Remote Area Health Research Articles

Addressing health inequities using cultural responsiveness in a student-implemented remote area health service

Addressing health inequities using cultural responsiveness in a student-implemented remote area health service

Health literacy of critical care patients in a remote area health service: A cross-sectional survey

BackgroundLower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse. ObjectivesThe primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the sample and to explore associations between HL and emergency department representation and discharge against medical advice. MethodsThis was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview. ResultsIn a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study. ConclusionTrends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.

Lessons learned from adapting a remote area health placement from physical to virtual: a COVID-19-driven innovation.

To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences. A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data. Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis. Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives. Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential. Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable "head, heart and hands" learning and do not create/reinforce inequities.

Improving Competency Management of Public Health Center In Indonesia Using The Problem Based Learning Model

The ineffectiveness of the existing training model in Indonesia, especially for remote area health center managers, needs to develop a Problem Based Learning model that is appropriate to the problems in the area. The methodological approach taken in this study is a quasi-experimental, pre-posttest control design. The study subjects consisted of 26 Public Health Centre heads from remote areas in South Sulawesi Province. The data collection instrument used was pre-posttest with Alpha Cronbach reliability coefficient of 0.938. The results showed that group competencies taught with Problem Based Learning (mean=88.72) were better than group competencies taught by direct learning methods (mean=73.33). Improved test results showed a significant difference between the experimental group and the control group (p=022). The correlation coefficient between the post-test score and the answer score of the Problem Based Learning worksheet shows positive significance (p=0,000). The use of Problem Based Learning in teaching planning material results in the planning of community health centers in accordance with the problems found in the working area

Delivering a diploma of community services (alcohol and other drugs and mental health) in the remote town of Katherine (NT): a case study

ABSTRACTObjective: To describe the design and implementation of a Diploma of Community Services in Katherine (NT) by RMIT University in collaboration with Sunrise Health Service Aboriginal Corporation (SHS).Method: This is a descriptive case study of how, in response to a need, a city-based Diploma of Community Services (Alcohol and other Drugs and Mental Health) was modified and delivered in the remote region of Katherine in the Northern Territory. The key aspects included organisational agreements, understanding local needs and realities, collaborative development of course design, overcoming funding shortfalls, incorporating two-way learning, managing with sparse resources, and building a conducive learning environment.Results: Of the 24 students who completed the course in the first two iterations of the program, 91% received their Diploma. Workshops conducted as part of the course enabled students to develop cross-agency and cross-sector connections as well as professional collaborations. After graduation, a number of students successfully applied for higher paying positions within their own or alternative services whilst others decided to go onto further study. The program has since been delivered across the NT in Alice Springs, Tennant Creek, Katherine and the remote community of Ngukurr.Discussion: The lessons learnt from this endeavour could be utilised by other remote area health services and city based training organisations to design and deliver courses in remote areas of Australia.

Editorial

Welcome to the final edition of Children Australia for 2016. For this edition, I am pleased to be guest co-editor along with regular editors Jennifer Lehmann and Rachael Sanders. Living in rural and remote Australia can bring a high level of satisfaction and many rewards, including a strong caring community, rich, longstanding social relationships, outdoor lifestyle, happy childhood memories and psychological, cultural, spiritual and economic connections to country. Rural living and working can also bring unique challenges including harsh climatic conditions and crises, a tyranny of distance, isolation, family hardships, limited services and infrastructure, reduced education and employment opportunities; and increased risk of mental health issues, family violence and child safety concerns. The demands of providing remote area health, welfare and other professional services include high visibility and trying to ‘fit in’, managing confidentiality, and dual and inter-relationships. These and other geographical and environmental challenges lead to low workforce retention rates that, in turn, leave significant gaps in service provision for children, families and communities, including Aboriginal communities (Jervis-Tracey et al., 2016; Lehmann, 2015; Robinson, Mares, & Arney, 2016).

An exploration of the priority remote health personnel give to the development of the Indigenous Health Worker oral health role and why: Unexpected findings

This research was undertaken to explore the priority given by remote area health personnel to the development of the oral health role of Indigenous Health Workers and the rationale for this prioritisation. Semistructured individual interviews and focus group interviews were undertaken with remote area health personnel working alongside Indigenous Health Workers. Three Indigenous community clinics and two regional centres of remote northern Australia. Interviews were conducted with 32 remote health personnel (11 dental, 14 nursing, 5 medical and 2 allied health personnel). The findings highlight the strong support found among remote health personnel for the development of the Indigenous Health Worker oral health role emphasising not only the perceived high impact of oral disease on the health of community members and community health resources, but also on the clinical practice of remote health personnel. In identifying the high priority given to the development of this role, the study has also highlighted the impact of oral disease on the practice of remote health personnel and the need to develop training for remote health personnel to respond to oral disease.

Occupational stress in the Australian nursing workforce: a comparison between hospital‑based nurses and nurses working in very remote communities

Objective: To compare workplace conditions and levels of occupational stress in two samples of Australian nurses. Design: The research adopted a cross‑sectional design, using a structured questionnaire. Setting: Health centres in very remote Australia and three major Australian hospitals. Subjects: 349 nurses working in very remote Australia and 277 nurses working in three major hospitals in South Australia and the Northern Territory. Main Outcome Measures: The main outcome measures were psychological distress (assessed using the General Health Questionnaire‑12), emotional exhaustion (assessed using the Maslach Burnout Inventory), work engagement (assessed using the Utrecht Work Engagement Scale‑9) and job satisfaction (assessed using a single item measure based on previous relevant research). Results: Results revealed that nurses working in major Australian hospitals reported higher levels of psychological distress and emotional exhaustion than nurses working very remotely. However, both groups report relatively high levels of stress. Nurses working very remotely demonstrated higher levels of work engagement and job satisfaction. There are common job demands and resources associated with outcome measures for both nurses working very remotely and nurses working in major hospitals. Conclusion: This research has implications for workplace interventions and the retention of staff in both hospitals and remote area health care facilities.

Preparing Medical Students to Undertake a Cultural Immersion Experience: Introducing Frameworks for Preparatory and Post-Immersion Activities

Recruiting and retaining practitioners to rural and remote locations is a challenge for many industries including health and education. The medical, nursing and teaching professions have utilized immersion experiences for trainees and students to better prepare them and to address workforce shortages in cross-cultural and underserved areas. This paper describes the steps taken to improve an immersion experience for medical students and evaluates the impact of these improvements. The University of Notre Dame’s School of Medicine requires all second year medical students to undertake the Kimberley Remote Area Health Placement Program (hereinafter the ‘Program’). The Program provides opportunities to learn life skills required for remote area living via an immersion experience in which students live with, and do useful non-clinical work for, a host community or organization for one week in a remote area in Western Australia. A series of preparatory and post-immersion activities (including film viewing, debating and site visits) are provided to prepare students for the experience. In 2009, the style and format in which these activities were delivered was changed in response to student feedback. The changes comprised altering the format of the Program Handbook from an information repository to a workbook equipping students with critical thinking frameworks such as: de Bono’s Six Thinking Hats (1992) and graphic organizers to facilitate reflection on preparatory and post-immersion activities. All changes were based on humanistic, cognitive and constructivist approaches to learning. These changes were followed by improvements in students’ perceptions of several activities. Activities preparing students to undertake and reflect on a cultural immersion experience involve student engagement in active learning and critical thinking. Educators involved in preparing students for placements in other underserved, culturally and/or geographically diverse settings may employ these approaches to learning and adapt the activities described in this paper as suited to the needs of their particular professional group.

Remote Area Health Corps: Nurses making a contribution to primary health services in the NT

Remote Area Health Corps: Nurses making a contribution to primary health services in the NT

'Even if we get one back here, it's worth it...': evaluation of an Australian Remote Area Health Placement Program

In 2006 the Kimberley Remote Area Health Placement Program (hereinafter the 'Program') was established at the University of Notre Dame's School of Medicine (Fremantle campus, Western Australia). The Program was developed as one of the strategies to achieve the School of Medicine's mission to graduate knowledgeable, skillful, dutiful and ethical doctors who will want to work in Australian areas of unmet need. The Program aims to immerse medical students in non-clinical settings to provide them with opportunities to learn life skills required for remote area living, and to introduce them to the myriad of socio-cultural, geographic, climatic and economic factors that impact on the health and wellbeing of remote area residents. To meet these objectives, the School organizes for students to live with, and do useful non-clinical work for, a host community or organization for up to one week. In 2008 the Program was evaluated to explore and assess its immediate and potential future benefits and limitations as perceived by Kimberley residents. This paper reports on the evaluation's findings via Kimberley-based narratives and raises some issues that are essential to training and retaining a 'bloody good doctor...' in a remote Australian setting. Using a mix of qualitative, ethnographic methods, the Program was evaluated by an independent researcher during four weeks of field research in late 2008. The methods included a survey, structured and unstructured interviewing and participant observation to elicit data. Thirty-three formal interviews of at least one hour's duration were conducted. Data were also collected via 15 informal discussions. Both formal and conservational interactions occurred in a range of town-based and more remote settings. The majority of persons consulted generally highlighted the Program's benefits. The reasons for this positive evaluation varied, but a common thread was that exposure to the Kimberley introduced the students to local life, a quality that had the potential to result in a medical student returning as a qualified doctor. The Program was seen as beneficial because it provided a structured, constructive means for prospective doctors to appreciate the assets rather than the deficits of remote area living. Another positive implication was that the Program equipped future doctors (regardless of their eventual work location) to treat a person from the 'bush'. It also encouraged students to think and act cross-culturally. An important immediate benefit was that the Program offered human resource support to the host organization at a busy time of the year. In only three of the 33 formal interviews was a negative or ambivalent attitude toward the Program expressed. However, a common concern was the brevity of time students served with their host organization. The data collected revealed that Kimberley people believed that the Program held strong potential for the successful recruitment of doctors prepared to make a long-term commitment to the region. Never far from their minds, conversations and activities was the idea that the effort they put into accommodating, supporting and guiding the students was worth it because 'If only one good doctor comes from the Program, then that's a good thing. A good doctor would have a great impact - the implications are immeasurable...'.

Evaluating the long-term effectiveness of the Maternity Emergency Care course in remote Australia

The Council for Remote Area Nurses of Australia deliver the MEC course which is the only short-course on maternity emergencies offered to non-midwifery qualified remote area nurses and Aboriginal Health Workers. The aim of the course is to improve the maternity emergency skills and knowledge of health service providers who do not have midwifery qualifications. There has been no long-term evaluation of the course since its inception. To review the longer-term effectiveness of the maternity emergency care (MEC) course which was developed in consultation with the Australian College of Midwives (ACM) and rural and remote practitioners in 2003. Fifty-seven clinicians who completed the MEC course since 2003 responded to a survey. Seven remote area health managers and two course facilitators were interviewed. This study provides an evaluation of the experiences of non-midwives who manage maternity emergencies in the rural and remote setting; their perception of the skills, knowledge and confidence acquired through participation in the MEC program. The MEC course is valued by both remote health managers and practitioners. The learning activities, skills and knowledge gained are reported to be very beneficial and used by remote health practitioners.

Rural and remote health research: Key issues for health providers in southern Queensland

To determine what community health service providers in rural southern Queensland considered were major issues affecting their efficacy. Results will inform the future research strategy of the Centre for Rural and Remote Area Health with the aim of addressing specific regional needs. Interactive research workshops. Health providers and other key stakeholders. Participants from organisations directly involved with health care were complemented by representatives from local government, the police service and church groups. The workshops used the nominal group technique to identify what participants considered were key health issues in their locations. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. Seventeen themes were identified, with workforce by far the major concern of health providers. Recruitment and retention of health workers were the principal issues of concern. The other four highest ranked themes across all workshops were mental health care, access to health services, perceptions and expectations of consumers, and interagency cooperation. The workshops provided important information to the Centre for Rural and Remote Area Health for developing research strategy. Additionally, new alliances among health providers were developed which will support sharing of information and resources. The workshops enabled organisations to meet and identify the key health issues and supported research planning. New alliances among health providers were forged, and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange.

Aeromedical evacuations from an east Arnhem Land community 2003–2005: The impact on a primary health care centre

To understand the profile and impact of aeromedical evacuations in remote Indigenous communities. Descriptive study. A primary health care centre in east Arnhem Land, Northern Territory, Australia. Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005. Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources. On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours. Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs.

Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.

Maternity emergency care: Short course in maternity emergencies for remote area health staff with no midwifery qualifications

To improve the maternity emergency skills and knowledge of health service providers, without midwifery qualifications, in remote Australia. A descriptive paper utilising data from a needs assessment and course evaluations used to develop and refine a short course in maternity emergencies. Remote area health providers. A multidisciplinary short course, targeting non-midwives in remote areas, aimed at improving knowledge and skills in detection, management and referral of maternity emergencies. Ten courses have been delivered to 175 participants. Evaluations demonstrate a highly valued program, well received and supported by remote health staff. The course is an important strategy to improve the maternity services offered to women in remote Australia.

Learning together for remote area health care

Learning together for remote area health care

Planning research in rural and remote areas

In order to set a regional research agenda, an interactive research workshop was planned by the joint University of Queensland and University of Southern Quennsland Centre for Rural and Remote Area Health (CRRAH), in which researchers and regional organisations would meet together to discuss and prioritise local research needs, then formulate constructive ideas and activities. Selection of Participants: Organisations representing all key consumer, academic and health professionals within the Toowoomba, Queensland, Australia region were sent a letter inviting them to attend and to send at least one representative, resulting in a total of 75 workshop participants from 45 organisations representing 20 separate entities. The Design of the Workshop: The workshop was planned as an interactive research workshop, with a preliminary brainstorming to identify and prioritise topics, followed by facilitated small group discussions, and finally presentations to the reassembled total group. Forty three topics were put forward by participants during the plenary session, in which the following 12 major themes were evident: (1) health professional development and support; (2) mechanisms for identifying regional/local needs; (3) mental health; (4) health and interaction with the environment; (5) management of common conditions of which little is known; (6) post acute/aged care; (7) evidence based practice; (8) health workforce including volunteers; (9) indigenous health; (10) access to health service delivery; (11) economic impact of new programs; and (12) outcomes impact of research partnerships. Five subject areas from four of these themes were chosen for further small group discussion. A summary of the views, ideas and conclusions of each group, which were presented to a plenary session of reassembled participants over a 10-15 minute period by each group facilitators, are discussed below. Following each presentation, a 5-10 minute question session was provided after each topic. A workshop, enabling rural and remote organisations and regional researchers to meet and identify local research needs attracted strong local support. Although the final benefits of the workshop remain to be determined, a number of new collaborative research avenues are now being actively explored within the region, by a number of the participants.

Characteristics of chemotherapy practice in rural and remote area health facilities in Queensland

The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland. A questionnaire survey that elicited descriptive quantitative and qualitative data. Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy. Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs. Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues. The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes. It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.

CHARACTERISTICS OF CHEMOTHERAPY PRACTICE IN RURAL AND REMOTE AREA HEALTH FACILITIES IN QUEENSLAND

Objective The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland. Design A questionnaire survey that elicited descriptive quantitative and qualitative data. Setting Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy. Subjects Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs. Main outcome measures: Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues. Results The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes. Conclusions It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.