School of Nursing, University of British Columbia Okanagan, ART 150 - 1147 Research Road, Kelowna, British Columbia, V1V 1V7, Canada.
Faculty of Management, UBC-Okanagan, EME 4159-1137 Alumni Avenue, Kelowna, B.C., V1V 1V7, Canada.
Int J Equity Health. 2019 Jul 30;18(1):119. doi: 10.1186/s12939-019-1021-3.
Considerable evidence has advanced the role of citizen-led coalitions (CLC) in supporting the health and social needs of rural citizens. There has been little research focusing on the experiences and strategies of coalitions, with their limited resources and status, in targeting health inequities in their rural communities. The aim of this study was to understand the entrepreneurial strategies and experiences of rural coalitions to effect change in the delivery of health services for their older adult populations.
A qualitative descriptive study method was used to generate understanding of the entrepreneurial experiences and strategies of CLCs in advancing health services to meet the health and social needs of their citizens. Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys. Thematic analysis was used to construct themes from the data.
Two over-riding themes emerged: entrepreneurial strategies and societal recognition. CLCs engaged in numerous entrepreneurial strategies that enabled actions and outcomes in meeting their health care needs. These strategies included: securing quick wins, leveraging existing resources, and joining forces with stakeholder groups/individuals. However, despite these strategies and successes, coalitions expressed frustration with not being seen and not being heard by decision-makers. This pointed to a key structural barrier to coalition successes -- a broader societal and institutional problem of failing to recognize not only the health needs of rural citizens, but also the legitimacy of the community coalitions to represent and act on those needs.
Despite the potential for coalitions to mobilize and effect change in addressing the inequities of rural health service access for older adults, broader barriers to their recognition, may undermine their entrepreneurial strategies and success.
大量证据表明，公民领导的联盟（CLC）在支持农村公民的健康和社会需求方面发挥了作用。几乎没有研究关注联盟的经验和策略，以及它们在针对农村社区健康不平等问题时的有限资源和地位。本研究旨在了解农村联盟的创业策略和经验，以改变其为老年人口提供卫生服务的方式。
采用定性描述性研究方法，了解 CLC 推进卫生服务以满足其公民健康和社会需求的创业经验和策略。来自不同农村社区的七个不同的 CLC（n=40）参加了焦点小组以及个人和联盟层面的调查。使用主题分析从数据中构建主题。
出现了两个主要主题：创业策略和社会认可。CLC 采取了许多创业策略，使他们能够采取行动并取得成果，以满足他们的医疗保健需求。这些策略包括：快速取得胜利、利用现有资源以及与利益相关者团体/个人联合。然而，尽管采取了这些策略并取得了成功，联盟还是对决策者的忽视感到沮丧。这指向了联盟成功的一个关键结构性障碍——一个更广泛的社会和制度问题，不仅未能认识到农村公民的健康需求，也未能认识到社区联盟代表和处理这些需求的合法性。
尽管联盟有潜力动员并改变农村老年人获得卫生服务的不平等状况，但更广泛的认可障碍可能会破坏他们的创业策略和成功。
