{"paper_id":"0fdbba22-4d68-427f-b0bc-69a121832bac","body_text":"1/14\nOriginal Research\nConsumer-driven approach to determining health research priorities: what\nmatters most to people living in rural Australia?\nAUTHORS\nSoraia C Catapan  PhD, Senior Research Fellow *  [https://orcid.org/0000-0001-6223-1697]\nBushra F Nasir , Research Fellow  [https://orcid.org/0000-0002-8372-4877]\nTracy Kolbe Alexander  [https://orcid.org/0000-0002-5025-3204]\nAlison Bell  [https://orcid.org/0000-0002-0624-4685]\nJo Maxwell  [https://orcid.org/0009-0003-3976-5297]\nBec Jenkinson  [https://orcid.org/0000-0001-6723-8898]\nWilliam MacAskill  [https://orcid.org/0000000339795368]\nJess Taylor\nAnja Christoffersen  [https://orcid.org/0009-0002-2457-0342]\nLeonie Gavioli\nAnthony C Smith  [https://orcid.org/0000-0002-7756-5136]\nTrevor Russell , Director  [https://orcid.org/0000-0002-9732-6167]\nCORRESPONDENCE\n*Dr Soraia de Camargo Catapan s.decamargocatapan@uq.edu.au\nAFFILIATIONS\n Centre for Online Health, The University of Queensland, Brisbane, Qld, Australia\nr\nRural and Remote Health www.rrh.org.au\nJames Cook University ISSN 1445-6354\n1,2\n3\n4,5,6\n7\n8\n9\n3,10\n11\n2,12\n3,13\n1,14\n7\n1\n\n2/14\n Australian Frailty Network, The University of Queensland, Brisbane, Queensland, Australia\n Rural Clinical School, Medical School, Faculty of Medicine, The University of Queensland, Toowoomba, Qld, Australia\n School of Health and Medical Sciences and Centre for Health Research, University of Southern Queensland, Brisbane, Qld, Australia\n UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science\nand Sports Medicine, University of Cape Town, South Africa\n Manna Institute, Centre for Health Research, University of Southern Queensland, Brisbane, Qld, Australia\n RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia\n Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Qld, Australia\n UQ Clinical Trials Capability (ULTRA) team, The University of Queensland, Australia, Brisbane, Qld, Australia\n Rural Clinical School, Griffith University, Toowoomba, Qld, Australia\n QENDO and Australian Coalition for Endometriosis, Australia\n Champion Health Agency, Australia\n Telehealth Consumer Reference Group, Centre for Online Health, The University of Queensland, Brisbane, Qld, Australia\n University of Southern Denmark, Odense, Denmark\nPUBLISHED\n1 September 2026 Volume 26 Issue 3\nHISTORY\nRECEIVED: 17 April 2025\nREVISED: 29 April 2026\nACCEPTED: 5 July 2026\nCITATION\nCatapan SC, Nasir BF, Alexander T, Bell A, Maxwell J, Jenkinson B, MacAskill W, Taylor J, Christoffersen A, Gavioli L, Smith AC, Russell\nT.  Consumer-driven approach to determining health research priorities: what matters most to people living in rural Australia? Rural and\nRemote Health 2026; 26: 9949. https://doi.org/10.22605/RRH9949\nThis work is licensed under a Creative Commons Attribution 4.0 International Licence\nAbstract\nIntroduction: Rural, regional and remote (henceforth ‘rural’)\ncommunities face unique health challenges, including limited\naccess to health care, workforce shortages, and higher disease\nburden. Consumer and community involvement is essential for\naddressing real-world health needs and fostering equity, yet its\nrole in shaping research priorities remains largely underexplored,\nparticularly in rural contexts. This study aims to identify consumer\npriorities for rural health research in Australia and to describe the\nprocess and learnings of a novel approach to promoting\ninvolvement of rural consumers in health research.\nMethods: We adopted the World Café method, involving a 1-day\nworkshop and pre- and post-surveys with rural consumers and\nresearchers from the Western Downs region of Queensland,\nAustralia. We invited participants to share their health experiences\nand identify local health priorities. Discussions were graphically\nrecorded during the workshop. Participants and facilitators notes\nwere content-analysed to identify key research categories.\nDemographic data and pre- and post-workshop surveys were\nanalysed descriptively.\nResults: Five key priorities were identified: (1) recruiting and\nretaining GPs in rural towns; (2) expanding multidisciplinary care;\n(3) increasing community awareness of local health and wellbeing\nservices; (4) enhancing chronic care options, including remote\nmonitoring; and (5) addressing links between health and hardship,\nsuch as housing and financial challenges. Consumer and\nresearcher participants reached consensus on the need for\ntailored, community-driven interventions and increased\ncollaboration between researchers, policymakers, and local\ncommunities.\nConclusion: Active involvement of consumers is important for\ndetermining user needs and research priorities in rural community\nsettings and should be routine when planning and prioritising\nhealthcare services in order to foster improved health outcomes.\nKeywords\nAustralia, community-based participatory research, health care, health services research, research priorities, rural health, telehealth.\n2\n3\n4\n5\n6\n7\n8\n9\n10\n11\n12\n13\n14\n\n3/14\nIntroduction\nThe health of regional, rural and remote (henceforth ‘rural’)\ncommunities is a key priority for health system reform across\nAustralia due to inequitable healthcare access and complex\ncommunity needs. These challenges are compounded by\ninsufficient local service provision and long distances to access\ncare, which extend beyond the burden of disease to include the\nimpact of social determinants of health. As a result, rural\nAustralians experience disparities in healthcare affordability, longer\nwait times, and reduced access to health care, leading to higher\nrates of preventable hospitalisations. In Australia, burden of\ndisease varies with remoteness, and people living in rural areas are\nmore likely to die from preventable causes compared to those\nliving in major cities.\nReplicating metropolitan healthcare models in rural areas is often\nineffective due to differences in demographics, workforce\navailability, infrastructure, and community needs. Population\nhealth and health services research are vital for strengthening\nhealth systems at both local and broader levels, as they provide\nevidence-based insights into system functioning and identify\nopportunities to improve efficiency and performance. Such\nresearch ultimately contributes to better population outcomes and\ncan inform policy by aligning health services provision with\ncommunity needs. Consumer involvement is critical in\ntranslating lived health and service needs into research priorities,\nas these needs are related but not directly interchangeable. Studies\nsuggest involving communities in health reform and research\nprioritisation to address these disparities is vital. Engaging\nconsumers in research prioritisation ensures that emerging\nresearch questions remain grounded in real-world experience and\nare perceived as relevant to policy and practice. However, people\nfrom rural areas have often been left out of consumer and\ncommunity involvement initiatives in health research. Despite the\ngrowing expectation from funders and from the community for\nhealth and medical research to include people with lived\nexperience as partners throughout the research cycle, genuine\ninvolvement of rural consumers remains limited. It is important\nto overcome this gap as opportunities to build relationships\nbetween researchers, health consumers, and community members\nare recognised as key enablers to sustaining rural health\nresearch.\nTo support consumer and community involvement in rural health\nresearch, a consumer roundtable event was hosted by the\nUniversity of Queensland Consumer Network in early 2024. The\nevent was held in Dalby, a small rural town with approximately\n13,000 residents in the Western Downs region of Queensland,\nsurrounded by communities such as Toowoomba, Oakey, and\nChinchilla. Dalby is classified as Modified Monash Model (MMM)\ncategory MM 4, indicating limited access to healthcare services.\nLocal services include two GP clinics, an Aboriginal Medical Service,\nDalby Hospital, dental clinics, allied health providers, and\npharmacies. Access to medical specialists is scarce and most\nhospital doctors are rural generalists. This event aimed to bring\nresearchers to the rural consumer table to seed relationships,\nexplore emerging issues and possible shared priorities for future\nresearch, with the ultimate and indirect goal of promoting long-\nterm improvements in health service provision.\nAcknowledging the time required to bridge gaps between\ncommunity needs, health services research, policy change, and\nservice improvement, this study has two aims. First is to identify\nconsumer priorities concerning rural health research in\nQueensland. Second is to describe the process of a novel\nconsumer roundtable approach to promoting rural Queensland\nconsumers’ involvement in health research, and to provide\nrecommendations to support the planning of similar initiatives.\nMethod  \nStudy design\nWe used an adaptation of the World Café method to facilitate\ndialogue, explore topics of importance to local community\nmembers, and encourage connections between researchers and\nhealthcare consumers. World Café is a flexible, bottom-up\nparticipatory research method widely used to capture people’s\nlived experiences and varied perceptions, and to find sustainable\nsolutions to global challenges. Event leads (JM, AB, BJ) were\nexperts in consumer and community involvement, with extensive\nexperience in planning and conducting workshops, one with an\nacademic background (BJ) and two professional consumer and\ncommunity involvement staff (AB, JM). \nSampling and recruitment\nConvenience, purposive, and snowball principles were used for\nsampling and recruitment of participants to the 2024 consumer\nroundtable. Consumers were invited to participate in a two-way\nprocess. First, an invitation to register for the event was circulated\nby email list to consumer networks, including Health Consumers\nQueensland and the University of Queensland Consumer Network\nin Health Research. Second, a local community member (WM) was\nrecruited to distribute flyers and posters to local organisations and\nmeeting places (eg library, country local association, community\nboards, shopping centre, healthcare providers) and promote the\nevent by word of mouth among the community. Distributed flyers\nand posters contained a QR code to register for the event and\ncontact details for further information. Interested people were\ndirected to the participant information sheet, demographic and\npre-survey form hosted on the Qualtrics survey platform\n(https://www.qualtrics.com [https://www.qualtrics.com/]). A paid\nadvertisement on Dalby and surrounding towns’ community\nFacebook pages and a public radio announcement were also part\nof the recruitment strategy. People who emailed or sent a\nFacebook message were called back and registered over the\nphone by event leads (AB, JM).\nAll consumers who expressed interest were invited to attend the\nworkshop and offered an A$100 gift card to acknowledge their\ntime and contribution. Gift cards were provided to consumer\nparticipants on the day at the event to enable immediate payment\nand avoid delays associated with bank transfers.\nAcademics were invited to attend the 2024 Consumer Roundtable\nby emails circulated to research chairs across both University of\nQueensland’s Faculty of Health and Behavioural Sciences and the\nFaculty of Medicine. The selection of attendees was based on rural\nhealth research interest, representation across organisational units,\nas well as maximising gender and cultural diversity.\nReimbursement of travel expenses was negotiated with each\n1\n2\n1\n3\n4,5\n6,7\n8\n9\n10\n7\n9,11\n12\n13\n14\n15,16\n16\n15\n17\n\n4/14\nparticipant, on a needs basis. An A$50 gift card to contribute\ntowards out-of-pocket expenses incurred to attend the event was\ngiven to attendees on the event day.\nInitially, the consumer roundtable was planned for November\n2023, and the first wave of recruitment happened from August to\nOctober 2023. Due to bushfires in the region, the event had to\nbe postponed. It was rescheduled for mid-February 2024, and a\nsecond recruitment wave happened in January and the start of\nFebruary.\nWorld Café method\nThe consumer roundtable event was scheduled to take\napproximately 4 hours, and activities were planned based on the\nfollowing five World Café design principles.\n1. Setting the context and creating a hospitable space\nThe event was held in a large hall of the main local events centre\nand included round tables, chairs, and refreshments. Stationery\nmaterials (eg butcher’s paper, coloured pens, sticky notes) were\nprovided to record discussion points and ideas.\n2. Welcome and introduction\nAttendees listened to three presentations of approximately\n15 minutes each throughout the event (two at the beginning and\none before the harvest of ideas, item 5) to inspire and stimulate\nfollowing discussions. Topics presented included consumer\ninvolvement in rural research, challenges and solutions for rural\nhealth care, and how telehealth can make a difference.\n3. Small group rounds\nParticipants were invited to take part in three 20-minute rounds of\nconsumer-led small group discussion, each with a different focus\nquestion. Each table was planned to have approximately four or\nfive consumers and two or three academics, totalling eight tables.\nOne consumer attendee per table was asked to act as table host\nand remain at their chosen table for each round of discussion.\nTable hosts received a briefing document and on-the-day support\nfrom experienced consumers (JT and AC). Their role included\nwelcoming attendees, summarising previous groups’ ideas during\nthe second and third discussion rounds, encouraging participants\nto record ideas on butcher’s paper, actively contributing to\ndiscussions, and supporting quieter voices to participate. To\nmaximise participation and cross-pollination of ideas, consumers\nremained on their tables and academics rotated around tables at\nthe end of the first and second rounds.\n4. Questions that matter\nFour consumer consultants (WM, JT, AC, and a consumer who\nchose to remain anonymous and is not listed as an author) met\nwith an event lead (JM) to design recruitment strategies, plan the\nevent activities, and develop four focus questions, one for each\nround of discussion and the last for the harvest of ideas. Questions\nfor the small group rounds were as follows:\nWhat does regional and rural health care look and feel like?\nWhat unique health challenges and innovations have you\nexperienced or seen in your community?\nHow can the health system better respond to the needs of\nyour community?\n5. Harvest of ideas\nFollowing these three rounds of small group discussions, a whole\ngroup discussion to share ideas and directions was facilitated by\nevent leads (JM, BJ). JM displayed the butcher’s papers on the wall\nand summarised the main topics discussed in each round of\ndiscussion, reporting back to all attendees at the end of the three\nrounds to prompt further cross-pollination and idea generation,\nintroducing the harvest of ideas. BJ led the discussion open to all\nparticipants, focused on the consumer-designed question, ‘What\ndo consumers want rural and regional health research to\ninvestigate next?’\nData collection\nDemographic data\nWhen individuals consented to participate, they were immediately\nasked to answer demographic and perceptions of consumer and\ncommunity involvement questions (Appendix I), either online or in\npaper format, depending on how they signed the consent form.\nPerceptions of consumer and community involvement response\noptions were based on a five-point Likert scale ranging from\n‘strongly disagree’ to ‘strongly agree’.\nWorld Café roundtable discussions\nRoundtable discussions were not audio-recorded, to encourage\nfree, open, and spontaneous sharing and participation. All\nhandwritten notes produced by attendees on posters were\ncollected, and personal notes made by investigators (JM, BJ)\nduring and after the discussions. A graphic artist (recorder) was\nengaged to capture small and large group discussions in real time\nand reflect them back to the group in the form of a mural.\nParticipants reviewed the images and summary, providing\nfeedback to verify and ensure data accuracy during the event. After\nthe discussions, BJ led a review of the artwork and collective\nsummarisation of the main topics. Two consumer consultants (AC,\nJT) closed the day by reflecting on the discussions and offering\nattendees practical tips on how to move forward. \nFollow-up survey\nTwo days after the event, attendees were emailed an anonymous\nfeedback survey (Appendix II). The same pre-survey questions on\nperceptions on consumer and community involvement were asked\nagain to researchers and consumers. These questions address\nconsumer involvement in research, their role in shaping health\nstudies, confidence and readiness for collaboration, and the value\nof lived experience. Investigator notes and descriptions of the\ngraphic recording were used to set a list of research priorities, and\nconsumers were invited to a priority-setting exercise, by selecting\nand ranking, in order of importance, their top three ideas.\nData analysis\nDemographic data and follow-up survey\nParticipant demographic data were analysed using descriptive\nstatistics in Microsoft Excel, presented as counts and frequency.\nPerceptions on consumer and community involvement were also\nanalysed using Excel, and Likert scale responses were plotted in a\nstacked bar chart.\n18\n19\n\n5/14\nWorld Café roundtable discussions\nParticipants’ handwritten notes from the butcher’s papers were\ntranscribed into an Excel spreadsheet, separated under each focus\nquestion and subject to conventional inductive content analysis.\nCodes and code descriptions were attributed to each of the lines\nof text and a summary category combining related codes and code\ndescriptions was produced. For example, codes such as lack of\nlocal resources, continuity of care, sustainability, access to\ntechnology, and knowledge of local services were all combined\nand summarised under the category ‘lack of local resources and\nawareness of available healthcare services’. The graphic record of\nthe discussions was also integrated into the analysis and cross-\nreferenced with the raw data and identified categories in the Excel\nspreadsheet, with the goal of identifying shared ideas and research\npriorities. Extracts reproduced exactly as they were written by\nparticipants are reported in quotation marks (eg ‘It all comes down\nto the dollar’). Rigour was ensured through a systematic approach\nto analysis, with all authors present at the event providing\ncontextual understanding, multiple researchers contributing to\ncoding and category development, and thorough documentation\nsupporting transparency and credibility of the findings.\nPriority-setting exercise\nUsing the graphic records and harvested ideas, investigators\ncompiled a list of 17 priorities, which was then emailed to\nconsumers as part of a follow-up survey. The total number of votes\nfor each priority was recorded, and priorities were presented in\ndescending order.\nEthics approval\nAll participants were invited to give their informed consent to\nparticipate in this study. An email with an online link to the\nparticipant information and consent form (using Qualtrics, see\nAppendix I) was sent to all registered attendees. Printed copies\nwere also available at registration on the day. Attendees who did\nnot consent or did not want their data to be included in the\nresearch were asked to make notes in red pen, so their notes could\nbe excluded from data collected. Ethics approval was obtained\nfrom the University of Queensland Human Research Ethics\nCommittee (approval 2023/HE001724).\nResults\nParticipant characteristics\nA total of 43 expressions of interest were received from consumers\nduring recruitment. Twenty-seven (63%) of these consumers\nregistered for the event, and 21 (49%) attended. Twenty\nresearchers (academic staff) attended the event, resulting in\nequivalent numbers (1 : 1) of consumers and researchers.\nResearchers were from three different universities, five were\ncurrently based at rural or regional campuses, and others were\naffiliated with multidisciplinary schools and centres with experience\nin rural and remote health research. Demographic characteristics\nare shown in Table 1.\nTable 1: Consumer roundtable event participant characteristics\nCharacteristic VariablesConsumersResearchers\nn % n %\nGender Male 4 19.05 8 40.00\nFemale 17 80.95 12 60.00\nAge group (years) 20–29 2 9.52 1 5.00\n30–39 3 14.29 3 15.00\n40–49 2 9.52 6 30.00\n50–59 9 42.86 8 40.00\n60–69 3 14.29 2 10.00\n≥70 2 9.52 0 0\nAboriginal and/or Torres Strait Islander identity Yes 1 4.76 0 0\nNo 20 95.24 20 100\nLiving with a disability and/or chronic health condition Yes 4 19.05 1 5.00\nNo 17 80.95 19 95.00\nCaring for someone with a disability and/or chronic health conditionYes 4 19.05 0 0\nNo 17 80.95 20 100\nCulturally and/or linguistically diverse Yes 3 14.29 4 20.00\nNo 18 85.71 16 80.00\nLGBTQIA+ Yes 0 0 1 5.00\nNo 21 100 19 95.00\nTotal   21 100 20 100\nWorld Café roundtable discussions\nConsumer roundtable participants (n=41) were divided into six\ngroups for the table discussions. Considering the lower-than-\nexpected number of consumer attendees, each table had three or\nfour consumers and three or four researchers. Discussions were led\nby a consumer host. Analysis of the attendees’ contributions on\nbutcher’s papers, cross-referenced with the graphic recordings of\nthe session (Fig1, Fig2), is presented below.\nSmall group discussion round 1: What regional and ruralhealth care looks and feels like\nLack of local resources and awareness of availablehealthcare services\nAccording to attendees, healthcare access in rural regions faces\nsignificant challenges due to long wait times for appointments,\nhigh staff turnover, bed shortages in the local hospital, extensive\ntravel distances, limited transportation options and\nunderutilisation of telehealth services. Many people remain\n20\n20\n21\n\n6/14\nunaware of available health services due to the poor visibility and\npromotion of these, especially among older people and people\nwith disability. Often, they hesitate to seek help, fearing they might\nincrease strain on already stretched services. High staff turnover\nand shortages of GPs, specialists, and allied health professionals\nlead to delays in treatment and fragmented care. Emergency\ndepartments become overburdened as patients struggle to access\nGPs, and natural disasters, unintentional injuries, or emergencies\nexacerbate delays in care, especially in remote or isolated areas.\nMetropolitan models of care do not work in rural settings\nAttendees emphasised the value of local services and a greater\nneed for flexible, community-based approaches. Enhancing the\nroles of nurses and patient navigators; improving local healthcare\neducation and health literacy; and adapting services to fit the\nspecific needs of rural populations were perceived as crucial to\nbetter address the unique challenges and improve healthcare\noutcomes in rural areas.\n‘It all comes down to the dollar’\nParticipants said accessing specialist health providers and\nmedications in rural areas is costly, often requiring upfront\npayments, gap fees (out-of-pocket fees paid by a patient when a\nservice exceeds the Australian public healthcare system coverage),\nand self-funding travel expenses, reducing their access to care.\nDespite healthcare professionals’ efforts to focus on patients’\nneeds, the financial burden remains a significant barrier, with\nhidden costs and co-payments adding to the strain.\nSmall group discussion round 2: Rural communities’unique challenges and innovations\nRural communities face unique health challenges beyondlack of healthcare access\nIn addition to challenges like isolation, limited access to care, long\ntravel distances, and high costs, attendees highlighted poor local\nwater quality, lack of culturally appropriate care, nepotism in\nhealthcare institutions, and difficulties in accessing patient travel\nsubsidies as unique challenges faced by rural communities, such as\nthe difficulty of navigating the fragmented healthcare system. The\nincreased pressure and workload on healthcare professionals leads\nto high staff turnover, disrupting continuity of care and rapport-\nbuilding, and eroding trust between patients and healthcare\nproviders.\nInnovative models of care\nAlthough people living in rural areas might prefer face-to-face\ninteractions, participants agreed that innovations like telehealth\nhave the potential to improve access and continuity of care.\nChallenges include lack of digital literacy, connectivity issues, and\naccessing computing devices. However, improved telehealth\naccess, support from local health workers, and successful local\nvirtual health services can make a positive impact in changing\nperceptions about innovative models of care. Goondir Health\nServices, a local Aboriginal Community Controlled Health Service\nin Dalby, was mentioned by participants as an example of a\nsuccessful local virtual healthcare service.\nOther suggested innovations included mobile health units offering\npreventive and treatment services, drone deliveries for medications\nand lab sample collection, subsidised housing for healthcare staff,\nfly-in specialists, free mental health services, and enabling nurse\npractitioners to write prescriptions. Rural areas possess a unique\nand strong sense of community that should be valued. Participants\nwanted local health services to be multidisciplinary,\ninterconnected, and flexible to adapt to the needs of the\ncommunity. An effective local health system should not rely solely\non the generosity of community members and local organisations\nbut also draw on the social responsibility of resource companies\nbased in the area (eg solar, gas, and mining companies).\nSmall group discussion round 3: How the health systemcan better respond to the needs of the community\nShared decisions, integrated care, and communityempowerment are paramount\nTo improve the healthcare system, attendees emphasised the\nimportance of shared decision-making, where patients' voices are\nheard and valued. The event featured numerous testimonials of\nunilateral healthcare decisions made by the clinician without\nlistening to their patients, which often resulted in suboptimal\ntreatment and outcomes.\nAttendees wanted to see improved telehealth infrastructure,\nespecially using video rather than the phone, with continuity of\nfunding, integrating care with better handovers and detailed\ndischarge plans, and increasing health system efficiency with\nstreamlined processes and digitalisation of paperwork (eg\nimplementing electronic scripts). Additionally, facilitating patient\naccess and awareness of travel subsidies, funding training in first\naid, increasing the community’s health literacy, allowing more time\nfor appointments, enhancing communication through social\nmedia, and valuing relationships and local culture are essential. All\nefforts should be co-designed and sustainable, with local voices\nheard, acknowledged, and acted upon, decreasing the gap\nbetween healthcare management and the community.\nHealthcare professionals should be ‘trained and retained’\nParticipants agreed that incentives for a broad variety of healthcare\nworkers, not only medical doctors, with retention strategies should\nbe developed with sustainable models. The reality of rural\nhealthcare work often includes mental and emotional challenges,\nand retention strategies for healthcare workers should include\nliving allowance and childcare support, more bonded scholarships\nand better professional support. Permanency of staff providing\ncare in communities would increase continuity of care.\n‘Care should be prioritised over budget’\nAttendees agreed political short-sightedness and inconsistent\nfunding hinder sustainable healthcare improvements. The overall\nmessage was quality care and improved outcomes should be\nprioritised over budget. Leaders need to turn ideas into action and\nfund community initiatives and pilots, with a focus on flexibility\nand adaptability for broad implementation. Increasing bulk-billing\nGP facilities, prioritising continuity of care, enhanced coordination\nbetween state and federal health departments with better use of\nlocal data, and innovative solutions (eg using school buses for\naged care travel) could help address some of the funding\nchallenges.\n\n7/14\nFigure 1: Graphic recording of the three World Café roundtable small group discussions, by Rachel Apelt.\nHarvest of ideas whole group discussion: The next targetfor rural health research\nAttendees felt upcoming research in rural health should focus on\ndeveloping holistic and accessible healthcare services that retain\nlocal GPs and address the reactive nature of post-COVID health\ncare. One target area of research suggested for rural health care\nincluded implementing and evaluating a ‘super telehealth clinic’ to\nremove barriers, ensure continuity and access to care, with regular\nGPs and health professionals readily available, and clear safety\nparameters. Emphasis should be placed on improving telehealth\nexperiences, enhancing preventative health education, and\npromoting better patient-centred care. People want to be in\ncontrol of their own care, have their voices heard, and have choice\nof when they access care (eg get appointments when needed) and\na choice of who has input into that care (eg multidisciplinary team\ninput). Care should also be more compassionate and holistic,\nacknowledging the complexity of end-of-life processes, integrating\nmental with physical health and financial counselling. Improving\nsupport for community initiatives (eg teaching health literacy and\nhealth advocacy in schools, online yoga classes) was also\nemphasised. Additionally, the funding model should distribute GP\nresponsibilities (eg patient navigator, nurse prescription service) to\nadapt to rural needs, mapping available services to maximise\nresources and avoid duplication.\nFigure 2: Graphic recording of World Café roundtable whole group discussion (harvest) by Rachel Apelt.\n\n8/14\nPriority-setting exercise\nFrom the graphic representation of the whole group discussion\n(Fig2) and researchers’ notes taken during the harvest of ideas\ndiscussion, a list of 17 priorities was compiled and emailed to\nconsumers in the follow-up survey. Consumers then selected and\nranked their three most important priorities based on personal\npreference; three consumers voted for their 10, 13 and 14 top\npriorities (Table 2).\nWritten feedback given about the top three priorities reinforced\nthe urge to avoid unnecessary long travel and wait times, the\nunacceptability of turning patients away due to lack of\nappointments, and the need to attract and retain GPs in rural\nareas, ensuring continuity of care. It also pointed to the need to\neducate consumers about their healthcare rights and services to\nimprove support in rural areas.\nTable 2: Consumer priorities for the next target of rural health research, listed in descending order of total number of votes\nNumberPriority Total votes\n1 Attracting and keeping GPs in rural towns 7\n2 Expanding the care provided by community-based healthcare professionals other than doctors (eg pharmacists, nurse practitioners, midwives) 7\n3 Increasing awareness of health and wellbeing services available locally 7\n4 Options to proactively manage chronic disease, including remote monitoring 6\n5 Programs to address the connection between health and hardship, such as housing and money worries 6\n6 Improving access to mental health services (addressing GP gatekeeping) 4\n7 Improving telehealth services to support access and continuity 4\n8 Improving patient-centred communication 4\n9 Community driven, place-based programs to improve health and wellbeing of locals 4\n10 Integration of telehealth with face-to-face health services 4\n11 Bringing back health services that closed during COVID 3\n12 Improving empathy and compassion, especially when delivering bad news by telehealth 3\n13 Programs to improve access to fresh fruit and vegetables 3\n14 Online health and wellbeing programs (eg yoga, community connection) 2\n15 Programs to improve health literacy and self-advocacy skills in the community 1\n16 Increase access of secondary school students to GPs 1\n17 Impact of social pressures on children and young people, and its connection to mental health 1\nPre- and post-event perception on consumer andcommunity involvement analysis\nPerceptions on consumer and community involvement survey\nresponses for consumers pre-event (n=25) and post-event (n=12)\nand researchers pre-event (n=18) and post-event (n=10) are\npresented in Figure 3 and Figure 4, respectively. Survey responses\nshowed the event has raised consumers’ awareness of their\npotential role in shaping health research but appeared to reduce\ntheir confidence to participate in projects of interest. Researchers\nreported greater awareness of consumer involvement across all\nphases of the research cycle and increased confidence to\ncollaborate with consumers after the event.\nFigure 3: Comparison of consumer perceptions on consumer and community involvement pre-event (n=25) and post-event\n(n=12). \n\n9/14\nFigure 4: Comparison of researcher perceptions on consumer and community involvement pre-event (n=18) and post-event\n(n=10). \nDiscussion\nThis study identified health services research priorities from the\nperspectives of rural consumers and researchers in Australia,\nfocusing on empowering local voices in shaping research and,\npossibly, service delivery. By employing the World Café method\nthrough a consumer roundtable event and pre- and post-event\nsurveys, the study captured community-driven insights, solutions,\nand innovations. Key findings highlighted five pressing priorities:\nrecruiting and retaining a rural health workforce, expanding\nmultidisciplinary community-based care, increasing awareness of\nlocal services, enhancing chronic care management, and\naddressing social determinants of health such as housing and\nfinancial challenges. These priorities underscore the critical need\nfor tailored, community-led interventions and enhanced\ncollaboration between researchers, policymakers, and local\ncommunities to foster equitable healthcare services in rural areas.\nParticipants advocated for flexible, community-based healthcare\nmodels to alleviate barriers such as unreasonable wait times for GP\nservices. The desired model should extend beyond traditional GP\npractices, incorporating expanded nursing roles, mapping local\nservices to improve awareness and utilisation, and exploring\nalternative service delivery options, including telehealth and virtual\nhealth solutions. Rural communities such as the Dalby and\nsurrounds community demonstrate a strong sense of collective\npride and resilience, which can be leveraged to enhance local\nhealthcare models. Effective communication and ongoing service\nmapping are essential to ensure existing healthcare resources are\noptimally utilised and consistently updated. \nMapping local services not only enhances accessibility but also\nidentifies gaps where new services can be introduced. Participants\nemphasised the need for healthcare models to prioritise quality\nand health outcomes over budget constraints. These findings align\nwith existing literature, highlighting key opportunities to reshape\nrural spaces, promote justice, and reduce inequities, including (1)\nacknowledging the diversity within rural populations rather than\napplying a uniform approach; (2) leveraging local knowledge,\ncommunity values, and independence; and (3) designing care\nmodels that address local needs rather than replicating\nmetropolitan innovations. These insights suggest a paternalistic\nhealth system, which assumes consumers will passively accept\ninnovations to overcome geographical barriers and the tyranny\nof distance, is no longer a viable approach.\nInternational examples, such as Brazil's Family Health Strategy,\nillustrate effective community-based healthcare models. The\nstrategy utilises multidisciplinary teams to map households and\navailable services within designated territories, each team covering\nup to 150 families in rural areas. Community healthcare workers\nplay a critical role in regularly engaging with residents, collecting\nhealth data, and disseminating information on available services.\nThis structured approach facilitates dynamic territorial mapping,\nrisk stratification, and resource allocation, leading to improved\nhealth outcomes, reduced hospitalisations, and enhanced equity in\nhealthcare access. Such a model demonstrates the value of\nembedding healthcare services within rural networks, tailoring care\npathways to meet diverse needs.\nEnsuring that all healthcare professionals are working to the full\nextent of their scope of practice is an ongoing policy initiative in\nAustralia. In some cases, expanding their scope can also help\naddress gaps in rural health care. For example, since mid-2025,\nregistered nurses who complete accredited education programs\nhave been authorised to prescribe Schedule 2, 3, 4, and\n8 medications in collaboration with an authorised health\npractitioner. This expansion is expected to help reduce wait\ntimes for GP appointments and improve medication access for\nchronic condition management in rural areas. Additionally, primary\ncare nurse-led models supported by virtual care technologies have\nbeen shown to significantly reduce the need for rural residents to\ntravel for medical care. A pilot study in Australia demonstrated\nnurse-led virtual care reduced the necessity of leaving the\ncommunity by nearly 80%. Such models have also improved\nhospital indicators, improved chronic disease management, and\nincreased patient satisfaction.\nAustralia has implemented several virtual healthcare solutions to\nsupport rural communities over recent decades. However, the\nsuccess and sustainability of these solutions rely on their potential\nto be flexible and adaptable to local needs. The Virtual Rural\nGeneralist Service in Western New South Wales is an example of\nadaptability, with potential for sustainable success. Using a hybrid\n24/7 model that combines virtual and in-person consultations, this\nmodel enhances access to continuous and integrated primary care\nin rural areas. By mapping healthcare needs and available\nservices, the model addresses workforce shortages, optimises\nresource distribution, and reduces reliance on locum shifts, making\ncare more cost effective than usual care. Additionally, innovative\nmodels such as telemonitoring of chronic conditions have been\nco-developed with Aboriginal and Torres Strait Islander rural\ncommunities, allowing consumers to actively engage in their own\n22\n23\n24\n25\n26,27\n28\n29\n30\n31\n31\n32\n33\n\n10/14\nhealth care, from design to use. This co-designed approach\nenhances accessibility and ownership of the model, providing real-\ntime monitoring, and supporting patient empowerment and self-\nmanagement. \nAnother emerging solution that could potentially improve\nspecialist access in rural areas without requiring travel and\nmaintaining care coordination within the community is\nimplementing electronic consultations. Evidence suggests primary\ncare clinicians who seek specialist advice through a structured,\nstandardised and electronic system can reduce referrals by over\n30%, ensuring timely specialist input, minimising treatment\ndelays. This modality represents a cost-effective solution that\nenhances primary care capacity and addresses both workforce\nshortages and rural healthcare inequities.\nThe retention of healthcare staff remains a significant challenge in\nrural areas. Participants in this study recognised the importance of\nhaving a stable, local workforce to ensure high-quality, continuous\nprimary care. Effective retention strategies must be multifaceted,\nemphasising relationship-building, community integration, and\nworkforce development. Policy recommendations, such as those\noutlined in the Australian Government's Scope of Practice Review,\nhighlight the need for targeted GP retention strategies that focus\non strengthening education, recruitment, and support\nmechanisms.\nOne approach that has demonstrated success is immersive student\nexperiences, where trainee clinicians are placed in rural settings\nearly in their education. These initiatives foster connections\nbetween future healthcare providers and rural communities,\nincreasing the likelihood of long-term retention. Globally, WHO\nhas emphasised the importance of rural training programs, task-\nsharing, sustainable investment, and digital innovations in\npromoting equitable workforce distribution. Addressing social\ndeterminants of health, such as improved living conditions, may\nfurther contribute to attracting and retaining healthcare\nprofessionals in rural areas in addition to addressing key\npriorities raised by participants of this study.\nAnother key finding from the consumer roundtable was the\ndiffering impact on researchers' and consumers' confidence in\nresearch collaboration. While researchers reported increased\nconfidence in working with consumers, consumers felt less\nconfident about engaging in projects that interested them. This\ndecline may reflect uncertainty about their fit or relevance to the\nprojects discussed, despite more consumers expressing readiness\nto collaborate. It may also highlight consumers’ growing\nawareness of research complexities and the need for upskilling to\neffectively advocate for their priorities. To support meaningful\nconsumer involvement, capacity-building initiatives are essential,\nalongside genuine relationship-building and ongoing, open\ncommunication between consumers and researchers.\nStrengths and limitations\nThe project benefited from a multidisciplinary leadership team\ncomprising not only academics but also experienced consumer\nconsultants and professionals in consumer engagement, enriching\nthe planning and execution of the event. The participation of 20\nlocal consumers from 43 who were interested represented a broad\ndemographic spectrum and the willingness of locals to be involved\nin setting research priorities, ensuring the process was grounded in\nthe local rural context. This event has led to several follow-up\nresearch projects in collaboration with local communities,\ngrounded in identified priorities, although these outcomes were\nnot formally measured.\nThe event was held in a large rural town to optimise attendance;\nhowever, this may have reduced participation of residents in\nsmaller satellite towns due to travel time and costs. The provision\nof gift cards to offset out-of-pocket expenses was used to reduce\nthis limitation. Despite efforts to maintain a 2 : 1 ratio of\nconsumers to researchers, the final ratio was closer to 1 : 1, still a\nhigher consumer representation compared to similar activities.\nTo encourage free and open participation, discussions were not\naudio-recorded; however, this resulted in limited use of direct\nquotes. Another limitation of the study is the restricted\ngeneralisability of the findings to other rural contexts, considering\nthey are community-specific. However, similarities between the\nfindings and other consumer activities documented in the\nliterature, such as the priority to address the lack of GPs in rural\nareas, provide some validation. Low representativeness of\nAboriginal and Torres Strait Islander people in the event was also a\nlimitation considering the high proportion of this group in rural\nareas. Despite these challenges, the identified rural health issues\naligned with existing literature and reports, indicating the\nconsumer roundtable has captured relevant insights.\nLessons learned and recommendations\nConsidering this article reports on the second consumer\nroundtable event hosted by the University of Queensland\nConsumer Network (results of the first event were published\nelsewhere, we have learned this consumer and community-\ncentric model of research priority setting is transferrable to other\nsettings and communities, such as rural health. The first roundtable\nevent attempted to unite people on a pre-determined research\ninterest, telehealth, whereas the second showed it is still effective\nwhen focusing on identifying community needs more generally. \nThe broad range of priorities ranked as important to consumers\nreinforces the need to capture and progress as many priorities as\npossible, while creating pathways for relationships seeded at the\nevent to evolve into research projects. Progressing conversation to\naction, and maintaining and nurturing relationships with a\ncommunity in the time and way that suits them, is not always\nachievable due to the slow, stop–start nature of research and\nlimited funding dedicated to building genuine relationships in\ncommunity.\nThe open-ended nature of discussion questions in this study led to\nbroad, sometimes unfocused conversations, highlighting the need\nfor more structured prompts in future initiatives aimed at\ngathering community insights. To enhance future research,\nincorporating methodologies that ensure ongoing consumer\ninvolvement beyond priority-setting, such as participatory\ndesign, is recommended.\nIn future research priority-setting roundtables, greater investment\nis needed in structuring and framing the purpose and intended\noutcomes, particularly through the presentations and World Café\nquestions, considering that in this instance the community spoke\nmore about their health priorities rather than health research\npriorities. Narrowing down what we mean by research may also be\nbeneficial. Being able to progress these unexpected outcomes\n34\n35\n35,36\n4\n37\n38\n4\n39\n40\n41\n12\n42\n43\n\n11/14\nbeyond research – get them in front of the ‘bigwigs’ – becomes a\nresponsibility of conducting these priority-setting\nactivities. Researchers and community both need to be equipped\nto understand the pathways, purpose, and limitations of research,\nincluding pilot studies, implementation timelines, and translation\ninto policy and practice. Rural consumers were eager to see\nchange in how their community is cared for and resourced,\nwhereas researchers seek to understand their needs and trial\nsolutions. The missing link is being able to collaboratively trial\nsolutions to address identified priorities and transfer effective and\nsafe solutions with positive outcomes into recommendations for\npolicymakers, funders, government, and health services as this\nseemed to be the community expectation. \nAlso, in comparison to the previous community roundtable\nevent , the disconnect between what was heard and what is\ntestable and implementable in a research context to promote\nchange was wider. The first event was conducted in a metropolitan\narea, with experienced consumer representatives on the focused\ntopic of the event (telehealth), and those who attended had an\nestablished interest in the subject matter. When a more general\ncommunity without much consumer representative experience\nparticipated in a similar event, there was a greater focus on\npersonal experience, immediate needs, and solutions. While both\nproduced valuable outcomes, perspectives, and experiences, the\nurgency of the communities’ needs in the second roundtable come\nwith a greater responsibility for escalation and translation into\naction.  \nBased on our experience with this and similar events, we have\noutlined lessons learned as recommendations to assist other\nresearchers, clinicians, and service providers working with rural\ncommunities and consumers in setting health services research\npriorities and discussing solutions.\n1. Invest in building and maintaining relationships between rural\ncommunities and researchers to support partnership in all\nstages of research, drawing on local knowledge and\nresilience to shape effective and sustainable healthcare\nsolutions.\n2. Educate researchers about the value of consumer involvement\nand the importance to maintain genuine connections with\nthe community to support their active involvement and\nleadership in health research. This approach ensures co-\ndeveloped interventions to address real needs and are more\nlikely to be implemented successfully.\n3. Use flexible, creative recruitment strategies. Leveraging\nmultiple platforms (eg local radio, community noticeboards,\nsocial media, and telephone follow-up) and involving a well-\nconnected local consumer to lead face-to-face promotion\n(eg distributing flyers, word-of-mouth invitations) can enable\nbroader reach, especially for people without reliable internet\nor digital literacy.\n4. Enhance community voice and skill-building through\npartnerships with community representatives and champions\nto build trust and drive engagement. Involving consumers in\nleading or assisting parts of the research project (eg\nrecruitment, data collection or analysis) is key to bridge the\ngap between researchers and rural communities.\n5. Provide pathways for skill building to strengthen research\ncapacity, including understanding of the research\nframeworks and approaches to community needs, and how\nto progress priorities and partner with researchers across the\nresearch cycle. Offer follow-up training, mentorship, or peer\nsupport to build consumer research capacity and ensure\nsustained involvement beyond a one-off event. These actions\nare important because consumer confidence to participate\nmeaningfully in research may initially decrease as awareness\nof the research process increases.\n6. Have structured, solution-focused prompts and use innovative\nparticipatory methods for gathering consumer and\ncommunity input on potential solutions once local needs are\nidentified and prioritised. Prioritise consumer choice by co-\ncreating flexible, tailored, community-based models of care\nthat improve access, optimise resources, and help address\nworkforce shortages by expanding existing roles, creatively\naddressing gaps in rural health care.\n7. Understand the pathways to progressing priorities both within\nand outside of a research context, ensuring the community\nhas a voice in investment and decisions into rural health\nresourcing, initiatives, and research. Empowering both\nresearchers and consumers to progress and disseminate\npriorities after a roundtable event helps build trust and\ncultivate meaningful, lasting relationships.\nConclusion\nThis study identifies key consumer priorities in rural health\nresearch by using a consumer-centred approach, underscoring the\nvalue of promoting consumer involvement in shaping research and\nhealth care. Consumer involvement in setting the research agenda\nallows for a strategic, responsive and powerful method for future\nresearch that has the potential to positively impact policy and\npractice. Understanding consumer and community needs is the\nbest way to initially address some of the challenges experienced by\nrural communities through developing sustainable, effective and\nco-designed practical solutions. Addressing workforce shortages,\n42\n\n12/14\nexpanding existing roles, leveraging virtual care, and implementing \nflexible, community-driven models are crucial steps in improving \nrural healthcare delivery. Successful examples provide valuable \ninsights into integrated approaches that could inform Australian \nrural health policies. Additionally, targeted workforce retention \nstrategies and consumer-researcher collaboration initiatives can \ncontribute to sustainable healthcare improvements.\nReferences\n1 Australian Institute of Health and Welfare (AIHW). 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Always refer to the live site https://www.rrh.org.au/journal/article/9949 for the\nVersion of Record.","source_license":"CC-BY-4.0","license_restricted":false}