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MSU Rurality Index
Clarann Weinert, SC, PhD, RN, FAAN
Tool Developer
Montana State University
College of Nursing
cweinert@montana.edu
The
MSU Rurality Index was developed for use as a research instrument. It
is a relative index which assigns the degree of rurality based on the ranking
of a resident on selected characteristics relative to other residents in
the study group. In contrast, an absolute measure like that used by the Census
Bureau, assigns the category of rural based on satisfying fixed criteria.
In this case, the criteria are applied identically to a resident of Manhattan,
NY and Manhattan, MT. An absolute scale, such as those discussed earlier,
have certain inherent limitations. However, they are currently used
for planning federal programs, and for the distribution of resources. Yet,
for the purposes of research, were more finely delineated degrees of rurality
are necessary to examine relationships between rurality and a variety of
health variables, the existing absolute measures are not adequate.
A
primary reason for developing the MSU Rurality Index was that the usual indices
potentially misrepresent the degree of rurality of study participants particularly
in the western states were counties cover large geographical areas. For example,
many families in the Montana Family Cancer Project lived in rural areas. Some
families lived in remote rural areas of large counties that contain a major
population center and would be classified as urban by the commonly employed
absolute indicators. Other families lived in counties that do not contain
a major population center, yet their degree of social, economic, and cultural
isolation varied widely. These families would be classified as
rural by the commonly employed absolute indicators, without regard to their
degree of isolation.
A
whole state like Montana could be considered as rural based on the large
land mass, sparse population (less that 800,000), low over all population
density (average of fewer than 5 persons per square mile), only two metropolitan
areas Billings (approximately 90,000) and Great Falls (approximately 56,000),
and the primary economies of farming/ranching, mining, logging, and recreation. By
the OMB designation all but two of Montana's 56 counties are classified as
nonmetropolitan yet on many dimensions these counties are very different
from each other. For example, a nonmetropolitan county in eastern Montana
may have a population density of less than 1 person per square mile, with
great distances to travel to a town large enough to have even marginally
adequate retail, health, and other necessary services. While
a nonmetropolitan county in western Montana may be much smaller in square
miles, have a more dense population, and relatively easy access to a small
city, with a university, retail, health care, and essentially all needed
services. Clearly, to adequately examine the critical variables of
the Montana Family Cancer Project, such as resources utilization, support
networks, and costs of managing the illness an index which reflected the
degree of rurality was imperative.
For
the purposes of developing the MSU Rurality Index a working definition of
the concept of rurality included the two characteristics as noted by Lee
(1991); low population density and diversity. The characteristic of
low population density effects communication and transportation patterns;
social network composition and interaction patterns; and availability of
specialized services (Cordes, 1985). The concept of rurality incorporates
diversity in demographic composition, life styles, values, occupations, and
other social features.
Various
strategies for developing a relative index of rurality are feasible. Carney,
Burns, and Slinkmen (1991) developed an economic index by performing a principal
components analysis on eleven county-based variables measured on each county
in Texas. This strategy required substantial effort in data collection
followed by somewhat standard data analytic techniques. The development
of the MSU Rurality Index used an alternative strategy. Two
key variables were carefully selected to reduce data collection effort and
a slightly more complex analytic technique was employed. Overall,
the cost is lower if a small amount of high quality data are collected and
subjected to more extensive analysis.
The
MSU Rurality Index is constructed from the following two variables: the
population (as reported in the census) of the county of residence, and distance
(in miles) to emergency care as indicated by self-report of study participants. The
intent is to form a surrogate variable that reflects the degree of rurality. County
population is a measure gauging the threshold size of the market necessary
to support various types of health care and other services. For example,
tertiary care or radiation treatment centers require a very large population
level to make them economically viable.
Accessibility
to various types of care and treatment will vary for people living in rural
areas even within the same county. Thus, there is a need to differentiate
among residents in rural areas within the same county as well as across counties.
The MSU Rurality Index employs distance to emergency care to achieve this
differentiation. Emergency assistance in a rural state is provided
in a variety of ways ranging from a Emergency Room in a small hospital to
the office of a sole provider such as a nurse practitioner or family practice
physician. These services exist in a population center, albeit a small
town. Thus, distance from even the most basic service of emergency
care was selected to be used in the calculation of the degree of rurality. Distance
to emergency care was selected over distance to other health care because
in the case of an emergency, for example a serious laceration, a person would
tend to seek the closest source of assistance. However, rural residents
are known to skip the local hospital or health care provider to seek help
for less emergent conditions in a larger or more specialized facility. Even
though it is a considerably further distance to travel. Like all self-report
measures there is a margin of error in reporting that is unavoidable. However,
for the most part persons living in rural areas are very aware of distances,
as traveling is a integral part of their way of life. Likewise,
small discrepancies in the reported distances to emergency care will not,
in the long run, substantially effect the calculation of the MSU Rurality
Index.
The
MSU Rurality Index value increases as the degree of rurality increase. Thus,
a person living close to emergency care in a highly populated county would
have a lower score (more urban) than a person who lived in the same county
but at a greater distance from emergency care. Likewise, a person living
in a sparsely populated county in a small town with emergency care available
would have a lower score (more urban) than a person residing on a ranch in
a more heavily populated county, but who is a longer distance from emergency
care. When the MSU Rurality Index is calculated for a study sample
a range of scores is developed that provides an indication of the degree
of rurality for each participant that is not possible when the standard dichotomous
indicators of rural/urban or metropolitan/nonmetropolitan are used. Because
the MSU Rurality Index is calculated using only county population and distance
to emergency care, it is not intended for use when all participants in a
study live in the same county.
Weinert, C., & Boik, R. (1995). MSU Rurality Index:
Development and evaluation. Research in Nursing and Health, 18,
453-464. Abstract
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