In the following combined results and discussion section, the themes developed are presented and discussed in connection with existing literature, and especially our conceptual framework, while being accompanied by quotations from the participants to illustrate and corroborate the content. Specifically, through analysing participating youths and professionals’ narratives, we developed one main theme, ‘landscapes of care and despair’ comprising the two themes: ‘(dis)connectedness’ and ‘extended support or troubling gaps’. In accordance with Milligan and Wiles [23], our results portray ‘landscapes of care’ as encompassing various health-promoting and enabling features spanning across structural and organisational levels while emphasising the importance of rural youth experiencing empathic encounters with people alongside senses of inclusion and belonging to place (see also [24]). At the same time, negative aspects were brought to the fore and by making them explicit, we expanded our framework to illustrate how landscapes can simultaneously be a source of despair, for rural youth in general and minority groups in particular. To ensure the participants’ confidentiality and anonymity, pseudonyms are used throughout the following text.
(Dis)connectedness
Based on the idea that care encompasses people-place interactions and also interpersonal relations that occurs within formal and informal spaces outside traditionally medical settings [23, 24], this first theme, ‘(dis)connectedness’, portrays how various physical and social features of landscapes can give rise to both care and despair.
With reference to health-promoting features characterising landscapes of care, the participating youth discussed several aspects contributing to feelings of belonging, defined by Antonsich [38] as being rooted in or emotionally attached to a place. In this regard, their narratives painted a classical picture of rural areas as being marked by sparse settlements, tranquillity and safety [6]. These aspects appeared through positive expressions like “it’s generally calmer [here], less people and more free” (Tim, ninth grade student, S5) and “you feel really safe here and like, walk around knowing that nothing will happen” (Anna, high school student, S2). Adding to these representations of ‘peace and quiet’ [5], the youths valued the pristine nature through outdoor activities like snowmobiling and fishing that – especially in young men – seemed to bring meaning to their spare time and promote wellbeing. Besides being experienced through physical and more tangible features, attachments to their home place appeared to also be felt, as depicted by Lisa (high school student, S2): “it’s not as if I have any hatred for [the local area], I love it, and always think it’s so nice to come home when I’ve been away”. Following conceptions of the ‘rural idyll’, where Norwegian youth have portrayed peripheral areas as characterised, for example, by solidarity, neighbourliness and spirits of cooperation [6], the participants further described a closeness within their locale. This aspect came across through reports of tight-knit communities shaped by strong social ties where “everyone knows everyone” and people both friendly and helpful.
Besides expressing ‘idyllic’ accounts of affection for, senses of comfort in and feelings of connectedness to their locale, a negative story portraying landscapes of despair, was told in parallel. On the one hand, this emerged from a perceived lack of opportunities for organised leisure, education and employment, which in line with discourses on rural deficit and decline [4, 10] appeared as (re) constructions of rural areas as boring [5] and dull [6], with “nothing to do” and “nowhere to be”. On the other hand, this tale comprised reservations about the benefits of being close and visible to include descriptions about the problems of rural proximity and transparency. Following Haugen and Villa [39], this came across in the youths’ narratives as strict and limiting social norms with gossip and rumours appearing as obstacles to privacy, as sources of labelling and as control mechanisms that pressured youth to look, act and behave in certain ways.
It’s just this trash-talk, I don’t even have to say anything … Say I have a fever and don’t have the energy to put make-up on, I haven’t had the energy of putting a pair of jeans but wear sweatpants to the store. Then you are … yes, my god what a chatter it will be. You cannot walk a certain way … In one way, I long for [a bigger city down south], where you can be yourself, it’s not a problem how you look. (Sophie, young adult, S3).
In accordance with Sophie’s narration showing the struggles of conformity associated with intrusive aspects of informal social control, the youths’ discussions illustrated how “everyone has to be like everyone else” in order to ‘fit’ within landscapes more generally and peer groups in particular. Based on this notion, portrayed was several examples of racist accounts where discourses and practices that distinguished ‘us’ (the ones who belong in a place or to a group) from ‘them’ (the ones who do not) [38] appeared to create clear social and physical boundaries between native- and foreign-born refugee youth. This aspect became visible in the immigrating youths’ narratives, for example, through descriptions about the difficulties of getting integrated into and accepted by the community, no matter how hard you tried. From the perspective of native youth, in turn, it appeared through discussions portraying ‘them’ – the immigrating youth who could not speak the language or “behave” by following norms and laws – as different and inferior to ‘us’ who can. Adding to these discriminatory struggles, the youths’ believed that identifying and/or coming out as lesbian, gay, bisexual, transgender or queer (LGBTQ) might be difficult since it deviated from the heterosexual norm. In this regard, most participants assumed that youth with non-binary gender identities or non-heterosexual sexual orientations would (have to) leave for the cities to avoid the prejudice and isolation associated with being ‘different’ in the rural.
To this end, the theme ‘(dis)connectedness’ illustrates how circumstances of and in landscapes may be a source of care for some youth by allowing them to feel ‘at home’ in their rural locale and like they ‘fit’ within a group; circumstances that according to Antonsich [38] generate senses of connectedness to people and place on which belonging relies. Due to a perceived marginalisation and exclusion of different sub-groups of young people, the theme shows how conditions of and in landscapes might also be reason for despair, especially to minority youth. In line with Leyshon [40], the theme thus portrays how landscapes can be ‘enabling and inclusive’ as well as ‘restrictive and prohibitive’ at the same time, thereby contributing to complex landscapes characterised by care and despair.
Extended support or troubling gaps
The second theme, ‘extended support or troubling gaps’, illustrates the importance of organisational and more formal arrangements in the provision and practices of care, while also suggesting that both political and affective aspects facilitate and hinder the process of caring for and about rural youth [23]. In particular, this theme describes how the mere existence of health and social services does not guarantee that youth will benefit from them, but rather that their access to care and experiences of being cared for and about involve both structural and interpersonal components.
Following Milligan and Wiles [23], who stress the value of ongoing commitments to and responsibilities for care, this theme captures features within landscapes that the participants’ saw as central to ensure good and consistent care for rural youth. In this regard, the participants considered the willingness of policy-makers and managers to prioritise youths’ needs and invest in their health as essential, for example, by providing staff at youth clubs and youth clinics with full time positions to increase the availability of services (see [41]). As further examples stressing the importance of caring at structural levels while taking long-term perspectives to care [31], emphasised was also the benefits of being able to work strategically, continuously and preventively with issues that mattered to youth. The professionals then further described the value of cooperating and communicating across sectors to care for youth, circumstances that appeared to be partly facilitated by the rural closeness and transparency.
Several examples of ‘pioneering’ care-work also appeared in the participants’ narratives, illustrating how care is largely an interpersonal concern involving ‘the provision of practical or emotional support’ ([23] p. 737). At the general level, this came across through descriptions of omniscient and hardy professionals that transcended barriers while extending their support beyond the roles and responsibilities of their profession to care for and about youth. More specifically, it comprised portrayals of practical assistances such as personalising and tailoring care according to need while “fixing appointments for them” (Elin, social councillor, S3) to help youth navigate within ‘complex, fragmented bureaucratic health systems’ ([42] p. 377). The work of pioneering professionals also involved accounts of empathy and compassion, with them stretching emotionally outside what might be expected in their profession. In line with Milligan and Wiles ([23] p. 738), who stress that ‘care-givers do not simply do things for people’ but support them with ‘personal attention’ and ‘encouragement’, this aspect came across, for example, through descriptions of professionals trying to help young people ‘at-risk’ by compensating attentively for parental shortcomings. From the youths’ perspectives, in turn, these emphatic and compassionate aspects of care appeared through descriptions of being treated as equals and of having someone – besides family and friends – that took interest in and cared about them.
I got a great psychologist who took care of me. It was (...) we talked, and it was like five appointments set up at a time and I thought “finally, finally someone that sees me”. (Sophie, young adult, S3).
Parallel to the above health-promoting or enabling features, the participants’ discussed several obstacles to the provision, practices and experiences of care. Here, the professionals described how financial constraints, problems with recruiting and retaining staff as well as collaboration challenges emerging from the different roles and responsibilities of actors made it difficult to prioritise youth and provide them with adequate care. From the youths perspectives, it appeared to result in ‘system inefficiencies’ ([43] p. 10) and troubling gaps in service delivery, with the care being shaped by long waiting times, needs to repeat their story and fragmented or disrupted contacts which implied that they rarely saw the same physician twice: “the craziest thing is that I’ve never had the same medical doctor and I’ve been going to the psychiatry [team] for over ten years” (Lexi, young adult, S3). In accord with Robards and colleagues’ [43] notions of an unresponsive rural health system for young people, the youths also typically considered various health services as vital, but not necessarily as providing appropriate care. This issue built on the perception that health centres often disregarded problems that went beyond the reason for consultation with a “you only get what you came for” attitude, while being mainly concerned with somatic problems which yielded tensions between what the youths’ wanted or needed and what they actually received.
Alva: It is like... they sit there and just “we give you this medicine, it might work” and then when you come back and say that it doesn’t work, either they increase the dose or give you a new medicine. It’s all or nothing. You never get to talk about things.
Nina: They are just like” here, take this and maybe you feel better”.
Alva: Yes.
Nina: That they just don’t care about us, just like “never mind how you feel”. (Alva and Nina, ninth grade students, S1).
As illustrated in Alva and Nina’s discussion, most youths’ wanted and needed someone that they could talk to and address face-to-face. This meant that although they recognised the importance of ‘care technologies’ to overcome rural problems of accessibility and anonymity, the expansion of eHealth was generally not considered to be an adequate or optimal solution since it allowed caring for to ‘become progressively more disembodied’ ([23] p. 742).
In line with the construction of youth as a transitional period [44] and a ‘maturity gap’ in the life course [45] where young people are considered en route to, but not able to fully participate in, an ‘adult society’, the narratives illustrated how the challenges as well as the strengths of rural youth were often overlooked or disregarded in their community. Specifically, there was a strong general perception among the youths’ that local policy-makers were distant and degrading others that rarely saw, heard or acted on their needs, which came across in expressions like “I think it’s sad that politicians don’t think you have a voice that is important enough just because you’re not eighteen” (Erik, high school student, S3). The professionals largely corroborated this view of accountability [46] by explaining how young peoples’ opinions seldom were considered since older generations typically saw youth as ‘topics’ of rather than ‘actors’ in the community discussions. In addition, while some sites had formal structures for ensuring a democratic representation of young people through the youth councils, their role as “referral bodies” were generally questioned by the young people involved.
Dani: In terms of democracy, we really didn’t get a response from the municipality when we tried to work politically. But with events, we could do as much stuff as we wanted.
Jonah: Yes, that is when the municipality started to react.
Dani: Yes, or rather it was like … instead of the youth council being a democratic body as it should be, it became a group of young people that created events for each other. And that is very practical, but then at the same time they [the politicians] increase the price of bus tickets and implemented both this and that without … then just writing, “no consequences for children and youth”, even though such things matter. (Dani and Jonah, young adults, S4).
Instead of acting as pathways to ‘real’ influence, efforts within the youth councils were often consultative and reduced to the arrangement of events. This generated a lot of frustration among the youth involved while aligning with Coe and colleagues’ ([47] p. 1331) notions that social activities seem to be an ‘important but insufficient aspect of political action’.
Overall, the theme ‘extended support or troubling gaps’ indicates that the provision of care for rural youth should follow from the ‘priority of care’ [48] by moving beyond personal and practical aspects of service delivery to also include the political and the participatory. In line with Milligan and Wiles ([23] p. 747) notions ‘blurring of boundaries’, it further shows how the practices of care involve the pioneering work of committed and compassionate professionals who span across institutional spaces while stretching emotionally outside their profession to care for and about rural youth. Conversely, the theme illustrates how the care sometimes neither align with youth wishes nor correspond to their needs. This followed largely from experiences of receiving fixed rather than flexible services that focused on specific problems instead of seeing the whole person. Additionally, the theme show how many youth felt ignored (and sometimes even exploited) by seemingly ‘care-less’ policy-makers who delegated responsibility without allocating resources or power thereby preventing them from really participating in decision making to extend their influence beyond mere consultations and instrumental engagements.
Study strengths and limitations
Our analysis comprised an extensive dataset including diverse sites regarding, for example, location, size and socio-economic situation; different youth voices in terms of, for example, ethnicity, gender, functionality, age and sexuality; and various vocations with professionals working across many sectors. Using a conceptual framework coupled with thematic analysis, we chose to illustrate the richness, diversity and discrepancies in the material by illustrating a multitude of ‘care-ful’ and ‘uncaring’ aspects and experiences. Along with Braun and Clarke’s [34] criteria for rigor, the data was thoroughly coded and analysed by scholars active in the research process. Trustworthiness was further achieved through prolonged engagement with the participants, which was aided by several personal contacts and site visits that allowed us to build trust and familiarise with the setting. The interdisciplinary research team contributed to critical assessments, triangulation and the integration of concepts.
Despite the diversity captured, there may be perspectives that we have not yet covered. In particular, although we tried to involve Sámi youth, capturing their experiences and perceptions was unfortunately not possible at the time of data collection.
