Last mile research: a conceptual map

Abstract

Background: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.

Keywords: Global health research; concept mapping; hard-to-reach populations; health equity; last mile; research methods.

Figure 1.

Conceptual point map of 64 statements in relative location based on number of times statements were co-sorted by 15 independent global health researchers.*

Figure 2.

Point map of the project statements showing the central location of the statement: ‘13. Understanding the barriers to equitable health from the perspective of people in the last mile’.*

Figure 3.

Final five cluster concept map for ‘last mile research’ determined through discussion and consensus with global health researchers

Figure 4.

Identifying next steps- average level of importance and current presence ratings for 64 ‘last mile research’ statements as determined by 15 global health researchers.*