Building Rural-Urban healthCare Equity for Scotland (BRUCES)

Scotland's rural and island communities are diverse and form a considerable part of the population. In 2020 17% people lived rurally with a further 12% in Scotland's small towns. Rural Scotland also has an older population than urban Scotland, and this trend is set to continue in the coming decades. Consequently, age-related health inequalities are emerging fastest in rural Scotland, which poses serious challenges to access to, and delivery of, appropriate care.

We already know that rural-dwellers can receive less (or at least different) care from those living in urban areas, and this can result in poorer health for people in these areas. However, it is unclear why, and significant research gaps remain in our understanding of what care is available in different places, how this affects patients and how healthcare services could better meet the needs of rural and island areas.

To improve care, we need to better understand why rural health outcomes are poorer and identify ways to make it fairer.

Addressing inequality is a Scottish Government priority, however, existing efforts to tackle geographical health inequalities have so far largely focused on improving outcomes in more deprived urban areas as opposed to rural communities.

Findings from the BRUCES project will be used to inform new Scottish Government policies that take into account the needs of those who live in, for example, remote mainland rural communities, small islands in the inner Hebrides and communities in close proximity to cities like Aberdeen.

Michelle Stevenson lives in rural Scotland and decided to get involved in the project so she could share her own experiences. Michelle said:

“I wanted to get involved in this project because addressing rural inequalities in health is very important to me, my family and my community. I have a chronic inflammatory arthritis for which I receive strong medication to suppress my immune system. As a result, I recently developed an infection in my hip which was very serious and resulted in an emergency admission to hospital over an hour from my home in the Highlands.

“I needed to continue strong intravenous antibiotics at home but because there were no local district nurses I had to travel 120-mile round trip three days a week to receive this. I'm now receiving regular intensive rehabilitation at the rheumatology unit in Dingwall which means being an inpatient for three weeks at a time, away from my family and friends.

"This has brought home to me the real, complex challenges faced by people living in rural communities to access health and social care.”

The BRUCES project aims to improve health equity in remote and rural areas by investigating existing inequalities in health, healthcare access and health outcomes. We will produce evidence-based recommendations for future healthcare that take into account the needs of people living in diverse geographical areas, and which are informed by care experiences and patient preferences.

The project will focus initially on three common health issues: cancer, musculoskeletal conditions and frailty; issues which have a major impact on the Scottish population as a whole, and where there is existing evidence in inequity of health and care for people living with these conditions in rural areas. However, this will provide insights into acute and longer-term conditions across different age groups and health conditions treated locally and in specialist centres.

Our research will involve patients, healthcare professionals, those who plan and manage healthcare services and the wider rural population. The project involves four key steps:

1. Understanding existing services and policies - Firstly, we will use existing data from healthcare records to develop a detailed understanding of how people with cancer, musculoskeletal conditions and frailty currently use health services in rural settings and identify particular groups of patients who may be at a disadvantage. We will also explore how local and national policies support (or don't support) care delivery in rural areas, and identify existing models of rural care in Scotland, the rest of UK and elsewhere that have worked well.
   
2. Individual experiences of healthcare in rural areas - We will interview people living with cancer, musculoskeletal conditions and frailty in rural areas, as well as health and social care professionals who provide services to them, to try and understand from both perspectives what 'good care' looks like. We will also explore other key topics in these interviews, such as specific workforce challenges of delivering care to rural communities (for example, recruiting and retaining people to work in delivering services in these communities) and ask what needs to be continued/changed to achieve good care across rural Scotland.
   
3. Evaluating care solutions - Using the information from steps 1 and 2, we will work out what aspects of care people living in rural areas value the most and consider these alongside other factors such as the cost of possible solutions identified in these steps. This will help us understand what changes might need to be made to existing ways of providing care in rural areas and will help inform our recommendations in step 4.
   
4. Making recommendations to improve care - We will bring together all of our work from steps 1-3 to set priorities for actions which can help improve care for people living in rural communities across our exemplar conditions and beyond. We will work closely with the Scottish Government's National Centre for Remote and Rural Health and Care to test our findings in workshops with patients, carers, health and social care staff, health managers, policymakers and academic experts. Finally, we will create an action plan to introduce and measure impacts of the most promising solutions and produce guidance to support local and national service planning.

Throughout this project, we will ensure a strong focus on patients and carers by engaging with our Patient and Public Involvement (PPI) group members. Our PPI members have already helped us write our research plans and have helped us to better involve patients and carers throughout our programme of work.

A dedicated study PPI team will help guide our work throughout the project and will help us test our findings and create action plans. You can find out more about getting involved with BRUCES in our 'Patient Research Partner Role Descriptor' document, which is available below in both Word and PDF formats:

• BRUCES PRP Role Descriptor - Oct 2024 (DOC)
• BRUCES PRP Role Descriptor - Oct 2024 (PDF)

This notice explains how the University of Aberdeen handles your personal information when you register your interest in patient and public involvement (PPI) activities that take place within the Epidemiology Group as part of the BRUCES study.

Who we are

The organisation responsible for your personal information in terms of data protection legislation is the University of Aberdeen.

If you have any questions about the University's handling of your information, or your rights under privacy laws, you can contact the University Data Protection Officer in the following ways:

• By email: dpa@abdn.ac.uk
• By post: King's College, Aberdeen, AB25 3FW
• By telephone: 01224 272596

Information we collect and use about you

You will have provided us with information such as your name, telephone number and/or email address and areas of interest for taking part in PPI activities.

Why we process this information, and our lawful basis

We collect and use your personal information with your consent in order to send you information about taking part in PPI activities that will be used to conduct academic and scientific research with researchers at the University of Aberdeen and research partners, including adverts for participation in University of Aberdeen studies, and studies from approved external research organisations if applicable.

The University is authorised to undertake research under powers provided by the Universities (Scotland) Acts, and also undertakes research in the public interest.

Disclosing your information

We will not disclose the information you provided on the sign-up form to any other organisation, other than when required do so by law or with your consent (either verbal or written).

The external suppliers we use for IT support may have access to your personal information in order to provide that service to the University. Our third-party supplier arrangements are regulated by contracts designed to protect the information and limit the way it is used.

How long your information is kept

We will keep information about you for the duration of the BRUCES project.

Your rights

You have the right to withdraw your consent at any time for the University to continue to process your information. If you wish to withdraw consent, please contact us at the following address:

Epidemiology Group
University of Aberdeen
AB25 2ZD

Email: epidemiology@abdn.ac.uk

You also have rights to obtain a copy of your personal information, and to ask us to correct inaccurate or incomplete personal information. Under certain conditions, you can ask us to restrict the way we use your personal information, erase your personal information and object to the University processing your personal information. These rights depend on our lawful basis for processing your personal information. This means we may not be able to comply with your request in every case. If we cannot do as you ask, we will always reply to you and explain our position.

There is no charge to make a request, but we may need evidence to confirm your identity before we respond in full.

You can ask about your privacy rights or make a request about your personal information by contacting the University Data Protection Officer:

• By email: dpa@abdn.ac.uk
• By post: King's College, Aberdeen, AB25 3FW
• By telephone: 01224 272596

If are dissatisfied with the way the University has handled your personal information or dealt with your data protection issue, you have the right to lodge a complaint with the Information Commissioner. The Information Commissioner's Office can be contacted via their website at www.ico.org.uk/concerns .

Chief investigators

• Prof. Peter Murchie
• Dr Rosemary Hollick

Other co-investigators

• Dr Natalia Calanzani
• Prof. Louise Locock
• Dr Andrew Maclaren
• Dr Stephen Makin
• Prof. Lorna Philip
• Prof. Mandy Ryan
• Mrs Michelle Stevenson

For further information about BRUCES, please contact the team at bruces@abdn.ac.uk .