A multi-scalar, mixed methods framework for assessing rural communities’ capacity for resilience, adaptation, and transformation

Previous criminological literature has mostly neglected rural communities, often treating these places as smaller pieces of urban culture. Literature suggests rural communities operate differently than urban neighborhoods, with distinctive values, norms, and community cohesion. For example, concepts surrounding collective efficacy may work counterproductively in rural areas—further exploiting outed community members within "close-knit" environments. The current study sought to compare perceptions of collective efficacy and social cohesion, crime, and victimization between rural and urban counties across one Midwestern rural state. Using a mixed-methods approach, community stakeholders from a variety of professions were surveyed. Quantitative results suggest similar perceptions of collective efficacy and social cohesion in rural and urban communities while qualitative responses paint a much different picture—an image of rural communities "minding their own business" and both formally and informally intervening only in the most extreme and personalized scenarios.

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Physical Activity Barriers and Assets in Rural Appalachian Kentucky: A Mixed-Methods Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147646 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7646

Author(s):

Natalie Jones ◽

Deirdre Dlugonski ◽

Rachel Gillespie ◽

Emily DeWitt ◽

Joann Lianekhammy ◽

...

Keyword(s):

Physical Activity ◽

Mixed Methods ◽

Rural Communities ◽

Community Support ◽

Mixed Methods Study ◽

Cultural Barriers ◽

Health Concern ◽

Socioecological Model ◽

Appalachian Kentucky ◽

Rural Appalachia

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five focus groups with elected community leaders, community residents, members, and key stakeholders to assess perspectives on physical activity barriers and resources within the county. The cohort survey sample (N = 152) reported a median of 6 barriers (range 0–13) to participating in at least 30 min of physical activity daily. The qualitative analysis yielded three overarching themes related to physical activity participation: lack of motivation, physical environment, and cultural barriers. This mixed-methods study revealed the challenges and perceptions among rural residents across the socioecological model when assessing physical inactivity. Findings can be used to tailor future interventions focused on expanding social support, designing infrastructure, and creating policies that promote physical activity.

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Rural citizen-patient priorities for healthcare in British Columbia, Canada: findings from a mixed methods study

BMC Health Services Research ◽

10.1186/s12913-021-06933-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jude Kornelsen ◽

Christine Carthew ◽

Kayla Míguez ◽

Matilda Taylor ◽

Catherine Bodroghy ◽

...

Keyword(s):

British Columbia ◽

Mixed Methods ◽

Rural Communities ◽

Mixed Methods Study ◽

Local Health ◽

Structured Interviews ◽

Rural Patient ◽

Healthcare Planning ◽

Healthcare Needs ◽

Survey Responses

Abstract Background The challenge of including citizen-patient voices in healthcare planning is exacerbated in rural communities by regional variation in priorities and a historical lack of attention to rural healthcare needs. This paper aims to address this deficit by presenting findings from a mixed methods study to understand rural patient and community priorities for healthcare. Methods We conducted a provincial survey of rural citizens-patients across British Columbia, Canada to understand their most pressing healthcare needs, supplemented by semi-structured interviews. Survey and interview participants were asked to articulate, in their own words, their communities’ most pressing healthcare needs, to explain the importance of these priorities to their communities, and to offer possible solutions to address these challenges. Open-text survey responses and interview data were analyzed thematically to elicit priorities of the data and their significance to answer the research questions. Results We received 1,287 survey responses from rural citizens-patients across BC, 1,158 of which were considered complete. We conducted nine telephone interviews with rural citizens-patients. Participants stressed the importance of local access to care, including emergency services, maternity care, seniors care, specialist services and mental health and substance use care. A lack of access to primary care services was the most pronounced gap. Inadequate local health services presented geographic, financial and social barriers to accessing care, led to feelings of vulnerability among rural patients, resulted in treatment avoidance, and deterred community growth. Conclusions Two essential prongs of an integration framework for the inclusion of citizen-patient voices in healthcare planning include merging patient priorities with population needs and system-embedded accountability for the inclusion of patient and community priorities.

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A mixed-methods impact evaluation of the feasibility of an initiative in small rural stores to improve access to fruit and vegetables

Australian Journal of Primary Health ◽

10.1071/py15136 ◽

2016 ◽

Vol 22 (6) ◽

pp. 545 ◽

Cited By ~ 12

Author(s):

Claire Palermo ◽

Breeana Gardiner ◽

Carena Gee ◽

Stella Charaktis ◽

Miranda Blake

Keyword(s):

Mixed Methods ◽

Rural Communities ◽

Impact Evaluation ◽

Vegetable Intake ◽

Community Support ◽

Fruit And Vegetables ◽

Qualitative And Quantitative ◽

Sustaining Change ◽

Post Evaluation ◽

Improve Access

Retail stores are a promising setting for improving access to nutritious food. This study opportunistically evaluated an initiative that supported stores in small rural Victorian towns to sell fresh fruit and vegetables. It aimed to measure whether the initiative showed a trend towards improved access to fruit and vegetables in these rural communities. A mixed-methods, pre-post evaluation was employed to measure the range and price of 39 fruits and 45 vegetables, together with 15 interviews with stakeholders 2.5 years after the commencement of the initiative. Twenty-one of 35 eligible stores took up the initiative. Analysis of qualitative and quantitative data showed that the initiative improved the availability of and access to fruit and vegetables, and that stores have a role in improving access to fruit and vegetables. The overall range of fruit and vegetables increased over 18 months from a median of 10 varieties (n=10) to 17 varieties (n=15) (P=0.028) and the prices decreased over 12 months in five out of seven stores where data was available. The capacity to influence availability of fruit and vegetables was affected by time, human resources and community support. Sustaining change to fruit and vegetables access is challenging. Using stores for health promotion may be an effective strategy for improving rural populations’ fruit and vegetable intake.

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Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives

BMC Family Practice ◽

10.1186/s12875-019-1029-1 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Kathy L. Rush ◽

Lindsay Burton ◽

Fransien Van Der Merwe ◽

Linda Hatt ◽

Camille Galloway

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Mixed Methods ◽

Rural Communities ◽

Primary Care Physicians ◽

Weight Maintenance ◽

Care Physician ◽

Patient Perspectives ◽

Exercise Intolerance ◽

Rural Patient

Abstract Background Atrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option. Methods Using a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated. Results Findings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic. Conclusions The study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.

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Leadership transfer in rural communities: A mixed methods investigation

Community Development ◽

10.1080/15575330.2021.1874456 ◽

2021 ◽

pp. 1-29

Author(s):

Lindsay Hastings ◽

Hannah Sunderman ◽

Matthew Hastings ◽

LJ McElravy ◽

Melissa Lusk

Keyword(s):

Mixed Methods ◽

Rural Communities

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Establishing Cross-Systems Collaborations for Implementation: Protocol for a Longitudinal Mixed Methods Study

10.21203/rs.3.rs-29980/v2 ◽

2020 ◽

Author(s):

Alicia C. Bunger ◽

Emmeline Chuang ◽

Amanda Girth ◽

Kathryn E. Lancaster ◽

Fawn Gadel ◽

...

Keyword(s):

Mixed Methods ◽

Child Welfare ◽

Rural Communities ◽

Service Delivery ◽

Controlled Trial ◽

Mixed Methods Study ◽

System Level ◽

Wide Range ◽

Collaborative Strategies ◽

Cross System

Abstract Background: Cross-system interventions can help integrate services across different service delivery systems but require organizations to establish strong collaborative relationships for implementation. Contingency theory suggests that the effectiveness of different collaborative strategies (i.e. specific ways organizations align operations and services) varies by context. This paper describes a study of different strategies for fostering collaboration between child welfare and substance abuse treatment agencies and the conditions under which they are effective for implementation. We also describe the development and piloting of the Collaborating Across Systems for Program Implementation (CASPI) tool—a decision-making guide intended to help researchers and organizational leaders identify and use appropriate collaborative strategies for their context. Methods/Design: This multisite longitudinal, mixed methods study, leverages a naturally occurring implementation initiative -- in up to 17 Ohio counties -- to implement Ohio START (Sobriety Treatment and Reducing Trauma). START is a child welfare model that requires strong collaboration with local substance use treatment organizations to promote integrated services. During the first two years, we will identify collaborative strategies associated with improved START implementation (penetration and fidelity) and service delivery outcomes (timeliness), given system, and organizational features. We will conduct a convergent mixed methods study drawing on worker surveys, agency documents, administrative data, formal partner agreements, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). To develop the CASPI, an expert panel comprised of implementation experts, and community stakeholders will convene to synthesize our findings and develop contents (including a decision tree). During the final year of the study, we will assess the acceptability, appropriateness, and feasibility of the CASPI in a randomized vignette experiment, and a pilot-test with 3 child welfare agencies that have not yet implemented START. Discussion: Our results will lay the groundwork for a larger controlled trial that will test the CASPI’s effectiveness for supporting effective and efficient implementation of cross-system interventions like START. The CASPI is expected to help leaders and researchers select and use collaboration strategies tailored to their context and be applicable in a wide range of settings including rural communities. Our work also advances system-level implementation strategies.Trial Registration: NCT03931005, Registered April 29, 2019, https://clinicaltrials.gov/ct2/show/NCT03931005

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Status of Cancer Care at Network Sites of the Nation’s Academic Cancer Centers

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7656 ◽

2021 ◽

Vol 19 (6) ◽

pp. 726-732

Author(s):

Stanton L. Gerson ◽

Kate Shaw ◽

Louis B. Harrison ◽

Randall F. Holcombe ◽

Laura Hutchins ◽

...

Keyword(s):

Mixed Methods ◽

Rural Communities ◽

Clinical Research ◽

Care Coordination ◽

Cancer Care ◽

Quality Measures ◽

The United States ◽

Cancer Centers ◽

Patient Navigators ◽

Main Center

Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care. Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018. Results: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center’s EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks. Conclusions: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

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Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

American Journal of Audiology ◽

10.1044/2019_aja-18-0136 ◽

2019 ◽

Vol 28 (3) ◽

pp. 660-672

Author(s):

Suzanne H. Kimball ◽

Toby Hamilton ◽

Erin Benear ◽

Jonathan Baldwin

Keyword(s):

Mixed Methods ◽

Verbal Behavior ◽

Coping Strategies ◽

Mixed Methods Study ◽

Self Report ◽

Anxiety And Depression ◽

Negative Consequences ◽

Emotional Tone ◽

Explanatory Mixed Methods ◽

Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

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