Mobilising cross-sector collaborations to improve population health in US rural communities: a qualitative study

Xi Zhu; Paula Weigel; Jure Baloh; Mochamad Nataliansyah; Nichole Gunn; Keith Mueller

doi:10.1136/bmjopen-2019-030983

Mobilising cross-sector collaborations to improve population health in US rural communities: a qualitative study

BMJ Open. 2019 Nov 6;9(11):e030983. doi: 10.1136/bmjopen-2019-030983.

Authors

Xi Zhu¹, Paula Weigel², Jure Baloh³, Mochamad Nataliansyah², Nichole Gunn², Keith Mueller²

Affiliations

¹ College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA xi-zhu@uiowa.edu.
² College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.
³ Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Abstract

Objectives: This study examines types and forms of cross-sector collaborations employed by rural communities to address community health issues and identifies factors facilitating or inhibiting such collaborations.

Setting: We conducted case studies of four rural communities in the US state of Iowa that have demonstrated progress in creating healthier communities.

Participants: Key informants from local public health departments, hospitals and other health-promoting organisations and groups participated in this study. Twenty-two key-informant interviews were conducted. Participants were selected based on their organisation's involvement in community health initiatives.

Results: Rural communities used different forms of collaborations, including cross-sector partnership, cross-sector interaction and cross-sector exploration, to address community health issues. Stakeholders from public health, healthcare, social services, education and business sectors were involved. Factors facilitating cross-sector collaborations include health-promoting local contexts, seed initiatives that mobilise communities, hospital visions that embrace broad views of health and shared collaboration leadership and governance. Challenges to developing and sustaining cross-sector collaborations include different institutional logics, financial and human resources constraints and geographic dispersion.

Conclusions: Rural communities use cross-sector collaborations to address community health issues in the forms of interaction and exploration, but real and lasting partnerships are rare. The development, operation and sustainment of cross-sector collaborations are influenced by a set of contextual and practical factors. Practical strategies and policy interventions may be used to enhance cross-sector collaborations in rural communities.

Keywords: cross-sector collaborations; population health; rural health; social determinants of health.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cooperative Behavior*
Health Services Needs and Demand
Humans
Iowa
Middle Aged
Public Health / methods*
Qualitative Research
Rural Health Services / organization & administration*
Rural Population / statistics & numerical data
Social Determinants of Health