Australian Community Research Articles

Language and terminology to describe transgender communities; Perspectives from people with lived experience

Background There is no consensus over the meaning of “transgender,” “trans and gender diverse,” and other terminology used to describe people with a gender different from the gender presumed or recorded for them at birth. We aimed to survey transgender (trans) individuals to understand lived experience perspectives on terminology. Methods An online cross-sectional survey of trans people currently living in Australia and aged ≥16 was conducted from June 2021 to April 2022. Demographic data and terminology preferences were ascertained through fixed-option and free-text questions. Results Of 1023 respondents with a median age of 30 years (IQR 24, 41), 37.1% were trans women, 34.9% were trans men, 27.6% were non-binary, and 0.4% had a culturally specific identity. There was no consensus regarding community-level terminology, with “trans/transgender and gender diverse” the most preferred term (21.9%), followed by “trans/transgender” (19.3%), and “gender diverse” (15.1%). The term “trans/transgender” was more preferred by trans women (27.9%), trans men (19.0%), respondents who had a history of or wanted gender-affirming hormone therapy (GAHT; 20.7%), and gender-affirming surgery (GAS; 20.9%), compared to non-binary respondents (8.2%), and respondents who did not want GAHT (4.9%) or GAS (13.9%). Three themes emerged from free-text responses regarding term preference: (1) Inclusivity, (2) Trans as a binary and medicalized experience, and (3) Societal understanding, accessibility, and destigmatization. Conclusion From Australian trans communities’ perspectives, the term “trans/transgender and gender diverse” was the most preferred community-level terminology to collectively describe people with a gender different from the gender presumed or recorded for them at birth. Further perspectives are needed from other cohorts internationally.

Resistance of Australian fish communities to drought and flood: implications for climate change and adaptations

Climate change‐induced extreme weather and related drought and flood conditions are heterogeneous across space and time. The variability in location, timing, and magnitude of rainfall can alter how species respond to the drought and flood disturbances. To further complicate this matter, when droughts end they are often followed by extreme flooding, which are rarely considered as a disturbance (Humphries et al. 2024), let alone assessed with its own heterogeneity. Consequently, it is difficult to quantify impacts on ecological communities across large spatiotemporal scales without considering flood‐drought disturbance characteristics in sequence (Burton et al. 2020). We hypothesized that native organisms have evolved resistance to withstand repeated cycles of drought‐flood disturbances, and that established non‐native species have adapted to persist in novel conditions. To test this, we fit spatiotemporal models of species occurrence with local rainfall patterns as covariates in the drought and flood impacted Murray‐Darling basin in Australia during the decade long Millenium Drought, and its recovery period. During these drought conditions, river‐floodplain organisms in the Murray‐Darling became localized in refugia that limited longitudinal and lateral connectivity (Bond et al. 2008), and following flooding the same organisms were exposed to dispersal and recruitment opportunities (Humphries et al. 2020), as well as to hypoxic blackwater events that lead to the mortality of aquatic organisms (Small et al. 2014). At the basin‐scale we found that the range size of most native and non‐native fishes were highly resistant to the extreme drought and post‐flood conditions. At local scales, species richness, or detection, actually increased under drought conditions. Both findings highlight the resistance of species to climate change driven extreme weather, which opens new questions on community adaptations.

Place attachment and lived values in Western Australian communities

Substantial research exists on attachments people have to places and the phenomena and objects they value. However, insights on how values vary between different locations and across demographics and how place attachment differs between rural and urban areas are more limited. These understandings are needed to design meaningful adaptation strategies for people and communities at risk from climate change. This study examines attachment to place and things people value in eight communities in Western Australia, using a survey with 403 participants. Results showed that residents across the rural communities shared similar values, but that the values of urban communities were differentiated socioeconomically. Contrary to our hypothesis, place attachment was not stronger among the rural compared to the urban sites. The findings point to the importance of incorporating place-based, lived values and needs, particularly from less affluent residents, into inclusive adaptation planning.

Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study

ObjectivesParamedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted...

An inpatient mental health placement for paramedic undergraduate students: a pilot study

BackgroundThe prevalence of mental and behavioural illnesses in the Australian community is increasing. Paramedics are frequently the first health responders to a mental health crisis, and their workload associated with mental health presentations is also increasing. The present study explored the experience and perspectives of undergraduate paramedic students who participated in a pilot mental health placement.MethodsA pilot workplace learning opportunity was established in which students completed a portion of their community service hours in an inpatient mental health setting at Port Macquarie Base Hospital. Eight students attended and completed the placement and were administered the Clinical Placement Evaluation Questionnaire.ResultsStudent responses to this placement experience were overwhelmingly positive. The data showed that all the students responded “Strongly Agree” or “Agree” to each of the survey items. Thematic analysis of the qualitative data yielded four central themes related to benefits, additional training and education, nursing staff, and improvements.ConclusionsThis pilot study suggests that mental health placements for paramedics have meaningful educational value and can impact student learning. Since this pilot study, mental health placements have been permanently included as part of the undergraduate curriculum in our institution.

Investigating the influence of information sources on flood-coping appraisal: Insights into flood mitigation behaviour

Understanding how individuals and communities respond to flood risks is paramount for effective disaster management and community resilience. This study investigates the impact of information sources on the coping appraisal of Australian flood-prone communities (flood-coping appraisal) to gain insight into flood mitigation behaviour. Utilizing the cognitive process of Protection Motivation Theory (PMT) and integrating it with the Health Belief Model (HBM), a comprehensive framework is developed to explore the interplay between sources of information, cognitive appraisals, and coping responses. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), data from a research survey are analysed to examine the relationships between latent variables within the framework. The results reveal two key components significantly affecting flood-coping appraisal: Benefit/barrier Appraisal and Social Environment. Benefit/barrier Appraisal evaluates individuals' perceptions of the cost-effectiveness of mitigation measures, their potential impacts on property appearance, and property resale value, while the Social Environment assesses individuals’ observational learning from social norms and the availability of social support. Additionally, experiences with floods inside buildings emerge as a significant factor influencing the flood-coping appraisal. The findings underscore the importance of understanding the sources of information that drive higher flood-coping appraisal for effective flood risk management and community resilience. These insights contribute to developing targeted flood risk communication strategies to promote adaptive behaviours and enhance community resilience in the face of flood hazards.

Food intake in an Australian Aboriginal rural community facing food and water security challenges: A cross-sectional survey.

Researchers were invited by Aboriginal leaders to collaborate on this study which aimed to assess food intake in the Walgett Aboriginal community to inform long-term community-led efforts to improve food and water security and nutrition. Aboriginal adults living in or near Walgett, a remote community in north-west NSW, Australia, completed an adapted Menzies Remote Short-item Dietary Assessment Tool, which was administered verbally and face-to-face in early 2022. Aboriginal people were involved in the survey design, training and collection, and analysis of data. Descriptive statistics were tabulated, overall and by gender, age, and location. Differences by sex, age group (18-44 years versus ≥45 years), and location (Walgett town or other) were determined using a chi-square test. A total of 242 participants completed the survey; 55% were female. Three-quarters of participants reported meeting the recommendations for discretionary foods (73%); however, more than half (56%) exceeded the recommended maximum serves of sugar-sweetened beverages. The proportion of participants meeting core food group guidelines was 72% for meat, 36% for fruit, 20% for bread and cereals, 6% for dairy, and 3% for vegetables. Overall, none of the participants met the recommended serves of all food groups outlined in the Australian Dietary Guidelines. Findings show that Walgett Aboriginal community members surveyed were consuming a healthier diet than national data reported for Aboriginal and Torres Strait Islander people in Australia. However, none of the participants were meeting all of the national dietary guidelines, placing them at increased risk of diet-related chronic disease. Local Aboriginal community-led efforts to improve food and water security should include specific strategies to improve nutrition.

Delivery of enhanced asthma care in pharmacies: Perceptions and experiences of Australian service providers

BackgroundEvidence-based asthma management services have been tested in Australian community pharmacies for over 2 decades and have been well received by patients but are not retained in practice. The positive clinical outcomes of these tested services suggest the potential for wider implementation, for which the providers’ perspective is critical. ObjectiveThis investigation evaluates the implementability of the Pharmacy Asthma Service (PAS) through the experiences and perceptions of the community pharmacists delivering the service. MethodsForty-eight pharmacists took part in a posttrial semi-structured qualitative telephone interview, representing 42 of 51 (82%) eligible PAS intervention arm pharmacies. Qualitative data were deductively analyzed in accordance with the Implementation Outcomes Framework. ResultsPharmacists recognized the positive impact of the service on patients’ health outcomes, the pharmacist’s practice, and in fostering stronger and more beneficial pharmacist-patient relationships. However, whilst acknowledging the importance of such a service, the pharmacists faced challenges in recruitment and patient follow-up. Pharmacists stated that further work is required to address pharmacist and patient time constraints, patient health beliefs and to increase the acceptance of pharmaceutical care provision in community pharmacy practice by patients and other health care professionals. ConclusionPharmacists can deliver enhanced clinical care for asthma patients with positive perceived professional and patient outcomes. However, it remains evident that time, remuneration, and recognition of the pharmacist’s role in chronic care management form barriers to the implementation of asthma services in community pharmacies. Broader policy and systemic changes are required to successfully balance medication supply and quality patient management roles at the same time as a required shift in research processes.

Experiences of COVID-19 in an Australian community cohort of adults with epilepsy

A number of studies have been conducted on the effects of the COVID-19 pandemic on people with epilepsy (PWE), some showing increased seizures, poorer psychosocial states, and reductions in Quality of Life (QoL). During the latter stages of COVID-19, well before the UN declared an end to the state of emergency, our study was conducted in Australia of a sample of women and men ≥ 18 years. The study was based on Wave 6 of the Australian Epilepsy Longitudinal Study (AELS). It used mixed methods. Two main scales were used in the study, the QOLIE-31 for QoL and the MOS-8 for social support. The quantitative component of the study looked at QoL in relation to COVID-19 and found no QoL differences in those who contracted the virus. However, there was significantly lower QoL in those having difficulties in seeing a GP, for those with limited access to healthcare, and for those who had problems in gaining ASMs (anti-seizure medicines) and/or other medicines and being unvaccinated. Being younger and living in rental accommodation were most likely significant contributing factors. Those not being vaccinated were less than the proportion in the whole national population., The qualitative component focussed on reasons for being vaccinated or not. Overall, the responses to the question “Were you vaccinated?” demonstrated that people made informed decisions on vaccinations, taking into account their own health as well as protecting family and public health considerations.

Factors Associated with Advance Care Planning Engagement Among Community‐Dwelling Older Adults: A Cross‐Sectional Study

ABSTRACTAimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community‐dwelling older adults.DesignA cross‐sectional study was conducted with 262 community‐dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.MethodsValidated self‐reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.ResultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.ConclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community‐dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community‐dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.ImpactUnderstanding factors associated with advance care planning engagement among community‐dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community‐dwelling older adults in advance care planning.Reporting MethodThe STROBE statement checklist was used as a guide to writing the manuscript.Patient or Public ContributionThe study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Are Australian Jewish community organisations meeting child safe standards in their policies? An exploratory desktop audit

Are Australian Jewish community organisations meeting child safe standards in their policies? An exploratory desktop audit

Melatonin Use in School-Aged Children and Adolescents: An Exploration of Caregiver and Pharmacist Perspectives

ABSTRACT Objective This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use. Methods A convenience sample of caregivers with children (aged 11–16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach. Results Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible. Conclusion Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.

Consideration of life safety risk equity principles in the assignment of design flood probability

ABSTRACT When designing hazardous infrastructure a life safety assessment process can be applied that considers three tests; 1 an individual risk equity test; 2 a societal intolerance test; and 3 a ‘legal’ test as to whether risks are reduced to be ‘so far as is reasonably practicable’ (SFAIRP) or ‘as low as reasonably practicable’ (ALARP). This approach, which is embedded in many workplace health and safety regulatory jurisdictions and safety standards for infrastructure including dams, nuclear facilities and industrial facilities, has clear justification, can be rigorously tested, and is defensible. While evidence to suggest a strong societal intolerance to floods is limited (i.e. there does not appear to be a disproportionate reaction to life loss from flood events compared to, for example, dam failure) there is a clear connection between flood risk and life safety equity principles. An individual life safety risk equity test, considering a person’s right to certain levels of protection in our society, compares flood risk with that of the background life safety risks from all hazards that exist in the Australian community. Based on age and gender distributed census data and typical annual exceedance probabilities assigned for flood management, there may be circumstances where flooding is the leading fatality risk for particular individuals living on a floodplain. Other considerations include ownership of flood risk (the floodplain manager or the individual), the distinction between voluntary and involuntary risk taking (noting that many road fatalities occur during flood events), the ratio between flood exposure and fatality (including flood hazard) and any legal and ethical obligations relating to public safety and a standard of care.

Creating effective research partnerships with rural communities: a community culture framework

ABSTRACT Researching alongside rural communities often garners vastly different outcomes between communities despite applying the same research methodology and considering the contextualized and nuanced nature of such projects. In this paper, we explore what might account for these differences through the lens of an education and career pathways project conducted in three Australian rural communities. The project drew on community-based participatory, collaborative research which supports the development of responsive community–researcher partnerships that can be adapted to community context. While the outcomes of any research project often appear to be an accident of timing and circumstance, in this paper we argue that community–researcher partnerships can be more deliberately targeted to take account of community context. We present a conceptual framework that considers particular characteristics of communities and the people within them, suggesting how community–researcher partnerships might be developed to help deliver more consistently effective outcomes that address ‘real-life’ issues in critical and transformative ways.

SynD: Australian synthetic health data community of practice

ObjectivesThe current workflow for health data research in Australia is inefficient. After funding is secured, researchers often face delays of months or years to access the necessary data. Synthetic data could significantly improve the pace and impact of health data research but lacks foundational infrastructure. We aim to develop this infrastructure and support the use of synthetic data to improve data access and research quality across Australia. ApproachWe held two workshops with Australian groups working on synthetic data. The format included participant updates and invited talks on international approaches to synthetic data and health data research. Workshops collected use cases and stimulated discussion on national collaboration. A facilitator then led thematic analysis to draft a consensus roadmap and terms of reference towards national synthetic data infrastructure. ResultsWe recruited 18 participants. Participants were cross sectoral: universities (9), research funding bodies (5), state health departments (4). Represented six states and territories: Queensland (6), New South Wales (3), Victoria (3), Western Australia (3), Australian Capital Territory (2), South Australia (1). Gender: women (11), men (7). The roadmap includes stakeholder engagement, a governance framework, and training events. ConclusionSynD is an Australian community of practice for synthetic health data. Our mission is to unlock the value of health information through synthetic data to advance research, education, innovation and service delivery within the health and care sector. This collaborative effort should ensure a harmonised approach to the safe and effective utilisation of synthetic data to enhance health outcomes across Australia.

Factors That Influence Medical Retrieval Decisions in Remote Central Australia

Introduction Medical retrieval services play a key role in the transportation of unwell patients from remote communities across Australia. Decision to retrieve a patient from a remote community is dependent on unique characteristics of remote locations and thus different to urban and rural retrievals. The study aims to explore various factors that affect medical practitioner decisions to retrieve patients from remote central Australian communities. Methods Semi-structured interviews were conducted with 36 staff involved in medical retrieval processes in central Australia. The data collection and analyses were part of a broader study evaluating a newly implemented medical retrieval model in central Australia. All interviews were recorded and transcribed. Transcripts were co-coded inductively by two researchers using NVivo software. Similar codes were grouped into themes, one of which related to the range of factors that affect decisions to retrieve a patient or request a retrieval which is the focus of this paper. Results: Decision-making about who, when and how to retrieve patients was complex and involved trade-offs. Severity of patient illness, resource availability (e.g. transport infrastructure, remote area staff workload and fatigue), the skills, experience and relationships with community of primary health care and medical retrieval staff, strength of primary health care systems in remote communities, specific primary health care and retrieval policies, and innovations in disease prevention and management influenced medical retrieval decisions. Conclusion: It is critical to understand that both general and contextual factors unique to remote communities affect medical retrieval decisions. Decisions are highly complex and necessitate trade-offs, frequently related to resource scarcity, which are somewhat different from those of urban retrieval services. Resource allocation in the context of providing retrieval services for remote populations must account for differences in burden of disease, cultural requirements, workforce characteristics and overall access to health care compared to urban populations.

Mediation in Matters Involving Sorcery in PNG Villages and Remote Australian Indigenous Communities

The article discusses the application of mediation to conflict involving sorcery and sorcery-related violence in Papua New Guinea (PNG) villages and remote Australian Indigenous communities. The article proposes that a Hybrid Mediation Approach to managing this form of conflict can be effective. This approach re-imagines the stages of mediation not as fixed or rigid steps but as design parameters that empower the parties through incorporating local values and traditions into the dispute management process. The hybrid element of the approach refers to the incorporation of local values and traditions into the mediation design. The article makes reference to specific examples of sorcery-related conflict at the remote Australian community of Aurukun and a village in PNG to provide a background to this discussion of effective mediation techniques.

Motivators and barriers for studying podiatry in Australia and New Zealand: A mixed methods study.

Podiatry enrolments at Australian and New Zealand universities have decreased by 17.3% since 2015, which threatens the profession's sustainability and the health and wellbeing of Australian and New Zealand people and communities. Reasons for this decline remain unclear due to insufficient evidence on factors influencing career choices. The overarching aim of this study was to identify motivators and barriers for studying podiatry in Australia and New Zealand. This study used a convergent mixed methods design. Students enrolled in (i) podiatry and (ii) relevant non-podiatry health, sport or science programs at nine Australian and one New Zealand university, were invited to participate in an online survey. First-year podiatry students were also invited to participate in an online workshop. Quantitative data were analysed using descriptive statistics and linear/logistic regression models. Three independent assessors used inductive thematic analysis for the qualitative data. Overall, 278 podiatry students (mean age 24.9±8.5years, 65.1% female) and 553 non-podiatry students (mean age 24.8±8.2years, 75.4% female; 32.2% from physiotherapy and 29.1% from occupational therapy) responded to the survey. Interest in a health-related career, wanting to make a difference to people's health, and opportunity to care for people from different backgrounds/age groups were key motivating factors among podiatry students. Barriers to studying podiatry were encountered by 28.1% of podiatry students. Thematic analysis identified seven themes concerning career choice, which are as follows: (i) awareness of profession and scope of practice; (ii) stereotypes and negative perceptions of the profession; (iii) awareness of career pathways; (iv) job prospects and earning potential; (v) working with people and building relationships; (vi) podiatry is not the first preference; and (vii) barriers which limit student enrolment. There are a variety of factors that motivate and influence students to study podiatry, however, altruistic reasons are most highly rated. Allied health students have limited understanding of the scope of practice and career opportunities in podiatry. Additionally, the podiatry profession often faces negative stereotypes. Further work is required to reverse the negative stereotypes and perceptions of podiatry and build knowledge of the profession's scope of practice, career pathways/opportunities, job prospects and earning potential.

The Australian Biosecurity Genomic Database: a new resource for high-throughput sequencing analysis based on the National Notifiable Disease List of Terrestrial Animals.

The Australian Biosecurity Genomic Database (ABGD) is a curated collection of reference viral genome sequences based on the Australian National Notifiable Disease List of Terrestrial Animals. It was created to facilitate the screening of high-throughput sequencing (HTS) data for the potential presence of viruses associated with notifiable disease. The database includes a single verified sequence (the exemplar species sequence, where relevant) for each of the 60 virus species across 21 viral families that are associated with or cause these notifiable diseases, as recognized by the World Organisation for Animal Health. The open-source ABGD on GitHub provides usage guidance documents and is intended to support building a culture in Australian HTS communities that promotes the use of quality-assured, standardized, and verified databases for Australia's national biosecurity interests. Future expansion of the database will include the addition of more strains or subtypes for highly variable viruses, viruses causing diseases of aquatic animals, and genomes of other types of pathogens associated with notifiable diseases, such as bacteria. Database URL: https://github.com/ausbiopathgenDB/AustralianBiosecurityGenomicDatabase.

Preparing Allied Health Students for Culturally Responsive Interprofessional Practice in Remote Northern Australia

University students, working with First Nations communities, need to build skills in culturally responsive practice. This study explores the experience of allied health students completing service-learning placements in First Nations communities. A qualitative post-placement study was undertaken. Semi-structured interviews were completed with allied health students (n=27) from Australian universities. Data was thematically analysed using inductive and deductive analysis. The settings were healthy ageing services in two remote northern Australian First Nations communities. Students received interprofessional, discipline-specific, and cultural supervision and training. Three key themes emerged: Readiness for remote practice; cultural supervision and practice; and learning and skill development. Further, the experience of immersive service-learning placements in remote First Nations communities appear to support the transformation learning process required to build knowledge, confidence, and skills to engage in culturally responsive practice. Results could inform university curriculum to better support students to prepare for rural placements, and identify resourcing requirements while students are participating in culturally immersive placements.