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1
R U R A L H E A L T H H I S T O R Y
The development of the Canadian Rural Health
Research Society: creating capacity through
connection
MLP MacLeod
1
, JA Dosman
2
, JC Kulig
3
, JM Medves
4
1
University of Northern British Columbia, Prince George, BC Canada
2
Institute of Agricultural Rural and Environmental Health/Canadian Centre for Health
and Safety in Agriculture Saskatoon, University of Saskatchewan, Canada
3
School of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
4
School of Nursing, Queens University, Kingston, ON, Canada
Submitted: 13 July 2006; Resubmitted: 4 January 2007; Published: 27 March 2007
MacLeod MLP, Dosman JA, Kulig JC, Medves JM
The development of the Canadian Rural Health Research Society: creating capacity through connection
Rural and Remote Health 7: 622. (Online), 2007
Available from: http://www.rrh.org.au
A B S T R A C T
Context: The organization of rural health research in Canada has been a recent development. Over the past 8 years, rural and
remote researchers from more than 15 universities and agencies across Canada have engaged in a process of research capacity
building through the development of a network, the Canadian Rural Health Research Society (CRHRS) among the scientifically
and geographically diverse researchers and their community partners. The purpose of this article is to discuss the development of
the CRHRS as well as the challenges and lessons learned about creating networks and building capacity among rural and remote
health researchers.
Issue: Key elements of network development have included identifying and developing multidisciplinary research groupings,
maintaining ongoing connections among researchers, and promoting the sharing of expertise and resources for research training.
The focus has been on supporting research excellence among networks of researchers in smaller centres. Activities include a
national annual scientific meeting, the informal formation of several regional and national research networks in specific areas, and
the development of training opportunities. Challenges have included the issues of sustaining communication, addressing a range of
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
2
networking and capacity-enhancement needs, cooperating in an environment that rewards competition, obtaining resources to
support a secretariat and research activities, and balancing the demands to foster research excellence with the needs to create
infrastructure and advocate for adequate research funding.
Lessons learned: The CRHRS has learned how to begin to support researchers with diverse interests and needs across sectors and
wide geographical areas, specifically by: (1) focusing on research development through creating and supporting trusting
connections among researchers; (2) building the science first, followed by infrastructure development; (3) making individual
researchers the nodes in the network; (4) being inclusive by accommodating a wide variety of researchers and researcher strengths;
(5) emphasizing social exchange, knowledge exchange, and mentoring in annual scientific meetings; (6) taking opportunities to
develop separate projects while finding ways to link them; (7) finding a balance between advancing the science and advocating for
adequate funding and appropriate peer review; (8) developing a network organizational structure that is both stable and flexible;
and (9) maintaining sustained visionary leadership.
Key words: Canada, capacity-building, network, research.
Context
Although there is a long history of research into the health of
rural Canadians, as well as a long history of international
research symposia and meetings on rural health issues
1
, the
rural health research community remains small and dispersed
across the country. Within the last decade, sparked largely
by the new research funding opportunities created by the
establishment of the Canadian Institutes of Health Research
(CIHR), there has been a concerted effort to develop more
substantial connections among rural health researchers from
many different disciplines and parts of Canada. The
Canadian Rural Health Research Society (CRHRS), created
by researchers as a means to establish a robust and well-
funded rural health research community, has developed as a
network of researchers in the four principal areas of rural
health research: (i) biomedical; (ii) clinical; (iii) health
services and policy; (iv)population and public health.
The development of this rural health research networked
community has not been without its challenges. The purpose
of this article is to discuss the development of the CRHRS as
well as the challenges and lessons learned about creating
networks and building capacity among rural and remote
health researchers.
Issue: research networks and
networking
Health research networks have been described as, ‘networks
of investigators who are equipped with tools to facilitate
collaboration and information sharing’
2
and whole systems
that ‘facilitate cultural change and grass-roots participation
in research’ that also enable ‘individual innovation, through
multidisciplinary participation’
3
. Approaches to research
networks differ, from highly coordinated endeavours to
loosely coupled connections of researchers and others who
maintain ‘various types of contacts, co-operation and
communication’
4
. Networks fulfil various purposes,
including overcoming fragmentation of research on a
particular topic
5
, improving multidisciplinary approaches to
pressing research problems
6
, linking researchers and
decisionmakers
7
, and increasing researcher competitiveness
nationally and internationally
6-10
.
Research networks are important in building research
capacity as well as influencing the development of
multidisciplinary teams to address complex research
questions
6,8
. It is not always clear what structures and
processes can best enhance and sustain researcher capacity
11
.
Key elements in successful networks include: a common,
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
3
clear vision with a modest number of goals
12
; proven,
charismatic leadership of an individual or individuals with a
deep understanding of all aspects of research in the field
6
; a
structure that suits the network’s goals and purpose
6,10,12
;
clear, effective processes of communication, coupled with
mechanisms to foster and sustain researcher engagement and
collaboration
11,12
; sufficient resources
12
provided in a
judicious and timely manner
8
; and ways of working that
reflect the intent and context of the network
9,11
. Networks
develop largely in response to contextual forces.
Rural health research
The pattern of rural health research development occurs in
relation to the role of rural health in the country’s health
agenda, the availability of national research funding, the
organization of health services, and the availability of
universities and researchers to rural communities. In the
USA, for instance, rural health research is largely health
policy driven and focuses on access issues
13
. As Hartley
notes, this is due primarily to three factors. First was the
establishment of the Federal Office of Rural Health Policy in
1987 that provided funding and capacity-building support for
research centres focused on rural issues. Second was the
National Rural Health Alliance, which began in 1978 as a
merger of two rural hospital and rural primary care
organizations, serves as an umbrella organization, and
advocates successfully for research dollars. Third was the
creation of issue networks, made up of federal/state
decisionmakers, clinicians and researchers, to lobby for
specific issues such as rural hospital policy.
In Australia, a number of rural health units were established
within state health departments in the late 1980s to focus on
policy related issues. The increase in regional universities,
the funding of university departments of rural health in each
state and the Northern Territory, as well as the establishment
of the rural clinical schools has resulted in an increase in
rural health research. Most research is focused on public
health and health services, however, and remains small in
scale
14
. At the same time, funding for research that is
specifically rural in nature remains limited
15,16
, and there are
continuing needs for capacity development and
communication among researchers dispersed over a vast
geographic area
16
.
In Canada, the development of rural health research has been
more researcher driven than policy driven, and hence is
uneven across the country. Provinces are responsible for the
provision of health and education, and interest in rural health
varies from province to province. Although there is an
increasing number and range of rural health research projects
and programs across the country
17
, there are few long-term
provincially-funded centres with a central mandate for rural
health research, such as Ontario’s Centre for Rural and
Northern Health Research (CRaNHR).
Developing a Canadian Rural
Health Research Network
By the late 1990s an increasing appreciation that specific
knowledge was required to address rural and remote health
needs in Canada
18
led to the emergence of a network that has
become the CRHRS. Developmental milestones, including
policy and organizational influences, are outlined (Fig 1).
Two rural health research conferences in 1998, one at the
University of Lethbridge
19
; the other at the University of
Saskatchewan
20
, provided opportunities for researchers from
a broad range of disciplines and research interests to meet
for the first time. Also in 1998, the national department of
health, Health Canada, formed the Office of Rural Health for
the purpose of putting a ‘rural lens’ on national health
issues
18
. Rural health research was the focus of two
proposals during the consultation phase of the development
of the Canadian Institutes of Health Research (CIHR)
21,22
.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
4
Figure 1: Milestones in Canadian Rural Health Research Society networking.
University of Lethbridge
Alberta
September
“Health in Rural Settings
From the Ground Up”
University of Saskatchewan
Saskatchewan
October
“Rural Health and Safety in a
Changing World”
Saskatoon
Saskatchewan
Rural He
alth Research
Consortium Meeting
Ottawa
Ontario
October
1
st
Annual Conference
Rural Health Research
Consortium
Saskatoon
Saskatchewan
October
2
nd
Annual Conference
Rural Health Research
Consortium
Health Canada
Office of Rural Health
Established
Prince George
British Columbia
October
“Rural and Remote
Health Research
The Quest for equitable
Health Status for all
Canadians”
MRC/CIHR
Funding obtained by
Consortium
Health Canada
Ministerial Advisory
Council on Rural
Health Established
1998
1999
2000
2001
Halifax
Nova Scotia
October
3
rd
Annual Conference Rural
Health Research Consortium
Saskatoon
Saskatchewan
October
4
th
Annual Conference
with International
Symposium “Future of
Rural Peoples”
Sudbury
Onatrio
October
5
th
Annual Conference
with International
Rural Nurses Congress
Quebec City
Quebec
October
6
th
Annual Conference
with Canadian Society
for Circumpolar
Health
CRRHS
Receives CIHR Workshop
Funding and CIHR Rural
Initiatives funding
Canadian Rural
Health Research
Society
Established
CIHR
Initiatives
Rural Health
Canada Rural and
Remote Health Studies
Meeting
CIHR
Centre for Research
Development Canadian
Centre for Health and
Safety in Agriculture
Thunder Bay
Ontario
March
Canada Rural and Remote
Health Study(ies) (CRRHS)
Investigator Workshop
2002
2003
2004
2005
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
5
In 1999, two national meetings served to accelerate
connectedness. The University of Saskatchewan hosted a
meeting of 129 researchers from a wide variety of disciplines
from across Canada to explore whether specific
interdisciplinary cross-university research groupings might
be formed to seek funding for new research projects from the
emerging CIHR and other funding venues. The outcome was
the Canadian Rural Health Research Consortium
(Consortium) and the emergence of research groups in
nursing, the physical environment, and rural children’s
health. A month later, Health Canada’s Office of Rural
Health and the University of Northern British Columbia
hosted the National Rural Health Research Summit at which
researchers, rural residents and government representatives
further defined the area and recommended means of
supporting rural and remote health research
18
.
With the support of a Medical Research Council/CIHR
Opportunities grant, the Consortium met in April 2000 to
establish its mission, goals and 5 year targets. The
Consortium held its first national scientific conference in
October 2000 with 75 scientific abstracts and presentations.
Workshops at this meeting resulted in the identification of
nine key research areas, and requests for closer scientific
connections and project development, and advocacy for
increased funding for rural and remote health research.
The Canadian Rural Health Research
Society: a network of networks
Rather than a single network, rural and remote health
researchers have developed what can be considered a virtual
network of networks, which is enabling research capacity
development. The Consortium has become the Canadian
Rural Health Research Society (CRHRS), annual national
scientific meetings have continued, an inventory of research
training in rural health research has been created
23
, new
research groupings have emerged, and network members
have worked with CIHR and other funding agencies to hold
workshops and institutes, as well as to extend funding
opportunities.
The Society
Between 2001 and 2003 the Consortium evolved into the
CRHRS. As a national not-for-profit incorporated society,
the CRHRS aims to build interdisciplinary,
multidisciplinary, mutually supportive and community-
focused research networks that are responsive to the needs of
people living in rural and remote communities. The
Society’s activities are focused on researcher capacity-
building, networking, increasing the availability of funding
for rural health research, as well as knowledge translation
24
.
Connections among researchers have been fostered through
annual scientific meetings. The number of abstracts and
range of disciplines has increased each year. Joint
conferences have identified new areas of research and
expanded networks: in 2003, with the International
Symposium on the Future of Rural Peoples; in 2004 with the
International Rural Nurses Congress; in 2005 with the
Canadian Society for Circumpolar Health (CSCH); and in
2006 with the Canadian Centre for Health and Safety in
Agriculture, the National Collaborating Centre on Aboriginal
Health, The National Collaborating Centre on Environmental
Health, and the British Columbia Rural and Remote Health
Research Network, among others. The conferences have
served as the venue for research priority-setting and
networking on topics such as rural women’s health,
definitions of rural and rurality
25
working with large
databases, rural health professional education, research
ethics and aboriginal knowledge translation.
Research groupings
From the Consortium’s earliest meetings, structured
opportunities have been provided for researchers with
similar interests, from various universities and disciplines to
get together to explore the questions: what are the major
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
6
research issues in this area? What research questions could
be worked on?
One of the earliest networking results was in health services
and policy research, with the nursing group’s study, ‘The
Nature of Nursing Practice in Rural and Remote Canada’
26
.
This Canada-wide study, was conceived when the principal
researchers first met at the 1999 Saskatoon meeting, and
were later supported by a Medical Research Council/CIHR
Opportunities grant in 2000
27
. The physical environment
group, which also met at the 1999 meeting, was successful in
its 2002 application to CIHR Strategic Training Initiative in
Health Research (STIHR) Program for a multicentre training
grant, Public Health and the Agricultural Rural Ecosystem
Training Program (PHARE)
28
. In 2004, two CIHR Centres
for Research Development were funded: the Centre on the
Changing Physical and Social Landscape in Atlantic Rural
Canada
29
, and the Canadian Centre for Health and Safety in
Agriculture
30
, with its researcher network now numbering 66
scientists in 14 Canadian universities and other national and
international organizations. Most research within these
centres is in the areas of population and public health, and
health services and policy research, although increasingly
projects cross into biomedical research and genomics, on
topics such as mechanisms of lung inflammation related to
swine barn air
31
.
In March 2002, with the support of 8 CIHR Institutes,
37 researchers met in Thunder Bay, Ontario. Five additional
research groupings, in addition to the ones on rural nursing,
environmental health and rural children’s health, were
created. Subsequent proposals included a project on the links
between health status and community resiliency
32
, and an
evaluation of national information sources for developing a
baseline data set on the health of rural Canadians
29
. Other
research groupings, including one on children’s mental
health and a clinical research-focused group on chronic
disease management have been unable to garner a sufficient
critical mass of researchers to proceed.
A grant received by the Society’s co-leaders
33
, which
enabled the provision of small grants ($4000 – $5000), has
added substantial value. The grants allowed investigators of
varying levels of research maturity, and often with little
infrastructure available to them in their home universities, to
meet and prepare proposals for funding. Small grants, and
the networking they have funded, have enabled researchers
to achieve a critical mass across universities, to be successful
in national competition, and to compete on standards of
international excellence
34,35
.
Research training
Fostering research training has been a continuing theme.
During 2001 a Canada-wide survey of training opportunities
in rural and remote health research was undertaken
23
. The
relationships built among researchers through the CRHRS
and the research grant activities, have created new research
training opportunities, for example, the PHARE Program
through the rural health CIHR Centres for Research
Development located in Nova Scotia
29
and Saskatchewan
30
.
Summer institutes have been implemented in Ontario and
Newfoundland. No fewer than 22 students presented their
research at the 2005 conference and, with their mentors,
participated in a mentorship workshop.
Making supportive networks possible
CIHR funding has been central to fostering research
groupings, networking and capacity building among rural
and remote researchers
27,33
. The need for a Canada-wide scan
of research priorities, first raised by CRHRS researchers,
was taken up by the CIHR. In September 2001 a national
meeting organized by CIHR resulted in a proposed strategy
for rural and remote health in Canada within the context of
the CIHR
36,37
, and led to CIHR strategic competitions in
2002, 2003 and 2004. In 2002, the CIHR created a strategic
initiative across all 13 institutes, now the Special Joint
Initiative in Rural and Northern Health, to provide support
for the development of this strategic priority
38
. Funding for
this initiative was discontinued in 2006.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
7
Challenges of network development and sustainability
The challenges faced by the CRHRS are characteristic of a
small research community with multiple disciplines, diverse
interests, and limited capacity, dispersed over a large
geographical area. Predominant among the challenges are
the following:
1. Sustaining communication among a small research
community with a range of disciplines and research
foci, spread over a vast geography.
2. Addressing a range of networking and capacity-
enhancing needs within the research community.
3. Engendering cooperation in a research environment
that rewards competition.
4. Resourcing a secretariat or service centre, and other
network supports.
5. Balancing the demands to foster research excellence
with the needs to build infrastructure and engage in
advocacy action to increase research funding for
rural health.
The rural health research community in Canada remains
small and widely dispersed, with few senior researchers. The
networking and capacity enhancing needs vary considerably
within the research community, and as excellence can be
defined in terms of competitive success, cooperation is
sometimes stifled.
Attempts to identify gaps and set priorities in rural health
research have met with limited success
36,37
. The list of
important topics for research has been far-ranging, and
researchers have been unable to reach consensus on focused
research priorities because of diverse needs, interests, and
disciplines. The broad range of research topics contrasts with
the approach in the USA or Australia, where health services
or health policy as drivers and funders of rural health
research have prompted more focused research priorities
13,14
.
In Canada, it is frequently challenging to create a critical
mass of researchers around a particular topic, or to offer
research training, except by finding non-traditional ways to
link with others across the country or internationally. A
Canadian strength however, is a multidimensional approach
to understanding the determinants of rural health taken by
groups of researchers examining complex issues related to
the health and economic sustainability of rural
communities
30
. The breadth of interests and disciplines
among the rural health research community has been central
to fostering larger multidisciplinary research groups.
Most rural and remote health researchers are located in small
universities where research resources are limited. Small
universities, often located in more rural or remote parts of
Canada, frequently have sustained, substantive linkages with
their surrounding communities. These links foster
community based research, alignment of research interests,
and the ability for research findings to directly impact health
programs and services
18,38,39
. It is these abilities that provide
groups of rural health researchers, often networking across
provinces, with the potential to compete successfully
nationally and internationally, particularly in the new
funding era which increasingly emphasizes the need to work
with the users of research for improved research uptake.
The targeted national support for rural health and rural health
research has been short-lived: Health Canada’s Office of
Rural Health has been dismantled and CIHR has ceased
strategic funding for rural health research. The decrease in
targeted funding has made networking and capacity-building
more challenging. Among the challenges is finding
appropriate publication outlets. CRHRS members have
edited special issues of other publications
40
, but efforts to
create a rural health research journal in Canada have not yet
been successful.
Finally, it is challenging for a small research community
with few resources to develop the necessary infrastructure,
while maintaining a balance between advancing the science
and advocating for adequate research funding. Network
members have been diligent in recommending colleagues to
serve on CIHR peer review committees, and institute
advisory boards, as well as regularly communicating with
CIHR about rural health research needs. The CRHRS, a non-
profit society funded by memberships, has sustained its
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
8
leadership, and maintained its secretariat and conference
planning endeavours by means of in-kind contributions by
members and their universities. Without a national focus on
rural health on the part of those responsible for research
funding and policy development, and a more central place of
rural health on provincial agendas across the country, the
sustenance and growth of research excellence and funding
opportunities cannot happen easily.
Lessons learned in network
development
In addressing the challenges, the CRHRS has learned how to
begin to support researchers with diverse interests and needs
across sectors and a wide geographical area, specifically by:
1. Focusing on research development through creating
and supporting trusting connections among
researchers.
2. Building the science first, followed by
infrastructure development.
3. Making individual researchers the nodes in the
network.
4. Being inclusive by accommodating a wide variety
of researchers and researcher strengths.
5. Emphasizing social exchange, knowledge
exchange, and mentoring in annual scientific
meetings.
6. Taking opportunities to develop separate projects
while finding ways to link them.
7. Finding a balance between advancing the science
and advocating for adequate funding and
appropriate peer review.
8. Developing a network organizational structure that
is both stable and flexible.
9. Maintaining sustained visionary leadership.
Unlike research networks, designed as infrastructures for
information and services
8
, the CRHRS has developed as a
fluid channel so that researchers may find best ways of
achieving their own goals of excellence in rural and remote
health research. In pursuing excellence, researchers have
created a variety of smaller, often overlapping knowledge
networks, communities of practice and soft networks
7
.
Building a network of networks has been an intertwined
process of researchers reaching out, taking the risk to trust
one another, building community-linked projects and
programs of excellence, receiving funding, developing new
knowledge, using the knowledge to train students, building
capacity, learning how to translate our knowledge to each
other and to our stakeholders and partners, and reaching out
in new ways.
Conclusions
The CRHRS has made strides in enabling inclusive networks
of researchers and communities to develop capacity
collectively. Challenges that remain are to find new ways to
link together population health, health promotion, and health
services researchers with clinical and biomedical researchers
to address the human and health ecosystem issues that are of
such importance in rural and remote communities. New
developments may see large, multidisciplinary research
teams working in partnerships with communities to address
the diverse health agenda of rural and remote Canada, while
being connected and competitive nationally and
internationally. The network of networks approach that has
characterized the development of rural and remote health
research in Canada may permit some innovative ways to
move to this next stage.
Acknowledgements
The authors would like to acknowledge the Canadian
Institutes of Health Research for funding the process leading
to the formation of the Canadian Rural Health Research
Society. The authors also wish to thank the efforts of
colleagues from across Canada who participated in and
supported the process that led to the formation and
incorporation of the Society.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
9
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