Urban Australia Research Articles

(In)equality of opportunity: educational attainments of young people from rural, regional and urban Australia

Since 1990, the Australian higher education system has experienced ongoing reform resulting in the number of universities and student populations more than doubling. Despite this expansion, inequalities in access to higher education related to family background and location persist. Due to the concentration of higher education campuses in the capital cities of each Australian state, inequalities related to geographic location may be as important as those related to socio-economic status. Our analysis of data collected by the Longitudinal Surveys of Australian Youth (LSAY) research programme shows that students from regional and rural areas are less likely than their urban peers to enrol at university. Furthermore, this trend persists when levels of academic achievement at age 15 and Australian Tertiary Admission Rank (ATAR) are accounted for. Given that demand for highly educated workers is increasing and that workers with no post-school qualifications are the most likely to experience unemployment or underemployment, the inaccessibility of educational opportunities may consign the current generation of non-metropolitan youth to extended periods of precarious employment.

Longer-Term Safety and Efficacy of Contemporary Percutaneous Coronary Intervention – Insights from 2-Year Follow-Up of a Single Australian Centre Registry

Non-Caucasian populations are under-represented in randomised controlled trials in interventional cardiology. Urban Australia is increasingly becoming ethnically diverse. There is little data assessing outcomes of non-Caucasian populations undergoing percutaneous coronary intervention (PCI) in the Australian setting.

Impact of Racial Background on Longer-Term Outcomes in Patients Undergoing Contemporary Percutaneous Coronary Intervention

Non-Caucasian populations are under-represented in randomised controlled trials in interventional cardiology. Urban Australia is increasingly becoming ethnically diverse. There is little data assessing outcomes of non-Caucasian populations undergoing percutaneous coronary intervention (PCI) in the Australian setting.

The impact of vicarious trauma on Aboriginal and/or Torres Strait Islander health researchers.

To describe and reflect on an Aboriginal researcher's experience of vicarious trauma arising from a qualitative study of Aboriginal and Torres Strait Islander women with chronic disease. In-depth semistructured interviews with thematic analysis were undertaken to explore the psychosocial factors experienced by Aboriginal and Torres Strait Islander women as they managed their chronic disease. An 'Indigenous women's standpoint theory' approach was adopted to frame discussion. This approach gives strength and power to the voice of Aboriginal and Torres Strait Islander women and their diverse cultural lived experiences. The raw and often brutal realities this approach exposed had a triggering impact on the Aboriginal team member for whom these realities were familiar. Interviews were conducted with participants from four Aboriginal Medical Services from urban, rural and remote Australia. Analysis of the interviews, and reflection regarding the researcher's experiences, occurred within the context of a multidisciplinary team. Participant selection for the interview study was purposive. Seventy-two participants were selected for this study. The duration of the study was 2 years, and it was undertaken between March and December 2014, and finalised in December 2016. In exploring how Aboriginal and Torres Strait Islander women managed their own health and wellbeing, compelling stories of trauma, domestic violence and generational incarceration were shared with the researcher. Hearing and re-living some of these overwhelming experiences left her feeling isolated and distressed. These compelling stories contributed to her experience of vicarious trauma. When Aboriginal and Torres Strait Islander researchers conduct research in Indigenous communities, we should monitor, prepare for and provide appropriate care and support to researchers to address the potential for vicarious trauma. These considerations are paramount if we are to build the capacity of Indigenous and non-Indigenous researchers to conduct Indigenous health research.

Socio-demographic, behavioural and health-related characteristics associated with active commuting in a regional Australian state: Evidence from the 2016 Tasmanian Population Health Survey.

Physical activity is lower and rates of preventable common diseases are higher in regional/rural than urban Australia. Active commuting (walking/bicycling to get from one place to another) may benefit health through increased physical activity, but most evidence of its correlates come from urban studies. This study aimed to investigate associations between active commuting, socio-demographic characteristics, behaviours, total physical activity and health in a regional/rural Australian state. This study used data from the 2016 Tasmanian Population Health Survey, a representative cross-sectional self-report survey of 6,300 adults in Tasmania, Australia. Logistic regression modelling investigated associations between socio-demographic, behavioural and health characteristics and past week active commuting frequency. In multivariable models, being younger, having tertiary qualifications, living in a socio-economically advantaged area, being physically active, having a healthy body mass index and good/excellent self-rated health were associated with engaging in more active commuting. Inner regional dwellers were no more likely than outer regional dwellers to actively commute after covariate adjustment. Strategies to promote active commuting in regional/rural areas might consider targeting older adults, those less educated, those living in socio-economically disadvantaged areas, those less physically active, those with poorer health and those with higher body mass index. Research could further investigate why these groups appear to be less active for commuting purposes. SO WHAT?: Increasing physical activity and active commuting may help to reduce rates of preventable common diseases in regional/remote areas.

Increased diagnostic yield of routine multiplex PCR compared to clinician requested testing for detection of Trichomonas vaginalis

Trichomonas vaginalis (TV) infection is the leading cause of non-viral sexually transmitted infection (STI) globally and is endemic in rural and remote Australia. However, current accurate prevalence data for TV in urban Australia are scarce as TV is not a notifiable infection outside of the Northern Territory (NT). This study evaluated Australian guidelines for TV testing and determined TV prevalence among patients at a large urban public hospital in Melbourne, Australia. A retrospective analysis of genitourinary samples screened for STIs by multiplex polymerase chain reaction (MPCR) between May 2017 and April 2019 was performed. A total of 7155 results (5064 females) were included in the analysis. A prevalence for TV of 1.7% (n=123) was found, which was higher than Neisseria gonorrhoeae (1.4%, n=103) but less than Chlamydia trachomatis (5%, n=358). The highest rate of TV (3%) was found in females aged 30-44 years (n=48). Routine MPCR improved TV detection almost six-fold compared with clinician request based testing. Current targeted testing guidelines for TV were inadequate for case finding in an urban setting, and clinical request among symptomatic patients was rare. MPCR testing provides a comprehensive testing strategy for curable STI, and removes the need for clinical suspicion of TV. Implementation of MPCR for STI screening can improve TV detection in populations not normally suspected to be at risk and therefore potentially reduce disease transmission or complications associated with undiagnosed infection.

Managing impacts of extreme hydrological events on urban water services: the Australian experience

ABSTRACT Australia experiences a wide range and increasing incidence of extreme hydrological events, including step changes in stream flows, extreme drought, bushfires followed by heavy rain, and storm events, which impact water availability and water quality. This article discusses the management of these events in the provision of water services in urban Australia. These events are being actively and effectively managed by large water service providers, covering around 80% of the population. But the experience for the remaining 20% is mixed, with smaller service providers often struggling to meet community expectations. This suggests a need for further governance reforms.

Acceptability of the culturally adapted ASQ-TRAK developmental screening tool to caregivers of Aboriginal children.

The Ages and Stages Questionnaire-Talking about Raising Aboriginal Kids (ASQ-TRAK) culturally adapted developmental screening tool is widely used in Australian Aboriginal communities. However, there has been limited exploration of the tool's acceptability to caregivers. The aim of the study is to determine the acceptability of the ASQ-TRAK developmental screening tool to caregivers of Aboriginal children in urban, regional and remote South Australia. Caregivers of Aboriginal children completed a survey regarding acceptability of the ASQ-TRAK. Convenience samples of caregivers were invited to a telephone interview. Ninety-two caregivers completed the survey (96% response). Acceptability (92%) and caregiver satisfaction (73%) were high. Families perceived the screen as easy to use and understand, strengths-based and providing valuable information about their child's development. The ASQ-TRAK tool was highly acceptable to caregivers in Aboriginal communities in South Australia. The study highlights the importance of culturally safe practice and supports ASQ-TRAK implementation. Broader use and further evaluation of the ASQ-TRAK in Aboriginal communities needs consideration.

Recognising the value of urban runoff and reclaimed water for cultural flows in melbourne: implementation through the planning scheme

ABSTRACT In Australia, contestation over the use of water resources remains fierce and these contests extends into regional cities and urban capitals. The 2008 Echuca Declaration by the Murray Lower Darling Indigenous Nations called for a share of these water entitlements to be legally and beneficially owned by First Nations with an associated right to use such resources for economic liberation – termed as ‘Cultural Flows’. This was necessary because of the inadequacies First Nations of the Murray–Darling Basin encountered when seeking legal recognition of their cultural rights to water; but as the literature has shown these difficulties are not unique to just First Nations of the Murray–Darling Basin. Similar problems confront First Nations throughout Australia, especially so in urban Australia. There is limited research into how Cultural Flows can be procured in cities, or how recycled water and treated urban stormwater runoff might have a part to play in the achievement of cultural water management objectives set by Indigenous communities. Centred on the Victorian planning scheme, this research aims to bridge this gap through a policy analysis of recycled water and urban stormwater runoff governance. From here, how this approach might be implemented is discussed.’

Eliciting recovery narratives in global mental health: Benefits and potential harms in service user participation.

The engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health. We present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives. Within each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care. Recovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pancreatic cancer in Australia: is not it time we address the inequitable resource problem?

The present study reviewed the geographical variations in the delivery of pancreatic cancer therapy and whether this impacts overall survival. The evidence suggests a difference in the accessibility of pancreatic cancer care to patients in rural as compared with urban Australia. While centralization of pancreatic surgery is essential to deliver high quality care to patients, it may be interfering with the ease of access of this form of care to patients in regional areas. Access to chemotherapy in regional Australia is also limited. There is need for a concerted effort to improve the overall care and uptake of medical services to patients in metropolitan and remote Australia with the overarching aim of improving survival and meaningful quality of life.

An exploration of midwives’ role in the promotion and provision of antenatal influenza immunisation: A mixed methods inquiry

ProblemNo South Australian study has previously investigated the role of midwives in the promotion and provision of antenatal influenza immunisation. BackgroundInfluenza acquired in pregnancy can have serious sequalae for both mother and foetus. Recent studies have demonstrated that influenza vaccine in pregnancy is both safe and effective. Despite this, evidence suggests that vaccine uptake in pregnancy is suboptimal in both Australia and worldwide. AimThe aim of this study was to investigate the role of midwives in the promotion and provision of antenatal influenza vaccine and, to provide a statistical and thematic description of the barriers and enablers midwives encounter. MethodsThis mixed method study incorporated a cross sectional on-line survey and in-depth interviews conducted with midwives, employed in urban and regional South Australia. FindingsQuantitative data were available for 137 midwives and 10 midwives participated in the interviews. Recruitment for the interview phase was through the last question on the survey. Whilst all midwives indicated that education and vaccine promotion were part of their role, immunisation knowledge varied between Registered Nurse/Midwives (RM/RN) 80% and Registered Midwives (RM) 48.90% (p=0.001). Quantitative data showed that only 43% of midwives felt sufficiently educated to provide the vaccine. Midwives who had received formal immunisation training were more likely to recommend the vaccine 93.7% (p=0.001). Qualitative data confirmed these results and identified the lack of immunisation education as a barrier to practise. ConclusionMidwives identified an immunisation knowledge deficit. Midwives who had received immunisation education were more likely to actively promote and provide the vaccine to pregnant women. These findings indicate the need for more immunisation education of midwives in both tertiary and practice settings.

Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners' Perspectives.

Introduction:Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners’ experiences of care provision.Methods:The study used a qualitative design in two phases: 1) semi-structured interviews, 2) one focus group. The setting comprised one public health network and five community services in urban Australia. In Phase 1, health practitioners across settings were interviewed about their experience of transitional care. Phase 2 sought feedback about the Phase 1 findings from different practitioners. All data were thematically analysed.Findings:In Phase 1), 48 healthcare practitioners were interviewed across multiple settings. Few participants were aware of the introduction of consumer-directed care in community aged care. Four main themes were identified: ‘Rapid and safe care transition’, ‘Discussing as a team’, ‘Questioning the discharge’, and ‘Engaging patients and carers’. In Phase 2), seven participants from different settings reviewed and endorsed the findings from Phase 1.Discussion and conclusions:Findings indicate that healthcare practitioners use a range of communication and coordination processes in optimising integrated transitional care. Although participants involved their patients in transitional care planning, most participants were unaware of the recent implementation of consumer-directed care. In contexts of community-based care shaped by multidisciplinary, sub-acute and CDC models, care integration must focus on improved communication with patients and carers to ascertain their needs and to support their increased responsibility in their care transitions.

Dreaming Diversity: Second Generation Australians and the Reimagining of Multicultural Australia

Dreaming Diversity: Second Generation Australians and the Reimagining of Multicultural Australia

Inclusive health care for LGBTQ+ youth: support, belonging, and inclusivity labour

ABSTRACT Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of ‘inclusivity labour’ were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities.

Talking Saivism in a Tamil migrant faith classroom

ABSTRACTThis study is located in a lesser-known educational context and investigates aspects of migration, religion and multilingualism. Focusing on the discourse of second-generation adolescent migrants in a Tamil Hindu temple school in urban Australia, I discuss how flexible language practices manifest in this migrant faith setting. I argue that the use of the heritage language is not always at the forefront, despite a monolingual Tamil language policy, because religious transmission is given priority over language transmission. At the same time, there are certain motivations that influence the use of Tamil: to index the close relationship between language and religious culture and to index one’s membership of the ethnoreligious community. This paper draws on ethnographic data to provide both a macro and micro view of these motivations – what drives adolescents to use their heritage language, how it is deployed from their linguistic repertoires, and how it contrasts with the use of the students’ dominant language, English. The analysis takes a whole of conversation approach to understanding the relationship between religion and heritage language use for second-generation migrant students.

Provider attitudes to the empiric treatment of asymptomatic contacts of gonorrhoea.

An online anonymous survey for nurses and doctors working in public sexual health clinics and general practices in urban, regional and rural Australia was developed. Information on the relative importance of a range of factors influencing delivery of empiric treatment was collected. Participants were asked whether current guidelines should change. Surveys were distributed to 468 healthcare providers and 188 (40.2%) fully completed the survey. Most of the participants worked in public practice (84.9%) and 86 (43.2%) were doctors. Factors influencing provision of empiric treatment were: if the patient was unable to return (95.9%) or may not return (95.3%); risk of transmission to others (93.3%); likelihood of infection (88.6%); and patient request (82.9%). Respondents were evenly split as to whether current guidelines should change, with providers in private practice being less likely to support guideline change (P = 0.03). The model of empiric treatment of all asymptomatic sexual contacts was 34% more expensive than a model of testing and treatment of those with a positive result. Currently, the majority of clinicians provide empiric treatment for asymptomatic contacts in Australia. There was significant support for a change in guidelines with specific scenarios requiring individualised responses.

Disability and migration in urban Australia: The case of Liverpool

AbstractThis article presents and analyses population data on the Liverpool area of Greater Western Sydney, identifying trends with significant policy implications. Liverpool city is home to one of the highest concentrations of Australia's recent arrivals, many of whom have refugee backgrounds. From those who arrived under Australia's post‐Second World War resettlement programme to new arrivals, it is also home to a rich diversity of sociocultural and linguistic communities at different stages of settlement. Demographic data show significant relationships between age, country of origin, year of arrival and need for assistance variables, many of which are either qualitatively distinct or quantitatively different from other regions in Sydney, New South Wales and Australia. Building on this analysis, the article further identifies significant policy issues in relation to disability, care and support. While Western Sydney has figured prominently in national and state public‐policy directives, particularly in relation to economic growth, public infrastructure and transport mobility corridors, the analysis presented here illustrates that national policy directives for socioeconomic imperatives, such as the appropriate uptake of the National Disability Insurance Scheme, are critical to facilitate social sustainability, cohesion and equity within the region.

Built and social environmental factors influencing healthy behaviours in older Chinese immigrants to Australia: a qualitative study

BackgroundNeighbourhood environments influence older adults’ health and health-enhancing behaviours, such as physical activity, eating a healthy diet and socialising. However, little is known about the effects of the neighbourhood environment on the health of older immigrants, the number of which is rapidly increasing in developed countries. Using Nominal Group Technique (NGT) sessions, this study of older Chinese immigrants to urban Melbourne, Australia, examined built and social environmental facilitators of and barriers to regular engagement in physical activity, eating a healthy diet and regular contact with other people.MethodsParticipants were recruited from four types of neighbourhoods stratified by walkability and proportion of Chinese dwellers. Twelve NGTs, four specific to each of physical activity, healthy diet and social contacts were conducted in Mandarin or Cantonese (91 participants). NGT responses from groups addressing the same questions were aggregated, similar items were combined, and scores combined across groups. Inductive thematic analysis was used to categorise answers into higher-order themes of factors associated with each behaviour.ResultsFor physical activity, 29 facilitators and 28 barriers were generated with the highest ranked facilitator and barrier being “proximity to destinations” and “poor/inadequate public transport”, respectively. For healthy diet, 25 facilitators and 25 barriers were generated, the highest ranked facilitator and barrier were “high food safety standards/regulations” and “lack of family/household members’ social support for a healthy diet”. The social contacts NGTs generated 23 facilitators and 22 barriers, with the highest ranked facilitator and barrier being “proximity to destinations and activities” and “poor public transport”, respectively.DiscussionIndependent living arrangements and the accessibility of destinations of daily living (e.g., bilingual health services, libraries, places of worship and grocery stores / supermarkets), recreational facilities, affordable public transport, and community centres and activities for Chinese people are key elements for promoting regular engagement in physical activity, healthy eating and socialising in older Chinese immigrants. Governments should plan for the provision of this basic infrastructure of community facilities for older immigrants.

Soil Compaction Affects the Growth and Establishment of Street Trees in Urban Australia

Growing conditions for street tree roots are generally harsh with restricted space and soils compacted from streetscape infrastructure. Allocasuarina littoralis, Corymbia maculata, Cupressus sempervirens var. stricta, Eucalyptus polyanthemos, Lophostemon confertus, Olea europaea, Quercus palustris, and Waterhousea floribunda were grown in compacted and uncompacted soils for 20 months in experimental blocks. The bulk density and penetrative resistance of the soils and height, canopy spread, trunk diameter, leaf area, and chlorophyll fluorescence were measured regularly. Root and shoot biomass were determined after harvesting. Since the bulk density of compacted compared to uncompacted soil was root growth limiting, it was hypothesised that species would have reduced growth in compacted soils. However, C. maculata and E. polyanthemos grew better, C. sempervirens, Q. palustris, and W. floribunda grew well, and A. littoralis, L. confertus, and O. europaea were the worst performing in compacted soil. E. polyanthemos, L. confertus, and Q. palustris had higher canopy:root ratios in compacted soil. Q. palustris had greater mass below ground than above, which has implications for its use in confined sites. In a field study, C. maculata, E. polyanthemos, L. confertus, O. europaea, and Q. palustris growing as street trees were surveyed to determine their rates of establishment and growth under urban conditions. In addition to the soil and tree parameters mentioned above, a Visual Tree Assessment (VTA) was undertaken. E. polyanthemos had the largest trunk diameter, height and canopy spread, indicating its potential for rapid establishment in streets. It was the only species with a larger mean leaf area in compacted soil. E. polyanthemos and O. europaea were the only species classed as healthy from chlorophyll fluorescence but there was no significant difference in fluorescence between compacted and uncompacted soils. VTA showed that C. maculata and O. europaea performed best and that E. polyanthemos, L. confertus, and Q. palustris had reduced but acceptable growth in compacted soil. Soils ranged from non-saline to moderately saline and were slightly to strongly acidic. All soils were compacted to some degree and penetrative resistance was at root limiting levels. The results suggest that careful species selection and soil amelioration for species prone to the effects of compaction would facilitate street tree establishment.