Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project
Research indicates that people living in rural and remote areas of Canada face challenges to accessing health services. This article reports on a community-engaged research project conducted by investigators at Memorial University of Newfoundland in collaboration with the Rural Secretariat Regional Councils and Regional Partnership Planners for the Corner Brook–Rocky Harbour and Stephenville–Port aux Basques Rural Secretariat Regions of Newfoundland and Labrador. The aim of this research was to gather information on barriers to accessing health services, to identify solutions to health services’ access issues and to inform policy advice to government on enhancing access to health services. Data was collected through: (1) targeted distribution of a survey to communities throughout the region, and (2) informal ‘kitchen table’ discussions to discuss health services’ access issues. A total of 1049 surveys were collected and 10 kitchen table discussions were held. Overall, the main barriers to care listed in the survey included long wait times, services not available in the area and services not available at time required. Other barriers noted by survey respondents included transportation problems, financial concerns, no medical insurance coverage, distance to travel and weather conditions. Some respondents reported poorer access to maternal/child health and breast and cervical screening services and a lack of access to general practitioners, pharmacy services, dentists and nurse practitioners. Recommendations that emerged from this research included improving the recruitment of rural physicians, exploring the use of nurse practitioners, assisting individuals with travel costs, developing specialist outreach services, increasing use of telehealth services and initiating additional rural and remote health research.
Keywords: rural, remote, healthcare, health services, social determinants of health
Alston M, Allan, J, Dietsch, E, Wilkinson, J, Shankar, J, Osburn, L, Bell, K, Muenstermann, I, Giorgas, D, Moore, E, Jennet, C, Ritter, L, Gibson, R, Wallace, J, Harris, J & Grantley, J 2006, 'Brutal neglect: Australianwomen's access to health services', Rural and Remote Health, vol. 6, pp. 119.
BC Ministry of Health 2007, Summary of input on the conversation onhealth, viewed 1 May 2014, www.health.gov.bc.ca/library/publications/year/2007/conversation_on_health/.
Boydell, K, Pong, R, Volpe, T, Tilleczek, K, Wilson, E & Lemieux S 2006, 'Family perspectives on pathways to mental health for children and youthin rural communities', Journal of Rural Health, vol. 22, no. 2, pp. 18288. http://dx.doi.org/10.1111/j.1748-0361.2006.00029.x
Canadian Institute for Health Information 2012, Healthcare in Canada2012: A focus on wait times, viewed 1 May 2014, https://secure.cihi.ca/estore/productFamily.htm?locale=en & pf=PFC1984 & lang=en
du Plessis, V, Beshiri, R, Bolman, R & Clemenson, H 2002, 'Definitions ofrural', Agricultural and Working Paper Series, Statistics Canada, no. 21, pp. 143.
Flaskerud, J & Winslow, B 1999, 'Conceptualizing vulnerable populationshealth related research', Nursing Research, vol. 47, no. 2, pp. 6978. http://dx.doi.org/10.1097/00006199-199803000-00005
Forbes, D, Morgan, D & Janzen, B 2006, 'Rural and urban Canadians with dementia: Use of healthcare services', Canadian Journal on Aging, vol. 25, no. 3, pp. 32130. http://dx.doi.org/10.1353/cja.2007.0003
Gibbs, A 1997, Focus Group Research Method, Social Research Update, Department of Sociology, University of Surrey, Guildford, England.
Gruen, R, Weeramanthri, T & Bailie, R 2002, 'Outreach and improved access to specialist service for Indigenous people in remote Australia: The requirements for sustainability', Journal of Epidemiology and Community Health, vol. 56, pp. 51721. http://dx.doi.org/10.1136/jech.56.7.517
Gryzbowski, S, Stroll, K & Kornelson, J 2011, 'Distance matters: A population based study examining access to maternity services for rural women', BM Health Services Research (Open Access), viewed 1 May 2014, www.biomedcentral.com/1472-6963/11/147/ .
Harbir, G, McLeod, S, Duerksen, K & Szafran, O 2012, 'Factors influencing medical students' choice of Family Medicine', Canadian Family Physician, vol. 58, pp. 64957.
Jones, M, Humphreys, J & McGrail, M 2012, 'Why does a rural background make medical students more likely to intend to work in rural areas and how consistent is the effect? A study of the rural background effect', The Australian Journal of Rural Health, vol. 20, no. 1, pp. 2934. http://dx.doi.org/10.1111/j.1440-1584.2011.01242.x
Kitzinger, J 1994, 'The methodology of focus groups: The importance of interaction between research participants', Sociology of Health & Illness, vol. 16, issue 1, pp. 10321. http://dx.doi.org/10.1111/1467-9566.ep11347023
Laurent, S 2002, Rural Canada: Access to healthcare, Library of Parliament, Ottawa, Canada.
Le, Q, Nguyen, B, Auckland, S, Hoang, H & Terry, D 2012, 'Access to healthcare services in Australian rural area: A qualitative case study', International Journal of Annotative Interdisciplinary Research, vol. 1, no. 3, pp. 2936.
Leipert, B & George J 2008, 'Determinants of rural women's health: A qualitative study in Southwestern Ontario', Journal of Rural Health, vol. 24, no. 2, pp. 21018. http://dx.doi.org/10.1111/j.1748-0361.2008.00160.x
Morgan D 1988, Focus groups as qualitative research, Sage, London.
Orzanco, M, Lovato, C, Bates, J, Slade, S, Grand'maison, P & Vanasse, A 2011, 'Nature and nurture in the family physician's choice of practice location', Rural and Remote Health, vol. 11, no. 3, pp. 184959.
Romanow, R 2002, Building on values: The future of healthcare in Canada Final report, Commission on the Future of Healthcare in Canada, Ottawa, viewed 1 May 2014, http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf .
Sahid, S, Finn, D & Thompson, S 2009, 'Barriers to participation of Aboriginal people in cancer care: Communication in the hospital setting', Communication, culture, and health, vol. 190, no. 10, pp. 57479.
Sanmartin, C & Ross, N 2006, 'Experiencing difficulties accessing first-contact health services in Canada', Healthcare Policy, vol. 1, no. 2, pp. 10319.
Society of Rural Physicians of Canada, viewed 1 May 2014, www.srpc.ca/.
Szafran, O, Crutcher, R, Woloschuk, W, Myhre, D & Konkin, J 2013, 'Perceived preparedness for family practice: Does rural background matter?', Canadian Journal of Rural Medicine, vol. 18, no. 2, pp. 4755.
Statistics Canada 2011, GeoSuite (software and data package for the 2011 Census), viewed 1 May 2014, www12.statcan.gc.ca/censusrecensement/2011/geo/ref/geosuite-eng.cfm.
Wakerman, J & Humphreys, J 2011, 'Sustainable primary healthcare services in rural and remote areas: Innovation and evidence', Australian Journal of Rural Health, vol. 19, pp. 11824. http://dx.doi.org/10.1111/j.1440-1584.2010.01180.x
Wardman, D, Clement, K & Quantz, D 2005, 'Access and utilization of health services by British Columbia's rural Aboriginal population', Leadership in Health Services, vol. 18, no. 2, pp. xxvixxxi. http://dx.doi.org/10.1108/13660750510594864
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