Health promotion and disease prevention by small rural hospitals: reasons, obstacles, and enablers

Abstract

Rural health stakeholders expect small rural hospitals to help improve health status in their communities. Those hospitals may try to offer health promotion and disease prevention (HPDP) services, but they confront big obstacles when doing this. Research interviews with chief executive officers (CEOs) at small rural hospitals found that low reimbursement, community attitudes, inpatient priorities, personnel shortages, low educational levels, weak local economies, and large older populations are often barriers to HPDP. Research also found practical methods that enabled CEOs to overcome obstacles and to offer HPDP in their rural communities. Collaboration with many organizations within and beyond their communities is essential to expand and leverage facilities, equipment, legitimacy, funds, interpersonal connections, knowledge, and resources. Philanthropy, grant writers, and grants are important, as is the involvement of employee champions and volunteers. Political advocacy can help. Implementing these enablers requires effective leadership, communication, interpersonal relations, and trust building.