Leaders of rural public health systems often experience challenges with accessing quality data on certain communities or populations, making it difficult to track and address health disparities, according to a study published in JAMIA.
While data can give rural communities the power to identify health inequities and inform decision-making, stakeholders in these areas often don’t have the means to access and use this information.
“Populations in rural areas already have suffered disproportionately from a lot of negative health outcomes,” said Betty Bekemeier, director of the University of Washington (UW) School of Public Health’s Northwest Center for Public Health Practice and a professor in the UW School of Nursing.
“Then on top of that, they lack the data, capacity and infrastructure to understand and better address those problems.”
To uncover the reasons for rural communities’ lack of data, researchers launched the Solutions in Health Analytics for Rural Equity across the Northwest (SHARE-NW). This federally funded, five-year project aimed to advance public health efforts in Oregon, Alaska, Washington, and Idaho through a better understanding of data access and capacity.
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Researchers conducted phone interviews with public health officials from all four states. The team found that rural communities faced significant challenges related to data use and collection.
“In our study with rural public health system leaders, we identified barriers to using data, such as 1) lack of easy access to timely data, 2) data quality issues specific to rural and tribal communities, and 3) the inability for rural leaders to use those data,” researchers said.
“In some cases, data needed to track disparities did not exist. Participants described searching for but finding no data meeting their needs. Without relevant data, participants felt their jurisdictions and communities were systematically excluded and that it was not worth it to search for data. Participants also wanted, but lacked, sub-county-level data to more precisely understand needs in specific areas.”
In other cases, researchers noted, participants did find relevant data, but the information was often scattered across multiple sources, making it difficult to identify appropriate sources. Some participants said that accessible data was often in complicated formats.
Many leaders said they lacked access to real-time data, including information on opioid abuse and social determinants of health. Participants also described having limited staff expertise and resources to collect and analyze data within their own facilities, as well as among partner public health organizations.
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“Many staff did not have formal training regarding data collection and analysis, and there was insufficient funding for training or for hiring those with the necessary expertise. Because of limited staffing, immediate pressures took precedence over comprehensive monitoring of health issues and disparities,” researchers said.
These data challenges were especially prevalent in tribal areas due to variation across tribes, smaller populations, and historic injustices related to data.
“You may have a very seemingly homogenous population on the face of it,” said Bekemeier, who is also the study’s lead author. “But you have small population groups that are very disproportionately impacted by certain issues, and leaders in those communities may not be aware that these problems exist, let alone how deeply individuals are affected.”
To address these problems, researchers advised that rural public health organizations advance their health informatics capabilities.
“The field of health informatics has the potential (and obligation) to offer solutions to address rural public health challenges regarding accessing and using data to address inequities,” the team wrote.
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“Professional health informatics organizations, such as the American Medical Informatics Association and Healthcare Information and Management Systems Society, should openly support proposed policies to provide affordable internet access for rural communities insuring the infrastructure is there for rapid communication, data sharing, and data transfer to help rural public health leaders access data and larger samples.”
The team also suggested that public health leaders use data visualization tools to better display data and educate stakeholders to support decision-making.
“Data visualization tools could support rural public health leaders in displaying data and telling the story of inequities while educating policy makers desirous of ‘high-quality information but in bite-size and readily accessible forms,’” the group said.
SHARE-NW will also build a readily accessible database and related visualizations to help health officials more easily discuss the makeup of their communities, identify local needs, and advance data-supported decisions. SHARE-NW is focusing on obesity, diabetes, tobacco, mental health, violence and injury, and oral health.
“If you have data, you can talk about what the issues are that need to be prioritized,” Bekemeier explained. “Now, we’re focusing on the six priority areas that were common across their community health assessments.”