Abstract
ObjectivesConsiderable evidence has advanced the role of citizen-led coalitions (CLC) in supporting the health and social needs of rural citizens. There has been little research focusing on the experiences and strategies of coalitions, with their limited resources and status, in targeting health inequities in their rural communities. The aim of this study was to understand the entrepreneurial strategies and experiences of rural coalitions to effect change in the delivery of health services for their older adult populations.MethodA qualitative descriptive study method was used to generate understanding of the entrepreneurial experiences and strategies of CLCs in advancing health services to meet the health and social needs of their citizens. Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys. Thematic analysis was used to construct themes from the data.ResultsTwo over-riding themes emerged: entrepreneurial strategies and societal recognition. CLCs engaged in numerous entrepreneurial strategies that enabled actions and outcomes in meeting their health care needs. These strategies included: securing quick wins, leveraging existing resources, and joining forces with stakeholder groups/individuals. However, despite these strategies and successes, coalitions expressed frustration with not being seen and not being heard by decision-makers. This pointed to a key structural barrier to coalition successes -- a broader societal and institutional problem of failing to recognize not only the health needs of rural citizens, but also the legitimacy of the community coalitions to represent and act on those needs.ConclusionsDespite the potential for coalitions to mobilize and effect change in addressing the inequities of rural health service access for older adults, broader barriers to their recognition, may undermine their entrepreneurial strategies and success.
Highlights
Equitable access to care Well-known health and health care disparities exist in rural communities in Canada [1, 2]
Access and its provision is not a singular outcome, and health care access may be better understood in terms of responsiveness to need, with needs spanning differences across individuals and communities, across regions and geography, across class, race and gender
Design The study used a qualitative descriptive approach [21] to understand the entrepreneurial strategies of communitylead coalitions in their attempts to increase rural health service delivery
Summary
Equitable access to care Well-known health and health care disparities exist in rural communities in Canada [1, 2]. Cardiovascular disease, diabetes, and hypertension along with lower life expectancy are known to be higher in rural than urban areas [3]. Despite their greater health care needs, rural residents often have less health care access [2]. Access to health care is not necessarily satisfied by access to basic services or by the provision of government-subsidized universal health care coverage, and understanding it in these simplistic terms may obscure larger issues of equity and social justice. In a survey [6] of the Canadian healthcare system, 38% of Canadians
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