title: Patient perspectives on health, health needs, and health care services in a rural Irish community: a qualitative study.
abstract: BACKGROUND
  There is evidence that living in a rural environment confers certain health advantages in terms of health and wellbeing. However, there is limited knowledge of patients' perspectives on determinants of health in rural areas. The aim of the present study was to explore determinants of health, health needs, and healthcare services in a rural community in the west of Ireland.
  
  
  METHODS
  Semi-structured interviews were carried out on a purposeful sample of 12 participants who presented to a community medical centre during a designated 14 day period in May 2010. The often interwoven conceptual themes identified during analysis of the data included 'community', 'environment', 'familiarity', 'accessibility', and 'expectations'.
  
  
  RESULTS
  The advantages of living in a rural environment included the strong sense of community, the benefits of the natural environment, familiarity, and a general sense of satisfaction in life. Issues of geographical inaccessibility and availability of affordable food were highlighted as disadvantages. In addition, hesitation was expressed about confiding mental health issues to medical professionals.
  
  
  CONCLUSIONS
  The rural environment and sense of community with its associated strong social networks were identified as key determinants of good mental and physical health. However, the inaccessibility to mental health care and reluctance to seek help for mental health issues remain a significant problem in rural areas. In considering priorities for health, greater effort and resources are required to increase public awareness and change attitudes to mental health issues.
authors.affiliation: Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Ireland. ianrobertjohnson@hotmail.com
authors.forename: Ian R
authors.initials: IR
authors.lastname: Johnson
authors.forename: Christina
authors.initials: C
authors.lastname: McDonnell
authors.forename: Aine M
authors.initials: AM
authors.lastname: O'Connell
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D055815:Young Adult