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Carson, D. B., Johansson, A. B., Schaumberg, M. & Hurtig, A.-K. (2024). Addressing the workforce crisis in (rural) social care: a scoping review. International Journal of Health Planning and Management
Open this publication in new window or tab >>Addressing the workforce crisis in (rural) social care: a scoping review
2024 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Background: This scoping review identifies strategies potentially addressing the ‘workforce crisis’ in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.

Methods: The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.

Results: The most common strategies for addressing social care workforce shortages were to improve recruitment and retention (‘recruit and retain’) processes without materially changing the workforce composition or service models. Further strategies involved ‘revitalising’ the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved ‘re-thinking’ social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.

Conclusion: The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
recruitment and retention, rural social care, social care workforce
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-221017 (URN)10.1002/hpm.3774 (DOI)001153680000001 ()38297468 (PubMedID)2-s2.0-85184158850 (Scopus ID)
Funder
Swedish Research Council Formas, 2016‐00352
Available from: 2024-03-06 Created: 2024-03-06 Last updated: 2024-03-06
Carson, D. B., Messmer, R. & Leuf Fjällberg, E. (2024). Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement. Home Health Care Services Quarterly, 43(1), 18-38
Open this publication in new window or tab >>Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement
2024 (English)In: Home Health Care Services Quarterly, ISSN 0162-1424, E-ISSN 1545-0856, Vol. 43, no 1, p. 18-38Article in journal (Refereed) Published
Abstract [en]

Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging–role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.

Place, publisher, year, edition, pages
Routledge, 2024
Keywords
Aged care, Beyond Periphery, hospital to home transfers, rural nursing theory, rural Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-212435 (URN)10.1080/01621424.2023.2235321 (DOI)001027517800001 ()37439524 (PubMedID)2-s2.0-85165215604 (Scopus ID)
Funder
Swedish Research Council FormasSwedish Research Council, 2016-00352
Available from: 2023-07-27 Created: 2023-07-27 Last updated: 2024-04-26Bibliographically approved
Carson, D. B., Brunet Johansson, A. & Carson, D. A. (2024). Who gives? Non-commercial distribution networks in domestic food production in the inland north of Sweden. Sustainability, 16(6), Article ID 2300.
Open this publication in new window or tab >>Who gives? Non-commercial distribution networks in domestic food production in the inland north of Sweden
2024 (English)In: Sustainability, E-ISSN 2071-1050, Vol. 16, no 6, article id 2300Article in journal (Refereed) Published
Abstract [en]

This paper examines the social context of “domestic food production” (dfp) in the inland North of Sweden, with a focus on understanding the contributions of non-commercial food distribution to local food security and sustainable rural community-building. We report on the findings of an exploratory pilot study that included an online survey of 305 people who engaged in at least one dfp activity (hunting, fishing, foraging, or farming). The aims were to uncover common social practices of dfp, as well as to identify key values attached to dfp, the extent of commercial and non-commercial distribution of home-produced food, and motivations to give away food. The main findings emphasize the social nature of dfp activities, with the vast majority of respondents undertaking dfp in groups or as part of formal clubs. Key values attached to dfp included social and community-related aspects, while commercial interests were limited. Respondents were more likely to engage in non-commercial distribution networks, usually involving close family and friends. Food givers mostly cited social factors as their main motivations rather than other food-related aspects (such as food security, health benefits, or food waste). Food givers were also likely to receive food from others, emphasizing the relatively narrow and reciprocal character of non-commercial food networks. We conclude that non-commercial dfp networks may be expanded to the broader community by exploiting the social nature of dfp and encouraging generalized reciprocity led by dfp clubs. This could potentially reduce the negative impacts of food deserts whilst also stimulating community interactions, learning and local dfp communities of practice.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
domestic food production, non-commercial food networks, informal food sharing, food security
National Category
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-222556 (URN)10.3390/su16062300 (DOI)001192996100001 ()2-s2.0-85189024452 (Scopus ID)
Funder
Swedish Research Council Formas, 2017-00828Swedish Research Council Formas, 2016-00352The Kamprad Family Foundation, 2022-0029
Available from: 2024-03-21 Created: 2024-03-21 Last updated: 2024-04-22Bibliographically approved
Vaughan, G., Carson, D. B., Preston, R., Mude, W. & Holt, A.-M. (2022). A "toolkit" for rural aged care?: Global insights from a scoping review. Frontiers in Political Science, 4, Article ID 885636.
Open this publication in new window or tab >>A "toolkit" for rural aged care?: Global insights from a scoping review
Show others...
2022 (English)In: Frontiers in Political Science, E-ISSN 2673-3145, Vol. 4, article id 885636Article, review/survey (Refereed) Published
Abstract [en]

Community-based social models of care for seniors promote better outcomes in terms of quality of life, managing chronic illness and life expectancy than institutional care. However, small rural areas in high income countries face an ongoing crisis in coordinating care related to service mix, workforce and access. A scoping review was conducted to examine initiatives that promoted integrated models of multisectoral, collaborative aged care in rural settings which could help respond to this ongoing crisis and improve responses to emergencies such as the COVID-19 pandemic. A systematic database search, screening and a two-stage full text review was followed by a case study critical appraisal. A content analysis of extracted data from included papers was undertaken. Integrated care services, activities and facilities were identified that helped guide the review process and data synthesis. The three included case studies all emphasized key principles that crucially underpinned the models related to collaboration, cooperation and innovation. Challenges to effective care included fiscal and structural constraints, with underlying social determinant impacts. Based on these findings, we describe the genesis of a "toolkit" with components of integrated models of care. Effective care requires aging to be addressed as a complex, interconnected social issue rather than solely a health problem. It demands a series of coordinated system-based responses that consider the complex and heterogeneous contexts (and needs) of communities. Such models are underpinned by leadership and political will, working with a wide breadth of stakeholders across family, community and clinical domains in private and public sectors.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
community health, healthy aging, home care, models of integrated care, rural health, social care and housing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-201000 (URN)10.3389/fpos.2022.885636 (DOI)000995398400001 ()2-s2.0-85140965602 (Scopus ID)
Available from: 2022-11-16 Created: 2022-11-16 Last updated: 2023-09-05Bibliographically approved
Carson, D. A., Carson, D. B. & Argent, N. (2022). Cities, hinterlands and disconnected urban-rural development: Perspectives from sparsely populated areas. Journal of Rural Studies, 93, 104-111
Open this publication in new window or tab >>Cities, hinterlands and disconnected urban-rural development: Perspectives from sparsely populated areas
2022 (English)In: Journal of Rural Studies, ISSN 0743-0167, E-ISSN 1873-1392, Vol. 93, p. 104-111Article in journal (Refereed) Published
Abstract [en]

This article introduces the special issue ‘Rural hinterland development in sparsely populated areas (SPAs): new challenges and opportunities arising from urbanisation within the periphery’. It problematises the relationships between growing cities and hinterland areas in SPAs, such as those commonly found in Arctic, Outback and similar remote resource peripheries of developed countries. Many SPAs are rapidly urbanising, with polarised development becoming an ever-increasing concern for regional planners and policy-makers. This special issue contributes to debates about the impact that urban growth and city-centric development strategies in SPAs might have on the development prospects for small and distant settlements in the hinterland. We first discuss why SPAs are different from other rural contexts when it comes to urban-rural interactions and introduce the idea of regional disconnectedness as a defining feature of SPAs. We then review the papers in this collection, which include perspectives from northern Sweden, Iceland, Finland, Scotland, Alaska, and Australia, and position them according to their contributions to theory, policy and practice. The special issue challenges assumptions that city-centric regional development in SPAs will automatically generate spillover or backwash effects for the hinterland. It emphasises the need to consider diverse mobility flows within SPAs as part of urban-rural interactions. It also raises attention to micro-scale urbanisation within the hinterland, with housing, services, and amenities increasingly concentrating in a few small towns. The final discussion outlines important areas for research into more effective urban-rural partnership building in SPAs and on how to embrace regional disconnectedness for more targeted hinterland development.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Sparsely populated areas (SPAs), Urbanisation, Microurbanisation, Growth centre, Boomtown, Spillover, Disconnectedness, Urban-rural migration, Regional development
National Category
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-199049 (URN)10.1016/j.jrurstud.2022.05.012 (DOI)000808003700006 ()2-s2.0-85131598811 (Scopus ID)
Funder
Swedish Research Council Formas
Available from: 2022-09-01 Created: 2022-09-01 Last updated: 2023-05-02Bibliographically approved
Carson, D. B., Preston, R. & Hurtig, A.-K. (2022). Innovation in rural health services requires local actors and local action. Public Health Reviews, 43, Article ID 1604921.
Open this publication in new window or tab >>Innovation in rural health services requires local actors and local action
2022 (English)In: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 43, article id 1604921Article, review/survey (Refereed) Published
Abstract [en]

Objectives: We examine the role of "local actors" and "local action" (LALA) in health service innovation in high-resource small rural settings and aim to inform debates about the extent to which communities can be empowered to drive change in service design and delivery.

Methods: Using an adapted roles and activities framework we analyzed 32 studies of innovation projects in public health, clinical interventions, and service models.

Results: Rural communities can investigate, lead, own and sustain innovation projects. However, there is a paucity of research reflecting limited reporting capacity and/or understanding of LALA. Highlighting this lack of evidence strengthens the need for study designs that enable an analysis of LALA.

Conclusion: Innovation and community participation in health services are pressing issues in small rural settings where population size and distance from health infrastructure make service delivery challenging. Current reviews of community participation in rural health give little insight into the process of innovation nor understanding of how local actors produce improvements in innovation. This review outlines how communities and institutions can harness the essential role of LALA in supporting health innovations.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
community participation, innovation, local action, local actors, rural health services
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-199981 (URN)10.3389/phrs.2022.1604921 (DOI)000861751500001 ()36189186 (PubMedID)2-s2.0-85139185237 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00183
Available from: 2022-10-04 Created: 2022-10-04 Last updated: 2022-10-19Bibliographically approved
Carson, D. B., McGrail, M. & Sahay, A. (2022). Regionalisation and general practitioner and nurse workforce development in regional northern Australia: Insights from 30 years of census migration data. Journal of Rural Studies, 91, 98-107
Open this publication in new window or tab >>Regionalisation and general practitioner and nurse workforce development in regional northern Australia: Insights from 30 years of census migration data
2022 (English)In: Journal of Rural Studies, ISSN 0743-0167, E-ISSN 1873-1392, Vol. 91, p. 98-107Article in journal (Refereed) Published
Abstract [en]

The purpose of this research is to investigate the extent to which Australia's northern cities have become increasingly important mediators of migration of nurses and general practitioners (GPs) to the regional north since the 1980s. Over that period, national and provincial policy has focused on ‘regionalisation’ of health workforce development, including creating education and training infrastructure outside of metropolitan areas. This paper hypothesises that the effectiveness of regionalisation in northern Australia should be reflected in an increased net flow of GPs and nurses from northern cities (which are the hubs of education and training) to the regional north. Data from the seven Australian Census between 1986 and 2016 are used to model changing patterns of migration. Overall, there was limited evidence of substantial change in migration patterns, although for GPs there was a reduction in migration from the key metropolitan source markets (Brisbane and Adelaide) matching an increase in supply from northern cities. Northern cities have consistently been the source of about one quarter of new nurse and GP migrants to the regional north, but the regional north has become a much less favoured destination for professionals leaving northern cities as cities' populations have grown much faster than regional populations. Net flows have remained small and for nurses have favoured the cities while for GPs favoured the regional north. The paper concludes that, while there is limited evidence of increased ‘spillover’ of labour from the cities to the regional north, there is also no evidence of the cities increasingly ‘spongeing’ regional labour. Cities and regional migration systems may be increasingly disconnected as labour demands diverge, but new connections are being created with the rest of non-metropolitan Australia. The research is the first to analyse health professional migration over such a long period, and contributes to the debates about the roles of cities in sparsely populated areas in the development of their rural and remote hinterlands.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Health professional migration, Northern Australia, Regionalisation, Urban-rural migration
National Category
Human Geography
Identifiers
urn:nbn:se:umu:diva-193329 (URN)10.1016/j.jrurstud.2022.02.005 (DOI)000793626900009 ()2-s2.0-85126283153 (Scopus ID)
Funder
Swedish Research Council Formas, 2016- 00352
Available from: 2022-03-29 Created: 2022-03-29 Last updated: 2023-09-05Bibliographically approved
Carson, D. B., Carson, D. A., Lundmark, L. & Hurtig, A.-K. (2022). Resource deserts, village hierarchies and de-growth in sparsely populated areas: The case of Southern Lapland, Sweden. Fennia, 200(2), 210-227
Open this publication in new window or tab >>Resource deserts, village hierarchies and de-growth in sparsely populated areas: The case of Southern Lapland, Sweden
2022 (English)In: Fennia, E-ISSN 1798-5617, Vol. 200, no 2, p. 210-227Article in journal (Refereed) Published
Abstract [en]

Small villages in northern Sweden have seen a continuing removal of key services, such as schools, shops and public transport, since the 1970s. Disinvestment in public services has not been strategically planned but has happened in response to population loss and increased costs on a case-by-case basis. More recently, there has been a shift in policy thinking to what might be termed a ‘de-growth’ approach where digitalisation and increased personal mobility are used to provide new ways of delivering services. The purpose of this paper is to examine the existence of ‘resource deserts’ in Southern Lapland and the emergence (or consolidation) of village hierarchies in allocating public services. We map out the distribution of neighbourhood services (grocery stores, pre-/schools and petrol pumps) among villages, and explore the lived experiences in accessing these resources in different villages. Our results show that resource deserts clearly exist in the south and east of the region, while villages in the more sparsely populated western mountain areas were generally in a better position to retain resources. We identify a lack of consistent and transparent service planning at the village level as a key shortcoming in municipal and regional service strategies. There appear to be unofficial settlement hierarchies in the differential treatment of villages that are otherwise similar in population size, population change and distance to central places. We find that political decisions on service allocations are likely influenced by several factors. These include legacy effects relating to historic settlement status, the location of villages in relation to key transport or mobility corridors, as well as ideological factors favouring villages with more ‘exotic’ features and development potential in line with the municipalities’ economic, social and political priorities. We finally argue that a shift to de-growth needs to be more strategically planned if it is to eliminate resource deserts and promote equity of service access across all villages.

Place, publisher, year, edition, pages
Geographical Society of Finland, 2022
Keywords
resource desert, service decline, village hierarchies, rural planning, sparsely populated areas, northern Sweden
National Category
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-204609 (URN)10.11143/fennia.120788 (DOI)2-s2.0-85149036762 (Scopus ID)
Funder
Swedish Research Council Formas, 2016–00352The Kamprad Family Foundation, 2022–0029Forte, Swedish Research Council for Health, Working Life and Welfare, 2017–00183Swedish Research Council Formas, 2016–344
Available from: 2023-02-08 Created: 2023-02-08 Last updated: 2023-03-17Bibliographically approved
Jonsson, F., Carson, D. B., Goicolea, I. & Hurtig, A.-K. (2022). Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden. International Journal of Health Policy and Management, 11(1), 39-48
Open this publication in new window or tab >>Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden
2022 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 1, p. 39-48Article in journal (Refereed) Published
Abstract [en]

Background: Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patientand provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a noveleHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically,this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expectedto improve access to person-centred care and strengthen community health systems, especially for elderly residents ofrural areas.

Methods: The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematicanalysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome(ICAMO) configuration was developed and elicited into an initial programme theory.

Results: The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customizedfacility that connects communities and providers, might improve access to person-centred care and strengthencommunity health systems for rural populations. This is theorized to occur if mechanisms acting at individual (suchas knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered incontexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of ruralcohesiveness and creativity.

Conclusion: The elicited initial programme theory describes and explains how a novel eHealth initiative in ruralnorthern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continuedgradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work asintended, for whom, in what conditions and why.

Keywords
Northern Sweden, eHealth, Realist Evaluation, Community Health System, Person-Centred Care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
health services research; Public health
Identifiers
urn:nbn:se:umu:diva-179738 (URN)10.34172/ijhpm.2021.08 (DOI)000719956900001 ()33619935 (PubMedID)2-s2.0-85121661658 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00183
Available from: 2021-02-09 Created: 2021-02-09 Last updated: 2022-03-10Bibliographically approved
Carson, D. B. & Carson, D. A. (2022). Understanding the demographic future of small Arctic villages using agent-based modelling. In: Doris Friedrich; Markus Hirnsperger; Stefan Bauer (Ed.), More than 'nature': research on infrastructure and settlements in the North (pp. 263-281). Vienna: LIT Verlag
Open this publication in new window or tab >>Understanding the demographic future of small Arctic villages using agent-based modelling
2022 (English)In: More than 'nature': research on infrastructure and settlements in the North / [ed] Doris Friedrich; Markus Hirnsperger; Stefan Bauer, Vienna: LIT Verlag, 2022, p. 263-281Chapter in book (Refereed)
Abstract [en]

Large parts of the Scandinavian Arctic and sub-Arctic are characterized by small settlements of just a few dozen or hundred inhabitants. Many of these villages have experienced loss of population and services. However, recent in-migration and new technologies facilitating ageing in place and e-commute work have seen some villages grow, some stabilize their population base, and many undergo dramatic demographic transformation. These local processes have largely been hidden from policy-makers and planners because standard statistical analyses and demographic modeling are either only applied at regional level, or are poorly suited to such small populations. This chapter introduces an agent-based demographic model (ABDM) applied to small villages in the north of Sweden. ABDMs provide a way to combine quantitative and qualitative data about demographic change processes and model the impacts of these on population size, structure, and dynamics over time. This chapter presents examples of how ABDMs provide insights into demographic change in the northern inland of Sweden and how they might facilitate truly local-level planning in a peripheral Arctic context. 

Place, publisher, year, edition, pages
Vienna: LIT Verlag, 2022
Series
Beiträge zum zirkumpolaren Norden Contributions to Circumpolar Studies ; 3
Keywords
demographic change, small villages, agent-based demographic model, northern Sweden
National Category
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-199050 (URN)978-3-643-91218-3 (ISBN)978-3-643-96218-8 (ISBN)
Available from: 2022-09-01 Created: 2022-09-01 Last updated: 2023-05-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8143-123x

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