Regional Australian Communities Research Articles

A review of emergency laparoscopic cholecystectomies in Far North Queensland.

Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations. We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021. Over the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease

ABSTRACT Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.

Depression and thoughts of self-harm or suicide among gender and sexually diverse people in a regional Australian community.

There is a paucity of data regarding depression and thoughts of self-harm or suicide among gender and sexually diverse (GSD) people living within Australian regional/rural locations. This study aims to elucidate these issues and fill a critical gap. The sample included 91 GSD people from a regional community in South-West Queensland utilising the PHQ-9 to determine presence/severity of depression and self-harm/suicide ideation. These data were drawn from a larger health and wellbeing survey. Raw mean scores were calculated to determine prevalence/severity of clinical symptoms. Bayesian ordinal regression models were employed to analyse between-subgroup differences in depression and self-harm/suicide ideation. Overall, 80.2% of GSD sample experienced depression (35.2% severe, 45.1% mild/moderate) and 41.8% experienced self-harm/suicide ideation in the past two-weeks. Trans and nonbinary people experienced higher levels of depressions than sexually diverse cisgender people. Pansexual and bisexual people experienced higher levels of depression than gay people. Trans people experienced higher prevalence of self-harm/suicide ideation than cisgender and nonbinary people, with no differences between sexuality subgroups. These findings contribute to deeper and more nuanced insights regarding clinically salient depressive and self-harm/suicide ideation symptoms among trans, nonbinary, bisexual, pansexual and queer people in regional Australian communities, with the aim to ultimately reduce mental health prevalence, improve mental health outcomes and health promotion among GSD people. SO WHAT?: The current findings revealed GSD people experience high prevalence of depression and self-harm/suicide ideation indicating tailored mental health awareness-raising, training and health promotion is warranted to enhance psychological support.

Analysing responses of Year-12 students to a hands-on IT workshop: Implications for increasing participation in tertiary IT education in regional Australia

<abstract><p>Two hand-on workshops on social media apps were conducted for the Year-12 students from two schools, one from a regional city and the other from a remote community, in a computer laboratory on the Rockhampton campus at Central Queensland University before the COVID-19 pandemic. The school in the regional city offered a specialist Digital Technologies Curriculum (DTC) to students in Years 11 & 12 whereas the remote school did not offer a similar DTC to students in Years 11 & 12. Statistical analyses of the students' responses to two casual questions during the workshop indicated that firstly the hands-on activities improved all students' general IT knowledge, and secondly the Year-12 students from the regional city were more determined to undertake tertiary IT education than the students from the remote school. Therefore, it is recommended that a mandatory specialist DTC for students in Years 11 & 12 in ALL schools should be included in the national curriculum in the future. Implications of these findings on improving the participation rate of post-secondary education in Australian regional communities are also discussed in this article. In particular, regional universities can play a unique role in producing "IT allrounders" to meet the needs of the regional communities through collaborations with governments, secondary schools, regional industries and businesses.</p></abstract>

“There’s No Sewing Classes, There’s No Bedazzling Seminars”: The Impact of Masculinity on Social Connectedness and Mental Health for Men Living in Inner-Regional Australia

Regional Australian masculinities are typified by 'traditional' values (e.g., stoicism, self-reliance) known to restrict social connectedness. Thus, these masculinities have been implicated in worsening men's mental health. What remains unclear, however, is how men living in inner-regional communities (i.e., townships on the fringes of major cities) might uniquely experience masculinity, social connectedness, and mental health. We interviewed 29 boys/men and one non-binary participant (M age = 43.77 years) living in the Macedon Ranges (an inner-regional Australian community). Using reflexive thematic analysis, we generated three themes. Participants described inner-regional masculinities as traditional and rigid, and attributed the Macedon Ranges' comparatively high suicide rate to these masculinities. Conversely, migration from the neighbouring city of Melbourne was implicated in introducing more inclusive masculinities to the area that conflicted with existing masculine norms. Thus, Macedon Ranges men were framed as ultimately lacking a cohesive community identity. Proximity to Melbourne was described as encouraging local men to commute daily for work instead of working locally, thereby further weakening community identity. Overall, these phenomena were implicated in damaging the psychosocial wellbeing of local men via reducing social connectedness. Because men's mental illness is so pervasive within regional Australian communities, these findings have direct implications for policymakers. Namely, policies need to acknowledge that masculinities directly influence mental health and that inner-regional masculinities are impacted by unique place-based considerations distinct from men living in other regional communities.

Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings

BackgroundMany people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting.MethodsIn an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20–40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion); Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions); Adoption (drop-out and predictors); Implementation (barriers encountered); Maintenance (subsequent activity designed to embed new practices).ResultsTreatment was completed by 71%; significant large decreases in eating disorder cognitions were achieved; remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing.ConclusionsImplementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment.Trial Registration: This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).

A Workshop on Social Media Apps for Year-10 Students: An Exploratory Case Study on Digital Technology Education in Regional Australia

A designated hands-on workshop on social media apps was conducted for two groups of Year-10 students from three schools in or near Rockhampton, an outer regional city in Australia, before the COVID-19 pandemic. It was hosted in a computer laboratory on the Rockhampton campus of the Central Queensland University of Australia. Statistical analyses of the students’ responses to the interactive practices during the workshop indicated that social media apps were widely used among the school students living in Australian regional communities, but their general digital literacy seemed below the educational goals for Year-10 students required in the national digital technologies curriculum (DTC). The encouraging sign was that some students expressed a genuine desire and interest in learning more digital technologies and creating purposeful digital applications. In Australia, however, there is no national specialist DTC for students in Years 11 and 12. Hence, it may be worthwhile to consider designing and implementing advanced national specialist digital curriculum for senior students in Years 11 and 12 who are true lovers of digital technologies. Some thoughts on improving STEM education outcomes in secondary schools in regional areas are also shared.

Building community resilience through youth volunteering: towards a new model

ABSTRACT Australian regional communities are changing. The combined impact of out-migration and ageing populations means that the capacity of regional communities to function as they traditionally have is challenged. In this context, volunteer effort remains a vital part of building community resilience and social capital. Yet, volunteering per se is under threat, and encouraging young people to volunteer an even greater challenge. This paper presents the results of a project that sought to understand the barriers to, and incentives for, youth volunteering at three regional local government areas in South Australia. First, we find that despite a popular conviction that youth volunteering is on the decline, it has in fact increased; the actual decline is with those volunteers who are within the 35–55-year age groups. Second, we found that two models of volunteering exist in the regions: (1) volunteering as an activity involving participation on committees or doing regular primarily public good group-based work (e.g., emergency services, Rotary, conservation); and (2) event-based, one-off, fun activities (sometimes, but not always, for the broader public good). Volunteering per se, however, was considered by all participants as central to community identity. Culture, sports and youth clubs emerged as important hubs for youth activity and potential volunteer recruitment. We suggest a new model for regional youth volunteering that prioritizes events, partnerships and social media, as well as using existing institutions as bridging organizations.

Place identity and careers in regional Australia

Emerging public discourse about making a “tree change”, “green change”, or “sea change” emphasizes the putative benefits of working and residing in regional Australia. Yet, attracting and retaining workers in the regions is a challenge for policymakers, governments, and industries. The present research involved two separate surveys of people residing in regional Australian communities to discern demographic and psychological predictors of their intent to stay in their region: income, years in the region, family, life satisfaction, job satisfaction, and place identity. Multiple regression analyses found incremental evidence of place identity as a predictor of intent to stay. The findings regarding place identity have implications for career development practice, human resources recruitment strategies, and public policy focused on regional Australia.

Identifying dementia risk factors and implementing a culturally grounded risk‐reduction intervention in urban and regional Aboriginal Australian communities

AbstractBackgroundAboriginal Australians are disproportionately affected by dementia compared to other Australians and many populations globally. Dementia incidence and risk factors have not been identified for Aboriginal Australians living in urban or regional areas (comprising ∼80% of First Nations Australians). There is also a pressing need in this population for non‐pharmacological interventions that are culturally‐grounded and target dementia risk‐reduction. Psychological wellbeing is a risk factor for dementia, and is relevant for Aboriginal communities where there are high levels of exposure to stress and trauma.MethodThe Koori Growing Old Well Study (KGOWS) is a longitudinal, population‐based study with Aboriginal Australians aged 60+ years; participants were from 5 partnering communities in New South Wales (N=336 at baseline; n=165 at follow‐up; n=68 died before follow‐up; mean follow‐up=6 years). Biomedical and psychosocial risk factors (baseline assessment) were examined for cognitive decline (incident MCI or dementia) using logistic regression. To address the impact of lifecourse stress and trauma on dementia risk, a comprehensive co‐design process was employed to develop the Ngarraanga Giinganay (‘thinking peacefully’) mindfulness‐based program, including expert working group, community focus group and pilot trial (n=7 older Aboriginal Australians), with quantitative and qualitative outcomes.ResultKGOWS demonstrated high rates of incident dementia (17.55/1000 person‐years; age‐standardised rate=34.71) and cognitive decline (42.34/1000 person‐years; age‐standardised rate=73.51), comparable to a remote Aboriginal population. In models adjusted for age (OR=2.12), factors predicting cognitive decline included male sex (OR=2.91), lower education (OR=0.51), moderate to severe hearing (OR=4.80) and vision (OR=3.78) problems, greater waist‐hip ratio (OR=1.56), polypharmacy (OR=2.61) and unskilled work history (OR=5.27). The working group and focus group feedback strongly guided Ngarraanga Giinganay program development, ensuring content and activities aligned with cultural understandings and practices for that community (Gumbaynggirr people). Results from the Ngarraanga Giinganay pilot demonstrated feasibility, acceptability and preliminary effectiveness of mindfulness‐based stress‐reduction; and highlighted aspects for refinement and further evaluation.ConclusionThese findings provide the first urban incidence rates and identify potentially modifiable risk factors for cognitive decline in Aboriginal Australians. Our work with communities provides insight into partnering with underrepresented populations for dementia research; and highlights the effectiveness of co‐design approaches when developing culturally‐specific interventions.

High-speed rail transportation: key factors for the Australian eastern states

In Australia, where the population is contained mainly in series of widely dispersed centres and towns, separated by very long distances, the case for High-Speed Rail (HSR) has generally been less compelling. Subsequently, this research reviews and assesses the implications and advantages of building an HSR passenger-focused transport network in Australia - in particular for the eastern region, where the majority of the nation's population is concentrated. To support this synopsis, European and other HSR systems are reviewed as a capstone precedent for the purpose of lessons to be learned. Using empirical and factor analyses it was found that, the Australia HSR would subsequently increase the transportation sustainability and performance, via reduction in travelling time together with more regional zone coverage. Ultimately, such improvements would particularly benefit the Australian regional communities via appropriate transit of passengers.

High-speed rail transportation: key factors for the Australian eastern states

In Australia, where the population is contained mainly in series of widely dispersed centres and towns, separated by very long distances, the case for High-Speed Rail (HSR) has generally been less compelling. Subsequently, this research reviews and assesses the implications and advantages of building an HSR passenger-focused transport network in Australia - in particular for the eastern region, where the majority of the nation's population is concentrated. To support this synopsis, European and other HSR systems are reviewed as a capstone precedent for the purpose of lessons to be learned. Using empirical and factor analyses it was found that, the Australia HSR would subsequently increase the transportation sustainability and performance, via reduction in travelling time together with more regional zone coverage. Ultimately, such improvements would particularly benefit the Australian regional communities via appropriate transit of passengers.

Gambling in Two Regional Australian Aboriginal Communities: A Social Practice Analysis

Reflecting international patterns, Aboriginal people in Victoria are more likely to gamble and to experience gambling harm than non-Indigenous Victorians. This paper describes experiences of gambling reported by 50 Aboriginal people interviewed in regional Victoria in 2016 and 2017 as part of studies initiated by two Aboriginal community-controlled organisations. Data were analysed using social practice theory (SPT) and coded to the elements of ‘meaning’, ‘material’, ‘competence’, and ‘temporality’. Across each element we identified highly contradictory experiences. Gambling held meaning as an opportunity for community gatherings but was also regarded as a cause of domestic violence, conflict, isolation and shame. Materially, the venues that offered gambling were experienced by many Aboriginal people as safe and welcoming, but at the same time gambling produced a damaging affective sense of addiction for some. Gambling was a competency that some people valued and taught to children, but it was also seen as undermining cultural practices. While Aboriginal people were historically denied access to licensed venues offering commercial gambling, many participants now found opportunities to gamble inescapable. The intermingling of benefits and harms described above supports the need for a multi-faceted response to gambling in Aboriginal communities, which includes harm reduction as well as supply restriction and treatment. Some experiences of gambling related by our participants reflected those reported also by non-Indigenous Australians, while others were differently nuanced. Because SPT is used to understand collectively-shared practices, it facilitates the identification of gambling interventions at the level of the community, as recommended by our research participants.

Merger Melancholia: An Empirical Analysis of the Perceptions of the Residents of the Forcibly Amalgamated Manilla Shire Council

ABSTRACTNotwithstanding cogent reasons for the continued existence of small local authorities in the sparsely populated Australian hinterland, compulsory council consolidation has been a recurring theme throughout the history of Australian local government. Despite its ubiquity, especially in rural, regional and remote Australian communities, its local consequences have not yet been fully examined by scholars or policy makers. The present paper seeks to remedy this neglect with an exploratory study of the social and economic consequences of forced local government amalgamations through the lens of the ‘lived experience’ of the small rural community of Manilla, which was forced in merge with the much larger Tamworth in 2004.

Community Resilience to Change: Development of an Index

Structural economic change is inherently impacting upon community systems. Sustainable and adaptive processes are critical for community systems to respond and manage economic structural change. Resilience is an emerging change management approach for sustainable regional development; yet, the literature is void of instruments for long-term structural change. This research developed an 18-item index for measuring resilience in this context. A three-stage approach was used to develop, test and validate the index items, including (1) review of existing indicators, (2) Delphi panel, and (3) resident survey. The index was developed over four dimensions and validated in two regional Australian communities. Future research should further test this instrument.

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis.

There are well-established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta-theme was "Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide." This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.

Looking beyond incentives: the role of champions in the social acceptance of residential solar energy in regional Australian communities

ABSTRACTResearch into renewable energy adoption is increasingly identifying that the successful implementation of renewable energy projects is influenced by a combination of market, community and socio-political acceptance of renewable energy technology. This research uses case studies in two regional Australian communities to examine the social acceptance of residential solar energy, in particular under the influence of financial incentives and social interactions. Fifty-five semi-structured interviews with members of the local community, industry and government were undertaken between May and October 2015. Respondents were asked about their perceptions and knowledge of solar energy and incentives to support its adoption, and their interactions with actors important in the diffusion process. Responses indicated that financial incentives motivated solar adoption; however, social interactions in the communities also contributed to decision-making. In one case study, a local “solar champion” built a private solar farm to demonstrate the technical feasibility of solar, assisted community members with physically installing their own systems and helped community members to maximise the financial benefits of their solar installations. This solar champion contributed to this community having an earlier and more rapid rate of small-scale solar adoption compared with the second case study community. The second case study community included two individuals interested in promoting solar energy; however, they were less integrated with the community’s process of adopting solar, resulting in community members experiencing substandard installations and consequent distrust of the solar industry. This research concludes that local context influences solar adoption through complex interactions among market, community and socio-political acceptance.

Ageing in remote and cyclone‐prone communities: geography, policy, and disaster relief

AbstractFocusing on the experience of independent‐living older adults, this study explored how those in regional Australian coastal communities have coped with repeated natural disasters. Using an exploratory, mixed‐method, and phenomenological approach, an array of non‐probability snowballing techniques was used to seek participation from residents aged 65 years or more, and from emergency services officers, disaster managers, and community health care providers located in regional communities affected by Cyclone Larry (2006) and Cyclone Yasi (2011). The research found that post‐disaster political decisions have had a negative long‐term impact on local economies, causing outmigration by those seeking employment, and resulting in many elderly residents facing a future without family support. As government policies encourage ageing‐in‐place by providing subsidised in situ care, increasingly older adults are remaining in exposed vulnerable locations, reliant on authorities for their survival both day‐to‐day and during an emergency. Findings also uncovered inconsistent disaster management policies between neighbouring local government councils and an unrealistic reliance on in situ care organisations by disaster managers during preparation and recovery stages of a natural hazard. These results highlight the need for those charged with emergency management to reassess both the future natural hazard adaptive capacities of ageing regional communities and policy responses to such challenges.

Notwithstanding High Prevalence of Overweight and Obesity, Smoking Remains the Most Important Factor in Poor Self-rated Health and Hospital Use in an Australian Regional Community.

ObjectiveTo classify a rural community sample by their modifiable health behaviours and identify the prevalence of chronic conditions, poor self-rated health, obesity and hospital use.MethodSecondary analysis of a cross- sectional self-report questionnaire in the Hume region of Victoria, Australia. Cluster analysis using the two-step method was applied to responses to health behaviour items.Results1,259 questionnaires were completed. Overall 63% were overweight or obese. Three groups were identified: ‘Healthy Lifestyle’ (63%), ‘Non Smoking, Unhealthy Lifestyle’ (25%) and ‘Smokers’ (12%). ‘Healthy lifestyle’ were older and more highly educated than the other two groups while ‘Non Smoking, Unhealthy Lifestyle’ were more likely to be obese. ‘Smokers’ had the highest rate of poor self-rated health. Prevalence of chronic conditions was similar in each group (>20%). ‘Smokers’ were twice as likely to have had two or more visits to hospital in the preceding year even after adjustment for age, gender and education.ConclusionHigh rates of overweight and obesity were identified but ‘Smokers’ were at the greatest risk for poor self-rated health and hospitalisation.Implications for Public HealthWithin an environment of high rates of chronic ill health and obesity, primary care clinicians and public health policy makers must maintain their vigilance in encouraging people to quit smoking.

Exploring Community Attitudes Towards Sharing of Bushfire Information Online

This research describes outcomes from a project that aimed to present near real-time bushfire information to remote and regional Australian communities susceptible to bushfires through an intuitive and easy to use interface. This project arose as a response to calls for increased information sharing amongst communities and individuals in the wake of several severe fire events in Australia. Several rounds of user engagement were undertaken, which informed the design of an application that came to be known as MyFireWatch, which was launched as an officially-supported publicly-accessible web application. Previous research in Australia regarding bushfire information suggests that user-sourced data can provide rich, timely and meaningful information. Yet the MyFireWatch research, the first of its kind in Australia to ascertain community attitudes to user-sourced disaster information, found that user attitudes varied. This paper describes those user attitudes and how they pose both challenges and opportunities for organisations who provide publicly-accessible disaster information.