Off the beaten path: A scoping review of how 'rural' is defined by the U.S. government for rural health promotion.

Background: Given the recognition that the U.S. government lacks a consensus definition of the word rural , the purpose of this scoping review was to uncover how the federal government defines the term and to establish a nuanced understanding of what criterion is used to designate an area as rural. Methods: Arksey and O'Malley's framework was used to synthesize, analyze, and summarize the existing literature. A multi-system search was conducted, and articles were screened for eligibility by two independent reviewers using pretested forms. Results: Initially, 929 articles were screened that used the search terms rural and some variation of the word definition . After eliminating all ineligble studies, 49 documents were included in the final analysis. These documents revealed 33 federal definitions of rural . The majority of definitions centered on either population, population density, or urban integration provisions. Additionally, the analysis showed that the literature could be separated into two categories: how rural was defined in a particular industry or for a specific population and the multiple adverse effects of having multiple definitions of rural . Conclusion: The discrepancies found in current classification systems reveal the need for a standardized definition of rural . Ultimately, policies centered on securing health care services for rural populations are impacted by whatever definition of rural is used. Failing to establish a gold standard definition of rural could have harmful consequences to the health and wellbeing of the many people living in rural communities across the U.S.