OpenLB
Open Library of Bioscience
Advanced Search
Diabetic medicine : a journal of the British Diabetic Association
Mar 23, 2025; e70027.

'The seagull theory: Where people fly in, gather information��� fly out and nothing ever comes about': A qualitative exploration of barriers and enablers to research participation among adults with type 2 diabetes living in Australian rural communities.

Joanne Jordan, Jo-Anne Manski-Nankervis, Meaghan Read, Timothy Skinner, Jane Speight, Elizabeth Holmes-Truscott
Author Information
  1. Joanne Jordan: School of Psychology, Deakin University, Geelong, Victoria, Australia. ORCID
  2. Jo-Anne Manski-Nankervis: Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
  3. Meaghan Read: Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
  4. Timothy Skinner: School of Psychology, Deakin University, Geelong, Victoria, Australia.
  5. Jane Speight: School of Psychology, Deakin University, Geelong, Victoria, Australia. ORCID
  6. Elizabeth Holmes-Truscott: School of Psychology, Deakin University, Geelong, Victoria, Australia.
PMID: 40122592 DOI: 10.1111/dme.70027

Abstract

AIM: Rural communities are under-represented in diabetes research, with implications for the generalisability, implementation and reach of research outcomes. Increased efforts to conduct diabetes research in, or inclusive of, rural communities are predicated on effective participant recruitment. This study explores the motivations for, barriers to and enablers of research participation among adults with type 2 diabetes (T2D) in Australian rural communities.
METHOD: A phenomenological qualitative study was conducted involving adults (18+���years) living with T2D in rural communities, using multi-modal recruitment approaches and purposeful sampling across Australian states and gender. Audio-recorded, semi-structured interviews explored participants' perceptions of research participation. An abductive coding approach was undertaken to identify salient themes.
RESULTS: Twenty-one participants were recruited across all six Australian states, median (range) age of 63 (41-78)���years and 65% were women. Barriers to research participation include diabetes stigma, lack of community awareness of T2D, few research opportunities, geographical distances of rural communities from research sites and individual time and resource constraints. Enablers strongly focused on increased engagement and involvement of rural communities in research and offering education or access to diabetes care as part of research activities. Motivations for research participation included opportunities to help or advocate for rural and T2D communities and highlight under-resourcing of rural healthcare services.
CONCLUSION: Study findings inform practical strategies that may improve recruitment mechanisms for T2D research in rural communities, for example, community-driven recruitment methods. Evaluation of the effectiveness of such strategies in research practice will be needed.

Keywords

qualitative research rural type 2 diabetes

References

  1. Skinner T. One health the future of rural health? Aust J Rural Health. 2022;30(3):304���305.
  2. Alston L, McFayden L, Gupta TS, Payne W, Smith J. Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action. Med J Aust. 2023;219(S3):S27���S30.
  3. Richman L, Pearson J, Beasley C, Stanifer J. Addressing health inequalities in diverse, rural communities: an unmet need. SSM Popul Health. 2019;7:100398.
  4. Australian Institute for Health and Welfare. Rural and remote health Canberra: Australian Government. 2023. https://www.aihw.gov.au/reports/rural���remote���australians/rural���and���remote���health
  5. Jensen L, Monnat SM, Green JJ, Hunter LM, Sliwinski MJ. Rural population health and aging: toward a multilevel and multidimensional research agenda for the 2020s. Am J Public Health. 2020;110(9):1328���1331.
  6. Australian Health and Welfare Institute. Diabetes: Australian facts. Australian Government; 2023. http://www.aihw.gov.au/reports/diabetes/diabetes/contents/total���diabetes/total���diabetes
  7. Dugani SB, Mielke MM, Vella A. Burden and management of type 2 diabetes in rural United States. Diabetes Metab Res Rev. 2021;37(5):e3410.
  8. Puig���Garc��a M, Caicedo���Monta��o C, M��rquez���Figueroa M, et al. Prevalence and gender disparities of type 2 diabetes mellitus and obesity in Esmeraldas, Ecuador: a population���based survey in a hard���to���reach setting. Int J Equity Health. 2023;22(1):124.
  9. Morton JI, Ilom��ki J, Magliano DJ, Shaw JE. The association of socioeconomic disadvantage and remoteness with receipt of type 2 diabetes medications in Australia: a nationwide registry study. Diabetologia. 2021;64(2):349���360.
  10. Greville H, Haynes E, Kagie R, Thompson SC. It Shouldn't Be this Hard': exploring the challenges of rural Health Research. Int J Environ Res Public Health. 2019;16(23):4643.
  11. Bonevski B, Randell M, Paul C, et al. Reaching the hard���to���reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol. 2014;14(1):42.
  12. McElfish PA, Liston R, Smith V, et al. Rural research network to engage rural and minority community members in translational research. J Clin Transl Res. 2023;9(2):115���122.
  13. Alston L, Field M, Brew F, Payne W, Aras D, Versace VL. Addressing the lack of research in rural communities through building rural health service research: establishment of a research unit in Colac, a medium rural town. Aust J Rural Health. 2022;30(4):536���539.
  14. Simmons D, Glenister K, Magliano DJ, Bourke L. Changes in prevalence of diabetes over 15���years in a rural Australian population: the crossroads studies. Diabetes Res Clin Pract. 2020;170:108492.
  15. Ng AH, Quigley M, Benson T, et al. Living between two worlds: lessons for community involvement. Lancet Diabetes Endocrinol. 2024;12(3):155���157.
  16. Organization WH. Report of the WHO discussion group for people living with diabetes: virtual meeting 30���31 March 2023. World Health Organization; 2023.
  17. Levy MHC, Mendenhall A, Grube W. Engaging rural residents in patient���centred health care research. Patient Experience Journal. 2017;4(1):46���53.
  18. Friedman DB, Foster C, Bergeron CD, Tanner A, Kim SH. A qualitative study of recruitment barriers, motivators, and community���based strategies for increasing clinical trials participation among rural and urban populations. Am J Health Promot. 2015;29(5):332���338.
  19. Bharucha AE, Wi CI, Srinivasan SG, et al. Participation of rural patients in clinical trials at a multisite academic medical center. J Clin Transl Sci. 2021;5(1):e190.
  20. McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: a scoping review. Clin Trials. 2022;19(4):464���476.
  21. Mudaranthakam DP, Gajewski B, Krebill H, et al. Barriers to clinical trial participation: comparative study between rural and urban participants. JMIR Cancer. 2022;8(2):e33240.
  22. Arana���Chicas E, Prisco LMH, Sharma S, et al. Barriers to participation in clinical trials of rural older adult cancer survivors: a qualitative study. J Rural Health. 2025;41(1):e12852.
  23. Pelletier CA, Pousette A, Ward K, Fox G. Exploring the perspectives of community members as research partners in rural and remote areas. Res Involv and Engagem. 2020;6(1):3.
  24. Brockman TA, Shaw O, Wiepert L, et al. Community engagement strategies to promote recruitment and participation in clinical research among rural communities: a narrative review. J Clin Transl Sci. 2023;7(1):e84.
  25. Farris P, Crist R, Miller S, Shannon J. Rural research capacity: a co���created model for research success. Health Res Policy Syst. 2023;21(1):76.
  26. Hildebrand JA, Billimek J, Olshansky EF, Sorkin DH, Lee J���A, Evangelista LS. Facilitators and barriers to research participation: perspectives of Latinos with type 2 diabetes. Eur J Cardiovasc Nurs. 2018;17(8):737���741.
  27. Simacek KF, Nelson T, Miller���Baldi M, Bolge SC. Patient engagement in type 2 diabetes mellitus research: what patients want. Patient Prefer Adherence. 2018;12:595���606.
  28. Hood GA, Chowdhury TA, Griffiths CJ, Hood RK, Mathews C, Hitman GA. The mela study: exploring barriers to diabetes research in black and minority ethnic groups. Prim Health Care Res Dev. 2015;16(1):53���60.
  29. Emery JMK. Bringing Clinical Trials to Regional Patients. University of Melbourne; 2022. https://pursuit.unimelb.edu.au/articles/bringing���clinical���trials���to���regional���patients
  30. Walsh S, Dettwiller P, Puah L, Beks H, Versace V, Jones M. Decentralised clinical trials in rural Australia: opportunities and challenges. Aust J Rural Health. 2024;32(3):582���587.
  31. Hennink MM, Kaiser BN, Sekar S, Griswold EP, Ali MK. How are qualitative methods used in diabetes research? A 30���year systematic review. Glob Public Health. 2017;12(2):200���219.
  32. Creswell JW. aPC. Qualitative Inquiry and Research Design. SAGE Publications; 2024.
  33. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32���item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349���357.
  34. Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Health. 2024;2:100051.
  35. Forero R, Nahidi S, De Costa J, et al. Application of four���dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv Res. 2018;18(1):120.
  36. Australian Government DoHaA. Modified Monash Model 2023. https://www.health.gov.au/topics/rural���health���workforce/classifications/mmm
  37. Rahimi S, khatooni M. Saturation in qualitative research: an evolutionary concept analysis. Int J Nurs Stud Adv. 2024;6:100174.
  38. Speight J, Holmes���Truscott E. Challenging diabetes stigma starts and ends with all of us. Lancet Diabetes Endocrinol. 2023;11(6):380���382.
  39. Australian Government DoHaAC. Supporting research to address healthcare needs of rural Australians. PartyLine. 2023.
  40. Schmitz DF, Casapulla S, Patterson DG, Longenecker R. Building rural primary care research by connecting rural programs. Ann Fam Med. 2023;21(Suppl 2):S82���S83.
  41. Rodr��guez���Torres E, Gonz��lez���P��rez MM, D��az���P��rez C. Barriers and facilitators to the participation of subjects in clinical trials: an overview of reviews. Contemp Clin Trials Commun. 2021;23:100829.
  42. Holmes���Truscott E, Browne JL, Ventura AD, Pouwer F, Speight J. Diabetes stigma is associated with negative treatment appraisals among adults with insulin���treated type 2 diabetes: results from the second diabetes MILES���Australia (MILES���2) survey. Diabet Med. 2018;35(5):658���662.
  43. Mitchell S, Bragg A, Moldovan I, et al. Stigma as a barrier to participant recruitment of minority populations in diabetes research: development of a community���centered recruitment approach. JMIR Diabetes. 2021;6(2):e26965.
  44. Speight J, Holmes���Truscott E, Garza M, et al. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024;12(1):61���82.
  45. Ayton D, Braaf S, Jones A, et al. Barriers and enablers to consumer and community involvement in research and healthcare improvement: perspectives from consumer organisations, health services and researchers in Melbourne, Australia. Health Soc Care Community. 2022;30(4):e1078���e91.
  46. Brammall B, Teede H, Ng A, et al. Consumer and community involvement in preventive health: current insights and considerations for future best practice. Public Health Res Pract. 2024;34(1):e3412403. doi:10.17061/phrp3412403
  47. Alston L, Allender S, Peterson K, Jacobs J, Nichols M. Rural inequalities in the Australian burden of Ischaemic heart disease: a systematic review. Heart Lung Circ. 2017;26(2):122���133.
  48. Davis TC, Arnold CL, Mills G, Miele L. A qualitative study exploring barriers and facilitators of enrolling underrepresented populations in clinical trials and biobanking. Front Cell Dev Biol. 2019;7:74.
  49. Awuruonye A, Henderson F, Ferrell C, Harris K, Ramachandran V, Fox E. Facilitators and barriers to research participation in rural communities. J Rural Soc Sci. 2024;39(1):1���9.
  50. Kripalani S, Goggins K, Couey C, et al. Disparities in research participation by level of health literacy. Mayo Clin Proc. 2021;96(2):314���321.

Grants

  1. /Australian Centre for Accelerating Diabetes Innovation
  2. /Australian Centre for Behavioural Research in Diabetes
Journal Article

Word Cloud

Created with Highcharts 10.0.0researchruralcommunitiesdiabetesparticipationT2DrecruitmentAustralianadultstype2qualitativestudybarriersenablersamonglivingacrossstatesopportunitiesstrategiesflyAIM:Ruralunder-representedimplicationsgeneralisabilityimplementationreachoutcomesIncreasedeffortsconductinclusivepredicatedeffectiveparticipantexploresmotivationsMETHOD:phenomenologicalconductedinvolving18+���yearsusingmulti-modalapproachespurposefulsamplinggenderAudio-recordedsemi-structuredinterviewsexploredparticipants'perceptionsabductivecodingapproachundertakenidentifysalientthemesRESULTS:Twenty-oneparticipantsrecruitedsixmedianrangeage6341-78���years65%womenBarriersincludestigmalackcommunityawarenessgeographicaldistancessitesindividualtimeresourceconstraintsEnablersstronglyfocusedincreasedengagementinvolvementofferingeducationaccesscarepartactivitiesMotivationsincludedhelpadvocatehighlightunder-resourcinghealthcareservicesCONCLUSION:Studyfindingsinformpracticalmayimprovemechanismsexamplecommunity-drivenmethodsEvaluationeffectivenesspracticewillneeded'Theseagulltheory:peoplegatherinformation���nothingevercomesabout':exploration

Similar Articles

Cited By

No available data.