Towards a health career for rural and remote students: cultural and structural barriers influencing choices.

ABSTRACT Objective: To promote tertiary health careers to rural and remote young people. Design: Qualitative research using large and small group discussions and semistructured interviews. Setting: Fifteen secondary schools in rural and remote Western Australia including five senior secondary schools and 10 district high schools. Subjects: One hundred and twenty students from eight year 10 groups, 35 students from three year 11 groups, 54 students from five year 12 groups, 52 parents, 10 grandparents, 76 teachers and four Aboriginal and Islander Education Officers (AIEO). Results: Students prefer information about the range of health careers to be delivered interactively. Choices to follow a health career at tertiary level were constrained by structural and cultural issues including geographical isolation, financial cost, stereotyping of health professions, insufficient information about the diversity of health careers, obligation to family, community and place and a devalued rural culture. Conclusions: The under representation of rural and remote students in health related university courses needs to be addressed by long-term strategies taking into account both structural and cultural barriers when making career choices. Health policies should include the provision of financial support for rural and remote students and promote a broad range of health careers as challenging and rewarding life choices that offer much needed services to rural communities. What this paper adds: In 1997, only 19.2% of Australian university students came from rural and remote areas, a figure dramatically below the equity reference point of 28.8% of the population living in rural areas derived from the 1996 census data. [sup 1] In 2001, the figure remained steady with 19.1% of rural students attending university. [sup 2] These data highlight the need for developing higher education opportunities for all Australians regardless of where they live. However, despite ongoing concern about attracting rural and remote students to health careers, limited success has been achieved to date. Barriers to students choosing health careers at tertiary level include lack of information about the range of health careers available, the cost of tertiary education for families, social dislocation and a perceived lack of support structure for students at university. These are underpinned by cultural assumptions about gender, occupational roles in rural communities and professed lack of academic ability. Strategies to overcome barriers must be situated within a broad socio-cultural context to understand the complexity of issues underpinning students’ choices. [ABSTRACT FROM AUTHOR]