Addressing Rural Health Challenges in Georgia and Scotland: A Framework for International Collaboration

Background: Rural healthcare delivery is a growing concern in Georgia and globally due to the well-documented issues including affordability, access to care, quality of care, safety of care, and healthcare workforce recruitment and retention. It is a “wicked problem” due to its complexity and pervasiveness. CONVERGE is a collaboration between four universities in Georgia and Scotland (two in each) to address this problem. Methods: A qualitative case study approach was used to identify the contributing factors to successful collaboration as well as the barriers to improve rural health. A purposive sample of the 2021 CONVERGE International Symposium attendees were invited by email to participate in an interview and/or focus group with the research team. Twelve interviews and two focus groups were conducted virtually with a total of 17 participants. The interviews and focus groups were conducted using a semi-structured interview guide that focused on experiences with international collaborations, rural health, and CONVERGE. Data was analyzed using reflexive thematic analysis using NVivo. Results: We identified themes pertaining to three key areas: mechanisms for continuity, fostering symposium engagement, and reflections on rural health globally. First, continuity for international collaborations is contingent upon support, relational and structural factors. Second, symposium engagement required intentionality related to selectivity of leaders and participants, presentation format, and team building. The final theme addresses barriers to addressing rural healthcare needs shared in both countries including enduring structural inequalities, remote access, and ideological resistance preventing substantive change. Conclusion: Findings from this study can be used to improve international academic collaborations by offering a model for fostering continuity and engagement necessary to meaningfully address wicked rural health issues. Keywords: rural health, Georgia, Scotland, qualitative researc