357 - Strengthening Rural Health Systems Through Learning: Findings from a Collaborative Content Analysis

Publication Number: 4350.357

Preston Simmons, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Kragel, Seattle Children's, Seattle, WA, United States; Corrie E. McDaniel, University of Washington / Seattle Children's Hospital, Seattle, WA, United States

Background: Rural clinicians face barriers to pediatric care delivery. SPARK (Supporting Pediatric Access for Rural Kids), a monthly inter-hospital collaborative, connects multidisciplinary teams from eight rural hospitals across Washington, Montana, and South Dakota via videoconference case discussions.

Objective: To analyze conversational patterns within SPARK sessions to understand how interactions amongst rural clinicians translate shared experiences into collective learning.

Design/Methods: We conducted summative content analysis of monthly sessions using behavioral observation coding across four dimensions: interaction type, tone, engagement, and conversational momentum. Speakers were numbered in order of participation by session. Speaking interactions were coded and discrepancies resolved by consensus. Descriptive statistics and code co-occurrences identified interaction patterns, followed by latent content analysis to interpret the underlying function and meaning of behavioral patterns.

Results: We analyzed 12 SPARK sessions (N=463 speaking interactions). Speaking interactions mainly featured general discussion (26.6%), sharing experiences (21.4%), and questions (14.9%), with limited formal case presentations (9.3%) (Table 1). Co-occurrence analysis showed questions frequently redirected conversations (29.0% vs. 13.5% in other interaction types) while teaching points advanced discussions (39.1%) despite closed delivery (98.6%); positive tone clustered with experience sharing (23.2%) and general discussion (36.6%) (Figure 1). Speaker analysis revealed distributed expertise: case presenters (speakers 1-2) contributed 48% of speaking turns, while later participants (speakers 4-11) demonstrated selective but impactful engagement, with teaching points more likely to advance discussion (24.4% vs. 12.4%). Speaker 3 emerged as a facilitative bridge, redirecting conversation (16.3%) while asking and responding to questions equally. We identified four themes: personalization and contextualization, applied problem-solving, reflective exchange, and affirmation and emotional support (Table 2).

Conclusion(s): Behavioral analysis revealed SPARK mitigates structural barriers to rural pediatric care by transforming peer discussion into a distributed learning system. Interaction patterns demonstrate how rural clinicians collectively construct, adapt, and affirm knowledge through dialogue that blends context-driven framing, applied experience, and support of each other. This collaborative model represents a strategy for supporting pediatric care in resource-constrained settings.

Table 1: Behavioral Observation Code Occurrences and Definitions for an Inter-hospital, Muli-State Rural Hospital Collaborative


Table 2: Behavioral Themes Identified within Discussions in an Inter-hospital, Muli-State Rural Hospital Collaborative


Figure 1: Heat Map for Behavioral Code Co-occurrences for an Inter-hospital, Muli-State Rural Hospital Collaborative
Shades of green represent lower percentage of co-occurrence and shades of red represent higher percentages of co-occurrences.