Understanding work disability prevention among rural healthcare workers: A comprehensive literature review

Approximately 20% of Canadian healthcare workers work in rural or remote areas, yet disability management programs are typically developed in urban areas with little or no attention given to their applicability for rural workers. Work disability prevention research and rural health as fields of research have historically been studied in a highly compartmentalized fashion. We conducted a comprehensive literature review to connect these fields and understand rural workers' vulnerability to workplace injury and prolonged work absence, focusing on healthcare workers. We identified 814 references, of which 9 discussed disability prevention outcomes and 25 discussed known risk factors. This limited evidence was suggestive of high rates of injury among rural workers, which, together with work absence duration, may vary by occupation along a rural-urban continuum. We identified risk factors in rural areas at the environmental-, worker-, job-, organizational-, worker compensation system, healthcare access, and disability management process levels. In addition, several important methodological limitations were noted. This review points to a glaring paucity of evidence on work disability prevention issues for workers in rural areas including in the healthcare sector. Workplace violence, high workloads, lack of replacement staff, and challenges unique to rural contexts, such as distance and isolation, were identified as key risk factors for poor work disability outcomes in rural healthcare workers. Further research, addressing methodological limitations of previous studies, is needed to document the disparities in work disability outcomes between rural and urban workers, as well as to understand the source and risk factors associated with these disparities.