Rural Communities In Australia Research Articles

Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial.

BackgroundTo impact on the obesity epidemic, interventions that prevent weight gain across populations are urgently needed. However, even the most efficacious interventions will have little impact on obesity prevention unless they are successfully implemented in diverse populations and settings. Implementation research takes isolated efficacy studies into practice and policy and is particularly important in obesity prevention where there is an urgent need to accelerate the evidence to practice cycle. Despite the recognised need, few obesity prevention interventions have been implemented in real life settings and to our knowledge rarely target rural communities.MethodsHere we describe the rationale, design and implementation of a Healthy Lifestyle Program for women living in small rural communities (HeLP-her Rural). The primary goal of HeLP-her Rural is to prevent weight gain using a low intensity, self-management intervention. Six hundred women from 42 small rural communities in Australia will be randomised as clusters (n-21 control towns and n = 21 intervention towns). A pragmatic randomised controlled trial methodology will test efficacy and a comprehensive mixed methods community evaluation and cost analysis will inform effectiveness and implementation of this novel prevention program.DiscussionImplementing population interventions to prevent obesity is complex, costly and challenging. To address these barriers, evidence based interventions need to move beyond isolated efficacy trials and report outcomes related to effectiveness and implementation. Large pragmatic trials provide an opportunity to inform both effectiveness and implementation leading to potential for greater impact at the population level. Pragmatic trials should incorporate both effectiveness and implementation outcomes and a multidimensional methodology to inform scale-up to population level. The learnings from this trial will impact on the design and implementation of population obesity prevention strategies nationally and internationally.Trial registrationANZ clinical trial registry ACTRN12612000115831. Date of registration 24/01/2012

Rural Masculinities and the Internalisation of Violence in Agricultural Communities

This article is based on research we conducted in two agricultural communities as part of a broader study that included mining communities in rural Australia. The data from the agricultural locations tell a different story to that of the mining communities. In the latter, alcohol-fuelled, male-on-male assaults in public places caused considerable anxiety among informants. By contrast, people in the agricultural communities seemed more troubled by hidden violent harms which were largely privatised and individualised, including self-harm, suicide, isolation and threats to men’s general wellbeing and mental health; domestic violence; and other forms of violence largely unreported and thus unacknowledged within the wider community (including sexual assault and bullying linked to homophobia). We argue one reason for the different pattern in the agricultural communities is the decline of pub(lic) masculinity, and with this, the increasing isolation of rural men and the increasing propensity to internalise violence. We argue that the relatively high rates of suicide in agricultural communities experiencing rural decline are symptomatic of the internalisation of violence.

Training general practitioners in remote Western Australia in a method of screening and brief intervention for harmful alcohol use: A pilot study

High levels of alcohol-related harm are a salient feature of many rural communities in Australia. General practitioners (GPs) are uniquely placed to identify and treat patients with harmful alcohol use in remote settings, yet corresponding opportunities for education in effective brief psychological interventions for harmful alcohol use are limited. This study piloted a training model for alcohol screening and brief intervention for GPs working in Kalgoorlie-Boulder, a remote Western Australian community facing significant alcohol-related problems. Observational pilot study. Primary care. Perceived role in responding to harmful alcohol use, and confidence and knowledge of alcohol screening and brief intervention; satisfaction with a short training session focused on alcohol screening and brief intervention; and impact of training on implementation of screening and brief intervention for harmful alcohol use. Fifty per cent of GPs took up the training opportunity. GPs recognised their professional responsibility for conducting brief intervention but reported comparatively lower confidence and skills in implementing screening and intervention prior to training. The training improved knowledge and confidence in conducting alcohol screening and brief intervention. All GPs increased their frequency of alcohol screening, and 88% of GPs reported increasing the frequency of brief intervention at 6 months. Preliminary findings suggest that among participating GPs, subsequent compliance with identification and management of harmful alcohol use was improved. Further work examining methods to improve rural and remote GP participation in alcohol-related harm prevention training is required, as the potential impact on communities with disproportionately high alcohol-related difficulties is significant.

Editorial: Published Research, Data, and the Promise of Understanding

There is something comforting about categorizing objects and events in the world. Categories provide structure to what we see and what we talk about. They are often useful real-world distinctions that extend our capacity to understand and intervene in the world. Scientific instrumentation extends that capacity further, and I believe that scientific publications can do the same. Scientific articles can serve as spring boards for reflection, conception, and intervention in the same way that a telescope can open the skies to our eyes and expand our knowledge of the cosmos; hence, my commitment to JRIPE as an open access journal for the dissemination of peerreviewed research. In this issue, we publish seven new research articles for which I offer the follow ing categorization. The first three articles can be grouped on the basis of their research method. Using a Participatory Action Approach, Huijbregts et al. [1] describe a pilot study of the implementation of a Canadian mental health guideline in a long-term care residence; Baker et al. [2] use Action Research to develop an educational module on Adult Suctioning for multi-professional groups of students; and Brynes et al. [3] report on the development and evaluation of collaboration in three clinical settings in Southeastern Ontario, Canada, using a quasi-experimental research design. The next two articles have their unit of analysis as their most salient aspect. Not that these studies were without method; they used specific research designs to collect data, but their particular distinction was in the target of their analyses; namely, students and their interprofessional learning needs. Baerg et al. [4] explore collab oration learning needs among health professionals, teachers, and students, while Flynn et al. [5] report on differences between Family Medicine Residents and other healthcare learners. The last two studies have common ground in their research settings: rural com munities in Australia. Jacob et al. [6] investigate the perceptions of and opportunities for interprofessional education from the perspectives of staff from three rural health services, and Woodrofe et al. [7] report on three years of results from a mixed methods evaluation of the Australian Interprofessional Rural Health Education Pilot. As both studies seem to suggest, the rural context may be an ideal place to showcase effective interprofessional practice. We will never have an omniscient view of the nature of interprofessional learn ing and practice. We can only have categories and forms of reasoning about it. You will find plenty of both in the articles in this issue. How accurate those forms are is an empirical question which only sustained data collection can answer—more or

Using PhotoStory to capture irrigators' emotions about water policy and sustainable development objectives: A case study in rural Australia

Participatory research approaches have gained popularity within the natural resource management domain, particularly irrigation management since 1980s. Some of these methods allow the examination of values and emotions with regard to the management of natural resources and hence can supplement other ways of eliciting community responses to policy change. This article discusses the methodology and findings of an image-based participatory research project called PhotoStory. The project was conducted with members of stressed and conflicted irrigation communities in rural Australia. Participants were provided with cameras to record their views about different issues related to sustainable water management and conflicts and were also able to record their emotions and values on these topics. Findings of this project – PhotoStory – give a two-dimensional narration (visual and written) about complex issues related to water policy such as the creation of regional water allocation plans. This method answers how plans and a widespread drought have been experienced and interpreted by people living in two communities. The article concludes with some pros and cons of using this technique with an irrigation community and reflects on the use made of the work by the community and policy-makers.

Event stakeholder management: developing sustainable rural event practices

PurposeChanges to the economic and social fabric of rural communities in Australia have resulted in an outmigration of residents, shifting economies and disenfranchisement with rural life styles. As a result, events provide important social and recreational opportunities for residents. However, rural communities are constrained by limited resources, such as the number of individuals who are willing and able to participate in event organizations; therefore, it is essential for the sustainable organization of events that stakeholders are attracted and retained. This paper aims to apply a stakeholder theoretical approach to the organizing and planning of rural events to identify event stakeholders, monitor satisfaction and ensure stakeholder retention within rural events.Design/methodology/approachA qualitative research design using a multiple case study approach examined event stakeholders in three rural communities of Southwest Queensland, Australia. In total, 54 in‐depth interviews were undertaken with event stakeholders and analyzed using an iterative thematic content analysis.FindingsThe findings reveal that rural‐event stakeholders fulfill multiple roles, differentiated by risk, and fraught with competing or conflicting agendas. The paper identifies strategies that event organizers utilize to manage relationships, and that facilitate stakeholder satisfaction and continued involvement.Originality/valueThere is limited understanding of event stakeholders, particularly in rural communities. Involving rural residents in organizing and planning events develops individual skills, knowledge and capacity. Rural communities benefit from an ability to deal with adverse conditions based on improvements in capacity of individuals and the community.

Understanding contexts of family violence in rural, farming communities: Implications for rural women’s health

Research on family violence in rural communities in Australia and Canada has shown that women’s experience of family violence is shaped by social and cultural factors. Concern for economic security and inheritance for children, closeness and belonging, and values of family unity and traditional gender roles are factors in rural communities that form the social and cultural context in which health and wellbeing are embedded. The findings presented in this paper show that rural women often place their needs second to those of their partners, children and families and, as a result, may minimize their own health concerns, especially in situations that involve family violence. Rural health care workers need to recognize the way social and cultural contexts specifically impact on rural women in order to provide appropriate prevention and treatment programs to address rural women’s health issues.

Mortality–temperature thresholds for ten major population centres in rural Victoria, Australia

Mortality-temperature relationships in small regional towns in Victoria, Australia, were used to ascertain whether the effects of high ambient temperatures documented in the literature for major population centres in Europe and America are also noted in small rural communities in Australia. The establishment of threshold temperatures in all major rural regions of Victoria indicate that hot weather results in an increase in mortality in persons aged 65 years and older. This adds considerable strength to the argument that human populations are vulnerable to heat events regardless of location. Heat alerts can be issued through local health and welfare agencies, to increase awareness of 'hot' weather as a health hazard for elderly people by providing education campaigns involving local authorities based on these simple thresholds.

The relationship between risky alcohol consumption, crime and traffic accidents in Australian rural communities

Aim To estimate the alcohol-attributable crime and traffic accidents for rural communities in Australia, controlling for potential bias. Method For 20 rural communities in New South Wales, Australia, crime and traffic accident data was obtained from police records along with risky alcohol use estimated from a postal questionnaire. The relationship between community levels of risky drinking and crime and traffic accidents that occur in alcohol-related times is analysed controlling for the underlying level of crime by using the rate of incidents that occur in non-alcohol-related times. Findings For the 20 rural communities, it was estimated that risky alcohol use is likely to have attributed to between 1.4 and 7.7 common assaults per 1000 population and between 0.6 and 1.8 serious traffic injuries or fatalities per 1000 population, every year. Conclusions Rural communities in Australia are experiencing a sizeable amount of potentially avoidable harm due to risky alcohol use. Reducing the population levels of those drinking at risk of acute harm or improving the settings in which drinking takes place may have benefits for these communities, especially in terms of crime and traffic accidents.

Understanding Local Leadership in Building the Capacity of Rural Communities in Australia

AbstractCurrent approaches to rural community development in Australia provide for limited government intervention. Such intervention is usually housed within programmes that seek to build the internal capacity of communities to achieve long term socio‐economic sustainability. A fundamental implementation strategy for capacity building has been developing local leadership. The underlying assumption of this approach is that good leadership will result in existing resources being mobilised for a more sustainable function and new resources attracted. What though is good leadership in terms of building the capacity of rural communities to develop sustainable socio‐economic futures? This paper compares the conceptualisation of leadership within rural development policies and leadership training programmes with the nature of local leadership as it exists in on‐ground community building projects. From an in‐depth review of the role and nature of local leadership within six Australian rural communities it was found that local leadership could result in improved adaptive capacity if the leadership is similar in nature to Burn's (1978) transformational model of leadership. Within policy, local leadership was most often conceptualised as being similar to this transformational model. However, rural leadership training programmes tended to conceptualise leadership as a top‐down process, similar to Burn's (1978) transactional model. While this study of leadership within rural communities revealed that transactional skills, as taught in leadership training programmes, were important for successful project management, such skills did not necessarily result in improved community adaptive capacity. It is suggested that, while transactional leadership can have an important role in influencing the development of rural communities, greater attention needs to be given to developing strategies to support transformational leadership.

Water Reform and the Resilience of small Business people in Drought-Affected Agricultural Communities

The impact of drought on rural communities in Australia has been the subject of considerable research. Less well understood are the impacts of drought on rural small businesses and the mechanisms they use to adapt or cope through extended dry periods. In this study, strategies these businesses draw upon to manage this adversity are identified and the influence that a more secure water supply has on their resilience is investigated. Interviews with ten small business operators situated in two rural towns – one with and one without a secure water supply – in drought-affected north western Victoria are comparatively analysed. The study found that adaptive strategies existed at the individual, business and community level, and despite water supply differences the identified strategies were similar across the study areas. Water supply security however was perceived as important in terms of broader regional sustainability and liveability of rural communities.

The Intersection of Social Capital and Power: An Application to Rural Communities

The central aim of the article is to examine the relationship between power and social capital within the cultural, historical and spatial contingencies of three rural communities in Australia. These communities are West Wyalong NSW, Broken Hill NSW and Maleny Qld. Each has variously experienced the threats of deindustrialisation, revitalisation, and commercial development pressures (Beaver and Cohen, 2004). To understand how these communities have addressed their circumstances we examine each in turn within the overriding analytical framework of social capital. We find that social capital is used in different ways in each community. The article is prefaced by an exploration of the core theoretical concepts: Social capital, bonding bridging and linking and power, followed by a brief analysis of each of the three cases.

Innovative sewerage solutions for small rural towns

The development and implementation of alternative wastewater servicing approaches in rural communities in Australia appears more feasible than in larger urban developments as many rural centres rely on septic tanks and surface discharge of greywater. This method of disposal creates many environmental, social and economic issues and is seen to limit potential for growth in many towns. This paper describes a generic methodology for the selection of innovative sewerage options for six regional towns in Victoria, Australia. The method includes consultation with stakeholders, multi-criteria assessment and concept design of the most favourable option. Despite the broad range of initial wastewater servicing options presented which included cluster-scale systems, upgrade of existing systems, greywater reuse and alternative collection, the outcome for five of the six towns was a modified centralised collection system as the preferred option. Lack of robust and reliable data on the human health risks and environmental impacts of alternative systems were identified as the primary data gaps in the sustainability assessment. In addition, biases in the assessment method due to stakeholder perceptions were found to be an additional issue.

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age. Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria. A total of 1563 people, aged 25-74 years, randomly selected from the electoral roll. Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale. The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45-54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety. A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.

‘Shared Care – Shared Dream’: Model of shared care in rural Australia between mental health services and general practitioners

To identify a working model between rural and remote mental health services and the local GPs in Australia. Postal questionnaire to assess the GPs' satisfaction level with the involvement of the mental health services in their ongoing management of mentally ill in the community. There was a greater sense of satisfaction with the mental health services over the five years this program was implemented. This study offers a model on how a rural mental health service could enter into a shared care program with the local GP practice and achieve a greater level of satisfaction in serving the rural communities in Australia.

Sisyphus and self-management: the chronic condition self-management paradox

Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical intervention might begin. Hence, as in the case of Sisyphus and his rock, the self-management process is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, self-management, from an ideological perspective, represents a minor adjustment to the fabric of our health system.

Rurality and mental health: an Australian primary care study

Until recently, there has been a significant gap in the literature exploring the issues of the mental health needs for rural communities in Australia. In this study we investigated the prevalence of diagnosable psychological disorders in both a rural and a non-rural primary care sample in far north Queensland, Australia. In a previous study we had screened some 300 GP attendees, on a number of sociodemographic variables and measures of psychological wellbeing, from four rural GP practices and one regional GP practice. Of these, 130 participants agreed to further follow up. In this study, 118 of the participants were selected and contacted by phone to complete the Composite International Diagnostic Interview-Short Form (CIDI-SF). The CIDI-SF diagnosis was then analysed in relation to the sociodemographic indicators that had previously been collected. The prevalence of diagnosable mental health disorders in the rural sample was found to be higher in comparison with the regional urban sample. The sociodemographic factors of rural residence, gender, and length of residence were associated with having a CIDI-SF diagnosis. Although there were a number of methodological limitations to this study, there did appear to be a significant relationship between rural location and the likelihood of receiving a CIDI-SF diagnosis. Why this might be the case is not clear, and we consider a number of explanations, but our finding suggests that further research in mental health should consider the issue of rurality as a key feature to be explored.

Community participation in organising rural general practice: Is it sustainable?

We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it. A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis. One remote and two rural communities in Australia. Community members, GPs, health professionals, government officers and rural medical workforce consultants. High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation. We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making.

Rural Suicide—People or Place Effects?

To examine factors that may contribute to elevated rates of suicide among rural communities in Australia. A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices. A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms. Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.

A multicultural countryside? Ethnic minorities in rural Australia

This paper reviews previous social science knowledge about non-English speaking background (NESB) immigrant communities in rural Australia with the aim of systematising what has been a diverse and fragmented literature. We propose a number of unifying themes which suggest the outlines of an emerging social science of ethnic minorities in rural Australia. These themes include demography; influences on NESB people’s decisions to settle in rural areas such as cultural continuity, social exclusion and chain migration; access to resources and services; gender relations; intergenerational social mobility, and farming practices and natural resource management. In conclusion, we suggest that social capital is one theoretical approach that holds the potential to bring together aspects of the settlement experiences of immigrants in rural Australia.