Abstract
BackgroundRural-urban health care disparities are an important topic in health services research. Hence, developing valid and reliable tools to measure rurality is needed to support high quality research. However, Japan, has no index to measure rurality for health care research. In this study, we conducted a systematic scoping review to identify the important factors and methodological approaches to consider in a rurality index to inform the development of a rurality index for Japan.MethodsFor our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websites of national governments such as Government and Legislative Libraries Online Publications Portal (GALLOP), from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas used to calculate indices, and any measures for reliability and validity of these indices.ResultsWe identified 17 rurality indices from 7 countries. These indices were primarily developed to assess access to health care or to determine eligibility for incentives for health care providers. Frequently used factors in these indices included population size/density and travel distance/time to emergency care or referral centre. Many indices did not report reliability or validity measures.ConclusionsWhile the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index. The results will be helpful in the development of a rurality index in Japan and in other countries.
Highlights
Rural-urban health care disparities are an important topic in health services research
Numerous studies have reported that rural residents are more likely to have chronic diseases related to obesity, and less likely to engage in healthy behaviours, compared to urban residents [1,2,3,4]
The Rurality Index of Ontario (RIO) used a sum of community population, travel time to nearest referral centre and travel time to nearest advanced referral centre to produce a continuous variable from 0 to 100 [11] while the Modified Monash Model (MMM) used a combination of population size and geographical remoteness to provide a 7-level classification with 1 representing a major city and 7 representing a high level of remoteness [12]
Summary
Rural-urban health care disparities are an important topic in health services research. Addressing rural-urban health care disparities is an important health system challenge. The recruitment and retention of the health care providers are major challenges in rural areas [10]. Ontario, Canada originally developed the Rurality Index of Ontario (RIO) [11] in 2000 for policy purposes such as workforce incentives targeting physician recruitment and retention in rural areas [11]. A challenge for the development of rural indices is that many definitions of rurality exist as “rural” areas can include a wide range of community characteristics (e.g. level of affluence, degree of industrialization) [14, 15]. The RIO used a sum of community population, travel time to nearest referral centre and travel time to nearest advanced referral centre to produce a continuous variable from 0 to 100 [11] while the MMM used a combination of population size and geographical remoteness to provide a 7-level classification with 1 representing a major city and 7 representing a high level of remoteness [12]
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