title: Community participation in rural health: a scoping review.
abstract: BACKGROUND
  Major health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein's definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare.
  
  
  METHODS
  A scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies.
  
  
  RESULTS
  We identified six articles that most closely demonstrated higher level community participation; Arnstein's notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured.
  
  
  CONCLUSIONS
  In an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for research, policy and practice.
authors: La Trobe Rural Health School, La Trobe University, P,O Box 199, Bendigo, Victoria, 3550, Australia. A.Kenny@Latrobe.edu.au
authors: Amanda
authors: A
authors: Kenny
authors: Nerida
authors: N
authors: Hyett
authors: John
authors: J
authors: Sawtell
authors: Virginia
authors: V
authors: Dickson-Swift
authors: Jane
authors: J
authors: Farmer
authors: Peter
authors: P
authors: O'Meara
mesh_terms: D019058:Community Networks; D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D038622:Internationality; D012423:Rural Health