Photo by Gonz DDL on Unsplash

By Elyse Tsang

This blog post builds off our previous discussion on the various methodologies used in rural health research and takes a detailed look into the first step of this process – asking the right questions.

Approaching rural health through a rural lens

When it comes to rural health research, one size does not fit all. Because the health of rural populations is linked with a unique set of challenges, urban health care models often fail to provide suitable solutions for rural health issues and cannot directly be applied to rural communities. These challenges are influenced by distance, inaccessibility to health services, low population densities, vulnerability to hazardous weather events, scarce resources, and the nature of rural generalist medical care to name a few factors (2).

Adding to the complexity of rural health are various classification schemes to describe a region’s degree of rurality as well as different definitions to distinguish rural areas from urban centers (3). This heterogeneity between rural communities, such as population size, resource availability, geography, and culture, also contributes to the need for rural-based and community-specific interventions (4).

Check out our first blog post for resources on the definition of rural.

Most importantly, rural health research must serve the needs of rural populations. This seems rather intuitive, but more often than anticipated, researchers can misinterpret the concerns of a community or impose their own ideas of what a rural community is lacking in terms of health and health services. Therefore, it is ideal for health researchers to align their objectives with the priorities of rural communities for whom their research is intended to benefit (5).

Considering these factors, rural health research must be approached through a rural lens, and the first step involves developing a strong research question upon this central principle.

Why is a solid research question so important?

“To find the right question requires that we understand what we are asking about, and know to keep the question simple enough to be answerable, but challenging enough to be interesting” – John G R Howie (6)

Formulating a clear research question is the starting point of any project. It will define your study’s scope, including the population, variables, intervention, and outcomes of interest, while continuously guiding the purpose of your research (7).

For more on the importance of a well-defined research question, visit this guide by the Ingham Institute.

Topics in rural health research

There are many opportunities of study in rural health research partly due to a lack of attention directed towards rural health research in the growing body of health literature. These topics include, but are not limited to (8):

• Rural health services delivery (emergency health, primary care, surgery, maternity, transportation, etc.)
• Feasibility and sustainability of health facilities and personnel
• Determinants of health (social, genetic, environmental, behavioural, and medical care) in rural populations (9)
• Rural-urban and intra-rural disparities

Rural health research questions may stem from a few different sources such as practical issues encountered by rural healthcare providers and patients, government or institutional proposals, and knowledge gaps identified by existing literature (8). Arguably the most significant drivers of formulating a meaningful research question are represented by 3 I’s: interest, investment, and importance.

INTEREST – researchers should possess a genuine curiosity about the subject. This will fuel an authentic pursuit of discovery and ideally lead to effective knowledge translation.

INVESTMENT – to be personally invested in a research study constitutes a willingness to dedicate time and effort in finding answers, solutions, and valuable outcomes. Beyond this, researchers who are truly invested in their work will be prepared to persist through unforeseen challenges.

IMPORTANCE – the research question should address a real gap in the field and the expected findings should inform actionable steps looking forward.

Ensure the research is necessary and feasible

Any form of research requires resources, time, funding, and a great deal of effort, so before diving headfirst into a new study, it is essential to assess if the research is truly necessary and feasible. With respect to rural settings in particular, poor research methodology and practices can exacerbate existing health disparities faced by rural and marginalized populations (2). This further stresses the need to thoroughly evaluate the essentiality of the rural health research question and to implement additional measures focused on safeguarding culture, prioritizing equitable outcomes, and facilitating authentic partnering in rural contexts.

Outlined below are some considerations to weigh the necessity and feasibility of your research:

          Does my research have a well-defined purpose?

          Is this topic relevant and significant?

          How feasible is my proposal?

          Is there existing literature that has already addressed my research question?

It is worth noting the value in consulting other experts to answer these questions!

Supportive frameworks for developing a good rural health research question

Health researchers may employ different frameworks to guide the development of their research questions. Two widely used frameworks include the PICOT and FINER criteria (11,12).

PICOT: Population, intervention, comparator, outcome, and time frame  

The PICOT framework functions to define the research parameters and inform decisions on the project’s design and methodology. It is particularly relevant for quantitative research questions.

FINER: Feasible, interesting, novel, ethical, relevant

The FINER framework provides a means to assess the quality of the research question and can be broadly applied to different research methodologies.

More on the PICOT, FINER, and additional frameworks can be found through these resources:

Formulating a good research question: Pearls and pitfalls (Fandino, 2019)

Research questions, hypotheses and objectives (Farrugia et al., 2010)

Using a framework to structure your question (City, University of London, 2021)

The take home message

Ultimately, devising a strong research question will set up a solid foundation for the downstream processes involved in your rural health research study!

We would love to hear about the tips and frameworks you have used to structure your rural health research questions. Let us know in the comments!  

Contact us at rhsrn.bc@ubc.ca or find us on Twitter @RHSRNbc.

References

1. Research methodologies used in rural health research – RHSRNbc Rural Health Research Knowledge Hub [Internet]. [cited 2021 May 28]. Available from: https://blogs.ubc.ca/rhsrnbcresearchsupport/2021/02/04/hello-world/
2. Wilson CR, Rourke J, Oandasan IF, Bosco C. Progress made on access to rural health care in Canada. Can Fam Physician. 2020 Jan;66(1):31–6.
3. Muilu T, Rusanen J. Rural Definitions and Short-Term Dynamics in Rural Areas of Finland in 1989–97. Environ Plan A. 2004 Aug 1;36(8):1499–516.
4. Forgotten Rural Health? | OMICS International [Internet]. [cited 2021 May 28]. Available from: https://www.omicsonline.org/forgotten-rural-health-2161-0711.1000e106.php?aid=7071
5. Pelletier CA, Pousette A, Ward K, Fox G. Exploring the perspectives of community members as research partners in rural and remote areas. Research Involvement and Engagement. 2020 Jan 30;6(1):3.
6. Howie JGR. Refining questions and hypotheses. In: Norton PG, Stewart M, Tudiver F, Bass MJ, Dunn EV (ed). Primary Care Research: Vol 1. Traditional and Innovative Approaches. Newbury Park: Sage Publications; 1991:13-25
7. Why the research question is so important – Ingham Institute for Applied Medical Research [Internet]. [cited 2021 May 28]. Available from: https://inghaminstitute.org.au/resource/why-the-research-question-is-so-important/
8. Conducting Rural Health Research, Needs Assessment, and Program Evaluation Introduction – Rural Health Information Hub [Internet]. [cited 2021 May 28]. Available from: https://www.ruralhealthinfo.org/topics/rural-health-research-assessment-evaluation#questions-addressed
9. Frequently Asked Questions | Social Determinants of Health | NCHHSTP | CDC [Internet]. 2019 [cited 2021 May 28]. Available from: https://www.cdc.gov/nchhstp/socialdeterminants/faq.html
10. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. The Lancet. 2009 Jul 4;374(9683):86–9.
11. Fandino W. Formulating a good research question: Pearls and pitfalls. Indian J Anaesth. 2019 Aug;63(8):611–6.
12. Farrugia P, Petrisor BA, Farrokhyar F, Bhandari M. Research questions, hypotheses and objectives. Can J Surg. 2010 Aug;53(4):278–81.
13. O’Driscoll S. Library Guides: Doing postgraduate research: Use a framework to structure your question [Internet]. [cited 2021 May 28]. Available from: https://libguides.city.ac.uk/postgraduate_research/frameworks