Increasing Inclusion in Rural, Generalist Health Services: Developing a Process of Change

Project Details

This ARC funded research project is undertaking four case studies to understand how rural mainstream health services can increase their inclusiveness and responsiveness to the needs of diverse and particularly marginalised consumers.

Download the Framework and Toolkit (how to guide) for use by services HERE

Download a detailed discussion of the Framework HERE

Check-out the Shepparton News Article HERE

Download the Interaction Matters Report HERE

Project Lead

Professor Lisa Bourke


P: 03 5823 4519


Professor Lisa Bourke (University of Melbourne, Department of Rural Health)

Dr Olivia Mitchell (University of Melbourne, Department of Rural Health)

Dr Zubaidah Mohammed -Shaburdin (University of Melbourne, Department of Rural Health)

Dr Christina Malatzky (Qld University of Technology)

Professor Jane Farmer (Swinburne)


The research team at the University of Melbourne, University Department of Rural Health acknowledge the Australian Research Council for funding this research project and support from the Australian Government Department of Health, Rural Health Multidisciplinary Training program.

Research Outcomes

A framework to challenge exclusion

Many health services are striving to be more inclusive of all patients and clients. This is important in order to ensure that all local residents have access to health services and feel comfortable and respected when using them.  It is often those most reluctant to use health services and/or those disengaged from services who need care the most.  In rural areas, it is particularly important that local health services are inclusive as access to other services may be difficult.  It is hoped that our framework and toolkit provides rural health services with practical guidance on how to increase access and inclusion at their service in order to cater to all residents in their catchment.

Before strategies for inclusion of specific groups can be effectively implemented within health services, the barriers to inclusion need to be addressed. Researchers from the Department of Rural Health at The University of Melbourne have developed an approach for rural health services to challenge existing assumptions and practices that are exclusionary.  This approach is based on work with four rural health services over five years where many lessons were learned from successes and failures.

The Framework

This framework aims to prepare health services for inclusion by challenging exclusion.  Once these barriers to inclusion have been challenged and re-considered, specific inclusion approaches for particular groups will be more easily adopted.  The framework integrates the voices of diverse local residents and prepares the service for new practices aimed at inclusion.  It focuses on questioning assumptions, stereotypes, practices and systems that discourage or disrespect particular people. It also encourages practitioners and services to be guided by service users and to reflect on the cultural assumptions embedded in health care.

The Toolkit

Challenging exclusion requires action to bring about change.  The toolkit provides practical ideas, resources and activities to challenge exclusion in rural health services.  The toolkit can assist rural health services to make a commitment to inclusion, identify areas where exclusion exists, break down exclusionary processes and, in so doing, make the implementation of specific inclusion approaches possible and sustainable.  Use this toolkit as an opportunity to apply a critically reflective eye to your health service and how it delivers services and care to a wide range of diverse members of the community.  Use the resources to reflect carefully upon the objectives of the health service and what might be the intended and/or unintended consequences of current or future practices.  This toolkit has been designed as a resource that can be adapted to suit the needs of rural health services as they move along the journey to improving inclusion for everyone in their community.  We hope you find the materials and activities useful.

Research Publications

  1. Bourke, Lisa, Olivia Mitchell, Zubaidah Mohamed Shaburdin, Christina Malatzky, Mujibul Anam and Jane Farmer. (2021) Building readiness for inclusive practice in mainstream health services: A pre-inclusion framework to deconstruct exclusion. Social Science & Medicine 289: 1144449.  DOI:
  2. Malatzky, Christina, Mitchell, Olivia, & Bourke, Lisa (2018) Improving inclusion in rural health services for marginalised community members: Developing a process for change. Journal of Social Inclusion, 9(1): 22-36.
  3. Mitchell, Olivia, Christina Malatzky, Lisa Bourke and Jane Farmer (2018) A Modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services, Australian Journal of Rural Health, 26(3): 206-210.
  4. Malatzky, Christina, Raelene Nixon, Olivia Mitchell and Lisa Bourke (2018) Prioritising the cultural inclusivity of a rural mainstream health service for First Nation Australians: An analysis of discourse and power. Health Sociology Review 27(3): 248-262.
  5. Mohamed Sharburdin, Zubaidah, Lisa Bourke, Olivia Mitchell and Trudie Newman (2022) “It’s a cultural thing:” Excuses used by health professionals on providing inclusive care. Health Sociology Review 31(1): 197-207. DOI: 10.1111/ajr.12836
  6. Malatzky, Christina, Lisa Bourke and Jane Farmer (2022) ‘I think we’re getting a bit clinical here’: A qualitative study of professionals’ experiences of providing mental health care to young people within an Australian rural service. Health and Social Care in the Community, 30(2): 519-528.
  7. Malatzky, Christina, Zubaidah Mohamed Shaburdin and Lisa Bourke (2020) Exploring the role-based challenges of providing culturally inclusive health care for maternal and child health nurses: qualitative findings. Nursing Open. 7(3): 822-831.

Research Group

Access & Equity in Rural Health Care

Key Contact

For further information about this research, please contact the research group leader.

Department / Centre

Rural Health

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