Driscoll David, Dotterrer Bruce, Miller Jenny, Voorhees Hannah
Institute for Circumpolar Health Studies, University of Alaska-Anchorage, 3211 Providence Drive, Anchorage, AK 99508, USA.
Int J Circumpolar Health. 2010 Dec;69(5):528-44. doi: 10.3402/ijch.v69i5.17683. Epub 2010 Dec 16.
This formative study is intended to generate questions and hypotheses regarding the relationship between health and outmigration from Alaska's rural communities. This study is the first to provide perspectives of rural Alaskans in the context of health concerns and health care delivery as determinants of outmigration.
The study collected secondary data through a comprehensive review of the literature and primary data through semi-structured interviews.
The research design consisted of two iterative phases: a comprehensive review of published and gray literature relevant to rural health and migration in Alaska, and in-depth interviews with rural Alaskans who had recently moved from rural to urban settings. A total of 31 Alaskans aged 18+ from communities throughout the state were interviewed about the factors influencing their decision to move to an urban centre.
Three health-related determinants of outmigration from rural to urban Alaska emerged: (1) limited access to primary and specialized health care; (2) perceptions of health risks in rural communities; and (3) ripple effect migration of friends and family providing social support for rural Alaskans requiring health care. These determinants had disproportionate effects on young and female study participants.
We present data describing the growing influence of health concerns and health care delivery on outmigration in this underserved population, and conclude with recommendations for future avenues of research. Expanding the body of knowledge of the link between health and outmigration will provide rural Alaskans the opportunity to live and grow old in their own communities.
这项形成性研究旨在就阿拉斯加农村社区的健康与人口外流之间的关系提出问题并形成假设。本研究首次在健康问题和医疗服务作为人口外流决定因素的背景下，提供阿拉斯加农村居民的观点。
该研究通过全面的文献综述收集二手数据，并通过半结构化访谈收集一手数据。
研究设计包括两个迭代阶段：对与阿拉斯加农村健康和移民相关的已发表及灰色文献进行全面综述，以及对最近从农村迁往城市的阿拉斯加农村居民进行深入访谈。总共对来自该州各社区的31名18岁及以上的阿拉斯加人进行了访谈，询问影响他们迁往城市中心的决定的因素。
从阿拉斯加农村向城市人口外流出现了三个与健康相关的决定因素：（1）获得初级和专科医疗服务的机会有限；（2）对农村社区健康风险的认知；（3）朋友和家人的连锁效应迁移，为需要医疗服务的阿拉斯加农村居民提供社会支持。这些决定因素对年轻和女性研究参与者产生了不成比例的影响。
我们展示了描述健康问题和医疗服务对这一服务不足人群的人口外流日益增长的影响的数据，并最后提出了未来研究途径的建议。扩大健康与人口外流之间联系的知识体系将为阿拉斯加农村居民提供在自己社区生活和养老的机会。
