Abstract
Rural healthcare is recognised as being unique. Residents of Aotearoa NZ’s rural towns experience higher levels of socioeconomic deprivation, higher mortality rates, and poorer access to health services. Allied health professionals provide efficient and cost-effective health services which may be particularly important for underserved populations, including rural and remote communities.
This thesis aimed to understand the role of rural allied health professionals within Aotearoa New Zealand, helping to inform rural healthcare delivery, health professional training and government policy.
Design
An exploratory sequential mixed methods approach was taken to the thesis where the studies were integrated through ‘connection’.
A literature review formed the foundation for the following chapters, guiding the development of research questions, and informing implications of the research questions. A broad narrative review explored the key concepts of ‘rurality’, and ‘allied health’. A formal scoping review more specifically described what is currently known about allied health professionals within rural Aotearoa New Zealand.
The qualitative study explored what it meant to be an allied health professional working in rural Aotearoa New Zealand. This study collected the views of various allied health professions through semi-structured interviews, which were thematically analysed using an interpretive description approach.
The quantitative cross-sectional study investigated consecutive clinical consultations for physiotherapists in rural and urban settings. The recorded data underwent a descriptive analysis to describe the practice of publicly funded services within rural Aotearoa New Zealand.
Results
The literature reviews highlight the importance of understanding allied health in the rural Aotearoa New Zealand context. The definitions of rurality and allied health are challenging. There is little known about allied health within the context of rural Aotearoa NZ and a corresponding lack of rural workforce data, a contributing factor in rural health outcomes.
The qualitative study derived four main themes: identity, connectedness, expectations, and providing care. Proud of being rural, allied health professionals are immersed within their community, intertwining their professional and personal identities. The unique nature of this dual identity while empowering for some, can also be isolating. The connections they forge, and the breadth of their skills cumulate to enable allied health professionals to provide dynamic and responsive health services for their rural communities.
The cross-sectional study described data from 850 consultations of 18 rural and four urban physiotherapists. Physiotherapists working in rural hospital-based services encountered greater variation in clinical areas of practice in comparison to urban hospital-based physiotherapists.
The studies were then integrated to generate an understanding of the role of rural allied health professionals from different aspects and provide a comprehensive overview of the context and findings.
Conclusion
The work contained in this thesis provides insight into experiences, perspectives, and clinical practice of allied health professionals within rural Aotearoa New Zealand. Rurality is revealed as an important concept that modifies how allied health professionals see themselves, relate to one another, and practice. Understanding that rural allied health professionals have different needs from their urban counterparts is an important first step to better meet our healthcare goals for rural communities.