Utilising a collective case study system theory mixed methods approach: a rural health example

Area of Science:

• Rural health services research
• Physiotherapy service provision
• Health workforce studies

Background:

• Limited literature exists on local health service provision in rural communities.
• Existing rural health research often focuses on workforce shortages, neglecting service delivery details.
• Aggregated data obscures the visibility of local health service provision.

Purpose of the Study:

• To describe a methodology for exploring rural health service provision.
• To focus on understanding rurality in the context of rural physiotherapy services.
• To investigate stakeholder perspectives on rurality and its impact on service provision.

Main Methods:

• Employed a system theory-case study heuristic with a sequential mixed methods approach.
• Collected quantitative data via surveys and qualitative data through in-depth interviews.
• Investigated a large area in an Australian state encompassing rural, regional, and remote communities.

Main Results:

• Received 39 surveys from 11 locations and conducted 19 in-depth interviews.
• Developed six case types for exploring rural physiotherapy service provision based on stakeholder views of rurality and workforce.
• Found that participant perceptions of rurality differed from geographical classifications and were influenced by colleague numbers and local healthcare access.

Conclusions:

• Participant perspectives highlighted the complexity of defining rurality in relation to physiotherapy service provision.
• Dual measures (rurality and workforce) offer more relevant site differentiation for exploring specific services like rural physiotherapy than geographical classification alone.
• The system theory-case study heuristic is a valuable framework for mixed-methods rural health services research.