Remote Australia Online

Objective:Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity.Method:This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults.Results:The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales.Conclusion:The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.

Background: Young Australian Aboriginal people experience poor health outcomes, yet young people and Aboriginal people have low use of health care. Objective: To identify barriers and enablers of access for adolescent and young adult Aboriginal people at Derby Aboriginal Health Service (DAHS), a remote Western Australian Aboriginal Community Controlled Health Service (ACCHSs), to assist in improving access. Methods: This qualitative study was in the remote Kimberley town of Derby and three Aboriginal communities serviced by DAHS. Semistructured interviews with 26 young Aboriginal people in 2014 and 2015 were used to identify barriers and enablers to accessing local health care services. Results: Participants appreciated interacting with Aboriginal staff, local staff, and longer term DAHS staff. This improved communication and interpersonal interactions, which were reported to be of prime importance for young Aboriginal people accessing health services. Maintaining confidentiality, minimizing shame, and gender matching with health staff were also key issues for young people. Seeking health care was often based on acute need rather than proactive or preventive care; however, participants recognized that providing health education and health promotion should be a priority for the service. Conclusions: A number of approaches to improving health service use by young remote Aboriginal people may be effective. Improving youth engagement seems to be central to increasing acceptability and, hence, use. This requires that staff able to engage with young people are recruited, trained, and retained. More immediately, a range of simpler changes to service provision focus and environment for young people could potentially make important differences.

Objective Geographic mal-distribution towards urban over rural medical practice exists worldwide. The James Cook University medical school has focused its selection and curriculum on selecting and training students to address medical workforce needs for local regional, rural and remote areas. This study investigates final-year James Cook University medical students' intended rural practice modality and association with rurality of upbringing. Design, setting & participants Cross-sectional survey of final-year James Cook University medical students in 2018 (n = 147; response rate = 76%). Main outcome measure Association between students’ rurality of hometown at entry to medical school and self-reported intentions for rural practice. Results Overall, final-year students' preferred rural practice modality was “for a specific number of years” (38, 25%), followed by “periodic short-term locum” (33, 23%), “permanently based” (26, 18%), “orbiting” (21, 14%), “none” (14, 10%), “long-term shared position” (9, 6%) and “specialist outreach clinics” (6, 4%). Urban hometown at entry to medical school was associated with students preferring periodic rural practice, with rural-origin students contrastingly preferring more permanent rural practice. Conclusion Only 10% of James Cook University medical students did not want a rural career in any form, suggesting the majority, regardless of urban or rural hometown, are open to some type of rural practice. Urban-origin medical students around Australia might be a significant, untapped resource for periodic and more permanent rural practice if they can be provided with extended, immersive rural placements experiences. Government funding models should provide increased funding for immersive rural placements, and promotion of orbiting and longer-term job share practice modalities.

In early 2015, the prime minister of Australia delivered the seventh annual Closing the Gap Prime Minister’s report (Australian Government, 2015). In it he reported that the government’s goal to halve the gap in employment outcomes between Indigenous and other Australians by 2018 was not on track, a euphemism for failing, and that there was a decline in employment outcomes since the target was set in 2008. The report notes:It is clear that since 2008, no progress has been made against the target to halve the gap in employment outcomes within a decade (by 2018). The proportion of Aboriginal and Torres Strait Islander peoples aged 15–64 years who are employed fell from 53.8 per cent in 2008 to 47.5 per cent in 2012–13. In addition to the fall in Indigenous employment, the proportion of non-Indigenous Australians who are employed rose from 75.0 per cent to 75.6 per cent. Consequently, between 2008 and 2012–13 there has been an increase of 6.9 percentage points in the employment gap between Indigenous and non-Indigenous working age people (up from 21.2 to 28.1 percentage points). (Australian Government, 2015, p. 18)The report highlights variation in employment outcomes by remoteness declining from an employment/population ratio of nearly 50 percent in major cities to just 30 percent in very remote regions.

The Productivity Commission’s recent report Overcoming Indigenous Disadvantage, notes that the vision behind the report is that Indigenous people will one day enjoy the same overall standard of living as other Australians (SCRGSP 2005: 1.2). This admirable goal is a reflection of the Howard Government’s commitment to practical reconciliation; that is, to equality in health, housing, employment and education outcomes between Indigenous and non-Indigenous Australians. The futuristic reference to ‘one day’ suggests that the goal may indeed be more visionary than policy realistic.

In much of remote Australia where a sizable minority of Indigenous people live, labour markets are able to employ only a small fraction of the working-age Indigenous population, a legacy of Australia’s settler-colonial past and present. In this chapter, we do two things. First, we describe the former Community Development Employment Projects (CDEP) scheme as a basic-income-like programme. Using survey data from 2002–2003 to 2014–2015, we examine the impact of the abolition of the CDEP as a proxy for a future basic income scheme on cultural participation. We find that the existence of CDEP was associated with a modest increase in cultural participation, especially in attendance of sporting carnivals. Second, we argue for the implementation of a true basic income scheme in remote Australia as a first priority for a staged programme nationally.

Background: Despite the well-recognised Indigenous-non-Indigenous health disparity, some reports suggest improvements in Indigenous mortality. Our aim was to quantify Indigenous mortality in Outer Regional (OR), Remote (R), and Very Remote (VR) areas in New South Wales, Queensland, South Australia, Western Australia, and the Northern Territory and changes in mortality from 1998 to 2005. Methods: We calculated rates, standardized mortality ratios (SMRs) and percentage change in annual rates of Indigenous cardiovascular, diabetes and renal mortality mentioned anywhere on the death certificate by using ICD-10 codes and the 2001 total Australian population as the reference population. Results: In 1998-2001, Indigenous SMRs for all-cause mortality were 241%, 421% and 220% in OR, R and VR, respectively. In 2001-03, corresponding SMRs were 202%, 331% and 176%. Percentage changes (95% confidence interval) in annual all-cause mortality were -3.0% (-5.3%, -0.7%) in OR, -4.2% (-7.4%, -0.9%) in R and -0.5 (-9.1%, -0.7%) in VR. In 2002-2005, compared with 1998-2001, changes in the number of Indigenous deaths were -147, -195, and -197 in OR, R and VR, respectively. Similar patterns and trends were observed for cardiovascular mortality. Conclusions: Mortality was elevated about 2-fold in OR, 4-fold in R and 2-fold in VR areas. The downward trend in mortality regardless of remoteness of residence was partly attributable to a decrease in the absolute number of deaths. These patterns were observed for each of the states/territories individually.

Death rates are a useful indicator of the underlying health status of a population. In general, people living in regional and remote Australia have higher death rates than those living in major cities. This report, the eighth in the Australian Institute of Health and Welfare's rural health series, describes the patterns of death in regional and remote areas and quantifies the difference in death rates amongst people living in major cities and those living outside them.

Mobile hunter-gatherers are often characterized as living in small communities where mobility and group size are products of the environmentally determined distribution of resources, and where social organization is multi-scalar: groups of co-residents are nested within small communities that are, in turn, nested within small-scale societies. Such organization is often assumed to be reflective of the human past, emerging as human cognition and communication evolved through earlier fission-fusion social processes, typical of many primate social systems. We review the history of this assumption in light of recent empirical data of co-residence and social networks among contemporary hunter-gatherers. We suggest that while residential and foraging groups are often small, there is little evidence that these groups are drawn from small communities nested within small-scale societies. Most mobile hunter-gatherers live in groups dominated by links between non-relatives, where residential group membership is fluid and supports large-scale social networks of interaction. We investigate these dynamics with fine-grained observational data on Martu foraging groups and social organization in Australia's Western Desert. The composition of Martu foraging groups is distinct from that of residential groups, although both are dominated by ties between individuals who have no close biological relationships. The number of individuals in a foraging group varies with habitat quality, but in a dynamic way, as group size is shaped by ecological legacies of land use. The flexible size and composition of foraging groups link individuals across their “estates”: spatially explicit storehouses of ritual and relational wealth, inherited across generations through maintaining expansive networks of social interaction in a large and complex society. We propose that human cognition is tied to development of such expansive social relationships and co-evolved with dynamic socio-ecological interactions expressed in large-scale networks of relational wealth.

Aim Self-reporting and/or data from medical records are frequently used in studies to ascertain health history. Data on the discrepancies between these information sources is lacking for Indigenous Australians. This study reports such data for selected respiratory and atopic conditions common among Indigenous Australians. Methods Data were extracted from the Indigenous respiratory reference value study, a multicentre cross-sectional study of Indigenous children and young adults (3?25?years) between June 2015 and November 2017. Only those living in rural/remote regions were included. Self-reported history was collected from parents (if participants <18?years) or participants. Medical records were manually reviewed. Participants with incomplete data (missing self-reported and/or medical record information) were excluded. Agreement between sources was examined using Cohen's kappa. Results Of 1097 participants, 889 (97.1% <18?years) had sufficient self-reported and medical record histories for comparison. Asthma was self-reported by 15.7% of participants and was reported in medical records for 10.3% (? = 0.53, 95% confidence interval (CI) 0.45?0.61). For bronchiectasis, the reported rates were 1.5 and 0.7% (? = 0.52, 95% CI 0.25?0.80), pneumonia 1.1 and 5.8% (? = 0.15, 95% CI 0.02?0.27), allergic rhinitis 6.6 and 0.6% (? = 0.05, 95% CI ?0.03, 0.13) and eczema 5.8 and 6.2% (? = 0.30, 95% CI 0.18?0.42). Conclusions Within our cohort, agreement was moderate for asthma and bronchiectasis, fair for eczema and poor for pneumonia and allergic rhinitis. These results highlight the challenges associated with how best to obtain an accurate health history within Australian Indigenous rural/remote communities. Generalisability of findings and contributions of poor health knowledge and/or poor medical record documentation need further exploration.

Impetigo is common in remote Indigenous children of northern Australia, with the primary driver in this context being Streptococcus pyogenes [or group A Streptococcus (GAS)]. To reduce the high burden of impetigo, the transmission dynamics of GAS must be more clearly elucidated. We performed whole genome sequencing on 31 GAS isolates collected in a single community from children in 11 households with ≥2 GAS-infected children. We aimed to determine whether transmission was occurring principally within households or across the community. The 31 isolates were represented by nine multilocus sequence types and isolates within each sequence type differed from one another by only 0–3 single nucleotide polymorphisms. There was evidence of extensive transmission both within households and across the community. Our findings suggest that strategies to reduce the burden of impetigo in this setting will need to extend beyond individual households, and incorporate multi-faceted, community-wide approaches.

This review provides a comprehensive synthesis of key information on the use of kava among Aboriginal people in Australia. The review begins by summarising how kava is used traditionally, its immediate effects, and its chemistry. This is followed by a summary of the research into the effects of kava on health. The paper will then review the use of kava in Australia; the history of its introduction to Aboriginal people and the impacts of kava on the health and wellbeing of Aboriginal Australians. This discussion is focussed on the use of kava in Arnhem Land (Northern Territory) communities because concerns regarding the prevalence and effects of kava use are limited to this geographic region.The review critically discusses the regulation of kava in Australia, including the impacts these regulations have had on Aboriginal communities. The paper reviews strategies to reduce kava related harms and concludes by discussing possible future directions for research and action for minimising further harm.

Introduction: There is growing support for the prosocial value of role modelling in programs for adolescents and the potentially positive impact role models can have on health and health behaviours in remote communities. Despite known benefits for remote outreach program recipients, there is limited literature on the outcomes of participation for role models. Methods: Twenty-four role models participated in a remote outreach program across four remote Aboriginal communities in the Northern Territory, Australia (100% recruitment). Role models participated in semi-structured one-on-one interviews. Transcripts were coded and underwent thematic analysis by both authors. Results: Cultural training, Indigenous heritage and prior experience contributed to general feelings of preparedness, yet some role models experienced a level of culture shock, being confronted by how disparate the communities were to their home communities. Benefits of participation included exposure to and experience with remote Aboriginal peoples and community, increased cultural knowledge, personal learning, forming and building relationships, and skill development. Conclusions: Effective role model programs designed for remote Indigenous youth can have positive outcomes for both role models and the program recipients. Cultural safety training is an important factor for preparing role models and for building their cultural competency for implementing health and education programs in remote Indigenous communities in Australia. This will maximise the opportunities for participants to achieve outcomes and minimise their culture shock.

Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. Results Fifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health.

Objective The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting Seven diverse remote Aboriginal communities in the Northern Territory with government-run health clinics were visited. Participants Non-random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results Content analysis revealed that participants thought having the “right” nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions Participants identified the importance of clinical and cultural skills and reiterated that getting the “right” Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment.

Background Provision of internal medicine services in rural Australia is always problematic. Aim The aim was to undertake an audit of an outreach service operating in Northern New South Wales since 2006. Methods The service is conducted eight times a year, involving a consultant and an advanced trainee who travel by car to the towns of Moree and Mungindi and conduct clinics in a general practice setting, an Aboriginal medical service and a local health district clinic. Since 2008, a cardiology service and a diabetes service have been added on a fly-in fly-out basis. Case records of all patients enrolled in the service between February 2006 and July 2013 were reviewed in determining the demographics, clinical presentations and level of service coverage. The experience of the authors in establishing the service provided insights into the challenges and the success factors involved. Results Five hundred and eighty-three patients were seen on a total of 1070 occasions relating to a wide variety of clinical presentations. Of these, 31.3% were indigenous compared with 20% in the local statistical area, and both indigenous and non-indigenous patients were seen in all settings. Patients fell into 15 different diagnostic categories with indigenous patients more likely to present for diabetes (P < 0.001) and hepatitis B (P < 0.01), but less likely to present for treatment of hepatitis C (P < 0.01). Conclusions In providing an outreach service to a mixed community, flexibility in both setting and personnel are essential. Diabetes and liver disease are highly prevalent in indigenous patients, but the low numbers presenting for hepatitis C requires further study.

Introduction: Globally, most patients with rheumatic heart disease (RHD) do not have a history of acute rheumatic fever (ARF). The Indigenous people of the Northern Territory (NT) of Australia have some of the highest rates of ARF and RHD in the world. Coordinated register-based delivery of secondary prophylaxis has been active for two decades. This study aimed to better define the burden of RHD using active case finding for RHD in school-aged children in a remote community in the NT. Methods: A community-driven approach to engagement and education on ARF/RHD was implemented on the invitation of the Maningrida community. For active case finding, participants aged 5–20y had echocardiography performed by cardiologists. Diagnoses of RHD were made according to World Heart Federation criteria. Echo data were combined with register data to describe the burden of ARF/RHD. Results: Estimated target population (aged 5–20y) was 849 people. Of these, 615 (72.4%) underwent echocardiography (median age 11y). An existing diagnosis of probable/definite ARF and/or RHD was recorded in 44/615 (7.2%). At screening, 13 known cases and 19 new cases were found to have definite RHD (32/615, 5.2%); 6/615 (1.0%) have had cardiac surgery for severe RHD, including 3 new cases. Conclusion: The burden of ARF/RHD in Maningrida is extremely high. Active case finding using echocardiography facilitates detection and access to treatment, even in settings with effective primary health care and ongoing disease surveillance. Community engagement and education are key to early detection and treatment, as well as primordial and primary prevention of ARF/RHD.

A mixed-methods school-based screening study to detect rheumatic heart disease (RHD) in Aboriginal children and adolescents was conducted in 2018 in an Australian remote community with known high prevalence rates. Preparation for screening included community events and presentations with parents, community leaders and school staff. School staff, some of whom were also Aboriginal community leaders, were spontaneously galvanized and motivated to act on learning RHD population data for their community. The school’s language and culture unit, named Lurra, decided to create a novel 6-week unit of schoolwork on RHD in 4 of the community’s home languages as their main task over one school term. The aim was to improve low levels of knowledge of RHD among children and others in their community as a prevention strategy, along with preparation for screening. The Lurra team was multi-disciplinary and used principles of community-led development as well as Indigenous knowledge to create and deliver the unit of work concurrent with school screening. The unit matched the jurisdiction’s curriculum requirements and produced a broad range of learning aids. Improvements in school and community knowledge, along with activities related to the RHD screening led to wider community agency collaboration to address RHD. The unit is being refined for teaching again in 2019 and subsequent years as a long-term strategy towards ending RHD in the community.

Objectives: We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting. Methods: The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Household contacts were screened for ARF or group A Streptococcus (GAS) infection by questionnaire and swab collection, offered an echocardiogram if aged 5–20 years, and intramuscular benzathine benzylpenicillin if aged over one year or if less than one year with impetigo. Results: Fifteen definite and seven probable ARF cases were diagnosed in the community in July–December 2014 (all-age incidence of definite ARF: 1,473/100,000). The public health response identified two additional cases of ARF. A total of 81 contacts were screened; GAS was detected in 3/76 (4%) throat swabs and 11/24 (46%) skin swabs. Molecular typing revealed high GAS strain diversity. Conclusions: The incidence of ARF during this cluster was very high. Carriage and infection with GAS was observed, but no outbreak strain identified. Implications for public health: A national public health guideline has since been developed that includes advice on the investigation of an ARF outbreak/cluster. Sustained efforts with strong community engagement are required to tackle high ARF rates.

This paper explores how the appeal of the imagery of the Arnhem Land bark painting and its powerful connection to land provided critical, though subtle messaging, during the post-war Australian government’s tourism promotions in the USA.

Gastric volvulus is a potentially lethal condition with mortality rates reported up to 50%. The high mortality rate is largely due to the rarer complication of gastric infarction, the diagnosis of which is often difficult. From the small series published, it is known that delays to receiving definitive surgical intervention negatively impacts patient outcomes. We present a case of long-term survival of a 69-year-old man who presented to his local hospital in remote Australia with gastric volvulus and complete gastric infarction. His initial management was delayed as he could not undergo life-saving surgery at his presenting hospital. He was transferred to the regional referral hospital and survived both an upfront damage-control oesophagogastrectomy and then transfer to a metropolitan centre for alimentary tract reconstruction. He was alive and living at home without major postoperative morbidity 12 months later.

Background: Unintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements. Methods: Semi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18–49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation. Results: Most (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community. Conclusion: Consultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.

Objectives To examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.Design Qualitative study.Setting Primary health care services serving remote Aboriginal communities in the Northern Territory, Australia.Participants Seven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program.Methods Semi-structured in-depth interviews conducted in person or by telephone; data were analysed using an inductive and deductive thematic approach.Results Despite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems.Conclusions This study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.

Objective The aim of the present study was to identify evidence-based strategies in the literature for developing and maintaining a skilled and qualified rural and remote health workforce in Australia to better meet the health care needs of Australian Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) people.Methods A systematic search strategy was implemented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist. Exclusion and inclusion criteria were applied, and 26 papers were included in the study. These 26 papers were critically evaluated and analysed for common findings about the rural health workforce providing services for Aboriginal people.Results There were four key findings of the study: (1) the experience of Aboriginal people in the health workforce affects their engagement with education, training and employment; (2) particular factors affect the effectiveness and longevity of the non-Aboriginal workforce working in Aboriginal health; (3) attitudes and behaviours of the workforce have a direct effect on service delivery design and models in Aboriginal health; and (4) student placements affect the likelihood of applying for rural and remote health jobs in Aboriginal communities after graduation. Each finding has associated evidence-based strategies including those to promote the engagement and retention of Aboriginal staff; training and support for non-Aboriginal health workers; effective service design; and support strategies for effective student placement.Conclusions Strategies are evidenced in the peer-reviewed literature to improve the rural and remote workforce for health delivery for Australian Aboriginal people and should be considered by policy makers, funders and program managers.What is known about the topic? There is a significant amount of peer-reviewed literature about the recruitment and retention of the rural and remote health workforce.What does this paper add? There is a gap in the literature about strategies to improve recruitment and retention of the rural and remote health workforce for health delivery for Australian Aboriginal people. This paper provides evidence-based strategies in four key areas.What are the implications for practitioners? The findings of the present study are relevant for policy makers, funders and program managers in rural and remote Aboriginal health.

The treated prevalence of psychotic disorders in remote communities of Cape York and the Torres Strait, Australia, has been shown to be elevated compared with the Australian population. Our study used a unique dataset to assess treated incidence and prevalence of psychotic disorders and mortality over a 23-year period in the adult Indigenous population of this region.