Date Published: April 16, 2019
Publisher: Public Library of Science
Author(s): Laura Alston, Melanie Nichols, Steven Allender, Eileen Sutton.
Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas.
Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health.
The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy.
The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations.
Cardiovascular diseases (CVD), including ischaemic heart disease (IHD) are the leading causes of death in Australia[1,2]. Rural and remote dwelling Australians experience a higher and disproportionate burden of these diseases when compared to their metropolitan based counterparts[3,4].
This research was conducted with assumptions informed by a post-positivist stance (26). Post-positivism argues that the truth can be uncovered and described, but never completely understood (26). Semi-structured qualitative interviews (n = 21) were conducted with policy makers and government advisors, working with or advising on rural health policy at local, state and federal levels, with specific focus at local level in Victoria (n = 9). Perspectives of those working at local government (LG) level in the state of Victoria were compared with Victorian state government and federal perspectives on the issue of IHD and rural health policy. See S1 File for an outline of the interview questions. Interviews were conducted to the point of data saturation whereby no new themes were emerging from the data, and repetition was emerging between participant responses. In qualitative research methods, data saturation indicates adequate participant sampling has occurred in the context of the research question. Ethics approval was received from the Deakin University Human Ethics Advisory group within the faculty of Health reference number HEAG-H 91_2016.
The summary of findings from each theme derived from the frameworks is summarised in Table 4. The themes of the ‘Rural Locale’, ‘Broader Health Systems’ and ‘Power’ were most prominent in the results and are discussed in additional detail below.
Despite large advances in heart disease prevention globally this remains a key area of inequality between urban and rural dwelling Australians. The use of scientific evidence in health policy is influenced by multiple factors which is recognised on an international scale, and our findings show that the rural context leads to conditions which constrain the ability of the Australian government to focus on these inequalities and subsequently to apply evidence to their efforts in prevention. If these contextual inequalities are not addressed, the inequities in morbidity and mortality will persist for future rural-dwelling communities.