Kaneko Makoto, Ohta Ryuichi, Vingilis Evelyn, Mathews Maria, Freeman Thomas Robert
Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan.
Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
BMC Health Serv Res. 2021 Jan 4;21(1):9. doi: 10.1186/s12913-020-06003-w.
Rural-urban health care disparities are an important topic in health services research. Hence, developing valid and reliable tools to measure rurality is needed to support high quality research. However, Japan, has no index to measure rurality for health care research. In this study, we conducted a systematic scoping review to identify the important factors and methodological approaches to consider in a rurality index to inform the development of a rurality index for Japan.
For our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websites of national governments such as Government and Legislative Libraries Online Publications Portal (GALLOP), from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas used to calculate indices, and any measures for reliability and validity of these indices.
We identified 17 rurality indices from 7 countries. These indices were primarily developed to assess access to health care or to determine eligibility for incentives for health care providers. Frequently used factors in these indices included population size/density and travel distance/time to emergency care or referral centre. Many indices did not report reliability or validity measures.
While the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index. The results will be helpful in the development of a rurality index in Japan and in other countries.
城乡医疗保健差异是卫生服务研究中的一个重要课题。因此，需要开发有效且可靠的工具来衡量农村地区情况，以支持高质量研究。然而，日本尚无用于医疗保健研究的农村地区衡量指标。在本研究中，我们进行了一项系统的范围综述，以确定在农村地区指标中应考虑的重要因素和方法，为日本农村地区指标的制定提供参考。
在我们的综述中，我们检索了六个文献数据库（MEDLINE、PubMed、CINAHL、ERIC、科学网和灰色文献报告）以及政府和立法图书馆在线出版物门户（GALLOP）等国家政府官方网站，检索时间为1989年1月1日至2018年12月31日。我们提取了农村地区指标开发中使用的相关变量、计算指标的公式以及这些指标的任何可靠性和有效性测量方法。
我们从7个国家确定了17个农村地区指标。这些指标主要是为了评估获得医疗保健的机会或确定医疗保健提供者获得激励的资格而制定的。这些指标中经常使用的因素包括人口规模/密度以及到急诊或转诊中心的旅行距离/时间。许多指标没有报告可靠性或有效性测量方法。
虽然许多国家都认同农村地区的概念以及对农村居民获得医疗服务障碍的担忧，但农村地区的实际操作具有高度的情境特定性，构建农村地区指标的通用措施或方法很少。研究结果将有助于日本和其他国家制定农村地区指标。
