Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples.

OBJECTIVE: This paper explores how communities translate evidence-based and promising health practices to rural contexts. METHODS: A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation. RESULTS: Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. CONCLUSION: Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

From theory to practice: what drives the core business of public health?

In 1994, the Public Health Functions Steering Committee proffered a description of the Essential Public Health Services (Essential Services). Questions remain, however, about the relationship between the roles defined therein and current public health practice at state and local levels. This case study describes the core business of public health in Georgia relative to the theoretical ideal and elucidates the primary drivers of the core business, thus providing data to inform future efforts to strengthen practice in the state. The principal finding was that public health in Georgia is not aligned with the Essential Services. Further analysis revealed that the primary drivers or determinants of public health practice are finance-related rather than based in need or strategy, precluding an integrated and intentional focus on health improvement. This case study provides a systems context for public health financing discussions, suggests leverage points for public health system change, and furthers the examination of applications for systems thinking relative to public health finance, practice, and policy.

Transforming the delivery of rural health care in Georgia: state partnership strategy for developing rural health networks.

Since 1996, 19 networks covering 74 of the 117 rural counties in Georgia have emerged. This grassroots transformation of rural health care occurred through a series of partnerships launched by state government officials. These partnerships brought together national and state organizations to pool resources for investment in an evolving long-term strategy to develop rural health care networks. The strategy leveraged resources from partners, resulting in greater impact. Change was triggered and accelerated using an intensive, flexible technical assistance effort amplified by developmental grants to communities. These grants were made available for structural and organizational change in the community that would eventually lead to improved access and health status. Georgia's strategy for developing rural health networks consisted of 3 elements: a clear state vision and mission; investment partnerships; and proactive, flexible technical assistance. Retrospectively, it seems that the transformation occurred as a result of 5 phases of investment by state government and its partners. The first 2 phases involved data gathering as well as the provision of technical assistance to individual communities. The next 3 phases moved network development to a larger scale by working with multiple counties to create regional networks. The 5 phases represent increasing knowledge about and commitment to the vision of access to care and improved health status for rural populations.