Dean Bradley Carson

This paper investigates rural–urban disparities in the experiences of in‐home care services for older adults in a sparsely populated municipality (Storuman) in Northern Sweden. Such municipalities are characterised by long‐term population loss and ageing, an increasing concentration of residents and services in municipal centres and resultant rural ‘resource deserts’. Disparities are measured through four ‘endpoint’ measures—exits to residential care, resource use, longevity and survival in the in‐home care system. Data were drawn from the municipality’s care service contract database (2014–2020). Users living in the municipal centre had lower resource use and used direct care less frequently than those in smaller and more distant settlements. Those living near a grocery store were more likely than others to survive long term in the in‐home care system. The research reveals a potential to reduce exits to residential care, to make more effective use of direct care and shopping services and to limit disruptive transfers of care, particularly between municipal and regional health services. Overall, there was limited evidence of rural–urban disparities in in‐home care outcomes, but particular attention should be paid to transactional proximity of different parts of the care system and proactive rather than reactive care planning. The paper contributes to debates about quality measures for in‐home care and the impacts of micro‐urbanisation on the lives of people living in sparsely populated areas.

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.

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.

BackgroundThis 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.MethodsThe 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.ResultsThe 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.ConclusionThe 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. Understanding 'what works' is essential to inform future policy decisions. Literature recommends new recruitment, staff retention and reorganising tasks. Recommended solutions lack evidence; perhaps new service models are required? Concerted effort to build evidence relevant to rural social care is needed.

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 Tarnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tarnaby, 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.

Small villages in northern Sweden have seen a continuing removal of key services, such as schools, shops and public transport, since the 1970s. Disinvestment in public services has not been strategically planned but has happened in response to population loss and increased costs on a case-by-case basis. More recently, there has been a shift in policy thinking to what might be termed a ‘de-growth’ approach where digitalisation and increased personal mobility are used to provide new ways of delivering services. The purpose of this paper is to examine the existence of ‘resource deserts’ in Southern Lapland and the emergence (or consolidation) of village hierarchies in allocating public services. We map out the distribution of neighbourhood services (grocery stores, pre-/schools and petrol pumps) among villages, and explore the lived experiences in accessing these resources in different villages. Our results show that resource deserts clearly exist in the south and east of the region, while villages in the more sparsely populated western mountain areas were generally in a better position to retain resources. We identify a lack of consistent and transparent service planning at the village level as a key shortcoming in municipal and regional service strategies. There appear to be unofficial settlement hierarchies in the differential treatment of villages that are otherwise similar in population size, population change and distance to central places. We find that political decisions on service allocations are likely influenced by several factors. These include legacy effects relating to historic settlement status, the location of villages in relation to key transport or mobility corridors, as well as ideological factors favouring villages with more ‘exotic’ features and development potential in line with the municipalities’ economic, social and political priorities. We finally argue that a shift to de-growth needs to be more strategically planned if it is to eliminate resource deserts and promote equity of service access across all villages.

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.

Maps using data from population censuses have been published in The Journal of Maps since its inception and this source of data often acts as a fundamental input to research undertaken by social sc...