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Community participation and belonging during rural nursing placements in Queensland: A cross-sectional study

This cross-sectional study of 153 undergraduate nursing students in rural Queensland found that while community interaction increased during placements, a sense of belonging was more strongly associated with the breadth of active community participation and repeated rural experiences than with mere exposure or interaction frequency.

Original authors: Jessica Elliott, Liz Ryan, Professor Leah East, Professor Daniel Terry

Published 2026-07-22

📖 6 min read🧠 Deep dive

CC BY 4.0

Original authors: Jessica Elliott, Liz Ryan, Professor Leah East, Professor Daniel Terry

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you are a traveler arriving in a new town. You might walk past the bakery, wave at a neighbor, and grab a coffee. That is exposure: you are physically there, and you have seen the place. But there is a different feeling called belonging. Belonging is what happens when you stop just walking past and actually start helping to bake the bread, joining the neighborhood cleanup, or becoming a regular at the local sports team. It's the difference between being a tourist who looks at a map and a local who knows the shortcuts and the stories.

In the world of healthcare, there is a big problem: many small, remote towns don't have enough nurses. To fix this, universities send nursing students to these towns for a few weeks to learn how to care for patients. This is called a rural placement. For a long time, schools thought that just sending students to these towns (the exposure) would be enough to make them want to stay and work there later. But researchers are starting to wonder if simply being there is enough, or if the students need to actually feel like they are part of the community to truly belong. This study dives into that question, asking: Does just showing up make a student feel at home, or do they need to get their hands dirty and join in the fun?

The Study: Do You Just Visit, or Do You Join In?

A team of researchers from the University of Southern Queensland decided to investigate this by asking 153 nursing students who had just finished their rural placements in Queensland, Australia. They wanted to know: Did these students feel like they belonged? And what made them feel that way? Was it just the length of their stay, or was it something they actually did?

The researchers used a survey to measure two main things. First, they looked at community interaction, which is like how often you say "hello" to people. Second, they looked at community participation, which is like actually joining a game, volunteering, or going to a local event. They also measured the students' sense of community using a special checklist called the Brief Sense of Community Scale (BSCS), which asks questions about whether you feel you fit in, have influence, and share emotional connections with others.

Here is what they found, and it's a bit of a surprise for anyone who thinks "more time equals more friends."

1. Just Showing Up Isn't Enough
The study found that simply being in the rural town for a longer time didn't automatically make students feel like they belonged. Even though students who stayed for eight weeks interacted with locals more often than those who stayed for four weeks, the extra time didn't directly translate to a stronger feeling of belonging. It's like sitting in a classroom for an extra hour; you might see more people, but you don't necessarily make a new best friend just by sitting there longer.

2. The Magic is in the Doing
The real secret sauce was participation. The students who felt the strongest sense of belonging were the ones who actively joined in a wider variety of community activities. Whether it was hiking, visiting a local pub, or going to a community event, the breadth of their involvement mattered most. The data showed a clear link: the more different types of activities a student joined, the stronger their feeling of belonging. It suggests that to feel like you belong, you have to be an active player in the game, not just a spectator watching from the sidelines.

3. The "Home" Connection
Interestingly, the students who were already active in their own home communities (the places they lived before the placement) were the ones who got the most out of the rural experience. If a student was already used to joining sports teams or volunteering back home, they were more likely to do the same in the rural town. This suggests that belonging is a habit; if you are used to participating, you are more likely to participate when you are away.

4. The Gender Gap and Experience
The study also noticed some other patterns. Female students reported feeling a stronger sense of belonging than male students. The researchers suggest this might be because men in nursing sometimes feel more visible or stand out in a field that is mostly female, which can make it harder to blend in. Additionally, students who had done rural placements before felt a stronger sense of belonging than those doing it for the first time. It seems that repeated visits help students move from being "visitors" to becoming "insiders" over time.

What the Study Rules Out
It is important to note what this study says is not the answer. The researchers explicitly found that the frequency of interaction (how many times you say hello) was not the main driver of belonging. You can talk to people every single day and still feel like an outsider if you aren't actually doing things with them. The study suggests that exposure alone—just being in the location—is insufficient to create that deep feeling of connection.

How Sure Are They?
The authors are careful to say that their results suggest these connections rather than proving them as absolute laws. Because this was a "cross-sectional" study (a snapshot in time), they can't say for sure that joining a club caused the feeling of belonging, only that the two happened together. However, the patterns were strong and clear in the data they collected. They found that active participation is strongly linked to belonging, while just being there is not.

The Takeaway

So, if you want a nursing student to feel like they belong in a rural town, don't just drop them there for a long time and hope for the best. Instead, help them join the local sports team, get them to volunteer, or introduce them to the community events. The study suggests that belonging isn't about how long you stay; it's about how deeply you dive into the community's life. It's about moving from being a tourist who looks at the scenery to a local who helps paint the fence.

Technical Summary: Community Participation and Belonging During Rural Nursing Placements in Queensland

Problem Statement
Rural and remote communities globally, including in Australia, face persistent health workforce shortages and difficulties in recruiting and retaining nursing professionals. While Rural Professional Experience Placements (PEP) are a primary strategy for exposing undergraduate nursing students to rural clinical environments and shaping future workforce capacity, existing research has predominantly focused on clinical competence. Emerging evidence suggests that social dimensions—specifically social connectedness, belonging, and community integration—are critical to student wellbeing and future rural practice intentions. However, there is a paucity of quantitative evidence utilizing validated measurement tools to examine nursing students' "sense of community" during rural placements. Furthermore, it remains unclear whether belonging is driven by the frequency of community interaction or the breadth of community participation, and how these factors interact with placement duration and prior rural exposure.

Methodology
This study employed a quantitative, cross-sectional survey design to investigate nursing students' perceptions of belonging and community connectedness.

Participants: The sample consisted of 153 undergraduate nursing students who had completed a rural PEP within public health services in rural and remote Queensland, Australia. The placements occurred in the South West and Darling Downs Hospital and Health Services, covering Modified Monash Model (MMM) categories 4–7 (ranging from medium rural towns to very remote communities). Eligibility required the completion of a rural placement with a minimum duration of four weeks.
Data Collection: An online, self-administered questionnaire was distributed post-placement. The instrument included:
- Demographics and Placement Characteristics: Age, gender, placement duration, location, and history of rural living or previous rural placements.
- Community Engagement Measures: Items assessing the frequency of interaction with placement and home communities (ordinal scale) and the breadth of participation in specific social, recreational, and community-based activities.
- Sense of Community: Measured using the Brief Sense of Community Scale (BSCS), an eight-item instrument grounded in McMillan and Chavis' theory, assessing membership, influence, integration/fulfilment of needs, and shared emotional connection. The adapted scale demonstrated excellent internal consistency ( $\alpha = .969$ ).
Data Analysis: Due to non-normal data distributions, non-parametric statistical tests were utilized using IBM SPSS (Version 31.0.1.0). Analyses included descriptive statistics, Spearman's rank-order correlations, Mann-Whitney U tests, Kruskal-Wallis tests, Wilcoxon Signed Rank tests, and chi-squared tests to examine associations between engagement variables, placement characteristics, and belonging scores.

Key Results

Demographics and Interaction: The sample was predominantly female (80.0%). Students reported significantly more frequent community interaction during their rural placements compared to their home communities ( $p = .007$ ). However, they participated in a significantly broader range of community activities within their home communities ( $p = .005$ ).
Placement Characteristics: Longer placement duration (8 weeks vs. 4 weeks) was associated with more frequent community interaction ( $p = .023$ ) but was not directly associated with higher sense of community scores.
Gender Differences: Female students reported significantly stronger feelings of belonging (higher BSCS scores) than male students ( $p = .009$ ).
Impact of Prior Experience: Students with previous rural placement experience reported significantly higher belonging scores than those without ( $p = .045$ ). Furthermore, the number of previous rural placements completed was significantly associated with belonging ( $p = .022$ ), with scores generally increasing as the number of prior placements increased.
Engagement vs. Belonging:
- The frequency of community interaction during placement was not significantly associated with belonging ( $p = .268$ ).
- The breadth of community participation (number of different activities) was positively associated with belonging both during placement ( $\rho = .188, p = .044$ ) and within home communities ( $\rho = .225, p = .015$ ).
- A strong positive correlation existed between the breadth of activities undertaken at home and during placement ( $\rho = .724, p < .001$ ).

Key Contributions
This study provides quantitative evidence that belonging during rural nursing placements is not merely a function of exposure or duration but is significantly shaped by active participation in community life.

Distinction between Interaction and Participation: The findings challenge the assumption that frequent contact with community members automatically fosters belonging. Instead, the breadth of participation in diverse activities (social, recreational, community-based) is a stronger predictor of belonging than the frequency of interaction.
Role of Repeated Exposure: The study demonstrates that belonging is cumulative; students with repeated rural placement experiences report stronger belonging, suggesting that "ruralisation" is a process of progressive social integration rather than a single-event outcome.
Gender Disparities: The identification of significantly lower belonging scores among male students highlights a potential area of vulnerability in rural placement experiences, potentially linked to challenges in social integration within predominantly female cohorts or specific social networks.

Significance and Claims
The authors claim that the study contributes to the rural health education literature by shifting the focus from purely clinical learning outcomes to the social determinants of placement success. The significance of the work lies in its suggestion that universities, rural health services, and host communities must collaborate to create opportunities for meaningful community participation rather than relying solely on extending placement duration.

The paper posits that while exposure creates the opportunity for engagement, belonging is fostered through the active integration into community life, relationship building, and the accumulation of repeated rural experiences. Consequently, strategies to strengthen the future rural nursing workforce should prioritize facilitating student involvement in recreational, cultural, and social networks to support socialisation and community connectedness. The authors maintain a modest stance, noting that the cross-sectional design precludes causal inferences and that the findings are specific to the Queensland context, calling for future longitudinal research to further elucidate the mechanisms of belonging development.

The Study: Do You Just Visit, or Do You Join In?

The Takeaway

Technical Summary: Community Participation and Belonging During Rural Nursing Placements in Queensland

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