Challenges and Facilitators for Physicians and Medical Schools to Promote Social Accountability in Rural Communities: A Scoping Review and Thematic Analysis.

Background: Social accountability aligns the health demands and priorities of the community and the commitment of medical schools. Existing literature has proposed contextually distinctive interventions encompassing geographical initiatives, institutions and communities, and systematic categorizations for the implementation of social accountability in a rural setting. Research concerning social accountability implementation strategies has been insufficient. This study provides an overview of the existing literature surrounding the social accountability practice of physicians and medical schools, in rural settings, through evidence of the barriers and facilitators inherent to these communities. Methods: This scoping review of 53 studies was conducted to determine challenges and facilitators associated with promoting social accountability in rural settings that are faced by physicians and medical schools. The review was consistent with the Arksey and O'Malley framework and included a search of Web of Science, MEDLINE, CINAHL, Scopus, and Embase to identify peer-reviewed articles on the topic from inception until April 1, 2024. Articles were screened against eligibility criteria, and important study characteristics and findings were extracted. A thematic analysis and narrative synthesis approach was used to analyze the data and report the results. Results: A total of 2698 abstracts were identified, 180 full-text articles were reviewed, and 53 articles were identified as eligible for inclusion in the review. Strategies used and problems inherent in promoting social accountability across physician practice and medical education are reported. Conclusions: This scoping review synthesizes existing evidence on the barriers and facilitators of social accountability practices in rural settings globally. The identified literature captures recurring themes of medical infrastructure inadequacy, community immersion curriculum design, targeted admission, geographical isolation, and institutional or peer support.