Developing a Decision Aid for Selecting Rural Designations for Public Health Research

Rural public health requires analytical approaches that account for the unique characteristics of rural communities, including population size, geographic isolation, and access to health care resources. To support this work, we propose developing a decision aid to guide public health researchers and practitioners in selecting rural-urban classification schemes appropriate for their research or program goals. This aid will leverage existing, updated federal classifications and demonstrate potential use cases relevant to rural public health analysis.

Different classification schemes capture distinct aspects of rurality. For example, the Federal Office of Rural Health Policy (FORHP) classification emphasizes proximity to health care resources relative to rural populations, which is critical for determining eligibility for rural-serving programs or grants. In contrast, county-based classifications, such as the Rural-Urban Continuum Codes (RUCC) and the CDC NCHS scheme, define rurality based on central metro areas, economic integration, commuting patterns, and population size, making them more suitable for population-level studies of health outcomes, behaviors, or access to health-enabling amenities.

The decision aid will illustrate these distinctions and provide guidance on aligning classification choice with analytic objectives, modeling strategies, and intended outcomes. By tailoring the tool to the needs of rural public health researchers, it will promote consistent, transparent, and methodologically sound use of rural-urban classifications across studies. Ultimately, this resource aims to enhance the quality and relevance of research and public health interventions in rural communities, ensuring that analytic decisions reflect the unique characteristics and needs of these populations.