Last mile research: a conceptual map

ABSTRACT

Background: The term ‘last mile’ has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.

Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?

Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.

Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen’s University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.

Conclusion: This is the first time ‘last mile research’ has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.

KEYWORDS:

• Global health research
• research methods
• health equity
• concept mapping
• hard-to-reach populations
• last mile

Responsible Editor Stig Wall, Ume University, Sweden

Responsible Editor Stig Wall, Ume University, Sweden

Acknowledgments

The authors would like to acknowledge all of the researchers who participated in this mapping exercise. CMD and LVA were the Principal Investigators on the overall study and led the research team. All authors participated in the concept mapping exercise and contributed to the final map and interpretation of the findings. CMD wrote the first draft of the article, all authors contributed edits to the manuscript and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

This study was reviewed by the Queen’s University Health Sciences Research Ethics Board #6026037. All participants consented to take part in the concept mapping process.

Paper context

The term the ‘last mile’ is often used in public and global health research discussions. This paper outlines a concept mapping process undertaken to articulate ‘last mile research’ among global health researchers at one American and one Canadian university. The concept map denotes the who, the how and the why of last mile research in global health and represents the beginning of a longer conversation that is required among global health researchers more broadly.

Additional information

Funding

This study was supported by a Queen’s University and Dartmouth College Matariki Network of Universities Partnership Grant [Davison CM & Adams LV – PIs].