Background
Rural-urban health care disparities are an important topic. Hence, assessing rurality and evaluation of health outcomes based on rurality are indispensable. However, there is no universal measure of ruralityand Japan has no index to evaluate rurality for health care research. This study aimed to conduct a systematic scoping review to identify the important factors and methods of measuring rurality to inform the future development of a rurality index in Japan.
Methods
For our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websitesof national governmentssuch asGovernment and Legislative Libraries Online Publications Portal (GALLOP),from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas and reliability/validity measures.
Results
We identified 17 rurality indices in 7 countries. These indices mainly aimed to assess access to health care or to decide incentives for health care providers. Frequently used variables for the indices were population size/density, travel distance/time to emergency care or referral centre. Many indices did not examine reliability and validity.
Conclusions
While the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index.The results will be helpful to develop a rurality index in Japan and other countries/areas.