Understanding Rural Health Data Challenges Through Analysis of Peer-Reviewed Publication Limitations

Health data are commonly used for decision-making, population health efforts, funding, and reporting at the national, state, and local level. Despite their importance, systematic assessment of the challenges of rural health data and how these challenges may be addressed is lacking. This study systematically reviewed a subset of the published rural health literature in order to summarize the most common challenges of rural health data, types of data used, and efforts used by researchers in the field to overcome these limitations. Findings informed policies and other recommendations aimed at enhancing rural data collection and analysis to strengthen our understanding of rural health needs and priorities, and characterized the current state of data and methods used in the rural health research literature.

This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. Key inclusion criteria for the review included: publications from five peer-reviewed journals with a strong track record of publishing studies focused on rural health, manuscripts published in the past 10 years, studies with rural (or related terms) in the title or abstract, studies using secondary data sources to avoid limitations more closely aligned with primary data collection, studies using quantitative data, and studies based in the United States and published in English. Proposed journals included the Journal of Rural Health, American Journal of Public Health, Health Services Research, JAMA, and Health Affairs. After finalizing the inclusion/exclusion criteria and search strategy, the search was conducted through PubMed. Double review occurred at each of the title/abstract and full-text review stages. The final set of manuscripts included a minimum of 100 manuscripts. If this minimum was not achieved with the proposed journals, one or more additional journals were identified for inclusion. Data checks were conducted for quality assurance. Preliminary data elements to be extracted included characteristics of the manuscript, data and methods, and limitations. Manuscript characteristics included: journal, year of publication, setting of first author, primary topic, and sample/population characteristics. Data and methods included: data source(s), scope of study, level and type of data, measure and level of rurality used, an indicator for geographic focus, and an indicator for study design. Limitations related to data, study design, and methods as well as author-provided descriptions of how these limitations were addressed were extracted. Extracted data were inductively coded and summarized quantitatively and thematically, as appropriate.

Publications

• A Review of Common Limitations in Rural-Related Studies in the Peer-Reviewed Literature
  Policy Brief
  ETSU/NORC Rural Health Research Center
  Date: 09/2025
  This study describes limitations commonly reported in rural-related studies on health, with a focus on studies using secondary, quantitative data.