A new framework to support inclusion in rural health services


A new framework will help generalist rural health service providers assess their existing practices to help create inclusive cultures that welcome diversity.

3 Minute read

The outcome

A framework and supporting toolkit has been established to provide rural health services with practical guidance on how to increase access and inclusion at their service in order to cater to all residents in their catchment.

The framework indicates that before strategies for inclusion of specific groups can be effectively implemented within health services, existing barriers to inclusion need to firstly be identified and addressed.

Regional and rural generalist health settings are therefore better equipped personally and organisationally in their journey to inclusivity and supported to challenge existing assumptions and practices that are exclusionary.

The need

Rural and regional communities in Australia are diverse and many health services are striving to be more inclusive of all patients and clients.

Those who may experience exclusion include (but is not limited to) people who identify as First Nations, people not born in Australia or whose parents were born overseas, people who have experienced family violence or conflict, people who identify as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and non-gender binary (LGBTQIA+), the old or young, and people with disability or are differently abled.

Addressing inclusion is important in order to ensure those people living in rural settings have access to public health services and feel comfortable and respected when using them.

It is often those most reluctant to use health services or those disengaged from services who are most in need of care.

In rural areas, it is particularly important that local health services are inclusive as access to other services may be difficult.

Developing the solution

Researchers determined that before focussing on inclusion, providers first needed to identify any barriers to inclusion that may exist, whether those barriers were actual or inferred.

Researchers engaged with four rural health services over five years to explore factors involved in clients’ perception of inclusivity or otherwise, as well as providers’ own awareness of diversity and inclusion issues.

The team identified foundational concepts, tenets and actions to address exclusion as the three main elements of the framework.

The toolkit consisted of a series of readings about the foundational concepts and tenets so providers could learn more about diversity and inclusion, both individually and as an organisation.

Explore the framework and toolkit


Australian Research Council

Australian Government Department of Health, Rural Health Multidisciplinary Training Program


Bourke, Lisa, Olivia Mitchell, Zubaidah Mohamed Shaburdin, Christina Malatzky, Mujibul Anam and Jane Farmer (2021) Building readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion. Social Science & Medicine 289: 1144449

Bourke, Lisa, Mujibul Anam, Zubaidah Mohamed Shaburdin, Olivia Mitchell and Alan Crouch (2021) Social interaction and social inclusion in international rural health research. Handbook of Social Inclusion. Research and Practices in Health and Social Sciences, edited by Pranee Liamputtong.  Switzerland: Springer

Mohamed Sharburdin, Zubaidah, Lisa Bourke, Olivia Mitchell and Trudie Newman (2020) “It’s a cultural thing:” Excuses used by health professionals on providing inclusive care. Health Sociology Review

Malatzky, Christina, Lisa Bourke and Jane Farmer (2020) ‘I think we’re getting a bit clinical here’: A qualitative study of professionals’ experiences of providing mental health care to young people within an Australian rural service. Health and Social Care in the Community.

Malatzky, Christina, Zubaidah Mohamed Shaburdin and Lisa Bourke (2020) Exploring the role-based challenges of providing culturally inclusive health care for maternal and child health nurses: qualitative findings. Nursing Open. 7(3): 822-831.

Malatzky, Christina, Mitchell, Olivia, & Bourke, Lisa (2018) Improving inclusion in rural health services for marginalised community members: Developing a process for change. Journal of Social Inclusion, 9(1): 22-36.

Malatzky, Christina, Raelene Nixon, Olivia Mitchell and Lisa Bourke (2018) Prioritising the cultural inclusivity of a rural mainstream health service for First Nation Australians: An analysis of discourse and power. Health Sociology Review 27(3): 248-262.

Mitchell, Olivia, Christina Malatzky, Lisa Bourke and Jane Farmer (2018) A Modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services. Australian Journal of Rural Health, 26(3): 206-210.

Malatzky, Christina and Lisa Bourke (2018) A different perspective on the key challenges facing rural health: The challenges of power and knowledge. Australian Journal of Rural Health, 26(6): 436-440

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First published on 2 March 2022.

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