How can a rural hospital contribute to the health of its community? A study of community perspectives from a New Zealand rural hospital (WMRF #344)

Stephen Ram


Rural hospitals play an important role in providing healthcare to rural communities in New Zealand (NZ). These communities are typically at a distance from urban centres and specialist services. Approximately 15% of the NZ population access hospital care via rural hospitals.(1) Little is known about their wider role in rural communities and the health system. Some NZ rural hospitals are situated in communities with significant Māori populations who tend to have poorer access to health care, high health needs and lower socioeconomic status.


This project aims to explore community perceptions of the role of Tokoroa Hospital, a rural hospital in low socioeconomic community in the Central North Island of New Zealand. This rural community has a high Māori and Pacific population.


This study utilises a triangulated method of community engagement, data collection and thematic analysis and member checking. This is a qualitative study using thematic analysis. Descriptive statistical analysis will be used for demographic data collected during the interview process.

Phase 1 of the study will utilise existing networks and connections to establish and strengthen relationships with local stakeholders and community groups. These relationships are to ensure that the community are informed of the work, provide guidance on culturally appropriate ways of conducting the research, and facilitate feedback of results to the community. An important aspect of this process is to ensure that research is culturally safe, and the findings are relevant to the community. This is part of the important concept of rangatiratanga, or self-determination, which is intrinsic to Te Tomokanga.

Phase 2 will use learnings and stakeholder networks developed during the community engagement phase. Participants will be recruited for interviews using a combination of convenience and snowball sampling. Participants will be recruited for either individual interviews, interviews with 2-3 people, or focus groups of about 10-12 people, dependent on advice obtained during the engagement phase. A semi-structured interview technique will be used.

Phase 3 recognises the outsider status of the candidate and supervisors to these communities and will encompass a strategy called ‘member checking’.  This is for enhancing the trustworthiness of interpretations for Māori and Pacific participants. The strategy for undertaking this will be developed in consultation with Raukawa and SWPIC staff.

Media Summary

Rural hospitals are the way many rural New Zealanders receive emergency and hospital care. Not much is known about their role in the health system, or how these communities view the role of the hospital in their community. In this study we interview a rural community with a high Maori and Pacific population to understand their views on their rural hospital and its role.

Outcome Statement

The health system in NZ is currently in the process of major reform. Two important components of this are locality planning, a mechanism for communities to have direct involvement in the planning of services in their local area, and the legislated development of a national rural health strategy. It is therefore timely in the NZ context to understand how rural communities perceive the role and benefits of rural hospitals and therefore how these services may be configured to facilitate locally acceptable, patient-centred and high-quality healthcare that is integrated across the primary and secondary sectors.


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