Rural Australia Research Articles

Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation

BackgroundImplementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care.AimTo evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability).MethodsAn effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the ‘how’ and ‘why’ of quantitative results.ResultsHIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years.ConclusionThe behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts.Trial registrationANZCTR, ACTRN12621001456842. Registered 25 October 2021.

A RE-AIM Analysis of a Co-Designed Web-Based Cardiac Rehabilitation Program in Rural and Remote South Australia: An Implementation Study

A RE-AIM Analysis of a Co-Designed Web-Based Cardiac Rehabilitation Program in Rural and Remote South Australia: An Implementation Study

Endophthalmitis following intravitreal injections administered by junior medical officers in rural Western Australia.

Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post-injection endophthalmitis. A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid-2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed. A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5-year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%. The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations.

Farmer wants a skin check: Improving skin cancer surveillance in rural Australia.

Farmer wants a skin check: Improving skin cancer surveillance in rural Australia.

Shifting from distributive to recognitional social justice for rural educators through professional development

ABSTRACT Progress towards equitable schooling and educational outcomes in Australia has been notoriously slow, with countless reports highlighting stark inequities between rural areas and urban centres. Most reforms have been grounded in distributive notions of social justice – addressing funding, staffing, and resourcing – but fail to address other domains of injustice manifest in the positioning of the rural as Other, as deficit or in need of saving. To counter this trend, this paper examines how one teacher professional development (PD) initiative, Quality Teaching Rounds (QTR) Digital, built a “politics of recognition” for rural educators, analysed through two school-based case studies situated in diverse geographical regions of NSW, Australia: a remote central school and a small regional primary school. Drawing on interview data collected from rural educators and principals, we show how QTR Digital not only overcame the documented difficulties of accessing high-quality PD in rural Australia but also fostered a positive sense of group difference and respect for teaching and learning in these contexts. We argue that if we are to enact such significant change for rural educators, reforms that both challenge the normative ideals of city life and redefine a positive image of rural schools and communities are urgently needed.

Conducting mental health research with rural and regional older Australians: Reflections and recommendations.

This commentary aims to assist emerging leaders of mental health research with older rural Australians through (i) affirmation that others share the barriers, pitfalls and challenges being faced; (ii) reinforcing the rationale making this a pertinent area for research; and (iii) opening a dialogue for best practice to engage older rural Australians in mental health research. Supporting the mental health of older adults is a pertinent global challenge, none more so than in rural Australia where restricted access to services and supports are compounded by limited help-seeking behaviours and capacity to engage with support. Paradoxically, such limitations also extend to impact researchers' ability to engage rural older Australians in mental health research, particularly when combined with the stoicism and stigma that often envelopes mental health, and the contemporary challenges posed by the emergence of technology. Such challenges are however not often discussed, more-often sidelined in favour of reporting positive research outcomes, or seeing emerging researchers eschew such focus entirely. Through this paper, the authors utilised critical self-appraisal and iterative reflection to identify four recommendations for undertaking contemporary mental health research with rural older Australians, namely to: plan realistically through a collaborative, authentic and respectful approach; identify community champions and build/maintain trust; diversify thought, approaches and methodology; and cast the research net far, wide and often. By adopting recommendations, researchers can maximise accessibility to and possible participation in mental health research, providing foundations for older rural Australians' contributions to inform the development of policies and strategies to promote their health and well-being.

Oral glucose tolerance test-The imperfect gold standard for gestational diabetes screening: A qualitative study involving clinicians in regional, rural and remote areas of Western Australia.

The oral glucose tolerance test is the 'gold standard' for detecting gestational diabetes in Australian and International guidelines. Test completion in regional, rural and remote regions may be as low as 50%. We explored challenges and enablers for regional, rural and remote antenatal clinicians providing gestational diabetes screening to better understand low oral glucose tolerance test completion. We conducted a qualitative descriptive study using semi-structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team. We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships. Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women. SO WHAT?: Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy.

Lost in transition: Perspectives from women and their families living in rural Australia on relocation for specialist maternal and neonatal care

ProblemFamilies living in rural communities need to relocate, be transferred or travel long distances to access specialist maternal and neonatal care, leading to isolation from their support networks. BackgroundHigh-risk maternal and neonatal complexities in rural maternity units results in more transfers and retrievals to metropolitan services. There is limited understanding of the physical and psychological impacts for women and their families when they are transferred or displaced from their rural communities during pregnancy. AimTo investigate the lived experience of relocation for specialist pregnancy, birthing, postnatal and neonatal care on women and families. MethodsWomen (n=5) and partners (n=4) from rural South Australia, participated in semi-structured interviews on their experiences of transfer from local maternity providers. Couples interviewed together, interactions were recorded, transcribed verbatim and thematically analysed to identify overarching and sub-themes. FindingsThe overarching theme was ‘mismatched expectations’, with three identified sub-themes: ‘communication’, ‘compassion’ and ‘safety’. Discrepancies between expectations and realities during relocation left participants feeling isolated, alone and needing to self-advocate during this vulnerable period. Despite receiving specialist care, women and partners encountered unique hardships when separated from their rural community. Their social needs were poorly understood and seldom addressed in specialist units, resulting in poor experiences. DiscussionConsideration regarding the impact of attending specialist maternity services for women and partners from rural areas is required. The ‘one size fits all’ approach for maternity care is unrealistic and research is needed to improve the experiences for those uprooted from rural communities for higher levels of care.

'We know the lack of services': Service lead's perspective of enablers and barriers to hearing assessment for children in metropolitan, regional and rural Australia: A qualitative study.

To explore potential enablers and barriers to accessing paediatric hearing assessment from the perspective of Australian service leads, extending previous studies on this topic from the perspectives of two other stakeholder groups - parents and speech pathologists. This qualitative study, expanding upon previous mixed-methods studies, applied a pragmatism paradigm. The study was undertaken online via Zoom and included participants who were service leads of organisations that offer hearing assessment in metropolitan, regional, rural and remote parts of Australia. Eight Australian service leads participated in semi-structured interviews. Barriers identified were similar to barriers in previous studies. Three main themes were identified. First, children with hearing loss in Australia are well identified at birth. The second theme focused on the reduced and inconsistent hearing assessment services available after this age. Finally, service leads discussed the importance of embracing technology to solve service access difficulties. Consultation with key stakeholders, to consider the needs of different communities within Australia, will be crucial when identifying new service delivery options.

A Qualitative Enquiry of On-Farm Rules About Quad Bikes (ATVs): How Rules Are Determined and Implemented at a Farm Level in Rural Australia

ABSTRACT Objective Quad bikes are a leading cause of death and incident-related injury on farms, yet little is understood about rules used by farmers to ensure their safe operation. This study explored rules about quad bikes set by those who live or work on farms. Through the case of quad bikes, this study sought to understand how rules are determined and implemented at the farm level. Setting A mix of farm types and locations in rural Australia including Queensland, South Australia, and New South Wales. Participants Eight farmers were interviewed and recruited from information sheets at farmers’ markets, through a local health organisation, and a media release. Design Thematic analysis was used to transform data from eight semi-structured interviews with farmers in rural Australia. Results Data were distilled into two themes – “Rule content” described the explicit rules farmers had set on their properties, while the theme “Underlying rule principles” explored the values and norms which underpinned the creation and implementation of these rules. Conclusions Through the case of quad bike rules, this study illustrated how rules are determined and implemented at the farm level. Perceptions of risk were tied to farmers being experts in their own environment and therefore able to mitigate risk. In contrast to injury data, reckless use of quad bikes was perceived to cause incidents, and this was the basis of rules for adults and children.

Experiences of pursuing an intensivist career in regional and rural Australia: An interview study.

The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas.

Acceptability of a virtual prostate cancer survivorship care model in rural Australia: A multi-methods, single-centre feasibility pilot.

A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. A rural Australian hospital and health service. Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. Primary outcome: program acceptability. quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.

A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study.

Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. DERR1-10.2196/53454.

Exclusion, belonging and mental wellness: the sporting and physically active leisure experiences of women in rural Australia

ABSTRACT This study examined how access to, and experiences in, physically active leisure and/or sport impact on women’s physical, social, and emotional health and mental wellness in rural or remote communities across Australia. The online, open-ended survey participants were 92 females, aged 18–76 years (M = 44 years), including 64 women who were university educated, 20 aged 60 years and over, 10 from diverse sexual orientations and gender identities (SOGI) and seven First Nations Australians. Through a framework of intersectionality and an integrative theory for belonging, three key themes describing the women's experiences were uncovered: welcoming and inclusive spaces, mental wellness, and unwelcoming spaces and exclusion. Nuances across age, ethnocultural background and sexuality were identified in the data, as well as how intersections of gender and place/rurality affected women’s perceived overall health and mental wellness. These findings have implications for sport and leisure programming and policies in rural contexts.

Conceptualisations of pain amongst resettled Nepali-speaking Bhutanese adults in rural and regional Australia.

Nepali-speaking Bhutanese refugees have been subject to one of the largest resettlement programs in the world and experience higher rates of chronic pain when compared to the general population. The purpose of this study was to explore qualitative conceptualisations of chronic pain among a group of Nepali-speaking Bhutanese adults with a refugee background who relocated to rural and regional Australia. Participants included 22 individuals (females n=15) with chronic pain, who took part in structured qualitative focus groups exploring their experiences of chronic pain. Data were analysed using thematic analysis and five main themes were developed. The themes were: (1) pain is persistent and creates suffering, (2) pain is subjective and poorly understood, (3) pain is a biomedical problem that needs to be solved, (4) pain is complex and more than a biomedical problem, and (5) coping with pain is multi-faceted.Some participants viewed pain through a predominantly biomedical lens, and some recognised social and psychological factors as contributors to pain. Overwhelmingly, the participants believed pain is complex and multifaceted, requiring active and passive strategies for management, some of which are culturally informed. The experiences of resettled Nepali-speaking Bhutanese refugees living with pain are important to elucidate to improve healthcare inequalities among this marginalised group. This research will inform future assessment guidelines and treatment programs for Nepali-speaking Bhutanese adults living with chronic pain.

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.