How can rural community-engaged health services planning affect sustainable health care system changes? - A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project
Bibliographic record
Abstract
Abstract Objectives The objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community health care issues to help modify existing rural health care programs and inform government rural health care policy. Design An adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, and community representatives. Qualitative data was gathered using a semi-structured interview guide. Major themes were identified through content analysis, and this information was fed back to the government and interviewees in reports every six months. Setting The 107 communities visited thus far have health care services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care. Participants Participants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling. Primary and secondary outcome measures A successful process was developed to engage rural communities in identifying their health care priorities, whilst simultaneously building and strengthening relationships. The qualitative data was analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels. Results 36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed. Conclusion The SV Project appears to be unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped support system change. Article Summary This study process has adapted Boelen’s health partnership model and is unique in that it is physician led, prioritizes relationships, engages all of the health care partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis. A successful method of engaging with rural communities and building relationships and trust across multiple stakeholder groups is described that contributed to influencing positive health care system changes. As all communities in one province are being visited a picture of rural health care initiatives and challenges is highly comprehensive and therefore able to influence policy. One of the main limitations in this study is that because the interviewers were experienced health care providers, power differentials may have existed which may have introduced bias in the discussions. A potential limitation is the enormous amount of data to handle and analyze in a rigorous way, which was mitigated by having two full time analysts working together to ensure consistency with frequent meeting with the research team to consider and agree emerging themes. How can rural community-engaged health services planning affect sustainable health care system changes? – A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.011 | 0.011 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".