering the influence of professional roles on qualitative interviewing. Fam Pract 2000; 17(1): 71-5.
| Crossref | Google Scholar | PubMed |
20 Birt L, Scott S, Cavers D, et al. Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qual Health Res 2016; 26(13): 1802-11.
| Crossref | Google Scholar | PubMed |
21 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |
22 Bukamal H. Deconstructing insider–outsider researcher positionality. Br J Spec Educ 2022; 49(3): 327-49.
| Crossref | Google Scholar |
23 Liu L, Hader J, Brossart B, et al. Impact of rural hospital closures in Saskatchewan, Canada. Soc Sci Med 2001; 52(12): 1793-804.
| Crossref | Google Scholar | PubMed |
24 Blattner K, Clay L, Nixon G, et al. The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study. Rural Remote Health 2023; 23(2): 7583.
| Crossref | Google Scholar | PubMed |
25 Atmore C, Dovey S, Gauld R, et al. What is important for high quality rural health care? A qualitative study of rural community and provider views in Aotearoa New Zealand. Rural Remote Health 2023; 23(1): 7635.
| Crossref | Google Scholar | PubMed |
26 Fakhry M, Mohammed WE. Impact of family presence on healthcare outcomes and patients’ wards design. Alexandria Eng J 2022; 61(12): 10713-26.
| Crossref | Google Scholar |
27 Graham R, Masters-Awatere B. Experiences of Māori of Aotearoa New Zealand’s public health system: a systematic review of two decades of published qualitative research. Aust N Z J Public Health 2020; 44(3): 193-200.
| Crossref | Google Scholar | PubMed |
28 Cummins R, Preston R, Topp SM, et al. A qualitative exploration of the non-financial costs of cancer care for Aboriginal and Torres Strait Islander Australians. Aust N Z J Public Health 2023; 47(5): 100085.
| Crossref | Google Scholar | PubMed |
29 Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 2019; 18(1): 174.
| Crossref | Google Scholar | PubMed |
31 Pitama S, Huria T, Lacey C. Improving Maori health through clinical assessment: Waikare o te Waka o Meihana. N Z Med J 2014; 127(1393): 107-19.
| Google Scholar | PubMed |
33 Barnett R, Barnett P. “If you want to sit on your butts you’ll get nothing!” Community activism in response to threats of rural hospital closure in southern New Zealand. Health Place 2003; 9(2): 59-71.
| Crossref | Google Scholar | PubMed |
34 Grafton D, Troughton M, Rourke J. Rural community and health care interdependence: an historical, geographical study. Can J Rural Med 2004; 9(3): 156-63.
| Google Scholar | PubMed |
35 Doeksen GA, Schott V. Economic importance of the health-care sector in a rural economy. Rural Remote Health 2003; 3(1): 135.
| Google Scholar | PubMed |
36 Curtis E. Indigenous positioning in health research: the importance of Kaupapa Maori theory-informed practice. AlterNative 2016; 12(4): 396-410.
| Crossref | Google Scholar |
