title: Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.
abstract: OBJECTIVE
  to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services.
  
  
  METHODS
  data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category.
  
  
  METHODS
  fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia.
  
  
  METHODS
  117 health service employees and 24 consumers.
  
  
  RESULTS
  examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services.
  
  
  CONCLUSIONS
  our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning.
  
  
  CONCLUSIONS
  a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.affiliation: Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: jude.kornelsen@familymed.ubc.ca.
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jo.longman@ucrh.edu.au.
authors.forename: Jo
authors.initials: J
authors.lastname: Longman
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: sarah.robin@ucrh.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Robin
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Institute for Urban Indigenous Health, PO Box 5638, West End, QLD 4006, Australia. Electronic address: sue.kruske@iuih.org.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Mater Research Institute, The University of Queensland and Women's Health and Newborn Services (Maternity), Mater Health Service, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jpil2286@uni.sydney.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pilcher
authors.affiliation: Sydney Nursing School, University of Sydney, NSW 2006, Australia. Electronic address: tanya.martin@sydney.edu.au.
authors.forename: Tanya
authors.initials: T
authors.lastname: Martin
authors.affiliation: Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: sgrzybow@mail.ubc.ca.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: deborah.donoghue@ucrh.edu.au.
authors.forename: Deborah
authors.initials: D
authors.lastname: Donoghue
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: margaret.rolfe@ucrh.edu.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rolfe
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: geoffrey.morgan@ucrh.edu.au.
authors.forename: Geoff
authors.initials: G
authors.lastname: Morgan
mesh_terms: D001315:Australia; D016550:Birthing Centers / Q000600:supply & distribution*; D002585:Cesarean Section; D054521:Cultural Competency; D005260:Female; D017144:Focus Groups; D006271:Health Facility Closure; D007722:Health Knowledge, Attitudes, Practice; D006285:Health Planning / Q000639:trends*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000600:supply & distribution*; D061214:Patient Safety; D011247:Pregnancy; D036301:Qualitative Research; D018570:Risk Assessment; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012424:Rural Population
keywords: Birthing centres; Health; Health planning; Risk; Risk assessment; Rural health