Determinants of Health of Rural Populations and Communities

In 1999, the Rural Development Institute (RDI) of Brandon University was awarded the Determinants of Health of Rural Populations and Communities Project as an innovative, interdisciplinary research project funded by the Social Sciences and Humanities Research Council of Canada (SSHRC). The goals of the project were to examine the determinants of population health and community health indicators; to generate and adapt health indicators for application to rural populations and communities; to develop a framework, process and tools with selected rural communities to assist them with assessing their health and sustainability; and to apply and evaluate the resulting framework, process and tools with selected communities. Rural residents, researchers and project partners, developed a framework for rural communities. Participants in fifteen focus groups throughout southwestern Manitoba were asked to share their views of the concepts of ‘rural’, ‘health’ and ‘community’; to describe ways to determine if a community was healthy; and to suggest criteria to assess rural community health and well-being. Following the focus groups, representatives of each focus group participated in a workshop to develop a meaningful framework and indicators for rural community assessment. Ten framework categories were identified and visually represented as a flower.  During the same period of time, health care managers throughout western Manitoba were interviewed to ascertain their perceptions of quality of life in rural communities and to obtain their suggestions for indicators of rural health and well-being. The researchers used the resulting information to develop processes and tools, including a workbook A Rural Community Guide for Assessing Well-Being and Quality of Life for use by residents of rural communities to assess the health and quality of life of their communities.

Participatory Action Research (PAR) underscored the entire project. PAR involves participation in the research by people within communities, drawing on their knowledge and personal experiences to contribute to the research agenda, processes and findings. Two rural communities were required to test the processes and tools. The criteria for the pilot communities included a commitment and desire for residents to undertake a project to look at the health and well-being of their community; a contact person/coordinator to work with the research partners and act as a liaison with a community committee; and a group of volunteers to act as a steering group for the project. Research partners nominated two communities:  the Town of Shoal Lake and Rural Municipality of Shoal Lake; and the Town of Virden and the Rural Municipality of Wallace. The communities eagerly joined the project in late 2002 and formed steering committees of interested residents. A draft of the Guide was provided to each steering committee. Sub-committees were organized around the framework categories (petals) and each sub-committee reviewed the indicators within their category and decided which indicator to use and which data to collect. Local project coordinators were engaged to assist the committees in collecting and organizing the data with the support of student research assistants from RDI. When the committees wanted information and opinions that were not available through government, regional or local data sources, they developed community and local business surveys. Information gathered through the community assessment processes were compiled into community reports. The citizens will use these reports to surface public values, opinions and priorities; dispel myths; confirm knowledge; set priorities; develop short and long range plans; define and solve problems; stimulate action; build support to address issues; and provide evidence to influence others.  Following these pilots, researchers and other partners reviewed the project and a new guide, Rural Community Health and Well-Being: A Guide for Action, was developed.

In May 2004, RDI sought a community partner in northern Manitoba. The Town and Community Adjustment Committee of Leaf Rapids invited RDI to the community.  In June of 2004, members of RDI’s research team traveled to Leaf Rapids and met with several residents and groups in the community.  During that visit, the community invited RDI to assist them in studying well-being and quality of life in Leaf Rapids; implementing community action on key issues; and building skills and capacity that would remain in the community.  An advisory committee was established to guide the project, and a local community coordinator who provides support for the project was hired. RDI researchers and student interns continue to be involved with Leaf Rapids, traveling to the community on a regular basis.