Macaulay, Bobby, Neil McHugh, & Artur Steiner (2021, May). Public perspectives on health improvement within a remote-rural island community. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy. 14 pp. (ePub in advance of print) (doi: 10.1111/hex.13260) (Link: (Open Access: (Download:

Abstract: Background. Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐care, can help to inform resource allocation decisions to improve rural health. Objective. To identify and describe shared perspectives within a remote‐rural community on how to improve rural health. Method. Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews. Results. Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services. Discussion and conclusions. Factors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice. Public Contribution. Members of the public were involved in the development and piloting of the statement set.

Bobby Macaulay <> is in the Centre for Mountain Studies (CMS), Perth College, University of the Highlands and Islands, Perth, Scotland, UK.

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