Are you developing an MRFF application focused on the health of rural, regional and remote (RRR) communities? If so, now is a good time to think about how you can leverage the real-world impact of your research.
Understanding the MRFF's focus on RRR health
‘Research funded through the MRFF will address areas of unmet health need, to address underinvestment and support capacity development with a focus on achieving equity in health outcomes...’
To achieve the objectives in that strategy, one of the priority areas is RRR populations. Specific barriers experienced in these areas are defined by the MRFF as being “…the capacity and capability of the health workforce to engage in health research, education and training, and clinical care delivery to address specific and unique health challenges for priority populations.”
On 14 March 2024 the MRFF delivered an informative webinar that provided practical guidance for future applicants on how to build research capability and sustainability. It also discussed useful mechanisms and strategies for health practitioners, researchers, and healthcare services to engage in RRR health research.
In this blog we summarise those aspects of the panel discussion, beginning with what MRFF is doing to ensure real-world impact is seen by RRR communities. All quotes, unless otherwise noted are from the panel discussion.
The MRFF: Leveraging the potential of RRR research
The MRFF has embedded a specific focus in some funding opportunities to ensure research is conducted:
-in an area defined as RRR according to the Modified Monash Model | Australian Government Department of Health and Aged Care (MMM), which is a model based on Australian Statistical Geography Standard – Remoteness Area | Australian Government Department of Health and Aged Care
-by a lead or administering organisation located in a RRR area, as defined by the MMM
-by at least 50% of the investigator team, including the chief investigator, being located in a MMM area 2 or above
-with a focus on priority population including RRR communities, and/or Aboriginal and Torres Strait Islander communities: this ensures funding is dedicated to RRR research.
The webinar highlighted that senior MRFF staff have visited RRR areas and engaged with RRR stakeholders to consider whether their funding policies and strategies align with the needs of RRR end-users. Discussion surrounded MRFF’s interest in identifying factors that exclude healthcare services from applying for MRFF funding, for instance in grant guidelines or legislation.
MRFF has also:
-refined the eligibility requirement to ensure research funding is controlled by RRR researchers and not held by an urban-based university
-targeted funding through separate streams
-consulted with a range of stakeholders to tighten how rurality is defined by MRFF
-aimed to have grant applications focused on RRR research assessed by RRR researchers (the panel acknowledged potential burden on RRR researchers)
-produced a report on the increasing number of grants awarded in MMM2-plus and MMM3-plus areas to leverage transparency.
What can you do to leverage the impact of your RRR health research?
Avoid fly in, fly out (FIFO) research: the metaphorical seagull
If you’re a researcher not located in a RRR area of interest, your challenge is avoiding being seen as a seagull. You can do this by:
-understanding one rural town is not like another
-building long-term trusted relationships
-ensuring leadership roles and ownership to avoid disempowerment of RRR communities
-building local critical mass of RRR researchers
-formalising partnerships with RRR healthcare providers.
Positionality: understanding one rural town is NOT like another
Is your research place-based, or does it assume homogenous needs across RRR areas?
Understanding the local context enables researchers to know what will work locally and what won't, whether that's about logistics of moving around the communities, whether it's about what's a good time of year to do this research, who to talk to, to get the concept of your research accepted by the community, how to run local, all those sorts of things. In short, they have greater capacity to respond to local clinical questions and community concerns vs researchers not from the local area.
Local researchers’ have substantial capacity to ensure value-based research is more likely to impact on the healthcare delivered locally. Their established networks will also leverage their capacity to communicate findings efficiently and effectively to the local community.
‘…great ideas …are developed by very smart people with high capability and very good hearts, but that is not quite the same as investing in the research capability within rural regions with the resources that come with that, with the intellectual capability that comes with that.’
The panel also highlighted that telehealth is not the answer to all RRR healthcare problems, but in some instances is seen as ‘hollowing out’ communities because there is a lack of understanding of context (e.g. social, cultural, infrastructure, economic) that comes from having in-person interactions from health professionals visiting the RRR community.
Building long-term trusted relationships: just like building a healthy bank balance
Building long-term trusted relationships with local services and communities strengthens the value of health research in RRR communities, enhances the potential impact from the research and leverages the local critical mass of researchers.
To ensure research is geographically and culturally appropriate, long-term discussions are key. But it takes time to build rapport and establish ongoing, meaningful communication. Apart from initial investment into establishing long-term trusted relationships, the budget items for a project focused on RRR research must reflect the real cost of regular field visits to remote sites, to maintain engagement with community organisations, community leaders, elders, and to support community-based researchers.
Ensuring leadership roles and ownership: avoiding RRR disempowerment
A common theme in the webinar discussion related to urban-based researchers seeking partnerships with RRR bodies. While ticking the box for partnerships, the difficulty lay with RRR groups not leading the work nor managing the resources. This problem is evident in the data: only 2.7% of MRFF funds allocated during 2023 went to researchers located in RRR areas, defined by MMM 3 to 7.
‘…we've all been beneficiaries in some ways of MRFF funding. But there is a very strong sense I suppose that we … are not necessarily always the lead player in it. We get to partner, but we don't get to lead and that the resources are managed elsewhere.’
‘…sometimes investment might look like it’s going into rural and remote health research, but the investment is going into research institutes and universities that are based mostly in urban areas and the benefits, …the resources, the people are not there in rural and remote areas.’
MRFF is attempting to rectify this. So, if you’re currently developing an application, we encourage RRR partners to have key leadership roles and be named CIs. For some RRR-focused funding opportunities from MRFF, CIA and at least 50% of the CI team must be resident in a MMM 2-7 area. Other members of the CI team may not be from the RRR areas but would be contributing specific skills to complement those of the team. For instance, a biostatistician may not be locally available so for specific projects it makes sense to partner with them to complement your RRR-based team.
Best-evidence co-design brings all end-users together to design new services and policies. This builds confidence, consensus, and ownership. It produces community-led services and policies, but there are challenges, and these are largely about the imbalance of power related to locality and capacity to drive research from within healthcare settings where priorities are necessarily on patient care.
The responsibility for ensuring RRR leadership falls with the entire research team. When focused on the RRR populations to benefit, it seems obvious that greater impact can be achieved when embracing co-design and co-development, understanding the local context, challenging conventional urban design principles, and conducting culturally appropriate research. However, partnerships between RRR and urban-based researchers may be necessary, particularly given the multidisciplinary and complementary skillsets that are needed to solve complex problems.
The panel also discussed the predominance of descriptive research in RRR areas and the need to move away from describing problems and undertaking ‘…some of the very, very hard stuff around interventions…and that doesn't easily happen in 3 and 5-year projects’. That quote clearly identifies the need for RRR leadership, and long-term commitment and partnership of researchers and healthcare providers to achieve real-world change in RRR communities.
Building local critical mass of experienced researchers
Beyond the importance of local context and place-based approaches for research, the social, political, geographical, cultural, epidemiological context are essential to healthcare service delivery. For projects, this means methodology should have embedded processes for building critical mass of experienced researchers within healthcare settings confounded by RRR contexts.
For example, the webinar discussed how models of service delivery in rural areas change as remoteness increases. Researchers embedded in remote environments ensure rigour, but they’re few and far between. Building critical mass is therefore difficult in remote areas; while FIFO researchers aren’t the answer, they can certainly support building critical mass where appropriate engagement, leadership and ownership is first established. For instance, budgeting to employ First Nations community-based researchers, supporting their training and leveraging their opportunities was one example discussed. By employing community-based researchers who can liaise with individuals, the local council community Elders, run focus groups and organise interviews, the project itself will benefit and real-world impact on local capacity will be enhanced.
Formalising partnerships with RRR healthcare services
Many healthcare services now acknowledge the power of research. However, healthcare services necessarily need to prioritise service delivery, sometimes at the expense of research. An example of this was discussed by the panel whereby some services in NT have declared a moratorium on further research because of the pressure of service delivery in a generally underfunded, under-resourced environment.
What's the take home message from the webinar?
Each point raised by the webinar panel is relevant to each application focused on RRR populations.
Are you are undertaking or wanting to undertake RRR research, are you located in an area defined as RRR? No? Ok, it’s time for some self-critique. Do you have well-established partnerships with RRR communities and healthcare services? Has your research idea been co-conceptualised and co-designed by RRR communities and/or healthcare services? Do RRR communities and/or RRR healthcare services hold leadership roles? Are they named CIs? Where will the resources be managed? Do your RRR partners manage the funds, or an appropriate part of them? And the big question: how will you avoid be considered a FIFO researcher?
We strongly encourage you to consider these discussion points from the webinar panel in conjunction with the scheme-specific guidelines.
If you’re interested in watching the MRFF assessment webinar, it can be found here.
Good luck with your MRFF funding applications!
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