Community readiness and momentum: identifying and including community-driven variables in a mixed-method rural palliative care service siting model

V A Crooks,A Williams,H Castleden,M Giesbrecht,M Skinner,N Schuurman

doi:10.1186/s12904-018-0313-5

V A Crooks, A Williams + Show 4 more

Open Access

https://doi.org/10.1186/s12904-018-0313-5

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Abstract

BackgroundHealth service administrators make decisions regarding how to best use limited resources to have the most significant impact. Service siting models are tools that can help in this capacity. Here we build on our own mixed-method service siting model focused on identifying rural Canadian communities most in need of and ready for palliative care service enhancement through incorporating new community-driven insights.MethodsWe conducted 40 semi-structured interviews with formal and informal palliative care providers from four purposefully selected rural communities across Canada. Communities were selected by running our siting model, which incorporated GIS methods, and then identifying locations suitable as qualitative case studies. Participants were identified using multiple recruitment methods. Interviews were transcribed verbatim and the transcripts were reviewed to identify emerging themes and were coded accordingly. Thematic analysis then ensued.ResultsWe previously introduced the inclusion of a ‘community readiness’ arm in the siting model. This arm is based on five community-driven indicators of palliative care service enhancement readiness and need. The findings from the current analysis underscore the importance of this arm of the model. However, the data also revealed the need to subjectively assess the presence or absence of community awareness and momentum indicators. The interviews point to factors such as educational tools, volunteers, and local acknowledgement of palliative care priorities as reflecting the presence of community awareness and factors such as new employment and volunteer positions, new care spaces, and new projects and programs as reflecting momentum. The diversity of factors found to illustrate these indicators between our pilot study and current national study demonstrate the need for those using our service siting model to look for contextually-relevant signs of their presence.ConclusionAlthough the science behind siting model development is established, few researchers have developed such models in an open way (e.g., documenting every stage of model development, engaging with community members). This mixed-method study has addressed this notable knowledge gap. While we have focused on rural palliative care in Canada, the process by which we have developed and refined our siting model is transferrable and can be applied to address other siting problems.

Highlights

Health service administrators make decisions regarding how to best use limited resources to have the most significant impact
Building from our earlier pilot study, where we developed a preliminary siting model using data focused on British Columbia (BC), here we report on the findings of qualitative interviews conducted with key informants (n = 40) in four purposefully selected rural communities across other parts of Canada to assess the appropriateness of the siting model for other rural palliative care service contexts
In the discussion section that follows we point to the fact that the breadth of factors identified in the current study and our earlier research collectively show that community awareness and momentum variables in the siting model must be assessed subjectively and we consider how this can be done

Summary

Introduction

Health service administrators make decisions regarding how to best use limited resources to have the most significant impact. It is Canada’s rural communities that are experiencing the most rapid rates of aging when compared to their urban counterparts [2] This is largely due to local rural residents ‘aging in place,’ and to senior in-migration that is occurring in 16% of Canadian rural communities due to factors such as affordability and lifestyle [2, 3]. This rapidly aging rural population is a timely concern with regard to the provision and receipt of palliative care as those aged 65 years and over account for over 75% of the total deaths in Canada each year [4]. A fast-approaching reality is that health service providers in rural Canadian communities are facing heightened demand for palliative care provision while simultaneously coping with shrinking budgets and in many cases health care restructuring that is affecting service provision [5, 6]

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