Evidence map›Paper›PMID 37336534›Full record

ArticleBMJ open2023

Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study.

Makoto Kaneko, Takaaki Ikeda, Machiko Inoue, Kemmyo Sugiyama, Manabu Saito, Ryuichi Ohta, Upul Cooray, Evelyn Vingilis, Thomas R Freeman, Maria Mathews

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In one paragraph

Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Makoto KanekoDepartment of Health Data Science, Yokohama City University, Yokohama, Japan kanekom@yokohama-cu.ac.jp.ORCID 0000-0002-4581-8274
Takaaki IkedaDepartment of Health Policy Science, Yamagata University, Yamagata, Japan.ORCID 0000-0003-4325-4492
Machiko InoueDepartment of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Kemmyo SugiyamaDepartment of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Manabu SaitoGENEPRO, Asahi, Japan.
Ryuichi OhtaDepartment of Community Care, Unnan City Hospital, Unnan, Shimane, Japan.ORCID 0000-0003-2593-091X
Upul CoorayDepartment of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Evelyn VingilisDepartment of Family Medicine, Western University, London, Ontario, Canada.
Thomas R FreemanDepartment of Family Medicine, Western University, London, Ontario, Canada.
Maria MathewsDepartment of Family Medicine, Western University, London, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesRural-urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research.

designWe employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare.

settingThe panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise.

participantsThe initial survey recruited 100 people, including rural healthcare providers, local government staff and residents. PRIMARY OUTCOME MEASURES: Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy.

resultsThe response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was -0.45 (p<0.001), and the correlation coefficients with the life expectancies of men and women were -0.35 (p<0.001) and -0.12 (p<0.001), respectively.

conclusionThis study developed the RIJ using a modified Delphi method. The index showed good validity.

Indexed as

Health Services ResearchDelphi TechniqueFemaleHumansJapanMaleSurveys and Questionnaireshealth policyhealth services administration & managementinternational health servicesprimary carepublic health

Identifiers

PMID37336534
PMCPMC10314574

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.