Reflecting on Rural Matters: conducting research during the COVID-19 pandemic

By Jackie MacDiarmid, SHAAP Research and Projects Officer

I began working with SHAAP at the end of 2018, just after completing my Masters in Public Health at the University of Edinburgh. 

I was excited but slightly nervous. I had never worked in the public health field before, having originally pursued a degree in Political Science and worked in government in my home country of Canada before deciding to change tack. While I had enjoyed this previous work, it had all felt miles away from the “real world”. I had walked down the halls of Parliament I’d seen on TV, welcomed suits into the office, shook hands, sent tweets – but l felt as though I was considering the world’s most pressing problems from a great and comfortable height rather than pitching in to help solve them.

In contrast, this new job felt like a chance to work with an organisation effecting real change.

I was inspired by SHAAP’s leading involvement with Minimum Unit Pricing and their “evidence for advocacy” approach. I also felt extremely privileged to work with experts of all stripes: people with lived experience, physicians, academics, decision makers…all working directly on harm reduction and supporting people in recovery. Now that I am at the end of my time with SHAAP I feel most fortunate to have worked with and learned from this dedicated group of people.

Most of my time with SHAAP has been spent working on the Rural Matters project. This project aimed to learn about the cultural and social context of drinking in rural areas and barriers to accessing services in rural Scotland. The final goals of the report were to make recommendations for policy, practice and research in order to reduce harm from alcohol problems. Throughout the project, I spoke with people all the way from Peebles to Lerwick, all with backgrounds as varied as the communities they came from. Social workers, family carers, activists, doctors, nurses and people with lived experience of alcohol harms all generously shared their thoughts with me. I am so grateful that I got the chance to meet so many of the participants in person during our five consultations which took place around the country. I had just managed to conduct a couple of in person interviews when COVID-19 caught up with the UK and suddenly we were living in a brand new reality.

Even though I have been unbelievably lucky during this crisis, keeping good health and a job which allowed me to work from home, I still spent much of the first months of lockdown in haze of disbelief. Meetings around the country, visits to Recovery Cafes, ferries to Orkney and Shetland – these were all notions of the past. I felt strange and more than a little selfish asking people to give their time to a project about rural alcohol problems when we were in the grips of an unprecedented global pandemic. Slowly but surely however, we all settled into new routines. People got back in touch and participants were recruited. The fact that so many were still interested and willing to engage shows how important the goal of reducing alcohol harm is to many people in Scotland. As a result, many fascinating hours were spent chatting over the phone or to one another through screens. Some interviews, squeezed into busy schedules, ending up stretching into two hour conversations ranging from the history of Scotland’s deindustrialisation, shame, tradition, gender roles, coping mechanisms and more.

There is undoubtedly a dimension of understanding which gets lost when you are unable to physically visit a location in person, and meet face to face. However, I do think that working remotely and conducting interviews over the phone or internet ended up having some advantages. Given the wide variety of places people reached out from, it might have been difficult to meet all participants in person even if travel had been possible. In addition to this, in some cases people told me that they found it easier to speak about more difficult and personal matters over the phone rather than in a public place, particularly in a small community. I might have missed out on these insights had I gone on my road trips after all.

Furthermore, despite the immense challenges of this period, there have been some silver linings too. The pandemic, among other things, has shaken up the way we work. In some cases, this has allowed for positive changes with regards to treatment for alcohol problems and support for recovery. Some service providers shared with me that while they had felt the system was resistant to change, the pandemic had forced innovative and inclusive communication methods which actually benefit remote communities. People in recovery also spoke about a balance of positives and negatives during this time. Most agreed that a WhatsApp group or a Zoom call simply can’t replace in person connections. However, there were some who said that had it not been for the pandemic and the opportunity to talk about recovery remotely, in a safe and private space, they might never have sought out peer support. I felt encouraged and optimistic at the energy and determination of people in recovery to keep reaching out and looking out for another. This is representative of recovery communities full stop, but came out particularly during this challenging time.

Working in this field, we are familiar with alcohol harm statistics: Approximately 22 Scots per week die of alcohol-specific causes. In 2017/18, there were 34,499 alcohol-related hospitalisations. Behind these numbers however are the stories of individuals, families and communities. It was a privilege to share some of these stories in the Rural Matters report and my hope is that these voices will reach the ears of people who make decisions at all levels, from community licensing boards all the way to our top politicians. While we still face huge challenges in terms of gaps in service, stigma, shame, and resourcing, I believe there is cause for optimism for the future. In particular, participants mentioned greater availability of online and telehealth services, mobile care units, home-visits, and increased opportunities for education, training, networking and communication for rural service providers as examples of how flexible innovations, some of them arising from the pandemic itself, might improve alcohol care services in the future. While the crisis we are facing is by no means over and its effects are still years away from being fully understood, I hope that any positive lessons we have learned during COVID-19 about community engagement, flexibility and innovation will be brought with us into the future.

Read the full Rural Matters report here.

References:

Scottish Government. (2018) Scottish Health Survey 2018 - Volume One: Main Report. Available from: https://www.gov.scot/publications/scottish-health-survey-2018-volume-1-main-report/pages/24/ [Accessed 7 October 2020]

MacDiarmid, J. (2020) Rural Matters Understanding alcohol use in rural Scotland: Findings from a qualitative research study. Scottish Health Action on Alcohol Problems. Available from: https://shaap.org.uk/downloads/reports-and-briefings/278-rural-matters.html [Accessed 7 October 2020]

SHAAP. (2020) Minimum Unit Pricing. Scottish Health Action on Alcohol Problems. Available from: https://shaap.org.uk/our-work/minimum-unit-pricing.html [Accessed 7 October 2020]

All SHAAP Blogposts are published with the permission of the author. The views expressed are solely the author's own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems.