Rural Health and Care: Past, Present and Future
Lead Research Organisation:
University of the Highlands and Islands
Department Name: Centre For Health Sciences
Abstract
In this project, researchers, musicians and artists will work with community members to consider the history of rural health and care in the Highlands and Islands. In the year of the 75th anniversary of the NHS, project participants will draw on their own memories, as well as archive and research materials, to re-imagine what the future of rural health and care might look like. Together, we will go on a creative journey that asks us to reflect on the challenges, innovations and opportunities surrounding rural health and care and give our answer to the question: what should health and care in rural and island Scotland look like in the future? What will our rural communities need from health and care services as the NHS has its next significant birthdays and turns 80, 90 and even 100 years old? In what ways does the NHS need to work together with social care and the community sector to deliver for the needs of rural communities?
Project researchers will invite residents from Shetland and Inverness and its surrounding rural regions to take part in a series of workshops that discuss material from Highland archive, museum and library collections (including the Scottish Archive film Highland Doctor), ongoing UHI doctoral research (being carried out by Lyn Anderson on health and care in Shetland before the NHS) and new oral histories collected by project team members. Participants will be supported to record their own memories of rural health and care or to carry out peer research interviews with others.
Project partners, Science Ceilidh, will support the wider engagement connecting the community, arts and research elements. This includes co-developing with the community researchers two celebration ceilidh events that combine storytelling, traditional arts and discussion; to bring together and break down the barriers between the wider community alongside policymakers. Participants will be supported to produce materials that leave a legacy on the Scottish Rural Health Partnership website, such as podcasts, posters, drawings and narratives.
Project researchers will invite residents from Shetland and Inverness and its surrounding rural regions to take part in a series of workshops that discuss material from Highland archive, museum and library collections (including the Scottish Archive film Highland Doctor), ongoing UHI doctoral research (being carried out by Lyn Anderson on health and care in Shetland before the NHS) and new oral histories collected by project team members. Participants will be supported to record their own memories of rural health and care or to carry out peer research interviews with others.
Project partners, Science Ceilidh, will support the wider engagement connecting the community, arts and research elements. This includes co-developing with the community researchers two celebration ceilidh events that combine storytelling, traditional arts and discussion; to bring together and break down the barriers between the wider community alongside policymakers. Participants will be supported to produce materials that leave a legacy on the Scottish Rural Health Partnership website, such as podcasts, posters, drawings and narratives.
| Title | Rural Health: Past, Present and future |
| Description | A small installation painting or an upcycled old medicine cabinet. This was painted with art scenes of rural health care in the past, present and hopes for the future. |
| Type Of Art | Artwork |
| Year Produced | 2024 |
| Impact | All who viewed the artwork at the unveiling event have shared their thoughts and reactions to this on social media. We have displayed the artwork in the local UHI Inverness college campus and aim to get additional funding to share more widely and co-create additional work. |
| Title | Rural Health: Past, Present and future Shetland |
| Description | Following collection of story stems from the wider community responding to the following prompts: - Maya is 40 years old and lives in a small village in the Highlands in the year 2050. She has a long-term health condition. To access regular healthcare to manage her condition she - It is the year 2040 and Nick who is 26 lives in Cawdor and is seeking help for his mental health. He - Leah lives in the Highlands in the year 2032, she has had an accident while working and is trying to access rural health. She - Freya is 17 and lives in the Highlands in the year 2035. She has need of maternity and mental health services. She.. People were asked to complete these story stems and fictional stories. Researcher's analysed the story stems and presented themes with Heather, who drew and created a set of 4 bannered artworks as visual representations of the story stem responses. These banners were presented in a final feedback event. Subsequently, they are displayed in the Shetland library in Lerwick to disseminate the findings of the research with the wider community. |
| Type Of Art | Artwork |
| Year Produced | 2024 |
| Impact | We believe that by displaying this artwork in such a prominent area of Shetland, an area that is well used by local communities, we are able to stimulate thought and reflections from those who see it on the role of key families and individuals from the past, who have helped shape health care in Shetland. Similarly, people are able to see perhaps their own struggles reflected back to them, and acknowledged. Finally, in seeing the future, people will be able to share in the hopes for future healthcare in Shetland and the possibilities which are becoming available. |
| Description | The most significant achievement for this award was our ability to fulfil the main objective which in collaboration with researchers, practitioners and a variety of age groups from the general public led to the co-creation of a legacy product which illustrates an appreciation for the past of rural health care and a vision for future health. In our workshops with community members, retired and active health care professionals we identified a few key themes in understanding the past and present struggles with rural health. Presently, and in the past we found that isolation often impacted people trying to access health care. This meant that fewer GPs were available and people would need to travel, while sick in at times treacherous paths to get access to general care. In addition, their isolation meant that specialist care was not always available without long travel. This lead at times to a sense of hopelessness, and a loss of faith in the medical establishments. Looking forward however, people expressed a sense of cautious optimism through the possibilities associated with technology and holistic treatment. People shared imaginings of a future where virtual appointments were conducted in their own home. Some participants imagined a future where life saving treatments such as dialysis and diabetes care could be done at home with more technological advancements. people also expressed an openness to holistic health where they imagined that in the future, the NHS would move to consider social, emotional, physical and spiritual health. Finally, what appeared most strongly in each rural area was the value of community. People spoke about how living in a small rural community they were able to help and care for their neighbours, as many people had done before them. They spoke of using community halls to engage and develop mentorships schemes between grandparents and new parents. The strength and pride of these communities, and their resilience came through incredibly strongly. We also saw this when looking at archival footage and pictures of hospital and community health workers from the past. In being able to share these findings with local health workers, charities, partitioners and care planners, we were able to share their concerns, hopes and the strength of their community spirit. Most importantly, by working together with local artists and creating pieces of art, which are now on display in the local library and have been shown in the college campus. we were able to give these back to the communities and share them in a space where all who participated and those who did not are able to reflect on and become aware of our findings. |
| Exploitation Route | We would like these findings to be taken forward by policy makers and especially health care planners. We are certain that care planners are aware of the difficulties facing rural communities in accessing healthcare. However, we are not certain that they are aware of the strengths of these communities. These strengths include their sense of community and their openness to new ideas such as technology. In using these two pathways, we believe care planners can tap into existing strengths when designing care plans. In addition, we would like this model of research to be followed by future researchers who conduct research in small, rural communities. The specific aspects of the model include the use of co-creation of research, and giving the community something back. In this case it was artwork, but various other types of research such as this may be used to ensure that the community also benefit from taking part and sharing their intimate experiences with research. |
| Sectors | Communities and Social Services/Policy Healthcare Government Democracy and Justice |
| Description | The project has strengthened relationships between the participatory community arts projects who were partners in the project and the researchers. This has led to these researchers and participatory arts organisations collaborating on a new community wellbeing project for young people: Hilton Skate and Create Wellbeing Hub involving young people, skate organisations and skate coaches, the researcher team, psychoanalytic therapists, and the participatory arts organisations. Building these bridges across disciplines helps develop successful community projects which can deliver wellbeing. In addition, this outputs have increased public awareness of the funded project as the final art pieces are displayed locally both in Shetland public library and in The University of the Highlands and Islands Inverness campus - the biggest University campus in the Scottish Highlands. Finally, the findings have contributed to the public policy document: Designing the future of care with seldom-listened-to people. Authored by: Professor Mary Stewart, Bryony Nisbet, and other contributing authors: Professor Claire Cassidy, Dr Kim Wiltshire, Dr Bethan Evans, Dr Jasmine Hearn, Dr Rachel Carroll, Dr Myrtle Emmanuel, Dr Dave Hockman, Tracy Durrant, Sam Holmans Thompson, Professor Lisa Dikomitis, Dr Jasmine Hearn, Ian Whadcock, Professor Kate Sang, Professor Stephanie Snow, Dr Maxinne Connolly-Panagopoulos. This public policy document will be completed in March 2025. While its impacts cannot be currently determined, it will be shared nationally with charities, health and social care organisations, grass roots organisations, relevant think tanks, policy makers, academics, members of the public and civil society organisations. It will then be redraft for a more political audience. |
| First Year Of Impact | 2024 |
| Sector | Healthcare,Leisure Activities, including Sports, Recreation and Tourism |
| Impact Types | Cultural Policy & public services |
| Description | Designing the future of care with seldom-listened-to people |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Description | Collaboration with OpenArts Inverness |
| Organisation | Open Arts |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Our research team collected data from participants through community workshops which invited members from older persons groups, carer groups and school groups to join in. At these events, we used a variety of mechanisms for data collection, this included focus group style discussions as well as creative methods such as mapping stories on a map of the Highlands and Islands. These stories allowed us to begin understanding key themes from the work. We continued this by using a story stem methodology. In workshops, we asked participants to help us create 4 story stems of different fictional characters in various geographical locations of Shetland and Inverness. The stems included fictional characters from various rural parts of the Highlands and Islands. The characters also had a variety of ages and issues such as tooth ache, hurting arm due to farming accident, maternity, physical and mental health. We presented these stories to the wider community using online platforms to ask participants to finish the stories. Our analysis of the 35 stories further informed the themes of the findings. These themes were communicated to the artists at OpenArts Inverness who worked to create the final artwork. |
| Collaborator Contribution | The artists, Bonnie and Evija of OpenArts Inverness used their skills as artists to facilitate creative exploration of this issue within the workshops. Firstly, they brought materials for participants of the workshops to create postcards to express the stories of their experiences of rural health care. They also hosted various 'testing' workshops in which members of the community experimented with different forms of artistic expression such as scatter painting, interactive map formations and collages. Finally, the artists were then provided with the materials from the workshops and the analysed materials from the wider story stems and worked to create the final artwork which was exhibited to the wider public and key figures from the NHS Highlands and Islands and mental health charities around Inverness and Shetland. |
| Impact | Intergenerational workshops in Inverness x4 Exhibition at University of the Highlands and Islands Inverness Community feedback event 18 April WASPS Inverness Artwork Exhibition |
| Start Year | 2023 |
| Description | Collaboration with Prof Mary Stewart and Byrony Nisbet of Herriott Watt University Edinburgh |
| Organisation | Heriot-Watt University |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We have shared findings with Prof Stewart and Ms Nisbet in order to support the creation of the Policy Document: Summary and Recommendations: Designing the Future of Heath and Care. This policy document including findings from all projects funded by the AHRC NHS 75 public engagement fund. We have shared final art work, as well as had discussions around our recommendations for best practice when working with underserved rural communities in Scotland. We have also contributed to the write up of the final policy document. On completion (March 2025) this document will be shared with charities, health and social care organisations, grass roots organisations, relevant think tanks, policy makers, academics, members of the public, - civil society organisations and will be rewritten later for political audiences. Thus, our findings will contribute to a U.K wide contribution. |
| Collaborator Contribution | None. |
| Impact | The impact of the outputs is still ongoing, but at the moment we have a completed public policy document which will be shared widely across the U.K. |
| Start Year | 2024 |
| Description | Collaboration with Science Ceilidh |
| Organisation | Science Ceilidh |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Grant holders worked alongside Science Ceilidh to run a number of workshop events in Inverness and in Shetland and surrounding island Burra. Our team shared expertise in focus group facilitation, data collection and analysis. Specifically using creative, qualitative methods of data collection. Our team also created focus group questions and drove administration and organisation of the full project. |
| Collaborator Contribution | Science Ceilidh was responsible for helping to organise events. This included using their existing strong relationships with local community members and spaces such as the community hall, Shetland library and other spaces. Science Ceilidh supported by also organising local musicians and Ceilidh bands to contribute to the community events. This provided a relaxed atmosphere and allowed better conversation between researchers and those participating in the work. |
| Impact | Workshops x6 in Inverness and Shetland. These workshops provided spaces for intergenerational activities where younger and older members of the community in Lerwick, Bressay and Burra came together to share their experiences of the rural health care past, present and their hopes for the future. |
| Start Year | 2023 |
| Description | Discussion on Shetland Radio |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | MCP - The primary investigator appeared on Shetland radio to share the preliminary findings, and to inform listeners that the results of the study would be displayed in the Shetland Library in Lerwick |
| Year(s) Of Engagement Activity | 2024 |
| Description | Final Unveiling of Artwork in Inverness |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Third sector organisations |
| Results and Impact | The final event in Inverness included a feedback and unveiling event on 18/04/2024. This event took place at WASPS centre in Inverness and was attended by those who participated in the workshops and story stems. It also included researchers, lecturers, postgraduate and undergraduate research students from the psychology degree at the the University of Highlands and Islands. In addition, representatives from independent support groups, charities and third sector groups were in attendance as well as members from NHS Highlands and a local MSP. At this well attended event, which was a presentation of the artwork and a Ceilidh, we had local Scottish musicians present while people were able to network and discuss the findings of the project. The findings were presented by the PI and CO-I in a presentation. Then, the final artwork which was produced by Inverness OpenArts was unveiled. The postcards and interactive maps which participants populated were also put on display. At the event we were able to engage people in critical thinking and critical discussion. By having key members of the community, third sector and NHS present, we were able to collate views mostly of the future of healthcare. This has led to a growing interest in taking this research further and sharing the artwork and findings in other rural locations and hospitals. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Intergenerational community Workshops Inverness |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | Our research team collected data from participants through community workshops which invited members from older persons groups, carer groups and school groups to join in. At these events, we used a variety of mechanisms for data collection, this included focus group style discussions as well as creative methods such as mapping stories on a map of the Highlands and Islands. These stories allowed us to begin understanding key themes from the work. We continued this by using a story stem methodology. In workshops, we asked participants to help us create 4 story stems of different fictional characters in various geographical locations of Shetland and Inverness. The stems included fictional characters from various rural parts of the Highlands and Islands. The characters also had a variety of ages and issues such as tooth ache, hurting arm due to farming accident, maternity, physical and mental health. We presented these stories to the wider community using online platforms to ask participants to finish the stories. Our analysis of the 35 stories further informed the themes of the findings. These themes were communicated to the artists at OpenArts Inverness who worked to create the final artwork |
| Year(s) Of Engagement Activity | 2023,2024 |
| Description | Intergenerational workshops - Shetland |
| Form Of Engagement Activity | Participation in an open day or visit at my research institution |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | Our research team collected data from participants through community workshops which invited members from University of the Highlands and Islands Shetland, retired midwives as well as members of the public. This included members of the local farming community whose family had been involved in healthcare on Shetland and surrounding islands. Participants brought old family pictures, one participant set up a PowerPoint presentation to share pictures of the life of their father, who was a local doctor. Another participant brought pictures of their mother who was a nurse in the islands in the early 1930s and 1940s. Their family were responsible for self funding the first ambulance and medication delivery service on the remote Scottish Island. 6 workshops were run in November and February and most of which included participants returning and new participants sharing their experiences. In discussing the present and future of NHS in rural areas there was a combination of dissatisfaction, trepidation but also hope. Participants shared that services such as maternity care or paediatric care was difficult to access, and needed to be accessed by travelling to Aberdeen or Glasgow by way of a ferry or flight respectively. They also reported long waiting times and a lack of continuity of care. Participants shared deeply personal experiences, but also appeared encouraged when talking about the future. Interestingly, participants spoke about excitement around AI and technology in providing more care for people in rural spaces. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Presentation of Final Artwork Shetland |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Public/other audiences |
| Results and Impact | The final outcome of the Shetland work was that the panels created by artist Heather Christie are currently displayed in the Shetland Library in Lerwick. This is a shared community space where many of the local residents in Lerwick come to hire books, to attend workshops and use the internet. The library hosts a variety of workshops and events aimed at young people, mother and toddler groups and older people. This means that a wide variety of community members are able to view the art work. The hope is that they will also be able to reflect on their experiences of rural healthcare in the present and consider the possibilities of healthcare in rural areas in the future. |
| Year(s) Of Engagement Activity | 2024 |