'You have to face your mistakes in the street': the contextual keys that shape health service access and health workers' experiences in rural areas.

INTRODUCTION Rural healthcare provision is limited in many areas because of workforce recruitment and retention issues. Pharmacists and social workers are examples of allied health professionals who play vital roles in the provision of rural health care. Personal factors including an individual's fit with a local community and their professional role were explored to determine the way they affect access to rural health care. DESIGN Accidental sampling then 11 qualitative interviews with pharmacists and social workers. SETTING Six rural communities with populations less than 5000, New South Wales, Australia. METHODOLOGY Deductive and inductive analysis of data. RESULTS Exploration of health work in small rural towns identified that participants' work and personal experiences are affected by their professional role and associated tasks, and by the way the community perceives that role. Social workers are likely to provide outreach or visiting services and use different professional networks than pharmacists. Social workers tend to perceive their client's problems as related to poverty and rural decline with limited options for successful intervention through the health system. Pharmacists are confident in their role as treatment providers and have a thorough knowledge of their own community, although they use a limited range of other local healthcare providers, tending to rely on doctors. Access to healthcare services is affected by organisational strategies to manage demand on services, privacy and confidentiality and the community's perception of the effectiveness of the service and the individual worker. Local knowledge and local context shaped the services pharmacists and social workers provided, and the way they managed their personal and professional activities in a small community. CONCLUSION Access to rural health services is affected by an individual's concerns about privacy and confidentiality, by the reputation of the healthcare worker and by the value system of the health worker. Different professions use different networks of health care, subsequently approaching rural social conditions and their related problems from diverse perspectives. This influences the health worker's experience of effectiveness in their professional role and the way they manage their high degree of visibility in small communities. IMPLICATIONS The need for a systematic evaluation of health service access emphasising the particular aspects of local rural context is highlighted. Such a work should include investigation of multidisciplinary models of service provision. This will optimise the range of health care available to small rural communities.