Rural Australia Research Articles

Leading a successful rural school in Australia

PurposeThis paper presents a case study of successful rural school leadership in Victoria, Australia. The purpose of the paper is to identify how particular leadership practices were adapted to secure rural school success.Design/methodology/approachThe author used the International Successful School Principalship Project research protocols to develop a multiple-perspective, mixed-method case study that investigated the principal's leadership at the school.FindingsThe findings illustrate how the leadership practices of the principal healed the fractured school–community relationships, which allowed the school community to work together towards a common school vision. A key factor in the school's success was the principal's personal connection to the local rural community of which he was a part. This notion of native connection could have practical implications for the recruitment and retention of rural principals in the future.Originality/valueWhilst it is widely acknowledged that principals need to consider their school and community contexts when making leadership decisions, there have been few studies that have focussed on understanding how this can be achieved in the context of rural schools. This case provides a rich account of a principal's leadership practices in one successful school in rural Australia.

“We don't show everything”: Queer identity concealment in rural Australia

AbstractRural communities can be perceived as conservative and, therefore, hostile towards queer people who depart from heteronormative renditions of sexual orientation and gender identity. Such perceptions can force rural queer people to conceal their identity, fostering an environment of invisibility and displacement. This study consequently explores why queer people conceal their identity in rural communities. Drawing on a sample of rural queer Australians, this study examines why those who are out (public about their orientation) adopt identity‐concealing strategies. Using semi‐structured in‐depth interviews, the study draws on the experiences of 9 participants from rural towns varying in population size from 50,000 to under 3000. The findings highlight how perceptions of prejudice were based on historical experiences and still emerged through the people, systems and institutions. Such prejudice serves to stigmatise queer identities and motivates the adoption of concealment strategies as a coping mechanism. Four reasons for identity concealment were reported: to avoid exclusion, to avoid accusations of inappropriate behaviour, to avoid confrontation and to enhance perceptions of the queer communities. The findings highlight that there remain beliefs that concealing identity to various extents is necessary within certain rural contexts.

Antiarrhythmic preferences and outcomes post DC cardioversion for atrial fibrillation, an Australian rural perspective.

Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post-DCCV in rural Australia. The primary aim was to determine the preferred AAD post-DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR. A retrospective observational audit of patients with non-valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015-2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post-DCCV. 233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices. The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting.

Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia.

The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes. A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically. The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research. Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed. The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes. The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Mothers, social capital and children’s physical literacy journeys in rural Australia

ABSTRACT In rural communities in Australia, the provision of sport and physical activities for children almost exclusively relies upon parents and their ability to access and contribute to facilities, funding, volunteers, and administration. This paper brings Putnam’s social capital framework to Whitehead’s conceptualisation of physical literacy as a journey to offer original insight into children’s sport participation and the opportunities arising for physical literacy development in rural communities in Australia. Changes in sport participation in Australia and directions in sport policy set an important context for the project, which is located in a small rural community in Western Australia. It was recognised that access to and engagement with both formal and informal sport environments were important to examine, particularly given participation trends and the need to consider issues of equity and inclusivity concerning the physical literacy opportunities for children in diverse rural communities. Narrative inquiry methodology enabled in-depth exploration of issues of access and opportunity created through rural mothers’ social resources and identity. Participants provided rich insights into the realities and complexities of the rural social landscape and how this impacts their children’s participation. Data illustrates the importance of conceptual links between social capital and physical literacy development. The paper provides new perspectives for policymakers and the local community to consider in seeking more significant equity in children’s sport participation and physical literacy development in rural communities.

The experiences and perspectives of people with gout on urate self-monitoring.

Gout management remains suboptimal despite safe and effective urate-lowering therapy. Self-monitoring of urate may improve gout management, however, the acceptability of urate self-monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self-monitoring in people with gout. Semistructured interviews were conducted with people taking urate-lowering therapy (N = 30) in a 12-month trial of urate self-monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self-management. Deidentified transcripts were analysed thematically. Participants valued the ability to self-monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self-monitoring at home was easy, convenientand informed gout self-management behaviours such as dietary modifications, hydration, exerciseand medication routines. Many participants self-monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases. Urate self-monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self-monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines. One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.

Establishing a telehealth model addressing paediatric sleep health in remote and rural Northern Territory Australia: Overcoming the distance barrier.

This study examined the outcomes of a telehealth model for sleep health assessment among Indigenous and non-Indigenous children residing in remote and regional communities at the Top End Northern Territory (NT) of Australia. Video telehealth consultation, that included clinical history and relevant physical findings assessed virtually with an interstate paediatric sleep physician was conducted remotely. Polysomnography (PSG) and therapeutic interventions were carried out locally at Darwin, NT. The study participants were children referred between 2015 and 2020. Of the total 812 children referred for sleep assessment, 699 underwent a diagnostic PSG. The majority of patients were female (63%), non-Indigenous (81%) and resided in outer regional areas (88%). Indigenous children were significantly older and resided in remote or very remote locations (22% vs. 10%). Referral patterns differed according to locality and Indigenous status - (non-Indigenous via private (53%), Indigenous via public system (35%)). Receipt of referrals to initial consultation was a median of 16 days and 4 weeks from consult to PSG. Remote children had slightly longer time delay between the referral and initial consult (32 vs. 15 days). Fifty one percent were diagnosed to have OSA, 27% underwent adenotonsillectomy and 2% were prescribed with CPAP therapy. This study has demonstrated that a telehealth model can be an effective way in overcoming logistical barriers and in providing sleep health services to children in remote and regional Australia. Further innovative efforts are needed to improve the service model and expand the reach for vulnerable children in very remote communities.

Beyond the planned and expected: the unintended consequences of telehealth in rural and remote Australia through a complexity lens.

Beyond the planned and expected: the unintended consequences of telehealth in rural and remote Australia through a complexity lens.

Managing biodiversity on private land: Directions for collaboration through reconciliation ecology

SummaryNatural resource management in Australia is beset with ‘wicked’ problems: diminishing biodiversity, increasing soil erosion, spreading soil salinity and global climate change all impact private landholders across rural Australia. These problems highlight the complexity of biodiversity conservation, and the need for inclusive, respectful approaches that enable the participation of rural communities, private landholders and government agencies to effectively manage biodiversity on public and private lands. To address these problems, some landholders, rural communities and other stakeholders are seeking evidence‐based solutions through directly applicable research. In this paper, we identify current barriers to such research and highlight principles and processes for co‐designing and managing research based on mutual trust, respect, power sharing and acceptance of various knowledge systems, as embodied in the theory of reconciliation ecology. We suggest that a ‘community of practice’ approach could assist in establishing effective deliberative relations as a basis for active collaboration in natural resource management research to address these complex problems.

Depletion through transnational social reproduction: guestworker migration and uneven development in the South Pacific

The recent expansion of regional guestworker migration schemes has altered the political economy of the South Pacific, creating a ‘permanent labour reserve’ (MacWilliam, 2022) for low-wage industries in rural Australia and New Zealand. Historical structures of uneven development, against which the ‘blackbirding’ of indentured Kanaka labourers took place more than a century prior, have again enabled a transnational labour (im)mobility regime in which Pasifika workers are rendered unfree and situated as a ‘fix’ for accumulation: limited to racialised and gendered labour practices, tied to employer-sponsors in remote locations, and without the rights afforded to other migrant workers. Taking the Pacific Australia Labour Mobility (PALM) scheme as the paradigmatic example of a resurgent guestworker model in the region, this article foregrounds overlooked processes of transnational social reproduction that emerge from the interplay of restrictive migration policies and exploitative Local Labour Control Regimes (LLCRs). Drawing on extensive in-depth interviews with migrant workers, their family members, and government staff from four participating Pacific Island Countries (PICs), it examines how the PALM scheme spatially and temporally reconfigures care practices, skills formation, and communal labour to progressively deplete (Rai et al, 2014) socially reproductive capacity within the South Pacific. The article concludes by suggesting that the strains the PALM scheme places on social reproduction within PICs is itself a fundamental driver of uneven development across the region.

Cholecystectomy in the red centre: a review of the surgical outcomes in Central Australia in a five-year period.

Despite the high rates of cholecystectomy in Australia, there is minimal literature regarding the outcomes of cholecystectomy in rural Central Australia within the Northern Territory. This study aims to better characterize the outcomes for patients undergoing cholecystectomy in Central Australia and review clinical and patient characteristics, which may affect outcomes. A retrospective case-control study was performed using data obtained from medical records for all patients undergoing cholecystectomy at Alice Springs Hospital in the Northern Territory from January 2018 until December 2022. Patient characteristics were gathered, and key outcomes examined included: inpatient mortality and 30-day mortality, bile duct injury, bile leak, return to theatre, conversion to open, duration of procedure, length of stay, and up-transfer to a tertiary referral centre. A total of 466 patients were included in this study. Majority of the patients were female and there was a large portion of Indigenous Australians (56%). There were no inpatient mortalities, or 30-day mortalities recorded. There were two bile leaks and/or bile duct injuries (0.4%) and two unplanned returned to theatres (0.4%). Indigenous Australians were more likely to require an emergency operation and had a longer median length of stay (P < 0.001). Cholecystectomy can be performed safely and to a high standard in Central Australia. Surgeons in Central Australia must appreciate the nuances in the management of patients who come from a significantly different socioeconomic background, with complex medical conditions when compared to metropolitan centres.

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

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

Dynamics of belonging amid geographical immobility: a longitudinal analysis of youth trajectories in rural Australia

ABSTRACT Our analysis of young people who have stayed in rural communities contributes to a ‘relational turn' in youth studies that rejects substantialist approaches to make visible the range of relationships beyond simply educational qualifications and employment that inform youth life projects. This relational turn recognises that ‘youth' is a product of classificatory struggles that become routinised into taken for granted concepts. Our analysis challenges the tendency to see geographical mobility as a normative component of contemporary youth transitions; and rejects the assumption that geographical immobility for rural youth is necessarily associated with disadvantage. Drawing on Yuval Davis' concept of belonging we use longitudinal survey and interview data from rural Australians that left school in 2006 and who stayed in rural locations. Drawing on this data we employ a biographical approach that focuses on their everyday practices and narratives of life projects to explore the dynamics of belonging to place and community over time. Our qualitative analysis of youth narratives supports a relational analysis of belonging to reveal significant similarities between the life projects of rural ‘stayers’ and those who moved to urban areas emphasising belonging through relationships to place, work, family and friends and the personal recognition these elements bring.

Healthy rural hearts: The feasibility of a telehealth nutrition randomised controlled trial for rural people at risk of cardiovascular disease.

Improving dietary patterns using medical nutrition therapy delivered via telehealth could make an effective contribution to reducing cardiovascular disease burden in rural Australia. However, it is important that medical nutrition therapy programmes are developed in collaboration with rural stakeholders, to increase feasibility for the rural context and the likelihood of successful implementation. The aim of this study was to evaluate the preliminary feasibility outcomes of integration (implementation), practicality, acceptability, demand, and preliminary effectiveness at the 3-month timepoint of the Healthy Rural Hearts randomised control trial. Feasibility measures were collected from participants in the Healthy Rural Hearts medical nutrition therapy trial. Study participants were patients from eligible primary care practices who had been assessed by their general practitioner as being at moderate to high risk of developing cardiovascular disease in the next five years. The sample in this analysis includes those who had completed the first 3-months of the study. Feasibility outcomes were measured over the first 3-months of the trial intervention. A process evaluation survey was used to collect measures relating to intervention implementation, practicality, acceptability, and demand. Completion rates of the Australian Eating Survey Heart version, Personalised Nutrition Questionnaire, pathology tests and telehealth medical nutrition therapy consultations delivered by Accredited Practising Dietitians were also used to measure intervention practicality. Preliminary effectiveness was evaluated by comparing the intervention group's dietary change, measured using Australian Eating Survey Heart with data from the control group. A total of 105 participants (75 intervention, 30 control participants) were eligible for inclusion in analysis. Attendance rates at the first 3-months of dietitian consultations ranged from 94.7% to 89.3% between the first and 3-month consultations, and most participants were able to complete the Australian Eating Survey Heart and Personalised Nutrition Questionnaire prior to their initial consultation [Australian Eating Survey Heart (n = 57, 76%) and Personalised Nutrition Questionnaire (n = 61, 81.3%)] and the Australian Eating Survey Heart prior to their 3-month consultation (n = 52, 69.3%). Of the participants who completed a pathology test at the 3-month time-point (n = 54, 72%), less than half were able to do so prior to their dietitian consultation (n = 35, 46.7%). Of the 75 intervention participants, 28 (37.3%) completed the process evaluation survey. Intervention participants ranked acceptability of the Healthy Rural Hearts intervention highly (mean rank out of 10 = 9.5, SD 1.9), but provided mixed responses on whether they would access the intervention outside of the study (mean rank out of 10 = 6.0, SD 3.5). There were statistically significant increases in percentage total energy intake derived from nutrient-dense core foods compared to the control group (p ≤ 0.05). The positive findings related to acceptability and implementation outcomes suggest that the Healthy Rural Hearts intervention was acceptable, practical, and able to be implemented within this population living in rural NSW. This, combined with the small to medium effect size in the proportion of total energy derived from nutrient-dense core foods compared to the control group indicates that long-term intervention effectiveness on other cardiovascular disease outcomes is important to evaluate in the future.

Primary care dentistry: An Australian perspective

IntroductionPrimary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system. MethodsThis paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns. ResultsPrimary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups. ConclusionsAustralians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case. Clinical significanceAustralia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

Decentralised clinical trials in rural Australia: Opportunities and challenges

AbstractAimsTo present opportunities and a model to redress the under‐representation of rural communities and people in Australian clinical trials.ContextClinical trials are essential for building and understanding the health evidence base. The lack of representation of rural people in clinical trials is evident in other countries. Examining the Australian New Zealand Clinical Trial Registry (ANZCTR) suggests this is also the case in Australia.ApproachWe propose an approach that empowers rurally based academics and clinicians to co‐design clinical trials and increase rural Australians' participation in clinical trials to address this inequality of access. A case study of a decentralised, co‐designed clinical trial is presented to support this approach.ConclusionDecentralising clinical trials could improve access to clinical trials, strengthen the social capital of rural communities and help address the health inequalities that exist between rural and metropolitan communities.

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Economically disadvantaged areas in rural Australia. Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice.

This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice. Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end-of-life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home-based palliative care services. All Medical Benefit Scheme billings for after-hours or home-based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after-hours and home-visits delivered over a 12-month period, almost 58% (n = 150) were for palliative care. Patients receiving palliative care were generally older than non-palliative patients visited (79.9 years vs. 72.0 years respectively; p = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home-visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role-definition, and inadequate remuneration. Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team-based approach. Access to and integration with specialist services remains a key component of community-based palliative care pathways.

Social media behaviors and barriers impacting women e-commerce entrepreneurs in rural Australia: A pilot study

ABSTRACT E-commerce businesses have proven to offer lifelines for residents in regional, rural, and remote (RRR) locations traditionally reliant on agricultural income. Prolonged droughts and frequent floods have had devastating impacts on the ability to farm, propelling the need to generate off-farm income to survive. This ever-growing necessity to overcome climate hardship has catalyzed a new generation of women e-commerce entrepreneurs in RRR Australia, in turn, supporting community development. Our study focuses on interviews with successful women e-commerce entrepreneurs from rural Queensland, Australia, to explore the common barriers they face and their use of social media to connect with consumers throughout Australia and globally. Results identified their three greatest challenges to be product supply, product distribution, and unreliable internet connectivity. Data exploring social media behaviors suggested a strong reliance on Facebook and Instagram to drive website traffic and generate sales. This study provides a unique contribution to knowledge regarding an under-researched segment of entrepreneurs, and how they contribute to community development.

School-based well-being programs for children living in regional and rural Australia: stakeholder views

Children living in regional and rural areas report poorer mental health than metropolitan children, however, there are few, if any, evidence-based school well-being programs tailored for this group. This study aimed to elicit the views of stakeholders about what should be included in well-being programs for these young people and how they should be delivered. Nine online focus groups were conducted with 29 participants including children, teachers, parents/caregivers, school leaders, and school well-being staff. Thematic analysis was conducted, and findings revealed several unique aspects of rural life that should be included in school well-being programs for these communities. These included the losses and isolation experienced in these communities, the cumulative risk and impact of disasters in rural areas, and inadequate access to mental health and support services. The results can be used to justify further investment and delivery of targeted well-being programs for students living in regional and rural locations.