Rural Region Of Australia Research Articles

Maternity Care Sustainability in Rural Australia

Introduction: In recent years there has seen significant closure of small maternity units particularly in rural regions of Australia. Those small maternity units that do continue to care for childbearing women may only provide antenatal and postnatal care with women giving birth in a larger maternity unit often some distance away. There are some small maternity units that continue to provide complete care to childbearing women which is the focus of this research. The issue here is that these small rural maternity units tend to only cater for women who are having a low-risk pregnancy. When the women is deemed ‘high risk’ they will need to transfer to a larger maternity unit for their ongoing antenatal visits and to birth. These larger maternity units are often some distance away requiring women to travel for each antenatal care visit and for birth. This research aims to explore women’s experience of having to transfer their care to a larger maternity unit due to being deemed at risk through interview of 40 women deemed at risk. Methods: Focus of the research was women’s experiences of needing to transfer their maternity care and used a qualitative descriptive phenomenology approach. To date seven women have been interviewed. Results: This paper presents the preliminary findings from the interviews that have been undertaken to date on seven women. The data is presented under emerging themes which will be refined with further interviews. The emerging themes are ‘women had no agency’, ‘the hidden cost’ and ‘the journey continues’. Conclusion: The paper presents the preliminary findings from these interviews. Ultimately the aim is to assess how care can be improved for these women and potential options/models of care and make these small rural maternity units sustainable.

Australian Rural Identities in Barbara Baynton’s Bush Studies

Barbara Baynton, in her collection of short stories, Bush Studies, examines the various types of people that exist in the rural regions of Australia. She presents a study of different identities that were left out or wrongly represented in the traditional narratives of Australian national identity at the time. She dismantled the widespread and broadly accepted bush narrative of the Australian national identity that played a significant role in the marginalization of anyone who was not White and Male. Qualitative method is used to determine the accuracy of the hypothesis. It was observed that the women and people of other ethnicities belonging to the rural Australian region were marginalized through wrongful representation or no representation in the narrative of national identity and Barbara Baynton makes efforts in Bush Studies to do otherwise. She depicts the sufferings and psyche of the people in the rural region and presents a new layer of their identities. The theory used is Postcolonial Criticism.

Prescribing of long-acting reversible contraception by general practice registrars across different rural regions of Australia: A cross-sectional analysis of the Registrar Clinical Encounters in Training Study data.

To describe the pattern of prescribing long-acting reversible contraception by Australian general practitioner registrars across different classifications of rurality/urbanicity. A study nested within the Registrar Clinical Encounters in Training ongoing cohort study of Australian general practitioner registrars' in-consultation experience. A cross-sectional analysis of Registrar Clinical Encounters in Training data collected 2010-2017. Type of contraception prescribed by general practitioner registrars to women aged 12-55 for contraception-related indications was documented. Chi-square statistical analysis was performed to assess association of specific long-acting reversible contraception methods with rurality/urbanicity. General practitioner registrars enrolled in the Australian General Practice Training program in regional training providers/organisations participating in Registrar Clinical Encounters in Training. Long-acting reversible contraception was defined as etonogestrel implant, copper intrauterine device, levonorgestrel intrauterine device and medroxyprogesterone injection. In all 1737 registrars recorded 4073 registrar rounds of data from 2010 to 2017 (response rate 96%). Type of long-acting reversible contraception prescribed differed significantly across Australian Statistical Geography Standards classification of rurality (Pearson's χ2 =17, P=.002). Women living in outer regional/remote/very remote regions are prescribed proportionately more medroxyprogesterone injection and less levonorgestrel intrauterine device compared to major cities/inner regional areas. Long-acting reversible contraception methods prescribed differ across different classifications of rurality. Women living in more rural/remote regions might have access difficulties for the levonorgestrel intrauterine device.

Reading Between the Lines: Neurocognition and Reading Acquisition in Remote Indigenous Australia

Successful academic progression relies on a child’s ability to develop proficient reading skills. In Australia, the majority of children achieve this milestone during elementary schooling. Yet Australian Indigenous children, particularly those living in remote and rural regions of Australia, consistently struggle to meet national benchmarks for reading, as evidenced by national benchmark data. There has been extensive debate about whether sociocultural factors impinge on academic achievement for Indigenous Australians, but little discussion regarding the possible role of neurocognitive factors. In this review, we consider limited available research on neurocognitive mechanisms associated with reading for Indigenous populations and argue for an urgent need to consider the relationship between neurocognitive and sociocultural development when examining reading acquisition outcomes for this population. We also discuss the plausibility of targeting the potential neurocognitive strengths of certain Indigenous populations to scaffold reading acquisition and identify opportunities for furthering this line of research.

Advocating for end-of-life choice at home: a survey of rural Australian nurses.

Rural healthcare resource limitations can affect the choices people make and their quality of life during its end stages. In rural regions of Australia, district nurses (DNs) working in generalist community roles provide access to care by visiting people in their homes. They may be well positioned to improve the quality of the end-of-life experience by advocating for choice and person-centred end-of-life goals; however, knowledge about care in this context is limited. Initial findings from an exploratory qualitative study describing how rural DNs are able to successfully advocate for the end-of-life choices and goals of people living at home need to be confirmed and further developed to inform clinical practice. This survey aimed to test and complement the findings from a narrative exploration of how DNs advocate successfully for the end-of-life goals of rural Australians. A sequential mixed methods study based on a pragmatic design was used to explore how DNs advocate successfully for the end-of-life goals of rural Australians. In the first phase of the study two stages of reflection on experience by rural DNs from the state of Victoria (N=7) provided written and in-depth narrative understandings of how advocacy is enabled and actioned in the practice context. The data were analysed with interpretive description, resulting in findings that could be used to inform a survey for the second phase. The survey, reported here, was designed as an online questionnaire to be distributed by email across inner and outer regional Australia. It was trialled by rural health professionals (N=13) and modified according to the advice received. The participation criteria for the survey specified registered nurses working in generalist community nursing roles with experience in providing successful end-of-life advocacy for people at home. Scales were used to test and complement the phase 1 findings and analysed using Cronbach's alpha and descriptive statistics, with a 95% confidence interval calculated. Open-ended questions added to complement the understanding of how successful advocacy is enabled and actioned in this context were analysed with descriptive interpretation. A self-selecting sample of nurses (N=91) responded to the survey between March and July 2015. The response came from most Australian states and territories, and confirmed the findings that willing nursing involvement in end-of-life experiences, specialised rural relational knowledge, and feeling supported, together enable nurses to advocate successfully for person-centred goals. Actions based on advocacy that were highly rated for success include holistic assessment, effective end-of-life communication and the organisation of empowering and supportive care, confirming the phase 1 findings. High levels of emotional intelligence, understandings of 'going beyond duty', the types of support used and the need for advocacy for resources were reported. The results provide both confirmatory and new knowledge that can be used with confidence to inform practice with a model for rural end-of-life nursing advocacy in the home setting.

Rethinking Coxiella infections in Australia

Coxiellaburnetii is the causative agent of coxiellosis in animals and Q fever in humans. Despite being a vaccine preventable disease, Q fever remains a frequently reported zoonotic infection in Australia. Recently, a Coxiella species was identified in brown dog ticks (Rhipicephalus sanguineus) in urban and rural regions of Australia. Further molecular characterisation revealed that it is genetically identical to ‘Candidatus Coxiella massiliensis’ (KM079627) described in R. sanguineus ticks removed from humans with eschars in France and serologic cross-reactivity among ‘Ca. Coxiella massiliensis’ and C.burnetii may occur. This report highlights the need for molecular testing of seropositive companion animals and humans to determine which species of Coxiella they are infected with, in order to further assess Coxiella species associated with Coxiella infections in Australia.

The housing pathways of single older non-home owning women in a rural region of Australia

This paper reports on empirical, qualitative research conducted in a rural region of Northern New South Wales, Australia. Using a Feminist Standpoint approach, this paper examines the housing pathways in relation to the current circumstances of single, older, non-home owning rural/regional women who live independently. Between June and December 2011, 47 eligible women aged 45 years and over were interviewed and the data was analysed using thematic analysis. Key findings are that relationship dissolution and a gendered ethic of care had a cumulative and negative effect over the life course, for which the participants paid a large material penalty. We attempt to show how these women have been caught in the crosshairs of changing cultural norms which may still be current in rural/regional Australia. This study is important in raising the visibility of this specific cohort in rural communities so that policymakers can plan for their future housing needs.

Unmet Supportive Cancer Care Needs: An Exploratory Quantitative Study in Rural Australia.

BackgroundThere is a discernible, often ignored under-evaluated care-management gap in supportive cancer care, where the estimated clinical outcome is seldom translated into patient-centered benefit.MethodsThe present research is an exploratory cross-sectional quantitative questionnaire survey study done in rural regions of Australia with the sole purpose of evaluating the care-management gap in terms of the unmet supportive needs of advanced cancer patients to provide baseline data for planning, drafting and implementing innovative and effective supportive care services that will address the specific priorities and unmet needs identified in this vulnerable population in the remote and rural regions.ResultsThe questionnaire (NA-ACP) was comprised of 132 questions covering seven domains of supportive care. Three centers in rural regions of Australia were selected for the study. While center 1 had medical and surgical specialties, centers 2 and 3 were outreach oncology clinics with nurse-led chemotherapy units. A total sample of 75 patients getting continuous treatment procedures at these three oncology units was given the NA-ACP questionnaire.ConclusionThe data from this study can be used to improve and inform care for this population by identifying specific unmet supportive needs.

Service provision for older people with mental health problems in a rural area of Australia

Objectives: Unmet mental health care needs of older people (aged 65 and over) have been identified as a serious problem internationally, particularly in rural areas. In this study we explored the views of health and social care providers of the barriers to effective mental health care for older people in a rural region in Australia.Method: Semi-structured interviews were conducted with 19 participants from 13 organisations providing care and support to older people in a rural region of Australia. A framework analysis approach was used to thematically analyse the data.Results: Two main themes were identified: ‘Recognising the Problem’ and ‘Service Availability and Access’. In particular the participants identified the impact of the attitudes of older people and health professionals, as well as service inadequacies and gaps in services, on the provision of mental health care to older people in a rural region.Conclusion: This study supports previous work on intrinsic and extrinsic barriers to older people with mental health problems accessing mental health services. The study also offers new insight into the difficulties that arise from the separation of physical and mental health systems for older people with multiple needs, and the impact of living in a rural region on unmet mental health care needs of older people.

The relationship between body image, physical activity, perceived health, and behavioural regulation among Year 7 and Year 11 girls from metropolitan and rural Australia

This study examined the relationship between educational year level, regional differences in adolescent girls' body image perceptions, body mass index (BMI), physical activity (PA) level, self-reported health, and dietary behaviour. Also, the role of PA behavioural regulation on body image was examined. The sample (N=732; Year 7 aged 12.23 years and Year 11 aged 16.18 years) included girls in Year 7 (n=489) and in Year 11 (n=243), recruited from 17 metropolitan and 14 rural schools in Victoria, Australia. Girls completed a self-report questionnaire. Novel outcomes from this study revealed year level and region differences in girls' body image perceptions, BMI, and health behaviours. Body dissatisfaction was associated with poorer perceived health, and health behaviours, such as low PA levels and dieting and external PA motivational orientation. Interventions are needed to promote positive body image and intrinsic motivation for PA to increase PA levels among adolescent girls living in metropolitan and rural regions of Australia.

A Cultural-Historical Construction of Safety Education Programs for Preschool Children: Findings from SeeMore Safety, the Pilot Study

SCIENTIFIC RESEARCH HAS BEEN dealing with the problem and prevention of unintentional injury in children for some time, yet injury rates continue to increase in some areas. This paper reports on the outcomes of a study of children from seven preschools in a rural region of Australia, who were engaged in a cultural-historically designed safety education program. The study sought to examine the relations between safety knowledge and perceived action gained as a result of participation in a program called ‘SeeMore Safety’. SeeMore Safety combines preschool and home-based education for children aged four to six years, their parents and teachers. Using a mixed-method research approach, the study examined how the program contributed to knowledge of injury prevention in young children. The findings demonstrated that it had a positive effect on preschool children's behaviour and reasoning about safety. The paper concludes with an argument about the need for further research into this important area of early childhood education.

Factors Promoting Use of Mental Health Services in a Rural Area of Australia

This paper reports research which identified a number of mental health help-seeking responses in a rural region of Australia. It describes the characteristics of services and of individual health professionals, as well as some Australian government initiatives that may promote help seeking behaviours. Focus group and individual interviews were undertaken. Participants included those who had personally experienced mental ill health, family and professional careers of individuals with mental ill health and individuals from rural culturally and linguistically diverse (CALD) communities. The researchers found that while many previously reported factors, such as stigma, limited confidentiality, cost factors, and previous negative experiences with mental health care continue to inhibit help-seeking, a number of responses and initiatives may actively promote help-seeking behaviours. These include: mental health literacy; targeted government schemes; accessible information; continuity of care and affordable services. The paper concludes that promoting these help-seeking enablers may support more desirable outcomes for those experiencing mental-ill healths in rural areas of Australia.

Australian practice nurse immunisation scholarships: an evaluation study

Objective: This paper reports on an evaluation of an Australian Government program to improve immunisation services in primary care settings through the provision of scholarships to support access to education for Practice Nurses (PNs). Design: The study used a constructivist evaluation methodology to evaluate satisfaction with and effectiveness of a scholarship program to support PNs access to immunisation education and changing nursing immunisation practice. Setting: Australian Divisions of General Practice and General Practices Subjects: Twenty-seven PNs who had received immunisation scholarships completed an online survey. Sixty four Division of General Practice (DGP) staff, representing state and territory, urban and rural regions of Australia, participated in telephone focus group interviews. Results: The scholarships and scholarship processes were viewed positively by PNs. The access to scholarship information, the selection process and the time the scholarship allowed to complete an immunisation course were rated highly. Online learning was seen as an effective means to undertake immunisation education particularly for PNs in the rural sector. Overall, there was overwhelming support for the continuation of scholarships to assist PNs access to education opportunities to improve immunisation services. These opportunities were reported to improve their knowledge and skills which lead to changes in immunisation practice and the quality of care they provided to patients. They also helped overcome geographical and professional isolation. Conclusions: As PNs emerge as key players in the improvement of immunisation services in Australia, the provision of government assistance for continuing education is an important strategy to produce this appropriately skilled workforce.

Depression: An Important Comorbidity With Metabolic Syndrome in a General Population

OBJECTIVE—There is a recognized association among depression, diabetes, and cardiovascular disease. The aim of this study was to examine in a sample representative of the general population whether depression, anxiety, and psychological distress are associated with metabolic syndrome and its components.RESEARCH DESIGN AND METHODS—Three cross-sectional surveys including clinical health measures were completed in rural regions of Australia during 2004–2006. A stratified random sample (n = 1,690, response rate 48%) of men and women aged 25–84 years was selected from the electoral roll. Metabolic syndrome was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (NCEP ATP III), and International Diabetes Federation (IDF) criteria. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale and psychological distress by the Kessler 10 measure.RESULTS—Metabolic syndrome was associated with depression but not psychological distress or anxiety. Participants with the metabolic syndrome had higher scores for depression (n = 409, mean score 3.41, 95% CI 3.12–3.70) than individuals without the metabolic syndrome (n = 936, mean 2.95, 95% CI 2.76–3.13). This association was also present in 338 participants with the metabolic syndrome and without diabetes (mean score 3.37, 95% CI 3.06–3.68). Large waist circumference and low HDL cholesterol showed significant and independent associations with depression.CONCLUSIONS—Our results show an association between metabolic syndrome and depression in a heterogeneous sample. The presence of depression in individuals with the metabolic syndrome has implications for clinical management.

Social impacts of tourism: an Australian regional case study

AbstractAs the support of host communities is a precondition for a sustainable industry, regional social impact studies are a crucial input to tourism planning and decision‐making. This study assessed the social impacts of tourism in a rural region of Australia where tourism is an important sector of the economy. As well as providing data to aid regional tourism planning, this study identifies differences in personal and community‐wide impacts; advances understanding of the factors that influence residents' perceptions of tourism impacts; and assesses the degree to which tourism activity associated with protected areas contributes to the identified social impacts. Copyright © 2008 John Wiley & Sons, Ltd.

Multiple Sclerosis and Economic Well-Being: Role of Health, Age, and Duration of Illness

This study used quantitative and qualitative techniques to examine the role of health, age, and duration of illness among people with multiple sclerosis (MS) in their economic well-being. Participants were 113 adults (31 males and 82 females) with MS who lived in urban and rural regions of Australia. The results demonstrated that health and age had a significant impact on both the economic well-being and psychological adjustment of people who contract this disorder. Different health variables predicted different aspects of economic well-being. Fatigue was the major health variable that predicted costs of MS and economic pressure, with age also predicting economic pressure, whereas income levels were predicted by cognitive confusion and mobility problems. Duration of illness, gender, and urban/rural location were not significant predictors of the economic variables. These results demonstrate the importance of obtaining multiple measures of economic well-being, as well as a broad range of health-related measures, in determining the impact of MS on the economic well-being of people with this disorder.

Tourism in the South Pacific—A Case of Marginalities

This paper defines marginality and uses it to situate a discussion on the nature of tourism in the South Pacific. Small size, a limited resource base and globalization continue to reinforce the marginalization of the island nation states. This applies not only to airline routes, but also to the development of cyber networks. Parallels are drawn between the nation states and the rural regions of Australia and New Zealand, and reference is also made to the role of these two countries in the South Pacific region.

'Where's me dinner?': food preparation arrangements in rural Australian families

In the wake of the second-wave feminist movement and related social changes, including the participation of more women in the paid workforce, an egalitarian discourse has dominated notions of the ideal division of domestic labour in heterosexual households, including those tasks involving food preparation. Some critics have argued, however, that this discourse is not taken up in practice, with women still taking more responsibility than their partners for cooking for the family. This article presents findings from a qualitative study involving interviews with 34 heterosexual couples living in a rural region of Australia about their food preparation arrangements. The findings demonstrate that for most of the couples the female partner did indeed take major responsibility for cooking for the family. Three dominant rationales were expressed by the participants to explain why the division of labour remains unequal in relation to cooking: those of expertise, enjoyment and fairness. Importantly, however, there was evidence of a weakening in gendered assumptions about who should cook and of significant participation by men in food preparation. This was particularly the case among younger, more highly educated participants or those in professional occupations or in couples where the male partner was unemployed.

The heart of the meal: food preferences and habits among rural Australian couples

This article draws upon empirical data from a qualitative study investigating issues around the food choices and preferences of a group of 34 heterosexual cohabiting couples, with and without children living at home, in a rural region of Australia. It explores their everyday food habits and preferences, their notions of a healthy diet and their use of and attitudes towards takeaway food and dining out. The study found that the participants, for the most part, demonstrated a conservatism in their food preferences, lacking the desire for exotica and the gourmand sensibility that characterises members of the metropolitan middle class. The aspects of food they found most pleasurable and valuable were nostalgia, tradition, balance, health, family togetherness and sociality.

Issues for palliative care in rural Australia

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.