Toward a common framework for rural background.

BACKGROUND AND OBJECTIVES To develop a standardized framework to discuss rural background, a review of the literature to identify studies regarding the association of rural background with primary care and/or rural health practice was conducted. The various definitions of rural background were collated and from this data a framework for the conceptualization of rural background is proposed. METHODS The Medline database from 1966-2009 was searched to find citations that included a rural background definition as a variable for rural intent to practice, rural career choice, or rural practice. Studies that included medical school admission outcomes of US medical schools were included if there was (1) a definition of rural background noted, (2) a research-based question, and (3) a defined outcome of rural practice intent or practice in rural area. RESULTS A full text review was completed for all 45 articles identified. After applying the inclusion and exclusion criteria to the full length articles, there were 15 articles included in the review. The five most common definitions of rural background were (1) a positive answer to the question "Did you grow up in a rural area"? (2) a rural county of birth, (3) grew up in a town of less than 10,000 persons, (4) graduation from a high school located in a town of less than 10,000 persons, and (5) self-declared rural county of residence. CONCLUSIONS There are multiple terms used in research to elucidate the conceptualization of rural background. Based on a definition of rural as the "anchor," we propose the use of the five most common definitions of rural background as "rural connectors" that can be used to buttress the definition of rural background. The framework of rural connectors can then be used to more closely define rural background.