‘It's Putting All the Burden on the Patient’: A Qualitative Study of Health Literacy and Shared Decision-Making in Rural Australian Communities

Abstract

Objectives

Rural communities in Australia face significant barriers to health. Grounded in phenomenology as a research methodology, this study aimed to explore health literacy and shared decision-making in rural areas from the perspective of community members.

Design

Semi-structured interview study, with data analysed using Framework Analysis.

Participants

Twenty-five adults living in rural communities.

Setting

Interviews were conducted remotely, spanning seven Australian states and territories.

Results

Three main themes were generated from the data (comprising 10 sub-themes): (a) service access, (b) healthcare engagement, trust and decision making, (c) ‘a different approach for us’: leveraging community strengths. Demands on health literacy in rural settings were amplified, with additional health literacy requirements related to accessing and using healthcare services, navigating the healthcare system and understanding how to take appropriate health action in a rural setting. Participants reflected on the transient nature of the healthcare workforce in rural areas and experiences of pressurised health systems as barriers to service access and shared decision-making. Our analysis also identified a complex interplay between the social determinants of health and health literacy in rural contexts; challenges in healthcare access and navigation were discussed in the context of socioeconomic status, education, literacy and language. However, we also identified rural community strengths which could be leveraged to support health literacy action and responsiveness.

Conclusion

By addressing unique health literacy challenges and leveraging the strengths of rural communities, healthcare policies and interventions can better meet the needs of these populations.