Rural Australian Communities Research Articles

The People and the Fire Tree: Co-Designing a Bushfire Early Warning System to Meet the Sustainable Development Goals

Australian rural communities face significant climate challenges including catastrophic bushfires. In line with the UN sustainable development goals (SDGs), to build resilience in the face of bushfire threats, communities need to increase adaptive capacity while maintaining the community’s integrity. To build community resilience, they should harness the hybridity between digital technology and non-technological practices. Building community resilience is gaining attention in rural human–computer interaction to ensure those who are vulnerable to disasters strengthen their ability to address adversity even in the absence of formal government assistance. How they apply digital technology into practice to ensure it meets their needs is crucial. We outline a case study of a rural Australian bushfire-impacted community. A series of co-design workshops was conducted to understand local bushfire preparation activities and the role of digital technologies in these activities. Three creative participatory design activities supported the co-design of an early-warning bushfire system. The workshop participants co-designed and merged two solutions: first The Fire Tree, a conceptual map of a preventative information system fed and validated by the community itself; second, The People System identifies and harnesses government resources to feed and generate a rich, dynamic, and constantly updated information environment. The final solution based on the two concepts is Bushwire, a communication facilitator designed and used by participants in workshops four and five. Bushwire is a co-designed web-based collective platform that leverages citizen-science behaviours, enabling them to share local knowledge and prepare for bushfire threats. The system became a communication facilitator, a space to share detailed local information and connect; fed by locally produced elements including digital technologies, weather/road conditions, and on-the-ground instructions. This case study explores how Bushwire responds to a range of UN SDGs by seeking to build sustainable communities (SDG11), to address climate action (SDG13) for this rural Australian bush-fire-prone community, and harmonises life on land (SDG15) through multi-stakeholder partnerships (SDG17). We envisage that urban planners may derive value from listening and responding to messages from nature, and from citizen-scientists embedded in rural communities as depicted in this case study.

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.

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.

A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study.

Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. DERR1-10.2196/53454.

Physical activity to address mental health in a remote Australian community: community readiness assessment

PurposeThe mental and physical health of those residing in Australian rural and remote communities is poorer compared to major cities. Physical health comorbidities contribute to almost 80% of premature mortality for people living with mental illness. Leisure time physical activity (LTPA) is a well-established intervention to improve physical and mental health. To address the physical and mental health of rural and remote communities through LTPA, the community’s level of readiness should be first determined. This study aims to use the community readiness model (CRM) to explore community readiness in a remote Australian community to address mental health through LTPA.Design/methodology/approachIndividual semi-structured interviews were conducted using the CRM on LTPA to address mental health. Quantitative outcomes scored the community’s stage of readiness for LTPA programmes to address mental health using the CRM categories of one (no awareness) to nine (high level of community ownership). Qualitative outcomes were thematically analysed, guided by Braun and Clark.FindingsThe community scored six (initiation) for community efforts and knowledge of LTPA programmes and seven (stabilisation) for leadership. The community’s attitude towards LTPA and resources for programmes scored four (pre-planning), and knowledge of LTPA scored three (vague awareness).Originality/valueTo the best of the authors’ knowledge, this is the first Australian study to use CRM to examine community readiness to use LTPA to improve mental health in a remote community. The CRM was shown to be a useful tool to identify factors for intervention design that might optimise community empowerment in using LTPA to improve mental health at the community level.

Climate Change in Rural Australia: Natural Hazard Preparedness and Recovery Needs of a Rural Community

Climate change has resulted in a worldwide increase in intensity and frequency of extreme weather events including bushfires. Previous research has shown that communities often do not engage in disaster preparedness, even when sufficient education and resources are provided. With the projected increase in natural disasters, preparedness is paramount, and more research is needed to gain an understanding into what impacts community preparedness in the face of climate change. This study investigated one rural Australian community’s preparedness for the 2019–2020 bushfires. Thirteen Australian adults who resided within a small rural community in New South Wales during the 2019–2020 bushfires participated in semi-structured interviews. Data were analysed using inductive thematic analysis. Participants reported being unprepared for the 2019–2020 bushfires and that the community has started to prepare for future bushfires. However, they also described a belief in ‘climate cycles’ rather than climate change, limiting engagement in preparedness for future hazards. Participants also reported that they did not talk about the 2019–2020 bushfires, although described experiencing residual anxiety. Recommendations included support needed for rural communities to help with future preparedness efforts and mental health symptoms.

Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.

Determining the feasibility of a codesigned and personalised intervention (Veg4Me) to improve vegetable intake in young adults living in rural Australian communities: protocol for a randomised controlled trial

IntroductionDiets low in vegetables are a main contributor to the health burden experienced by young adults in rural communities. Digital health interventions provide an accessible delivery model that can be...

Health professional service-learning innovations in rural contexts

Service learning is not a new concept in Australia, although it could be better harnessed in rural Australian health student placements for the betterment of rural communities, students and rural health workforce development. The service-learning literature offers several concepts worth considering further in the Australian context. This paper addresses three common barriers to health professional service-learning uptake in rural Australian communities by drawing on service-learning concepts from the international literature. It offers rural Australian health organisations innovative strategies to consider when hosting health professional students on service-learning placement.

The new Diploma of Rural Generalist Anaesthesia: Supporting Australian rural and remote communities.

In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios.

Determinants of access to general practice in a shared care model for people living with HIV: a qualitive study of patients’ perspectives in an Australian rural community

BackgroundImproved management of human immunodeficiency virus (HIV) has resulted in improved life expectancy for people living with HIV and an ageing population with a significant comorbidity burden. Shared care models, involving the co-ordinated liaison between general practitioners and specialist physicians, have been advocated for in Australia to provide comprehensive care. People living with HIV in rural areas have reduced access to general practice and therefore shared care. This study explores the perspectives of people living with HIV on the barriers and enablers to accessing shared care in an Australian rural setting.MethodsIn this qualitative study, semi-structured interviews were conducted with adults living with HIV who either resided in or accessed care in a rural area of Australia. Interviews were conducted via video conferencing, phone or face-to-face. Transcripts were imported into NVivo, coded and analysed in alignment with a conceptual framework of healthcare access defined by Levesque and colleagues.ResultsThirteen interviews were conducted in total. Participants’ narratives demonstrated the substantial influence of accessibility to general practice on their ability to engage in effective shared care. Challenges included the perception that general practitioners would not provide additive value to participants’ care, which restricted the ability to both seek and engage in the shared care model. Healthcare beliefs, expectations and experiences with stigma led participants to prioritise the perceived interpersonal qualities of specialist care above a shared care system. Access to shared care was facilitated by continuity of care in general practice but logistical factors such as affordability, transport and availability impacted the ability to access regular high-quality healthcare.ConclusionsNavigating patient priorities and anticipated stigma in general practice within the resource limitations of rural healthcare were barriers to effective shared care. General practitioners’ ability to build rapport and long-term relationships with participants was instrumental in the perception of valuable care. Strategies are required to secure continuity of care with interpersonally skilled general practitioners to ensure provision of quality primary care for people living with HIV, which can be supported by specialist physicians in a shared care model.

“You fight your battles and you work out how you’re going to change”: the implementation, embedding and limits of restorative practices in an Australian rural community school

ABSTRACT Research suggests that the use of Restorative Practice (RP) in schools can foster more positive and inclusive school communities, yet there remains limited research regarding how to embed such practices. As part of a wider study, we present data from school leaders who describe their perspectives on RP and their struggles with implementing it in one rural Australian community school. This school is distinctive because of how it adopted a RP approach in an effort to change both the culture of the school and the culture of the wider community. To better inform our understanding regarding how RP was implemented, we focus on two overlapping dimensions – informing practice and embedding practice – before reflecting critically on some of the issues and limitations involved with using RP as a means of combating structural inequality.

Lived experience of participants who engaged in the co-creation of initiatives to improve children's health in a rural Australian community.

To describe participants' lived experience of co-creating and implementing initiatives to improve children's health. This manuscript reports an embedded case study design, which aims to describe participants' lived experiences of co-creating community-based initiatives. Information was gathered from an online survey and two focus groups. The two transcribed discussions from the focus groups were analysed using a 6-step phenomenological process. Mansfield, Australia, population 4787, is one of ten local government areas (LGA) participating in the Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-communicable Disease (RESPOND) project. Participants were purposively selected from established community groups previously engaged by RESPOND using a co-creation approach. The recruitment for the focus groups was a convenient sampling from participants that provided their email addresses in the online survey. Eleven participants completed the online survey. A total of ten participants attended the two focus groups of 1-h duration: five participants in each. Participants reported feeling empowered to create unique, locally relevant and readily adaptable community-wide change. They were supported by a strong partnership that mobilised funding for a part-time health promotion employee. Strengthened social connections were an unexpected though highly valued outcome. Co-creation processes may assist stakeholders in delivering prevention strategies in ways that are empowering for them, responsive to the changing needs of the community, strengthen organisational partnerships and enhance community participation, social inclusion and engagement.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Australian Rural Caregivers’ Experiences in Supporting Patients With Kidney Failure to Access Dialysis and Kidney Transplantation: A Qualitative Study

Caregivers of patients with chronic kidney disease from rural communities play a crucial role in access to dialysis and transplantation, but they face many challenges including geographical distance, financial hardship, and limited support. This study aimed to inform strategies to overcome these challenges by describing the experiences of caregivers of patients with kidney failure from rural Australian communities in accessing kidney replacement therapy. Qualitative study. 18 adult caregivers of Australian rural patients with kidney failure treated with dialysis or kidney transplantation. Semistructured interviews were conducted. Interview transcripts were thematically analyzed. The 18 participants were aged 20 to 78years; 13 (72%) were female, and 13 (72%) were the spouse/partner of the patient. We identified 5 themes: devastating social isolation (difficult periods of separation, exclusion from peers, forced relocation); financial dependency and sacrifice (burgeoning out-of-pocket costs, disruption to work life, foregoing autonomy); ongoing psychological trauma (concern for neglect and stress on children, long-term emotional distress); overwhelmed by multifaceted roles and expectations (patient advocacy, uncertainty in navigating multiple health systems); and persistent burden of responsibility (loss of self-identity, ongoing travel requirements, scarcity of psychosocial support, unpreparedness for treatment regime). The study was conducted in a high-income, English-speaking country with universal health insurance, which may limit the transferability of the findings. Australian rural caregivers of people with kidney failure treated by maintenance dialysis or transplantation experience an exhausting physical, financial, and psychological burden. Strategies to address these profound challenges are needed. This interview-based study elicited the challenges faced by people and family members who care for patients from rural towns who are receiving dialysis or kidney transplantation. The barriers and difficulties reported included traveling long distances, needing to move to larger towns and leaving their homes, feeling concerned for the long-term effects on their children, physical exhaustion, and financial issues. Additional efforts are needed to identify the means by which caregivers and their families in rural towns can obtain support to care for those with kidney failure.

Web-Based Technologies to Support Carers of People Living With Dementia: Protocol for a Mixed Methods Stepped-Wedge Cluster Randomized Controlled Trial.

BackgroundInformal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed.ObjectiveThis study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts.MethodsA stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist.ResultsBetween August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study.ConclusionsThe Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasfInternational Registered Report Identifier (IRRID)RR1-10.2196/33023

Middle Jurassic–Lower Cretaceous stratigraphy of the northern Great Australian Superbasin: insights from maximum depositional age constraints from the U–Pb detrital zircon record

The Great Australian Superbasin, incorporating the Great Artesian Basin, is host to one of the largest artesian groundwater systems on Earth. However, despite the crucial nature of this resource to Australian agriculture, industry and rural communities, key aquifer units remain poorly studied, apart from the exposed eastern/southeastern portions of the superbasin. In this study, maximum depositional age (MDA) estimations for stratigraphic units, derived from detrital zircon U–Pb geochronology, were undertaken across the Carpentaria and northern Eromanga basins, representing the northern Queensland sector of the Great Australian Superbasin. The objective was to better constrain the ages of key aquifer and aquitard units, thereby facilitating improved stratigraphic correlations and future hydrogeological modelling. Age dating of detrital zircon significantly enhances the confidence, accuracy and precision of age assignments based solely on palynology, especially in continental facies. Furthermore, the provision of MDA estimates permits confident correlation of endemic Australian spore-pollen zonations (used to date continental strata), and dinocyst zonations (used to date marine strata) to the international time-scale. Results indicate that calculated MDAs are commonly either equivalent to, or appreciably younger than, stratigraphic age estimates based on palynostratigraphy. Therefore, several of the most economically strategic aquifer units in the superbasin have been revised upwards in geological time. Similar geochronological campaigns are required in the central, western and southern superbasin to facilitate both high-resolution correlation of key aquifer units across the superbasin and the detailed tracking of the Jurassic to Early Cretaceous paleogeographic evolution of eastern Australia. Key points U–Pb detrital zircon maximum depositional age (MDA) constraints generated are applied to the Jurassic–Cretaceous stratigraphy of the northern Great Australian Superbasin. MDA estimates facilitate robust correlation of endemic Australian palynostratigraphic zones to the international time-scale, reducing chronostratigraphic uncertainty. Several of the key aquifer units across the northern superbasin (e.g. Hooray Sandstone) yield MDA estimates younger than age assignments based on palynostratigraphy and have been revised upwards in geological time. Several units yield divergent MDA estimates, suggesting either unit diachroneity or miscorrelation, indicating that the chronostratigraphic framework of the northern superbasin (and the superbasin at large) warrants further examination.

Use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review protocol.

IntroductionAfter-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia.AimTo review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities.MethodsThe proposed scoping review will be conducted using the Arksey and O’Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders’ perceptions and benefits and challenges of the services.

Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation

BackgroundThere is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation.MethodsA total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts.ResultsWhile there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient’s individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants.ConclusionThere was common ground around the respect for the dying person and the ideal of a “safe place” despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.

A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients

BackgroundCongestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments.MethodsQualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews.ResultsFifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs’ experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF.ConclusionRural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.