Abstract: Health research is important for innovation and assessment of health status and health interventions, and maintaining a strong, engaged cohort of rural health researchers is essential for the ongoing improvement of the health of rural populations. Ethical guidelines and processes ensure research is undertaken in a way that protects and, where possible, empowers participants. The researchers set out to systematically examine and document the challenges posed by ethics and governance processes for rural health researchers in Western Australia (WA) and the impact on the research undertaken. For researchers seeking to conduct studies to improve rural and Aboriginal health, extended delays in approvals can hold up and impede research, ultimately changing the nature of the research undertaken and constraining the willingness of practitioners and researchers to undertake health research. Unwieldy ethics processes were seen to have a particularly onerous impact on rural research pertaining to service delivery, multiple sites, and research involving Aboriginal people, impeding innovation and inquiry in areas where it is much needed.

Objectives: This study set out to describe the particular challenges of meeting the requirements of ethical review and research governance experienced by those undertaking rural research, many of whom focus on health equity issues and how health and health care can be improved for people living in rural settings.

Importance of study: It is recognised that Australia needs ‘better models of health care and services that improve outcomes, reduce disparities for disadvantaged and vulnerable groups, increase efficiency and provide greater value for a given expenditure.' A ‘strong research culture’ is needed to achieve this, and this requires understanding and embracing research as a way to improve health, ideally creating a partnership approach between researchers and end-users of the research.

Study type: In this qualitative study, fifteen WA-based health researchers who were undertaking research in a rural setting or with rural services were individually interviewed between 2014 and 2019.

Conclusion:​​​​​​​ Research and evaluation are important to highlight health disparities and to examine ways in which health and health service delivery can be improved. For rural populations that experience a higher burden of ill-health, investigating, evaluating and improving health systems is critical. However, the impediments to applying a critical lens to systems, programs and service delivery are exacerbated by distance, by funding and by the tortuous state of ethics and governance processes this study has described.

Key Findings:

• The identified challenges included inefficient systems, gatekeeping, apparent resistance to research and the lack of research experience of those involved in approval processes.
• The findings highlight that, despite the stated efforts to streamline them, inefficient ethics review and governance processes are continuing to hinder the development of a strong research culture in WA. As described by other researchers.
• Rural researchers in Western Australia were often dealing with systems that involved multiple health services and Aboriginal people, increasing the burden associated with approvals. Ethics reviews  were holding up smaller projects, quality assurance and validation studies, stifling rural research and deterring young researchers from entering into rural and Aboriginal research