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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.

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.

De kommande tio åren kommer att vara avgörande om världen ska nå en hållbar utveckling. Hela samhällssystem, sektorer och branscher måste ställa om. Det krävs modiga politiska beslut, nya sätt att organisera, styra och planera våra samhällen, nya affärsmodeller och förändrade konsumtionsvanor. Inget av detta är lätt eller uppstår av sig själv.

Denna bok är en översatt och omarbetad version av boken Dipping in to the North: Living, Working and Traveling in Sparsely Populated Areas, utgiven på engelska av Palgrave Macmillan förlag (år 2020). Redaktörerna för den boken är Linda Lundmark, Dean B. Carson och Marco Eimermann. Boken är utformad som en samling kapitel runt tre teman: i) vilka som lever, ii) vilka som arbetar och iii) vilka som reser inom det glest befolkade norr. Inom varje tema fokuserar kapitlen på olika former av mobilitet, migration och icke mobilitet och placerar individer som lever, reser och arbetar i norr i relation till aktuella frågor för området samt inom deras historiska och samtida kontext. Boken nyanserar vanligt förekommande myter som porträtterar glest befolkade områden som att de antingen ständigt kämpar med flertalet utmaningar eller som en tidlös lantlig idyll.

Om du har plockat upp denna bok är du förmodligen en av många som ä rintresserad av Norrland. Du kanske arbetar med utveckling i norr, samhällsprojekt på lokal, regional, nationell eller annan myndighetsnivå, eller kanske inom privat näringsliv. Kanske är du en del av en grupp studenter eller akademiker som formar och bidrar till de olika debatterna kring nordlig utveckling i eller utanför Sverige. Om du är intresserad av demografi, ekonomi, geografi, historia eller statsvetenskap kommer du att se att dessa är centrala för innehållet i denna bok.

I detta kapitel introduceras begreppen ”tomrum” och ”platser emellan”. Begreppen är delvis kopplade till en jämförelse mellan Nordnorge och norra Sverige. Tomrum kan begreppsliggöras på många sätt, från ett fysiskt vakuum till ett rum tomt på företeelser eller geografiska objekt. Inom samhällsvetenskap och geografi hänvisar det ofta till bristen på något i det geografiska rummet, brist på resurser, människor eller aktiviteter. Fördelningen av geografiska objekt som människor är också relaterad till aktiviteter, resurser och andra människor. Rummet blir relationellt. Den relationella förståelsen av rummet refererar bland annat till hur individer försörjer sig. Människans eller individens relation till det fysiska rummet förändras också över tid. Det relationella rummet genomgår en förändring. Många idéer om relationen mellan människor och rum är baserade på Torsten Hägerstrand och hans tidsgeografi (Hägerstrand 1974, Stjernström 1998, Rönnlund & Tollefsen 2016). Det relationella rummet (Lefebvre 2014) och tanken om den dynamiska relationen mellan aktör och struktur, som utvecklats av Anthony Giddens (1984) (inspirerad av Hägerstrands tidsgeografiska postulat om det fysikaliska rummet), markerar en av de teoretiska utgångspunkterna i denna text.

Introduction: While co-creation has emerged as a promising approach to address complex problems in health and care systems, few examples exist where scholars have examined what separate stakeholder groups do to enhance their potential to engage in collaborative processes of joint problem-solving. The current study seeks to bridge this knowledge gap by providing empirical insights into the challenges of one stakeholder enacting ‘pre-creation’ to reform care services for older adults in the rural Swedish north through the Storuman Cares 2050 initiative.

Methods: This case study draws upon data collected through extensive notetaking of 23 core group meetings within Storuman Cares 2050. The notes were summarized into a database, which also included reflections on how previous experiences with other projects should inform progress as well as deliberations on engagement with co-creation partners. The data was thematically analyzed with themes developed through an inductive approach.

Results: Three themes were developed. The first one, ‘getting our house in order’, makes explicit the values, principles, and approaches that a stakeholder might bring to a co-creation process. The second theme, ‘starting close to home’, describes the value of supporting and stimulating internal engagements through demonstrating a commitment and capacity for change. The third theme, ‘reaching out’, details the importance of, but challenges to, engaging with external stakeholders.

Conclusion: This case study bridges an important knowledge gap by detailing how one stakeholder navigated past experiences and the history of relationships with diverse stakeholders while trying to support internal engagements and other local voices when aspiring to co-create. By introducing the concept of ‘pre-creation’ as encompassing the enhancement of an organization’s potential to engage in complex processes of joint problem-solving, the findings provide a stimulus for scholars to further explore what separate stakeholder groups do to enable them to co-create.

Introducción: Aunque la co-creación ha surgido como un enfoque prometedor para abordar problemas complejos en los sistemas sanitarios y asistenciales, existen pocos ejemplos en los que los estudiosos hayan examinado qué hacen los grupos de partes interesadas por separado para mejorar su potencial para participar en procesos colaborativos de resolución conjunta de problemas. El presente estudio pretende colmar esta laguna de conocimiento proporcionando una visión empírica delos retos de una de las partes interesadas que promulga la ”pre-creación” para reformar los servicios de atención a los adultos mayores en el norte rural de Suecia a través de la iniciativa Storuman Cares 2050.

Métodos: Este estudio de caso se basa en los datos recogidos mediante una amplia toma de notas de 23 reuniones del grupo central de Storuman Cares 2050. Las notas se resumieron en una basede datos, que también incluía reflexiones sobre cómo las experiencias previas con otros proyectos deberían informar el progreso, así como deliberaciones sobre el compromiso con los socios de co-creación. Los datos se analizaron temáticamente con temas desarrollados mediante un enfoque inductivo.

Resultados: Se desarrollaron tres temas. El primero, ”poner la casa en orden”, explicita los valores, principios y enfoques que una parte interesada puede aportar a un proceso de co-creación. El segundo tema, ”empezar cerca de casa”, describe el valor de apoyar y estimular los compromisos internos demostrando el compromiso y la capacidad de cambio. El tercer tema, ”tender la mano”, detalla la importancia y los retos de la participación de las partes interesadas externas.

Conclusiones: Este estudio de caso cubre una importante laguna de conocimiento al detallar cómo una parte interesada navegó por experiencias pasadas y la historia de las relaciones con diversas partes interesadas mientras trataba de apoyar los compromisos internos y otras voces locales cuando aspiraba a co-crear. Al introducir el concepto de ”pre-creación”, que engloba la mejora del potencial de una organización para participar en procesos complejos de resolución conjunta de problemas, las conclusiones estimulan a los estudiosos a seguir explorando qué hacen los distintos grupos de interesados para poder co-crear.

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.

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.