PUBH6013 Qualitative Research Methods

Contents Executive Summary ........................................................................................................................... 1

Introduction ......................................................................................................................................... 1

Background and statement of the problem ................................................................................ 2

Health care and health care needs ............................................................................................ 2

Research question ............................................................................................................................. 3

Study design ....................................................................................................................................... 3

Study population and sampling ..................................................................................................... 4

Data collection methods and analysis ......................................................................................... 4

Reflection ............................................................................................................................................. 5

Conclusion ........................................................................................................................................... 5

References ........................................................................................................................................... 6

Appendices ........................................................................................................................................ 10

Questionnaire ................................................................................................................................ 10

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Executive Summary This research proposal is developed to explore the opinions of residents around

current health services available in a small rural country town in South Australia.

Rural and remote people matter, and so does their health.

The paper identifies:

• Current literature on health services and rural communities

• Summary of the selected methodology chosen and exploration of why

• Selection process for research participants and the suggested interview

process including addressing potential ethical issues

• Personal reflection on the motivation for selection of topic

Introduction The current population of Australia is estimated to be around 25 million (Australian

Bureau of Statistics, 2019). Of this 25 million some seven million or 29% of the

population live in rural and remote areas (Australian Bureau of Statistics, 2017).

People whom live in rural areas within Australia experience poorer health than those

living in metropolitan areas. In fact, studies have shown that Australians whom live

in ‘rural and remote areas live shorter lives, have poorer access to and use services

and higher levels of disease and injury compared to those in metropolitan areas

(Australian Institute of Health and Welfare (AIHW), 2017).

The poor state of health that is highlighted is further reinforced by the data on

expenditure records from the period of 2006-07. This records that there is an

‘annual shortfall in services available to those living in rural communities, a shortfall

of more than 25 million services and a deficit of $2.1 billion dollars in primary care for

the period of 2006-07’ (National Health Rural Alliance, 2016).

This paper discusses the current literature around the opinions of consumers whom

live in rural and remote communities and health care services. The methodology

and selection of participants including a personal reflection on the selection of this

subject matter will be addressed.

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Background and statement of the problem Health care and health care needs The Government of South Australia (2019) state that there are approximately ‘1.7

million people residing in South Australia, of this 77% live in Adelaide and its

surrounding metropolitan areas and that 29.2% of the state’s population reside in

rural and remote South Australia.

The average life expectancy of a woman living in ‘South Australia is 84.5 years,

which is higher than compared with the average male life expectancy which is

currently set at 80.4 years’. Those whom reside in country South Australia do have

a lower life expectancy, ‘female (84.1 years) and male (79.2 years)’ (Australian

Bureau of Statistics, 2017).

Recent statistics collated for Data Compendium for SA Health (2017) document

there are ‘more men living in regional rural areas compared to metropolitan areas

and that these regions were also more likely to report higher rates of people aged

between 0-14 years of age’. This report also identified that the ‘City of Victor Harbor

had the highest proportion of people aged 65 years and over (37.9%)’.

It is well documented that there are multiple barriers faced by those whom live

outside of metropolitan areas in accessing a range of health and aged care services.

People whom ‘live in rural communities tend to live shorter lives, have poorer access

to and use of health services and higher levels of disease and injury’ (Australian

Institute of Health, 2017). Reinforcing that having the ability to access a health

service does in fact effect an individual’s health.

There are multiple reasons and factors for those living in rural and remote areas or

poorer health outcomes such as a level of disadvantage related to education and

employment opportunities, income not to mention the mal-distribution of the health

workforce. This is further complicated when most health service providers are

concentrated in the large cities and it is difficult to recruit and retain health

practitioners to rural and remote communities.

The Australian government have ‘worked to improve health outcomes in regional

areas across Australia. Focusing on improvements around delivery of services and

coverage of the health workforce as well as ensuring information about health

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programs is accessible’ via the internet but there are still many deficits to address

(The Department of Infrastructure, Transport, Cities and Regional Development,

2018).

From the literature review undertaken some twenty-five year ago, the need for an

innovative model of rural service delivery which would meet the needs of a diverse

rural community was identified by the National Rural Health Strategy (Australian

Health Ministers Conference, 1994). Today there is still no national health strategy

and evidence supports that rather than pursuing more ‘innovative services there is a

need to use evidence that is already available to inform a cohesive, whole system

approach to improve rural and remote health outcomes’ (Australian Health Ministers

Conference, 1994).

It was also identified that there a lack of studies from an individual perspective of

living in a rural community and accessing health care services. This lack of

analytical and descriptive experience of such a phenomenon means there is globally

accepted perspective rather than specific on this subject matter.

Given the statistics available and knowing there are limited range of health services

to support those whom live in small rural communities reinforces the suggestion that

the needs of a community are based on health service needs of its population.

Actual and projected population demographics, epidemiological evidence of disease

patterns, risk factors and health of the communities in the associated catchment

zone all must be taken into consideration when creating a health service.

Research question Explore the opinions of residents living is a small rural country town about health

services available in rural communities. Examine the specific services that are

needed but unavailable.

Study design The qualitative approach used for this line of inquiry will be the Phenomenological

approach. The choice to use this approach is as it will concentrate on the

experience of health care in a rural community from the individual’s point of view and

will describe how the participants interprets the everyday world.

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This form of approach will hope to capture the essence of the experience rather than

measure the number of people whom use or don’t use the available services in the

rural community.

Study population and sampling The study population for this line of inquiry will be four individuals whom reside in a

rural community in South Australia and that all have accessed health services in their

community.

Phenomenological research depends on a subjects account which is obtained from

‘questionnaires, in depth interviews, observations as well as a variety of other

different documents’ (Harvey, 2019). For this line of inquiry, a face to face, in depth

interview will be conducted with each participant. These interviews will be recorded

with use of my personal phone with permission from the participants. Recording of

interviews will ensure that the ‘statements and perceptions made by the study

population will be accurate’ (Harvey, 2019).

It is important to ensure that during this method of inquiry that reference is taken

from the Australian Code for the Responsible Conduct of Research. This document

provides a guide to ‘responsible research practices, as well as promoting integrity in

research for researchers and providing an explanation of what is expected of

researchers by the community’ (Australian Government, 2007).

It is recommended that for this style of inquiry the sample size should be ‘between 5

to 25 individuals whom have experienced this phenomenon’ (Polkinghorne, 1989).

The sample size of this phenomenological study will be four.

The only specific criteria required for participants is that they reside permanently

within this area and have accessed health services.

Data collection methods and analysis The questionnaire for this line of inquiry will be a total of 18 questions, see Appendix.

The questionnaire is formulated into three specific areas –

• Community Overview

• Service Access

• Knowledge and utilisation of local health care services.

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The rationale for formulating the questions into groups is to make the transition to

data analysis easier.

The use of open-ended questions was undertaken in formulating the questionnaire.

This form of questioning ‘gathers data that will lead to a textual and structural

description of the experiences, resulting in an understanding of the common

experience of the participants involved’ (Creswell, 2013, pg. 81).

Collection of data and recordings from a phenomenological study is often large.

There is an enormous number of detailed quotes and information generated via the

interview process.

During analysis the data will be analysed looking for ‘significant statements,

sentences or quotes which provide an understanding of what the participants in this

form of inquiry experienced’ (Creswell, 2013, pg. 82). This information will then be

collated into a written report providing a clear description of what the participant

experienced as well as that of the researcher.

Reflection The motivation behind this form of inquiry is related to my personal situation. My

parents reside in a rural community in South Australia and both have significant

health issues and are contemplating the need to relocate to gain the necessary

treatment for their health issues, mainly due to the fact there is limited appropriate

services to meet their needs.

Conclusion This phenomenological study focuses on a small rural community in South Australia

and the availability of and access to health care services. Specifically, I focused on

the current services available within this community, and whether the services

available meet the needs of its community and what members within the community

felt was needed to improve the service.

The World Health Organisation identified that strengthening health care delivery is

key to achieving the health-related Millennium Development Goals (MDGs) as well

as a fundamental input to population health status (World Health Organisation, 2010,

pg. 2).

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Though services vary from country to country and often state to state, a well-

functioning health care system should consist of some key characteristics such as a

comprehensive range of services that are accessible and designed to meet target

population groups.

This paper provided a literature review around opinions from consumers living in

rural and remote communities and health care services. The methodology, sampling

process and data analysis was discussed. Personal reflection was provided on the

motivation behind undertaking this form of inquiry.

References Australian Bureau of Statistics (ABS) (2017e). Regional population growth, Australia,

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<https://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3218.0>

The Department of Infrastructure, Transport, Cities and Regional Development

(2018) Health: Regional Australia—Driving Our Economy 2017–18. Australian

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https://www.infrastructure.gov.au/department/statements/2017_2018/ministerial-

statement/health.aspx>

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Australian Health Ministers Conference. (1994). National rural health strategy.

Canberra: Australian Government Publishing Service. Retrieved from:

http://ruralhealth.org.au/sites/default/files/healthyhorizons/national%20rural%20healt

h%20strategy%2C%20 march%201994.pdf

Australian Government (2007). Australian Code for the Responsible Conduct of

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Bureau of Health Information. (2016). The Insights Series – Healthcare in rural,

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Creswell, J. (2013). Chapter 4 : Five qualitative approaches to inquiry. In Creswell, J

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Appendices Questionnaire Community Overview

1. What age group do you identify with?

a) Under 18 b) 19-30 c) 30-50 d) 50 – 70 e) 70-100

2. How long have you lived in a rural community?

3. Tell me about why you choose to live here compared to a metropolitan area.

4. What are the three things you like most about living in this small rural

community?

5. Tell me one thing that would make Port Vincent a better place to live.

6. What do you think are the three most significant social issues/challenges

facing our community?

7. In the last year how many times have you accessed health services in your

local area?

Service Access

8. What health services and programs are you currently using?

9. What do you think about the current level of health services that are available

to you in your local area?

10. How often have you been required to travel more than an hour to seek

medical attention and why?

11. How accessible are the health services for your use?

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12. What services do you feel would be beneficial to your local community and

potentially reduce the incidence of having to travel distances to seek help?

13. What do you think of the prices of the services available to you?

Knowledge and utilisation of current local health care services

14. Do you access Patient Assistance Transport Scheme (PATS). This scheme

provides subsidies towards the cost of travel and accommodation when rural

and remote South Australians have to travel to see their nearest medical

specialist? If not, why not?

15. Are you aware of what ACAT is and how you access this?

16. What is your opinion of telehealth?

17. Have you used the Health bus, a service which aims to improve the health

and wellbeing of people living on the Yorke Peninsula and to improve access

to Adelaide health services and specialist appointments for people of the

Yorke Peninsula at an affordable cost?

18. How affordable do you think the Health bus is?

19. Is there anything else you would like to share?