Considering community engagement for remote and rural healthcare design in Scotland
: exploring the journey from rhetoric to reality

  • Amy Nimegeer

Student thesis: Doctoral ThesisDoctor of Philosophy (awarded by OU/Aberdeen)


The way health care services are delivered in remote and rural Scottish communities is in a state of reconfiguration. At the same time the NHS faces pressure to plan these new services in partnership with communities themselves. Evidence, however, suggests that this is not necessarily being done well.
This study considered the contextual aspects of remote and rural Scottish communities that may impact on health care-related engagement, and examined current understanding of what constitutes a ‘good’ engagement process. It then went on to consider a two-year action research project (RSF) that took place in four remote and rural Scottish communities to engage local residents in an anticipatory process co-designing their own future health care services. Finally, this study examined ways in which individuals were able to wield power within the engagement described in the RSF project, by using a combination of participant observation and Foucauldian Discourse Analysis.
As well as making a number of practical recommendations for future engagement practice in a remote and rural context, this study makes three key contributions. Firstly, it contributes further contextual knowledge about the challenges of engaging with remote and rural Scottish communities for local health care service design; a topic about which little has been written. Secondly, it contributes a novel method for anticipatory health care budgeting aimed at a remote and rural Scottish context, namely the RSF Game. Thirdly, it draws the conclusion that individual (non-elite) community members have the ability to use French and Raven’s bases of social power to impact the engagement process at all stages, and also posits that discourse can be used within rural engagement as a new ‘base of power’, which contributes to the debate around individual power and agency within remote and rural community engagement for healthcare, which few studies have examined.
Date of Award3 Apr 2013
Original languageEnglish
Awarding Institution
  • University of Edinburgh
SupervisorMargaret Currie (Supervisor), Rachel Erskine (Supervisor) & Thomson Elizabeth (Supervisor)

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