This Toolkit makes it abundantly evident that better data and more research on rural health systems delivery and rural health/human services are needed. Several studies (1-4) suggest that entities that fund or sponsor research on these topics, and the organizations and individuals who plan and conduct such research, could take steps to improve the quantity and quality of rural health information.
To provide those of us who advocate for improved rural health with a foundation for promoting policy change to accomplish this, the following recommendations are abstracted and adapted from the USDHHS Rural Research Needs and Data Sources for Selected Human Services Topics, Volume 1: Final Report (3).
- Include Rural Populations, Areas, or Systems in More Studies. Entities that sponsor or conduct health services research ─ particularly through large national or regional studies and surveys ─ should more often include rural people, areas, or systems in studies.
- Incorporate Rural Sites into Program Evaluations. Since one-fifth of the nation’s population lives in rural areas, differences in the impacts and costs of programs that serve rural families could be large, both in social and in budgetary terms. Therefore, including rural sites and samples in evaluations, or conducting evaluations specifically designed for rural areas, could improve rural programs and policies.
- Oversample Rural Sites and Populations. Rural populations are small. This can make statistical analysis less precise or preclude the use of sophisticated analytic approaches. Oversampling of rural areas is an important option for improving rural health services research, conducting more sophisticated analyses, and better identifying significant rural findings or rural-urban differences. It is particularly important when there may be differences among racial/ethnic, cultural, or other demographic or community subgroups.
- Report Rural Findings. Many national and regional studies do include rural data. But if rural issues are not a specific focus of the study, or if key findings do not differ between rural and urban sites, report authors generally do not include discussions of rural experiences and findings in published reports, or even provide information on the breakdown of sample members by rurality. Providing such information could help answer many important rural research questions.
- Make Better Use of Existing, Detailed Rural Classification Systems. Detailed and informative classifications of rural areas have been developed for use in demographic and economic studies. To date, however, they have been little used in a number of rural health research topics such as poverty and health and human services issues. As a result, a paucity of information is available to study variation across diverse rural areas, or to capture the complexity of rural-urban differences. To the extent possible, rural data should include geographic identifiers that can support the use of detailed rural classification typologies, and researchers should make more use of alternative rural classification approaches.
- Disclose Rural Definitions and Classifications Used in Studies. Study authors should disclose the definitions used to classify rural observations. Failure to do so makes it difficult to interpret rural research findings, as well as to summarize and synthesize findings across studies.
- Add Information to Make Small, Region-Specific Rural Studies More Generalizable. The rural health and human services research literature is largely composed of small, region-specific studies. Findings from such studies can be useful, in the absence of nationally representative studies. Their generalizability could be improved, however, if in addition to including operational definitions of rurality, authors provided detailed descriptions of rural samples, along with descriptive and demographic information on rural study sites.
- DeClerque, JL, Pedulla, NM, Guild, PA & Bennet, TA. (1995). Data Sources for Research on Rural Adolescent Pregnancy: An Evaluability Assessment. North Carolina Center for Rural Health Research, Working Paper No. 41.
- Stearns, SC, Slifkin, RT and Walke, T. (1997). Using the Medicare Current Beneficiary Survey for Analysis of Rural Health Policy Issues. North Carolina Center for Rural Health Research, Working Paper No. 52.
- Strong, DA, Del Grosso, P, Burwick, A, Jethwani, V & Ponza, M. (2005). Rural Research Needs and data Sources for Selected Human Services Topics: Final Report. U.S. Department of Health and Human Services, Volumes 1 & 2.
- North Carolina Rural Health Research & Policy Analysis Center. (2007). State Profiles of Medicaid and SCHIP in Rural and Urban Areas. Available at: http://www.shepscenter.unc.edu/medicaidprofiles/, accessed November 9, 2007