Mixed methods systematic review of consumer engagement in rural health practice, research, and education

This systematic review aimed to synthesize evidence on consumer engagement in rural health practice, research, and education. It was conducted using the JBI mixed methods methodology, specifically the convergent integrated approach. PubMed, PsychINFO, Cochrane Library, SCOPUS, Web of Science, EMBASE, and CINAHL were searched, along with gray literature sources-Google, ProQuest Dissertation, and Theses Global. Primary research studies published globally in English, from 2011 to 2024 were included. Dual reviewer screening occurred in two stages, title and abstract, then followed by full text. Critical appraisals of included studies were undertaken using McMaster Critical Appraisal Tool for quantitative and qualitative studies, respectively, and the Mixed Methods Appraisal Tool. Extracted data was synthesized to develop themes for reporting per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review identified 25 studies that explored the top three levels of consumer involvement in rural healthcare settings, namely Partnership, Involving, and Consumer-led, adapted from the 2011 National Framework for Consumer Involvement in Cancer Control. Five key themes were developed from the data: positive impacts of co-design, importance of relationship building, sustainability of interventions, power issues in co-design, and the importance of context. Findings showed that interventions utilizing the top three partnership levels (consumer-led, partnership, and involving) consistently lead to positive impacts on health outcomes of rural communities with higher levels of sustained engagement. Enablers and barriers were identified and categorized into a macro, micro, and meso framework for direct comparison between studies. Rural healthcare initiatives involving consumer engagement appear to have several benefits including strengthening community-researcher relationships, enhanced sustainability, and enriching local contexts while addressing power imbalances to enhance healthcare outcomes.