Abstract
Background/Aims An earlier analysis of rural and urban focus group discussions of end-of-life care preferences documented that rural and urban participants often discussed “good health” and “meaningful survival” differently. In that study, rural participants tended to equate “health” with being able to function, particularly on one’s own behalf, and to dismiss the idea of meaningful survival when unable to do so. Urban participants were more likely to describe health and survival as goals independent of function.
Methods We conducted a review of the literature to assess the current understanding of rural definitions of health. PubMed and CINAHL and other databases (PsycINFO, AnthroSource, Sociological Abstracts, etc.) were searched for years 1970 to 2011 using terms including health definition, health belief, health attitude, health values, and health behavior for relevant articles pertaining to rural US, Canada and Australia. The initial search and subsequent follow up of cited material identified 101 articles, which were reviewed by the authors for content, methodology and rigor.
Results Thirty-nine of the articles included commentary or findings relevant to a rural definition of health. Rural residents had been found to characterize good health as being able to “take care of what has to be done” and to avoid dependency. In particular, rural residents assessed their health on the basis of their ability to work and to reciprocate in social relationships, and associated health with independence. While these findings were consistent across much of the literature reviewed, few studies compared rural and urban definitions of health directly. That is, a distinctive rural definition of health is suggested in the literature, but there has been little empirical documentation of differences between rural and urban health concepts.
Conclusions Rural-urban differences in the definition of health may be important in promoting healthy behavior, and in the delivery of health education, preventive services, and primary care. Future research must overcome methodological and conceptual challenges, including the heterogeneity of rural communities, inconsistent definitions of what is “rural,” the need to adjust for rural-urban differences in socio-economic status, and especially the need for valid rural/ non-rural comparisons.
