Contextualizing Rurality for Family and Community Health Research

Rural areas can be defined in many ways.1,2 Although rurality is often defined by geographic location or population density, the concept of rural is most aptly described within the context of people, culture, environment, and health care access.2 To better understand the health of rural residents, researchers, practitioners, and policy makers must rethink the lens through which they view rural populations. This includes economic and social resources that, along with geography, collectively define rurality, and impact the lives of residing residents. Framing the research issues within place and context gives specific meaning to rural health challenges. Understanding the unique challenges facing a rural region or rural population of interest gives greater meaning and relevance to the research message.

Although the majority of Americans live in metropolitan areas, the effect of place and context on families and communities is of growing concern, and relevance in understanding the correlates and influences of rural residence remains salient.2,3 It is well documented that rural areas, and those residing within them, encounter unique health challenges. Families and communities dwelling in rural areas often have less access to preventive health services and health care compared to their counterparts residing in more urban or suburban areas.4 The health infrastructures in these rural areas are commonly more dispersed, which forces residents to travel farther distances to obtain screenings, interact with health care professionals, and find appropriate health-related treatments.4 Further, rural areas are confronted by shortages of health providers and medically-related deficiencies.5 The unique characteristics of rural and underserved areas emphasize the need for effective health interventions, innovative techniques to integrate existing assets and deliver services, and dynamic partnerships necessary to maximize the reach and effect of community resources. In addition to disparities regarding health care and services, preventive behaviors including physical activity and nutritional provisions may be compromised in rural areas because of variations in the built environment, transportation, and access to healthy food or exercise facilities.

Despite existing research examining health and behavioral variation across the rural-urban continuum, merely residing in a rural or frontier area does not adequately provide insight into the origins or influences of rural disparities in America. For this reason, when assembling this collection of manuscripts, the Co-editors of this issue employed a philosophy of selecting articles that highlight what it means to be a person living in a rural area, not just studies focusing on rural participants. Recognizing that rurality is different in many parts of the country, this issue highlights research and practice across the country as well as in specific rural areas often characterized by poverty and lack of health services (eg, Appalachia).

This issue addresses key national policy issues such as how the expansion of the Patient Centered Medical Home model into rural and underserved populations can be part of a transformative strategy to address health care access, efficiency, quality, and sustainability.6 Health status disparities are explored with a family focused concern of examining both parental and child health status in relationship to health care access.7 Qualitative research about the performance of rural health clinics sheds light on factors associated with greater efficiency and effectiveness of these care models designed to improve primary care in rural areas.8 There are many barriers to screening for preventive care in rural areas, especially for cancer which still carries a stigma in many rural areas. Strategies for improving participation in cancer prevention and control studies are highlighted which can help others in general recruitment efforts,9 although it is important to be aware of the role of both insurance coverage and personality factors (eg, fatalism) in cancer screening behaviors.10 There has been increasing attention to a range of technological, behavioral, and environmental interventions to address rural health disparities. Tele-health has promise for increasing mental health services as demonstrated through a unique academic-campus partnership that has been mutually beneficial for both students and community members.11 Interventions to improve child health that draw upon and extend community partnerships can promote healthy lifestyles and also raise awareness for health-related careers.12 These programs embedded in school life can sustain benefits in active living and healthy eating.13 A community-wide health and wellness coalition which spurs a coordinated effort in many different sectors (eg, health, schools, community, government) can have a transformative effort.14 Focused urban design efforts to encourage transportation alternatives are beneficial to promoting active living and call attention to the importance of planning efforts in communities of all sizes.15

National objectives have been set for improving the health of Americans in rural communities.4 There is an urgent need to continue to set rural-specific health priority areas, document what is known about health in rural areas, identify rural best practice programs/interventions, and promote rural health services research and researchers. This can be accomplished in part by sustaining the Rural Healthy People project as part of the broader Healthy People 2020 initiative.16

Rethinking the lens through which we view rural populations and the challenges each distinct region faces provides greater understanding of the distinctive challenges facing a rural region or rural population giving greater meaning and interest to the research message. At the same time it is important to remember the rich, varied rural textures provided by rural regions, and populations. An appreciation of both the resources and challenges faced by rural populations is essential to accurately reporting rural research in a contextually accurate manner.

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