Posted: October 16, 2019

Letter of Intent due November 13, 2019; Application due December 13, 2019

Rural Americans, who make up at least 15 to 20% of the U.S. population, face inequities that may result in worse health care than that of urban and suburban residents. Americans living in rural areas are more likely to die from the five U.S. leading causes of death (heart disease, cancer, accidental injuries, chronic lower respiratory disease, and stroke) than their urban counterparts (CDC, 2017). Rural Americans also experience higher rates of chronic illness and poorer overall health than those living in urban areas. A wide range of risk factors confront rural Americans, including geographic isolation (given the great expanses of land in rural areas), and lower socio-economic status and limited job opportunities for rural residents. These risks correspond to less access to needed care, fewer medical professionals (and therefore no real pipeline for future ones) to provide needed care, and less affordable care. Rural health disparities challenge many best practices in the field of public health because no single factor—but a system of intertwined causes—explains why America's health is poorer than the health of other wealthy countries.

Many public health practices are developed with urban and suburban environments in mind, and often these practices are tested and implemented only in urban and suburban settings. As a result, we do not know if they will work in rural settings and relatively few researchers seek to translate their programs into rural communities. And relatively few researchers initiate development of evidence-based strategies in rural areas. More research is needed to increase our understanding of how to address rural health needs, and to eliminate or at least to reduce rural health disparities.

The 2018 NINR-led Rural Health Workshop, “State of Rural Health Disparities:  Research Gaps and Recommendations https://www.ninr.nih.gov/newsandinformation/events/pastevents/rural-health-disparities," underscored the need for more research around strategies to address rural health disparities. Workshop participants highlighted the need for research to incorporate innovative research designs and approaches relevant to rural settings, and to utilize approaches seen as relevant to rural cultural settings, including community based participatory designs. Participants also urged researchers to consider the need to test sustainability of interventions, and to better define rurality, and the uniqueness of rural populations, while also identifying the diversity within the rural communities.

This RFA encourages research into and development (or adoption/adaptation) of interventions that can reduce the health risks faced by rural Americans. Both prevention and treatment interventions are needed to address rural health issues. Prevention strategies should address and measure reductions in risk factors and enhancement of protective factors, while treatment approaches would seek to measure and address amelioration of health in individuals living with existing conditions. To accomplish these goals, the research community will be encouraged to use a wide range of methodological approaches that can enhance access to and acceptability of interventions in rural settings, such as telehealth and community-based prevention research, where appropriate. Research projects must study rural health issues within the United States. Applications to study populations or regions outside the US will not be considered responsive.

In 2021 and 2024, a grantees meeting will be held in the Washington, DC area to allow grant recipients to exchange information about their funded projects and develop collaborations.  Please see budget instructions below in section IV, 2. Applicants should request $1500 for travel to a grantees meeting in the Washington, DC area in years 2 and 5.

Research Objectives include, but are not limited to, studies that:

  • Promote a greater understanding of the challenges faced by rural population groups in the US
  • Identify disparities among population groups living in the rural US and strategies that specifically benefit those communities
  • Lead to identification of social determinants of health, especially
  • Risk and protective factors specific to rural areas
  • Encourage incorporation of these into development or adaptation of prevention interventions
  • Implement evidence-based interventions (EBIs) relevant to the culture of rural populations and settings in the US
  • Incorporate study designs that are most appropriate to, or can benefit, rural communities, such as:
  • Community-based Participatory Research (CBPR) approaches, that take advantage of resources central to rural areas
  • Remote health technologies to increase reach of intervention strategies (e.g., in remote rural areas)
  • Understand the factors that determine the sustainability of health promotion strategies in rural settings

Read full solicitation here

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