Remote Areas Of Australia Research Articles

A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings.

Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas. This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0-8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings. The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis. From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication. This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children.

Providing a localised cervical cancer screening course for general practice nurses.

Cervical cancer screening programs in Australia have been developed to detect early precancerous changes in women with a cervix aged between 25 and 74. Yet, many barriers remain to the uptake of cervical screening. Barriers include a lack of culturally appropriate service provision, physical access, poor health literacy, emotional difficulties, socio-economic disadvantage and not having access to a female service provider. In remote and very remote areas of Australia, additional barriers experienced by Aboriginal or Torres Strait Islander peoples include a distrust of healthcare providers and a lack of services, resulting in a much higher rate of diagnosis and death from cervical cancer. General practice nurses (GPNs) are well placed to conduct cervical screening tests (CSTs) after they have undertaken additional education and practical training. GPNs' increase in scope of practice is beneficial to general practice as it helps to remove some barriers to cervical screening. In addition, GPNs conducting CSTs reduce GP workload and burnout and increase teamwork. GPNs working in metropolitan clinics have greater access to training facilities, whereas those working in rural and remote clinics are required to travel potentially long distances to complete practical assessments. This highlights the need for training to be made available in rural and remote areas. The aim of this forum paper is therefore to generate further discussion on the need for training programs to be made available in rural and remote areas to aid the upskilling of GPNs.

Retention of outer regional, remote, and very remote speech-language pathologists influenced by professional support and community connection

Purpose Addressing the retention challenges faced by non-metropolitan speech-language pathologists (SLPs) is crucial for achieving health services equity in Australia. This study assesses the applicability of previous literature findings to the current context of Australian SLPs. Furthermore, identifying specific factors influencing the retention of SLPs in outer regional, remote, and very remote areas of Australia. Method Semi-structured interviews were conducted with 30 SLPs, who have been employed in non-metropolitan areas of Australia within the last 5 years. The collected data underwent online screening, with the interviews transcribed and analysed using content analysis techniques. Result Retention rates of non-metropolitan SLPs in Australia were categorised into three themes: professional, personal, and latent. The professional category included professional support, professional development, premature responsibilities, generalist skills, and funding. The personal category included community, family/relationships, burnout, and social justice. The latent themes included finances, management, and faith. Conclusion Retention rates of non-metropolitan SLPs in Australia are influenced by both protective factors and risk factors. Three recommendations to improve community access and reduce the current equity gap are outlined, namely: (a) tailored/bespoke professional education to maintain/enhance the clinical competence required, (b) prioritise community immersion and improve mentoring, and (c) strategies and policies to support SLPs.

Aged care service use by Aboriginal and Torres Strait Islander people after aged care eligibility assessments, 2017-2019: a population-based retrospective cohort study.

To characterise the socio-demographic characteristics, aged and health care needs, and aged care services used by older Aboriginal and Torres Strait Islander people assessed for aged care service eligibility. Population-based retrospective cohort study; analysis of Registry of Senior Australians (ROSA) National Historical Cohort data. Aboriginal and Torres Strait Islander people aged 50 years or older who were first assessed for aged care service eligibility (permanent residential aged care, home care package, respite care, or transition care) during 1 January 2017 - 31December 2019. Socio-demographic and aged care assessment characteristics; health conditions and functional limitations recorded at the time of the assessment; subsequent aged care service use. The median age of the 6209 people assessed for aged care service eligibility was 67 years (interquartile range [IQR], 60-75 years), 3626 were women (58.4%), and 4043 lived in regional to very remote areas of Australia (65.1%). Aboriginal health workers were involved in 655 eligibility assessments (10.5%). The median number of health conditions was six (IQR, 4-8); 6013 (96.9%) had two or more health conditions, and 2592 (41.8%) had seven or more. Comorbidity was most frequent among people with mental health conditions: 597 of 1136 people with anxiety (52.5%) and 1170 of 2416 people with depression (48.5%) had seven or more other medical conditions. Geriatric syndromes were recorded for 2265 people (36.5%); assistance with at least one functional activity was required by 6190 people (99.7%). A total of 6114 people (98.5%) were approved for at least one aged care service, 3218 of whom (52.6%) subsequently used these services; the first services used were most frequently home care packages (1660 people, 51.6%). Despite the high care needs of older Aboriginal and Torres Strait Islander people, only 52% used aged care services for which they were eligible. It is likely that the health and aged care needs of older Aboriginal and Torres Strait Islander people are not being adequately met.

Identifying areas of Australia with high out-of-hospital cardiac arrest incidence and low bystander cardiopulmonary resuscitation rates: A retrospective, observational study.

This study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR). Adult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide "smoothed" estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory's 75th percentile and a bystander CPR rate less than the state or territory's 25th percentile. A total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas-two in Adelaide and two in Perth. We have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.

Pets are family, keep them safe: a review of emergency animal management in remote First Nations communities

Planning for and considering animals is a growing area within emergency and disaster planning. As people adapt to the changing risks of disaster events that are increasing in magnitude and frequency, communities, particularly those in regional and remote areas of Australia, face challenges that are very different from other more populated areas. These communities are often home to pets, which pose unique challenges during evacuation, response and recovery phases of emergency management. Australian state and territory government emergency management plans give varied considerations to animal management. In the Northern Territory, the Territory Emergency Plan (Northern Territory Government 2022) serves as a base for animal management in disasters. However, significant reform is required to fill gaps in considerations of animals in remote communities, especially First Nations communities, given the strong socio-cultural connections within family structures and contributions to wellbeing under First Nations health worldviews and the human-animal bond. Such reform requires consultation and collaboration with First Nations Australians to promote ‘right-way’ science, build local capacity and support community resilience. Considerations of the interplay between people and their pets in disaster planning, response and recovery contributes to ongoing advances in the ‘One Health’ and ‘One Welfare’ paradigms.

A systematic review of effective local, community or peer-delivered interventions to improve well-being and employment in regional, rural and remote areas of Australia.

To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia. Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles. A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies. Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment. This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.

The changing psychiatry workforce in Australia: Still lacking in rural and remote regions.

There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.

Uncomfortable Echoes: Blackfishing First Nations Trauma During COVID‐19

The concept of enforcing or mandated medical treatment has a history for Aboriginal and Torres Strait Islander peoples that it does not have for those in the broader Australian migrant and settler communities. This involves not just physical sites of hospitals, lockdowns or quarantine camps but also central issues of identity involved with the larger arguments over citizenship and sovereignty. These are important claims of control over others and for what reason or legitimacy. There is a hauntology that persists here for First Nations people and discussions around COVID‐19 management especially in rural and remote areas of Australia must openly acknowledge this upfront. Since 2020, this discussion has involved competing and conflicting medical advice, hyper‐partisan politics and conspiracy theories imported from overseas Sovereign Citizen movements that were not aggressively present during the previous H1N1 pandemic of over a decade ago. As such, this article skirts issues of uncomfortable echoes of medicalised quarantines of the past and uncomfortable alliances between (on the surface) seemingly ill‐fitted groups, using the pandemic years as a case study in blackfishing, astroturfing, and co‐opted grievance.

Experiences of belonging and exclusion in sport and physical activity for individuals of diverse sexual orientation and gender identity (SOGI) in rural Australia

This qualitative study examined the sporting experiences of individuals of diverse sexual orientation and gender identity (SOGI) in rural and remote areas of Australia - contexts where marginalised groups can feel excluded based on gender or sexuality, and where physical activity options may be limited. Twelve participants (aged 29-73 years) identifying as female or gender fluid, and as queer, bisexual, gay, lesbian or pansexual, completed an online, qualitative survey. Thematic analysis and an integrative theory of belonging were used to interpret the experiences and feelings of belonging, exclusion and resistance to heteronormativity found in the data. The development of viable opportunities for sport participation and physical activities that foster a sense of belonging and health in rural or remote Australian communities requires strategies based on a deep understanding of the needs and identities of individuals of diverse SOGI, as well as the cultural and social contexts in which people live.

Exploring the barriers and enablers of diabetes care in a remote Australian context: A qualitative study.

This qualitative study explored the current barriers and enablers of diabetes care in the Indian Ocean Territories (IOT). A constructivist grounded theory approach that incorporated semi-structured telephone interviews was employed. Initial analysis of the interview transcripts used a line-by-line approach, to identify recurring themes, connections, and patterns, before they were re-labelled and categorised. This was followed by axial coding, categorisation refinement, and mapping of diabetes triggers in the IOT. The IOT, consisting of Christmas Island and the Cocos (Keeling) Islands, are some of the most remote areas in Australia. When compared with mainland Australia, the prevalence of type 2 diabetes in the IOT is disproportionately higher. There were no known cases of type 1 diabetes at the time of the study. Like other remote communities, these communities experience difficulties in accessing health services to prevent and manage diabetes. Twenty health care professionals and health service administrators in the IOT took part in semi-structured telephone interviews held during April-June 2020. Participants included GPs, nurses, dietitians, social and community services workers, school principals, and administrators. The interview questions focused on their perceptions of the current diabetes care in place in the IOT and their views on the challenges of providing diabetes care in the IOT. We identified four main barriers and two main enabling factors to the provision of effective diabetes care in the IOT. The barriers were: (i) societal influences; (ii) family; (iii) changing availability of food; (v) sustainability and communication. The two main enablers were: (i) tailoring interventions to meet local and cultural needs and values; and (ii) proactive compliance with the medical model of care. Due to the cultural and linguistic diversity within the IOT, many of the identified barriers and enablers are unique to this community and need to be considered and incorporated into routine diabetes care to ensure successful and effective delivery of services in a remote context.

Enabling dads and improving First Nations adolescent mental health: a pragmatic randomised controlled study

IntroductionThere are few empirically supported social and emotional well-being programmes for First Nations adolescents, and we found none targeting those living in Aboriginal communities in remote areas of Australia. The...

Child Dental Benefits Schedule Subsidised Existing Utilisation of Dental Care over Addressing Unmet Needs

Priority Populations in oral health are defined as people from remote areas of Australia, low-income households, specialised medical needs, and Indigenous people. Children in these groups have irregular dental visiting patterns and a higher proportion have never accessed services. The Child Dental Benefits Schedule (CDBS) is a means-tested policy which provides financial support for eligible children to access dental services. This study aimed to explore how the introduction of CDBS affected dental visiting behaviours of Priority Populations. The outcomes of interest were the use of CDBS and its monetary benefit in the four-year period post-CDBS implementation based on a sample from the Longitudinal Study of Australian Children. Binary logit and linear models with interaction terms were used to estimate the effect of priority status and previous reported dental visiting behaviours on the probability of use and the value of subsidy claimed from CDBS. Of the children with no previous access to dental services, 33.7% were CDBS users, compared to 29.9%, 41.1%, and 44.1% who reported historically accessing services once, twice, and thrice, respectively. After adjustment for confounders, there were no significant interactions between Priority Populations and previously reported visiting behaviours; however, the pattern of lower utilisation by those with no previously reported access was evident. The state of Western Australia had a significantly lower proportion of estimated utilisation compared to all other states and territories. Children from low-income families benefitted relatively more from CDBS compared to other income groups; however, only a small proportion of the program was used to subsidise new utilisation of dental care. Children with unfavourable past dental visiting behaviours are likely to have higher unmet need, face barriers to access, and the oral health benefit is likely to be the highest. Policymakers should consider how this and similar programs can better target populations with difficulty accessing services, which will also contribute to reducing inequalities in oral health outcomes.

Impact of energy conservation measures in residential buildings in very remote communities in Australia

This study investigated the impact of various energy conservation measures (ECMs) on total annual electricity consumption on a single level, two-bedroom residential building in an arid climate and in a very remote area of Australia. Base case scenario of annual energy consumption profiles of the building and its existing systems were modelled and simulated using DesignBuilder software, and the results were validated by on-site measured electricity data. Two categories of ECMs (major intervention and minor intervention) were investigated and analysed. The findings show that the total annual energy consumption of the case study building can be reduced by up to 44% (2 kWh/m2·yr) when compared against the base model and measured data if selected ECMs are implemented. Significant savings from implementing selected ECMs can help alleviate the cost-of-living pressure and stress currently experienced by many households on low incomes especially for residents of very remote communities in Australia.

Hepatitis C direct-acting antiviral treatment completion: Comparison of geographic, demographic and clinical characteristics in Australia.

Hepatitis C virus treatment uptake varies by geographic area in Australia; however, analysis has not been conducted on variations in treatment completion. Thisstudy investigated treatment completion according to remoteness, as well as demographic and clinical characteristics. A retrospective analysis was conducted on all Pharmaceutical Benefits Scheme claim data from March 2016 to June 2019. Treatment was considered completed if all prescriptions required to complete the course were dispensed. Treatment completion was compared by remoteness of residence, sex, age, state or territory, treatment duration and prescriber type. Of 68,940 patients, 85.6% completed treatment, although the completion rate decreased over time. Residents living in very remote areas had the lowest treatment completion rate (74.3%; odds ratio [OR] 0.52; 95% confidence interval [CI]: 0.39, 0.7; P < 0.005), particularly those treated by general practitioners (GPs;66.7%; OR 0.47; 95% CI: 0.22, 0.97; P = 0.042). This analysis suggests that people in very remote areas of Australia have the lowest hepatitis C treatment completion rate, particularly those accessing treatment through GPs. Further investigation into predictors of low treatment completion within these populations is required.

Beyond the 'big smoke': Enabling supervision of ophthalmology trainees in regional, rural and remote Australia.

Expansion of opportunities for ophthalmology training beyond the 'big smoke' is anticipated to support the future distribution of ophthalmologists in regional, rural and remote areas of Australia. However, little is known about what enables supervision outside of metropolitan tertiary hospital settings that would contribute to positive training experiences for specialist medical trainees and encourage them to leave the 'big smoke' once qualified. The aim of this study was therefore to explore the perceived enablers of ophthalmology trainee supervision in regional, rural and remote health settings across Australia. Australia. Ophthalmologists working in regional, rural or remote health settings with experience and/or interest in supervising ophthalmology trainees (n= 16). Qualitative design involving semistructured interviews. Seven key enablers of ophthalmology trainee supervision in regional, rural and remote health settings were identified: adequate physical infrastructure, resources and funding to host a trainee; availability of online curriculum and teaching resources so as to ensure equity of training opportunities; pre-established training posts, driven by supervision 'champions'; a critical mass of ophthalmologists to help share the supervisory load; relationships and support between training posts, the training network and the Specialist Medical College; alignment of trainee competence and attitude with the needs of the training setting; and the recognition of reciprocal benefits for supervisors through supporting trainees, including workforce support and renewal. With training experiences beyond the 'big smoke' anticipated to influence future ophthalmology workforce distribution, implementation of enablers of trainee supervision should occur in regional, rural and remote health settings wherever possible.

A randomized controlled trial of Promoting Physical Activity in Regional and Remote Cancer Survivors (PPARCS)

BackgroundPhysical activity (PA) is important for cancer survivors. Trials of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer survivors. The objective of this study was to ascertain whether wearable technology, coupled with health coaching was effective in increasing PA in breast and colorectal cancer survivors living in regional and remote areas in Australia. MethodsCancer survivors from 5 states were randomized to intervention and control arms. Intervention participants were given a Fitbit Charge 2TM and received up to 6 telephone health coaching sessions. Control participants received PA print materials. Accelerometer assessments at baseline and 12 weeks measured moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior. ResultsEighty-seven participants were recruited (age = 63 ± 11 years; 74 (85%) female). There was a significant net improvement in MVPA of 49.8 min/week, favoring the intervention group (95% confidence interval (95%CI): 13.6–86.1, p = 0.007). There was also a net increase in MVPA bouts of 39.5 min/week (95%CI: 11.9–67.1, p = 0.005), favoring the intervention group. Both groups improved light PA and sedentary behavior, but there were no between-group differences. ConclusionThis is the first study to demonstrate that, when compared to standard practice (i.e., PA education), a wearable technology intervention coupled with distance-based health coaching, improves MVPA in non-metropolitan cancer survivors. The results display promise for the use of scalable interventions using smart wearable technology in conjunction with phone-based health coaching to foster increased PA in geographically disadvantaged cancer survivors.

A meta aggregation of qualitative research on retention of general practitioners in remote Canada and Australia.

Our aim was to systematically review qualitative evidence regarding the experiences and perceptions of general practitioners and what factors influence their retention in remote areas of Canada and Australia. The objectives were to identify gaps and inform policy to improve retention of remote general practitioners, which should in turn improve the health of our marginalised remote communities. Meta-aggregation of qualitative studies. Remote general practice in Canada and Australia. General practitioners and general practice registrars who had worked in a remote area for a minimum of one year and/or were intending to stay remote long term in their current placement. Twenty-four studies were included in the final analysis. A total of 811 participants made up the sample with a length of retention ranging from 2 to 40 years. Six synthesised findings were identified from a total of 401 findings; these were around peer and professional support, organisational support, uniqueness of remote lifestyle and work, burnout and time off, personal family issues and cultural and gender issues. Long term retention of doctors in remote areas of Australia and Canada is influenced by a range of negative and positive perceptions, and experiences with key factors being professional, organisational, or personal. All six factors span a spectrum of policy domains and service responsibilities and therefore a central coordinating body could be well placed to implement a multifactorial retention strategy.

Translating aspects of The National Rural and Remote Nursing Generalist Framework 2023-2027 into practice: opportunities and considerations.

Reforms that grow the capabilities of the health workforce are critical to improving outcomes for populations residing in rural and remote areas of Australia. Nurses are central to improving the accessibility of health care for populations in these areas. The Australian Government's recent release of The National Rural and Remote Nursing Generalist Framework 2023-2027 is timely for identifying opportunities to strengthen the rural and remote nursing workforce. Further consideration of how the nursing workforce can be supported to translate aspects of the framework into practice is required. To achieve this, it is necessary to identify strategies to support registered nurses to develop capabilities stipulated within the framework. A logical vehicle for this translation is through the continued support of the Australian Government's Rural Health Multidisciplinary Training program, which includes an established network of 19 University Departments of Rural Health. Leveraging from this national network that is geographically expansive and has a long-term strategic impetus for growing the rural and remote nursing workforce, provides an opportunity for translating aspects of the framework at a national scale.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.