Understanding care coordination across primary health care services in a rural context for young children and their families experiencing adversity: A critical realist case study
Bibliographic record
Abstract
,This dissertation explores the complex and layered phenomenon of care coordination for young children and their families experiencing adversity in a rural primary health care setting. Despite growing recognition of the importance of coordinated care in addressing health inequities and improving outcomes, families in rural settings often face fragmented services, limited access, and systemic barriers that hinder timely and effective support. Applying critical realism to a case study design, this research investigates the structures, mechanisms, and contextual factors that shape care coordination practices in a rural community in northern British Columbia (BC), Canada. A mixed-methods case study approach was employed, combining qualitative interviews with service providers, parents, and caregivers; organizational document analysis; and quantitative service data from medical chart review. The lens of critical realism enabled a layered analysis across three domains: the empirical (what is experienced and observed), the actual (what happens), and the real (the underlying structures and mechanisms that generate outcomes). This critical realist case study approach allowed for a nuanced understanding of the visible practices of care coordination and the often-invisible systemic forces that enable or constrain care coordination activities. The study identified four interrelated dimensions of engagement, emotional, cognitive, behavioural, and social, as essential to effective care coordination. Engagement across these dimensions is sustained or disrupted by deeper mechanisms such as trust, system literacy, and relational continuity. The findings reveal that care coordination is a relational and ethical practice shaped by structural fragility, workforce instability, and geographic isolation. The study contributes a novel framework for understanding engagement in care coordination and introduces the concept of moral empowerment as a key enabler of sustained engagement by both families and providers. The dissertation also presents compassionate systems leadership as a strategy for fostering moral empowerment to sustain care coordination. Policy and practice recommendations emphasize the need to invest in relational infrastructure, support interdisciplinary collaboration, and design systems that enable engagement. This research advances understanding of rural care coordination and offers actionable insights to improve equity-oriented, family-centred care in underserved settings.
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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 | 0.012 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.027 | 0.016 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.003 | 0.008 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 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".