Rurality and health: perspectives of mid-life women.
BACKGROUND
Health researchers have paid scant attention to the role of place in health except as settings where interventions take place, and even less attention has been given to the influence of rural context on health. Explanations of the impact of environment on health status have traditionally been limited to a narrow picture of rural life. Much of the relevant research in health focuses on farming as central to rural living and as such, suggests that rural living is not conducive to optimum health. Using the term 'rural health' in a limited sense (only to mean the health of farmers) is also implicit in rural health research that emphasizes occupational health rather than general health. In this paper we explore the influence of living in a rural area as described by mid-life rural women from different parts of the province of Alberta in Canada. Our analysis focuses on ways in which these rural women understand, talk about, and experience health. Their insights add to our understanding of rural environments not just as a setting for research but also as a social construct (i.e. a range of social relationships and social processes associated with rural environments) that informs the results of research.


METHODS
This qualitative research used approaches from ethnography and grounded theory. 'Statistics Canada' criteria were used to define 'rural' as an area with a population of less than 10,000; therefore, small towns were included. Four female rural community interviewers from three geographic regions in the province were hired and trained for the purposes of the study. Participants were recruited through convenience and snowball sampling. Data collection using an interview guide continued until theoretical saturation was reached. All interviews were transcribed verbatim and imported into a software program for summary analysis and to aid in interpretation. Thematic analysis was conducted using memoing and coding as well as immersion and crystallization in conjunction with revisiting relevant literature.


RESULTS
Twenty-four women ranging in age from 40 to 65 years were interviewed. The majority was married and the minority had children still living at home. Women held a holistic view of health. They described rural living as very important to their health. Through analysis and interpretation, four important aspects of rurality were revealed: the meaning and symbols of rurality; change and the understanding of rurality; getting away and getting around; and, diversity in rurality. Heterogeneity or difference in rural places was evident in the women's discussions, including their descriptions of what it was like to inhabit a rural place.


CONCLUSIONS
The finding of differences in rurality reinforces the work of others and has important implications for researchers and program planners. To ignore this may perpetuate generalizations about rurality that are too simple to be useful and that have the potential to obscure important features of place. The data also challenge assumptions about the detrimental relationship between rurality and health. Myths of rural living should be set aside, and researchers and policy makers would be wise to listen to inhabitants to develop contextually relevant research and policy.
Thurston
W E
WE
Department of Community Health Sciences, University of Calgary, Calgary, Canada. thurston@ucalgary
Meadows
L M
LM