Regional Australia Research Articles

The impact of public sector employment on regional economic activity: countering seasonal fluctuations and economic shocks

ABSTRACT This research documents multidimensional facets of public value provided by public sector employment in regional Australia. Evidence and estimates of the contribution and impact of public sector employment to regional labour markets and economic activity are documented for the Illawarra, South Coast and Capital regions of New South Wales, Australia. Using a mixed methods approach, results presented illustrate that public sector employment embodies a significantly larger proportion of total employment and economic activity in most regional labour markets compared to Greater Sydney or Australia in general. Other analyses reveal both counter-seasonal and countercyclical contributions of public sector income and spending to regional economic activity. The main finding of this research is that public sector employment provides a stable foundation to regional economies that are otherwise strongly influenced by seasonal patterns associated with tourism and agriculture. The importance of public sector employment to the regional economies has been amplified in recent crisis periods associated with large scale bushfires and COVID-19.

Co-design of a nurse-led model of care to increase access to medical abortion and contraception in rural and regional general practice: A protocol.

Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. Nurse-led task-sharing models of care for provision of long-acting reversible contraception (LARC) and early medical abortion (EMA) are one strategy to reduce barriers and improve access to services but have yet to be developed in general practice. Through a co-design process, we will develop a nurse-led model of care for LARC and EMA provision that can be delivered through face-to-face consultations or via telehealth in rural general practice in Australia. A co-design workshop, involving consumers, health professionals (particularly General Practitioners (GPs) and Practice Nurses (PNs)), GP managers and key stakeholders will be conducted to design nurse-led models of care for LARC and EMA including implant insertion by nurses. The workshop will be informed by the 'Experience-Based Co-Design' toolkit and involves participants mapping the patient journey for service provision to inform a new model of care. Recommendations from the workshop will inform a nurse-led model of care for LARC and EMA provision in rural general practice. The model will provide practical guidance for the set-up and delivery of services. Nurses will work to their full scope of practice to increase accessibility of EMA and LARC in rural Australia.

Self-efficacy and oral health outcomes in a regional Australian Aboriginal population

BackgroundPerceived self-efficacy has been associated with psychological well-being, health behaviours and health outcomes. Little is known about the influence of self-efficacy on oral health outcomes for Aboriginal adults in Australia, a population experiencing high levels of oral health conditions. This study examines associations between oral health-related self-efficacy and oral health outcomes in a regional Aboriginal Australian population and investigates whether the associations persist after adjusting for sociodemographic characteristics and other general and oral health-related psychosocial factors.MethodsCross-sectional data were obtained from the baseline questionnaire of the Indigenous Oral Heath Literacy Project, South Australia. Oral health-related self-efficacy was measured using a six item scale, with total sum scores dichotomised into high/low self-efficacy. Oral health outcomes included self-rated oral health and oral health impacts, measured using the Oral Health Impact Profile (OHIP-14). Generalized linear models with a log-Poisson link function were used to estimate Prevalence Ratios (PR) of poor self-rated oral health according to levels of oral health-related self-efficacy. Multivariable linear regressions were used to estimate the association between oral health-related self-efficacy and OHIP-14 scores. Blocks of confounders were subsequently added into the models, with the final model including all factors.ResultsComplete data were available for 252 participants (63%) aged 18 to 82 years (mean age of 37.6 years). Oral health-related self-efficacy was associated with poor self-rated oral health, with a 43% (PR = 1.43 (95% CI 1.09, 1.88)) greater prevalence of poor self-rated oral health among those with low self-efficacy. Oral health-related self-efficacy was associated with OHIP-14 severity scores, with a score over six points higher for those with low self-efficacy (B = 6.27 95% CI 2.71, 9.83). Although addition of perceived stress into the models attenuated the relationship, associations remained in the final models.ConclusionLower levels of oral health-related self-efficacy were associated with a higher prevalence of poor self-rated oral health and greater impacts of oral health among Aboriginal adults in regional South Australia. These associations persisted after controlling for sociodemographic and psychosocial confounders, suggesting that increasing self-efficacy may provide an opportunity for improving oral health outcomes for Aboriginal adults.

When Entrepreneurial Leadership Identity and Passion Meet Venture Growth Intention

Within the emerging domain of entrepreneurial leadership research, gender issues have been largely ignored. This study aims to examine the nexus between entrepreneurial leader identity, entrepreneurial passion, and growth intention. This is done within the stacked context of being a woman entrepreneur, and in rural, regional and remote (RRR) Australia. This unique study draws upon a cross-sectional survey of 99 women entrepreneurs, employing a partial least square structural equation model. The study has found a positive relationship between entrepreneurial leader identity on the one hand and growth intention and passion on the other but could not find any conclusive evidence of a relationship between entrepreneurial passion and venture growth intention. The study opens new research avenues into the novel construct of entrepreneurial leader identity and helps to better understand the dynamics of RRR women entrepreneurship in the Australian context.

Geographical variation in implementation of the Pathways to Comorbidity Care program in Australian drug and alcohol services.

Comorbid drug and alcohol and mental health disorders are highly prevalent. Significant gaps in service provision make this problem particularly difficult to address in regional Australia. The Pathways to Comorbidity Care (PCC) program was designed to improve management of comorbidity by outpatient drug and alcohol clinicians in New South Wales, Australia. This paper uses the Consolidated Framework for Implementation Research (CFIR) to evaluate variations in implementation outcomes across geographically diverse services. Twenty clinicians across three drug and alcohol services from metropolitan, outer metropolitan and regional geographic locations were engaged at multiple levels of influence (directors, managers, clinicians) during the implementation of the multimodal PCC training package. The CFIR guided the development of self-report measures and semi-structured interviews evaluating implementation of the PCC training, and disparities in implementation barriers and facilitators were determined. Metropolitan clinicians identified less barriers than regional clinicians on several intervention characteristics (adaptability, complexity, design quality and packaging), as well as outer setting (peer pressure), inner setting (implementation climate, staff incentives, leadership engagement, available resources) and process (planning, opinion leaders, executing) domains. Regional clinicians evaluated the networks and communications construct more favourably. Specific barriers identified more strongly by regional clinicians included the importance of communication with local clinicians and leadership about the practicalities of incorporating the approach into routine practice (allocation of time, increased accessibility of implementation team). Metropolitan clinicians provided more favourable evaluations of the package design, implementation climate and specific implementation processes such as a clear and informative implementation plan.

Transitioning towards a circular economy solar energy system in Northern Australia: insights from a multi-level perspective

ABSTRACT Increasing resource efficiency and decreasing waste by 2030 through prevention, reduction, recycling and reuse is one of the 17 United Nations Sustainable Development Goals. Australia is predicted to have up to 145,000 t of solar panel waste by 2030 and many large-scale solar systems are proposed to be built across Northern Australia. Research suggests that solar panel consumption and waste patterns are not dissimilar to other forms of e-waste such as mobile phones. Consequently, there is a need to rethink how the end of life of solar panels is managed. In this paper we raise the question of how Northern Australia should plan for managing solar panel waste arising from these huge installations in the future. This paper draws on the multi-level perspective, as a framework for conceptualising the transition challenges associated with promoting a circular solar energy system in the region. Adopting this approach facilitates consideration of social, technical and political drivers of solar panel waste and their implications for governance and planning in regional Australia. It is suggested that planning activities aimed at strategic, tactical and operational levels can help Northern Australia transition into a sustainable regional future. Practitioner pointers Need to develop planning system/framework/process for waste arising from solar farms. Usefulness of the multi-level perspective for identifying the range of stakeholders, barriers and drivers. Rethinking regional development of Northern Australia through a new industry space between the solar and waste sectors.

Rethinking population shrinkage in the Australian context: a new research agenda

ABSTRACT Whilst the study on the impact of shrinkage is well documented in North America and Europe, the effects of population-driven shrinkage on rural and regional communities in Australia is comparatively under-researched. This is despite existing literature on the volatility of population change in regional and rural Australia. Therefore, there is cause for establishing a typology of shrinkage in the Australian context, unpacking the different and complex economic, social and environmental causes and consequences, and therefore impacts, and establishing a framework for ongoing research. In this paper, we set out the rationale for this typology, indicating how population drivers are not only extensive, but further complicated by the as-yet-unknown impacts of COVID-19 and teleworking. Regarding policy solutions, we suggest that while mindsets are increasingly changing from a need to reverse population trends to, instead, embracing opportunities and alternative futures for many regional and rural Australian towns, we need to first establish a typology of population shrinkage that is reflective of the Australian context to ensure policy responses are locally appropriate. Practitioner pointers - Mindsets around planning policies on the impacts of population-driven shrinkage are beginning to shift towards understanding the specific socio-economic circumstances of the localised area and adopting appropriate policy instruments accordingly. - To support this nascent shift, establishing a typology of shrinkage that is reflective of the Australian context is key.

The culture of science communication in rural and regional Australia: the role of awe and wonder

Experiences of awe and wonder are vital to science and innovation. In this practice insight we explore how these emotions shape the culture of science communication. In doing so, we examine how exclusively nature- and place-based experiences for awe and wonder are often features of resource-limited settings. We then describe strategies for awe- and wonder-centred science communication beyond reliance on nature or the power of place by detailing a successful hybrid resourcing model in a rural Australian science centre. We finish by describing the role of science communicators in engaging potential collaborators to enable science communication in resource-limited settings.

Competition or collaboration in regional Australia? A cross-border and multi-university approach to maximising rural health investments, community health and health workforce outcomes.

To describe the establishment of a cross-border and multi-university collaboration in rural Australia to mitigate potential competition, maximise Rural Health Multidisciplinary Training (RHMT) Programme investments and regional health workforce outcomes. Rural Health Multidisciplinary Training programme investments have enabled the establishment of 19 Australian University Departments of Rural Health (UDRH) and 17 Rural Clinical Schools. The importance of these investments is acknowledged. However, in regional settings, due to limited clinical placement and training opportunities, there is potential for heightened competition between universities who are operating within shared geographical footprints. Competition between universities risks focusing RHMT programme activity on individual reporting requirements and activities, in preference to: regional needs; existing community-university relationships; and place-based approaches to health workforce development. A rural New South Wales and Victorian RHMT-funded departments, collectively known as the Sunraysia Collaboration. Strategic and operational processes, structures and actions underpinning collaboration formation and relationship consolidation will be described. Co-design methodologies employed to collectively define collaboration vision and aims, governance framework and guiding principles, reporting structures and co-contributions to teaching, research and service will be discussed. Collaboration sensitivity to the social, cultural, relationship and economic connectedness within the region and existing health workforce flows will also be explored. The Sunraysia collaboration demonstrates one approach towards mitigating potential competition between RHMT Programme funded universities within rural and remote Australia. The collaboration is an exemplar of co-design in action providing an alternative approach to address RHMT Programme parameters and regional needs whilst supporting rural-remote health workforce training and education innovations.

Barriers for Junior Doctors to Specialize in Rural Generalism – A Medical Student Experience

Australia is an exceptional country, with the majority of its population living on the Eastern Seaboard in highly urbanized, developed capital cities such as Sydney, Melbourne, and Brisbane. However, more than seven million Australian’s live inland in some of the flattest, driest, and inhabitable regions on Earth.1 This provides unique challenges to Australia’s regional country towns, as they battle issues such as isolation, substandard health resources and poor welfare. Despite Australia’s world class healthcare system, unfortunately individual’s living in regional Australia, have health comparable to that of low and middle income countries.2 Government strategies have aimed to improve this through lackluster funding, empty promises, and ill-considered pathway strategies.

Australia needs to implement a national health strategy for doctors.

Australia needs to implement a national health strategy for doctors.

‘You don’t have to feel trapped’: architectural discourses of youth engagement in a community-based learning environment

The rigid architectures inherent within formal schooling continue to influence young people’s disengagement from education. Globally and locally, policy makers have proposed education reform and innovation, politicians have legislated for education change, yet still the problem of disengagement remains. This paper investigates one community’s effort to support the reengagement in learning of young people aged 15–18 years in regional Australia through a flexible, online, community-based education program. Theoretically, this study used critical discourse as a way in to expose so as to explain dimensions of power and ideological positions as to what counts as learning. Critical ethnography as a methodology extended critical discourse’s explanatory authority to a naming of spatial and social architectures and their impact on the young people’s lives. Discourses of a braided curriculum, structural conviviality and emotional well-being were found to reduce some barriers to reengagement in learning; develop a shared, multi-disciplinary approach to reengagement; and be inclusive of young people’s emotional well-being as central to the reengagement process. At this time of pandemic induced online learning as the new normal on a global scale, young people who are already vulnerable due to individual, school, and socio-cultural marginalising conditions deserve research processes with outcomes valorising their voices and those who work with them.

Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic.

Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.

A qualitative study exploring clinicians’ attitudes toward responding to and escalating care of deteriorating patients

ABSTRACT Recognition and escalation of the deteriorating patient is multifaceted and relevant to all clinicians involved. However, little evidence exists exploring how clinicians from different professions make decisions about early signs of clinical deterioration and how this affects their actions. The aim of this study was to explore interprofessional clinicians’ and students’ experiences of responding to and escalating care of deteriorating patients. A convenience sample of clinicians and students from acute hospital settings in regional Australia participated in focus groups. Participants were able to identify barriers, facilitators, and strategies for improvement during the recognition and escalation of the deteriorating patient. Four themes were detected throughout the 38 focus group discussions: a Standardized Approach, Workplace Culture and Teamwork, Confidence and Experience, and Communication. Although standardization of systems and processes supported clinician’s recognition and escalation of the deteriorating patient, use and misuse of the systems by some participants were identified as barriers to seeking assistance. Positive workplace culture and teamwork were important to promoting the escalation of care. Participants identified that experience in recognizing and responding to deteriorating patients increased their confidence.

Potential implications of Australia’s new post-study work rights policy and factors for regional tertiary education leaders to consider

ABSTRACT In 2019, the Australian Government introduced a new post-study work rights policy as a lever to attract international students to study and work in regional Australia. The aim of this paper is to explore the potential implications of the new policy and consider factors which may impact it from realising the intended benefits. An analysis of historical international student enrolment and post-study work rights data for three regions in Australia was conducted to make assumptions about potential growth in those three regions brought by the new policy. This illustrated that while regions are regularly homogenised in policy discourse, there are a variety of complex place-based factors that may impact the success of the policy such as local employment industries, institutional growth profile and community engagement. It recommends that tertiary education leaders undertake comprehensive place-based planning to support the intended outcomes of the policy change to be realised and sustainable.

ON THE DECLINE IN STATE POPULATION DISTRIBUTION: A COASEAN ROLE FOR SECTION 111 OF THE AUSTRALIAN CONSTITUTION?

Since Federation,22The Federation of Australia was the culmination of a series of constitutional conventions held in Melbourne, Sydney and Adelaide between 1890 and 1898. In the first convention, politicians from New South Wales, Victoria, Tasmania, Queensland, South Australia, Western Australia, and New Zealand affirmed their intention to enter into a political union. Later conventions were attended by elected delegates. New Zealand, however, decided not to continue with the proposed scheme for federation, mainly due to its geographic isolation from the Australian continent. The conventions culminated with the adoption of a draft constitution that was eventually adopted by all six Australian States. It is also worth noting that the first Commonwealth between Australian states came in 1885, with the passing of the Federal Council of Australasia Act 1885 (Imp), 48 & 49 Victoria, c. 60 (U.K.). This confederal union came to an end with the coming into force of the Commonwealth of Australia Constitution Act 1900 (Imp), 63 & 64 Victoria, c. 12, § 9 (U.K.). The Commonwealth Constitution came into force on 1 January 1901. the ratio of people living outside capital cities to those living within these cities have been declining in all six States. Historically, Australia opted for a regulatory approach that favoured in favouring satellite towns around state capitals, such as Newcastle and the Gold Coast, over the alternative of decentralised regional urban centres, such as Wagga Wagga or Townsville. The latest phase of this planning paradigm envisages integrating these satellites and their capital cities into mega-metropolises. Notwithstanding the benefits from agglomeration, rectifying the observed imbalance assumes an urgency not only through a national security imperative but also through social equity. To analyse the cause of this population decline, I use a theoretical model to explain how sub-national state political accountability distorts incentives when it comes to the provision of public goods. The equilibrium provision is not Pareto optimal given the observed population distribution externality. The inefficient provision of public goods is causing more people to choose to live in the capital city, which in turn creates a vicious circle of worsening population distribution. The model suggests that breaking this circle requires Coasean bargaining so that eliminating the externality is assigned to the Australian jurisdiction that can do so at the lowest cost. Surrender and acceptance agreements under section 111 of the Australian Constitution furnish a modality for the envisaged bargaining to the end of transforming regional Australia into a national jurisdiction. Whether this efficiency can be realised remains a question of transaction costs and income effects flowing from such jurisdictional reassignment.

The Impact of the SARS-CoV-2 Virus (COVID-19) Pandemic and the Rapid Adoption of Telehealth for Cardiac Rehabilitation and Secondary Prevention Programs in Rural and Remote Australia: A Multi-Method Study.

IntroductionCentre-based cardiac rehabilitation (CR) programs were disrupted and urged to adopt telehealth modes of delivery during the COVID-19 public health emergency. Previously established telehealth services may have faced increased demand. This study aimed to investigate a) the impact of the COVID-19 pandemic on CR attendance/completion, b) clinical outcomes of patients with cardiovascular (CV) diseases referred to CR and, c) how regional and rural centre-based services converted to a telehealth delivery during this time.MethodsA cohort of patients living in regional and rural Australia, referred to an established telehealth-based or centre-based CR services during COVID-19 first wave, were prospectively followed-up, for ≥90 days (February to June 2020). Cardiac rehabilitation attendance/completion and a composite of CV re-admissions and deaths were compared to a historical control group referred in the same period in 2019. The impact of mode of delivery (established telehealth service versus centre-based CR) was analysed through a competitive risk model. The adaption of centre-based CR services to telehealth was assessed via a cross-sectional survey.Results1,954 patients (1,032 referred during COVID-19 and 922 pre-COVID-19) were followed-up for 161 (interquartile range 123–202) days. Mean age was 68 (standard deviation 13) years and 68% were male. Referrals to the established telehealth program did not differ during (24%) and pre-COVID-19 (23%). Although all 10 centre-based services surveyed adopted telehealth, attendance (46.6% vs 59.9%; p<0.001) and completion (42.4% vs 75.4%; p<0.001) was significantly lower during COVID-19. Referral during vs pre-COVID-19 (sub hazard ratio [SHR] 0.77; 95% CI 0.68–0.87), and to a centre-based program compared to the established telehealth service (SHR 0.66; 95% CI 0.58–0.76) decreased the likelihood of CR uptake.DiscussionAn established telehealth service and rapid adoption of telehealth by centre-based programs enabled access to CR in regional and rural Australia during COVID-19. However, further development of the newly implemented telehealth models is needed to promote CR attendance and completion.

Evaluation of a teleaudiology service in regional Australia

Objective Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. Design Prospective mixed method service evaluation study. Study sample Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. Results Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. Conclusions A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants.

A comprehensive study of the epidemiology of haematological malignancies in North Queensland.

There is an absence of clinically relevant epidemiological data in regional Australia pertaining to haematological malignancies. To determine the incidence and geographical variation of haematological malignancies in North Queensland using a clinically appropriate disease classification. Retrospective, observational study of individual patient data records of all adults diagnosed with a haematological malignancy between 2005 and 2014 and residing within The Townsville Hospital Haematology catchment region. We report descriptive summaries, incidence rates and incidence-rate ratios of haematological malignancies by geographic regions. One thousand, five hundred and eighty-one haematological malignancies (69% lymphoid, 31% myeloid) were diagnosed over the 10-year study period. Descriptive data are presented for 58 major subtypes, as per the WHO diagnostic classification of tumours of haemopoietic and lymphoid tissues. The overall median age at diagnosis was 66 years with a male predominance (60%). We demonstrate a temporal increase in the incidence of haematological malignancies over the study period. We observed geographical variations in the age-standardised incidence rates per 100 000 ranging from 0.5 to 233.5. Our data suggest an increased incidence rate ratio for haematological malignancies in some postcodes within the Mackay area compared with other regions. The present study successfully reports on the incidence of haematological malignancies in regional Queensland using a clinically meaningful diagnostic classification system and identifies potential geographic hotspots. We advocate for such contemporary, comprehensive and clinically meaningful epidemiological data reporting of blood cancer diagnoses in wider Australia. Such an approach will have significant implications towards developing appropriate data-driven management strategies and public health responses for haematological malignancies.

I probably have a closer relationship with my internet provider: Experiences of belonging (or not) among mature-aged regional and remote university students

While fostering a sense of belonging among university students is an objective of many universities, the landscape of belonging is complex and multifaceted. It is worthy of deeper interrogation, particularly for “non-traditional” students. This article draws on data from a national mixed-methods study that explored proactive ways of supporting the mental wellbeing of mature-aged students in regional and remote Australia. One of the overarching findings was students feeling invisible, misunderstood and undervalued. While this theme was relevant for many participants, it was also the case that other participants reported feeling visible, known and a sense of belonging. These inconsistencies prompted us to conduct further analyses of the quantitative and qualitative data, which were collected from a cross-sectional online survey of 1,879 mature-aged undergraduate students in regional and remote Australia and 51 interviews. We employed Yuval-Davis’s analytical framework for the study of belonging. In the quantitative analyses, several variables were found to have a significant association with inclusion/connection/belonging. They included: study mode; socio-economic status; having a diagnosed mental health condition; and supports. In the qualitative analysis, we explored students’ experiences in greater depth to gain insights into why some students experience belonging and others do not. Connections and relationships with university staff; familiarity with university systems and places; and feeling included and “part of” a subject/course/campus manifested in students feeling understood, known and a sense of belonging. Due to certain entrenched institutional approaches, in many cases, students’ experiences fell short of the supportive and caring learning communities that pedagogical approaches advocate.