Remote Australia Online

Addressing evidence-practice gaps in primary care remains a significant public health challenge and is likely to require action at different levels of the health system. Whilst Continuous Quality Improvement (CQI) is associated with improvements in overall delivery, little is known about delivery of different types of care processes, and their relative improvement during CQI.

The previously described survey of food-purchasing behaviour in a central-Australian Aboriginal community demonstrated that children have sufficient disposable income to provision themselves directly from food outlets. Subsequently, a community-based intervention project developed strategies to provide healthier choices for these children. Two years after the initial survey, a follow-up survey was conducted in which all food purchases by children under the age of 15 in the community were recorded over a two-week period. The results demonstrate an improvement in the quality of foods and beverages purchased by children at the time of the second survey.

INTRODUCTION: Individuals living in rural/remote areas have recognised barriers to specialist services for persistent pain management. Although there is current evidence to support the use of telehealth to deliver individual pain management support, there is minimal evidence to support the use of pain management programs delivered within a group model, using telehealth. The aim of the present research was to perform a formative evaluation of a persistent pain management program implemented using a multisite telehealth group model, and to examine consumer perceptions. METHODS: The Manage Your Pain multisite telehealth group program was developed as a modified hub-and-spoke model. The model allowed participants from multiple rural/remote 'spoke' sites in Queensland, Australia to access four 2-hour specialist persistent pain management sessions from a metropolitan interdisciplinary persistent pain management centre ('hub' site, 491-1009 km from spoke sites), and simultaneously enable real-time access/interactions between participants at each of the spoke sites. Twenty-one individuals living with persistent pain participated in one of five multisite telehealth groups over the 10-month period. All participants completed standard pain scales before and after the pain management program, including Chronic Pain Acceptance Questionnaire 20 (CPAQ20), Brief Pain Inventory (BPI), Depression Anxiety Stress Scale (DASS 21), Pain Self Efficacy Questionnaire (PSEQ) and the Participant Reported Outcomes Measurement Information System (PROMIS). The Patient Impression of Change Scale (PICS), a telehealth perceptions survey, and a semi-structured telephone interview were completed post-program. RESULTS: Results revealed significant (p<0.05) improvements in the activity subscale and total score of the CPAQ, with 6 (30%) showing reliable improvement (90% confidence interval), indicating higher levels of activity engagement and pain acceptance after the program. Four (19%) participants made reliable improvement on the BPI interference. Post-program, the PICS revealed 65% of participants reported improvements in overall function, 61% indicated improved mood, 57% reported improved physical activity and 50% had some improvement in pain. Post-program, less than 10% of participants reported having technical (audio, visual) issues that had impacted on their sessions, and more than 90% found telehealth to be comfortable, convenient and would consider using it for their healthcare in the future. Post-program, most participants felt they had connected and were in a shared health experience with other group members through the multisite telehealth model. The interviews revealed three main themes: 'group experiences', which involved comments relating to the dynamics of the group and the shared experience; 'telehealth accessibility', which pertained to perceptions of the telehealth model for accessing specialist services; and 'limitations and concerns', where participants spoke of possible improvements to the program delivery model. CONCLUSIONS: Results confirmed that participants received benefit from the pain management program and that they had positive perceptions of receiving the service using a telehealth model. The present findings provide positive data to support using telehealth to deliver specialist persistent pain management for individuals who face accessibility issues in rural and remote communities. The model also demonstrated that positive elements of group treatment can be achieved through telehealth group models.

Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were sought out to explore how they achieved this success. Four Aboriginal men aged 20(-)35 years were identified and consented to participate. Their perceptions of motivation for change, strategies, and facilitators and barriers were explored through in-depth interviews. Themes developed from the interviews included self-efficacy, self-reliance, and increased knowledge and altered health beliefs underpinning change. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. In a setting with high levels of disadvantage, participants had relatively favourable socioeconomic circumstances with solid social supports. These findings highlight that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed. Increasing diabetes awareness among at-risk young people is important, emphasising the largely preventable and potentially reversible nature of the condition. Broad health improvements and individual changes will be facilitated by equitable socioeconomic circumstances and environments that support health.

Shortages of skills needed to deliver optimal health care in rural and remote locations raises questions about using extended scopes of practice or advanced practice models in a range of health professions. The nurse practitioner (NP) model was introduced to address health service gaps; however, its sustainability has been questioned, while other extended scope of practice roles have not progressed in Australia. This study aimed to explore the experiences and perceptions of NPs and their colleagues about barriers to and enablers of extended scope of practice and consider the relevance of the findings to other health professions.

Uptake of telehealth in the Northern Territory has been limited, for a variety of reasons including inadequate access to broadband internet.1 Through collaboration between multiple organisations — Northern Institute, Aboriginal Medical Services Alliance NT, Laynhapuy Aboriginal Community Controlled Health Services (LHS), eMerge (a local information and communications technology company), Telstra Health, and Broadband for the Bush Alliance — funding was obtained from the Regional Economic Infrastructure Fund (NT Government, $407 540) to provide access to reliable broadband for three very remote Aboriginal communities.

Regional and remote tourism in Australia is characterised by micro-, small- and medium-sized businesses, spatially dispersed and fragmented. Characteristics which present unique challenges for these communities attempting to develop tourism as a way of diversifying their economy. This study explored the views and experiences from residents and businesses in six remote local government areas in South Western Queensland to identify the barriers and enablers for remote communities to using tourism as a driver of economic and social-cultural growth. We found a lack of understanding of the structure and behaviour of the tourism industry; a lack of business acumen; a lack of financial and human resources; and a reluctance to collaborate by tourism businesses to be barriers to tourism-led economic growth. Enablers to tourism led growth included: local government support for tourism development; a sound understanding of the mechanics and structure of the tourism industry; and the capacity to engage in marketing that captured and narrated the visitor experience in digital channels.

The burden of skin infections across all age groups in remote Australian Indigenous communities is currently unknown. In a retrospective audit of 439 residents from two remote communities presenting to health clinics, skin conditions were the most common reason for presentation (1603/7392, 22%) and 330/439 (75%) residents presented at least once with a skin infection. Skin infections are an under-appreciated and dominant reason for presentation to primary healthcare centres in these indigenous communities and public health campaigns to address this should incorporate all age groups.

After years of research being dominated by Western scientific models and ways of knowing, Indigenous knowledge production and translation is gaining increasing attention and recognition. As a consequence this has led to the development of Collaborative Centres of Indigenous Health Research such as the Lowitja Institute in Australia. It is believed that a sharing of knowledge between Indigenous and non-Inidgenous people will lead to a collborative, culturally appropriate approach to research that can achieve postive benefits to 'close the gap' in Indigenous and Torres Strait Islander health disparities.

Singing is a universal activity, although the notion of a ‘song’ as generally understood in English is not found in every culture. Songs may originate locally, but they also travel, where they are picked up by different people and sung with a local touch. Folk songs, for example, have travelled across political, ethnic and language divides. Some ‘traditional’ Aboriginal songs similarly travelled great distances within Australia, where they too were sung by speakers of different languages. Some of these were shared among neighbouring groups and beyond, travelling along trade routes and gaining popularity, despite being in a foreign language and thus not understood. Throughout Aboriginal Australia, in addition to the localised land-based songs there are also songs that are sung purely for fun or entertainment, with no religious significance. Early colonists adopted the term ‘corroboree’ from the Sydney region word carib-berie (Hunter 1793: 143–45) for this genre, which they likened to European theatre; but as Clunies Ross (1986: 232) notes, the songs ‘were not generally received with much understanding’.This book is about such songs, in particular those known by Gurindji people at Kalkaringi, an Aboriginal community in the southern Victoria River District (VRD) of the Northern Territory (see Map 1). Such songs are called wajarra in Gurindji, and today they are only sung by senior men and women. With the massive social changes in remote Australia, wajarra ceremonies became less frequent by the 1960s and thus much harder to learn. In addition to the decline in performances, the songs themselves have features that make them difficult to learn. In this book we show how different the language of songs are from everyday speech. It is hoped that this book can help people learn wajarra today.

‘Bothways’ was an expression first utilised by Yolŋu educators in the late 1980s to convey the profound intercultural epistemological foundations of Yolŋu society that should also apply to modern Balanda (white) schooling systems. Despite the pressures from national, standardised curriculum and assessment regimes, ‘Bothways’ has not been abandoned by remote Yolŋu communities in the 21st century. In this paper we briefly revisit the first iterations of the ‘Bothways’ philosophy to demonstrate its symmetry with the Yolŋu transculturation heritage (of the Warramiri in particular), developed through many centuries of contact with sea-faring visitors. Lastly, we present data from community research at Gäwa, a Warramiri homeland on Elcho Island, which demonstrates that through a series of ‘multiple balances’, negotiation around issues of bilingual pedagogy, cultural knowledge transmission, parental engagement and student–teacher dynamic continues to renew the ‘Bothways’ approach.

Introduction: Medical education across the globe is in a state of flux influenced by a number of drivers for change. In response, institutions are seeking to re-align their curricula to address the prevailing imperatives. Against this backdrop, the training of practitioners for practice in rural communities was identified as an educational priority, and led to the establishment of a rural clinical school (RCS) within a Faculty of Medicine and Health Sciences in South Africa in 2011. This article describes the students’ experiences in the first year that this innovative educational model was implemented and explores the extent to which it influenced their thinking and practice. Methods: A qualitative, formative evaluation study of the first year of implementation was undertaken. Data was generated from in-depth interviews. This article focuses on individual interviews conducted with the eight students at the RCS, which explored their experiences during a year-long clerkship. Transcripts of interviews were thematically analysed. Results: Four themes emerged from the analysis: a learning experience that differed from what was experienced at the tertiary training hospital, an enabling clinical environment in the district and regional hospital, the positive role played by the specialists, and the influence of the community immersion. Underlying all of the responses was the building of relationships over time both with supervisors and with patients. Evident from the responses was that students’ confidence in their clinical skills and decision-making abilities was heightened while their approaches to their own learning were enhanced. Conclusions: To respond to the call for educational reform and a heightened awareness of social realities, innovative approaches to the training of medical students, such as those adopted at the RCS, are indicated. It is argued that the learning facilitated by these rural medical education models has the potential to offer learning experiences that can lead to transformation through a change in practice and attitude among the students, and ultimately also enable curricular renewal at the institutional core.

Background: Absolute cardiovascular risk assessment (CVRA) is based on the combined effects of multiple risk factors and can identify asymptomatic individuals at high risk of cardiovascular disease. Aboriginal and Torres Strait Islander people are disproportionately affected by cardiovascular disease and diabetes. Our study aimed to investigate variations in the use of absolute CVRA in patients with diabetes at Indigenous community healthcare centres, and to identify patient and health centre characteristics that may contribute to this variation. Methods: Audits of clinical records of 1,728 patients with a known diagnosis of diabetes across 121 health centres over the period 2012–2014 were conducted as part of a large-scale continuous quality improvement program. Multilevel regression modelling was used to quantify variation in recording of CVRA attributable to health centre and patient characteristics. Results: The proportion of eligible patients with documented CVRA was 33% (n=574/1,728). The majority (95%) of assessments were conducted in the Northern Territory (NT). Multilevel regression analysis showed health centre characteristics accounted for 70% of the variation in assessments in the NT. Government-operated health centres had 18.8 times the odds (95% CI 7.7–46.2) of recording CVRA delivery compared with other health centres. Conclusion: Health centres in the NT delivered the majority of absolute CVRA to Indigenous patients with diabetes in our study. Health systems factors that may have facilitated provision of CVRA in the NT include decision support tools and a reporting process for CVRA delivery. Implementation of similar systems in other jurisdictions may help improve CVRA delivery. Early identification and treatment of high risk individuals through wider use of CVRA may help reduce the burden of cardiovascular disease in Indigenous Australians with diabetes.

This paper discusses findings of a phenomenological study completed in 2015, which focused on the perceptions about secondary school from disengaged First Nations youth from a community less than 50km from Darwin in the Northern Territory. The study was informed by aspects of the transformative paradigm as social transformation for this cohort was a driving motivation for the researcher and there was also a desire to challenge the 'norms' in the mainstream education system for these First Nations young people. Ten young people (five male and five female), aged between 15 and 25 who had varying experiences of secondary schools but were not engaged in education at the time, were interviewed. This paper focuses on perceived barriers that prevented them from engaging in education, and their aspirations for the future. Family and community life, relational issues at school, their own feelings, drugs and alcohol and exclusion were described as barriers to engagement. Future aspirations included employment within their home community and wanting to re-engage with education. There are implications both at a school and policy level from this study. Schools must understand the cultural and family issues of First Nations young people ensuring adequate training of staff and where possible, increasing First Nations staff. Cross-cultural training and training to strengthen staffs' relationships with students is necessary, with specific efforts to engage communities and families. Further, place-based alternatives for educational pathways need to be explored that give heed to local ways of knowing, being and valuing.

INTRODUCTION:Generalism in the health workforce has been established as an important strategy to address health workforce maldistribution. Thus, to best serve the medical needs of northern Australia, the James Cook University (JCU) College of Medicine and Dentistry has a mission to produce graduates who both practise in the region and have a generalist orientation. This study investigated the postgraduate qualifications and key factors that shaped the current career choice of JCU medical graduates, and whether JCU graduates are more likely to choose generalist careers than other Australian medical practitioners of a similar level of experience. METHODS:JCU medical graduate data were obtained via cross-sectional survey of 298 early career JCU medical graduates from postgraduate year (PGY) 4 to PGY 10 (the first seven cohorts) who had consented to be contacted for further studies and were still contactable (n=180, response rate=60%). Australian medical graduate data were obtained via the National Health Workforce Dataset released by the Department of Health. RESULTS:Compared to a group of Australian medical graduates with similar years of experience, JCU medical graduates are significantly more likely to choose careers as 'generalists' (general practitioners/rural generalists (p=0.044)) or 'generalist specialists' in general surgery (p=0.008), general paediatrics (p=0.008), obstetrics and gynaecology (p=0.038) and emergency medicine (borderline significance p=0.058). However, they are less likely to be 'specialist specialists' such as pathologists/radiologists (p=0.003) or a physician subspecialty (p=0.004). Key factors identified as influencing current career choice included 'interest developed or strengthened during undergraduate training', 'interest developed from early postgraduate career experiences', 'specialty has a good work-life balance', 'specialty involves continuity of care with patients', 'interest in rural practice', 'enjoy a wide scope of practice/being a generalist' and 'mentors'. CONCLUSIONS:The JCU medical school produces significantly more graduates with a generalist rather than specialist career focus compared to a similarly experienced group of Australian medical practitioners. Contributing factors may include the JCU selection process, and the curricular focus on providing students with a wide range of generalist experiences and exposure to rural, remote, Indigenous and tropical health. Developing approaches that facilitate local vocational training and subsequent specialist practice is also an important part of the regional, rural and remote training pathway. Lastly, the findings suggest JCU medical graduates choose a career that is not only compatible with regional, rural or remote practice, but also involves continuity of care with patients, a wide scope of practice and a good work-life balance, and that this choice has been influenced by a combination of undergraduate and early career experiences. These findings are in line with international evidence and have implications for other jurisdictions planning an educational and workforce strategy to meet the needs of their own regional, rural and remote locations.

The vegetation communities of the eastern and southern shores of Lake Lefroy, a large salt lake near Kambalda, Western Australia, were studied. The aim of the studies was to explore the relationship between the distribution of vegetation along salt lake shores in relation to soil conditions and the depth to ground-water. Four distinct lake shore types were investigated and two-way indicator species analysis (TWINSPAN) was used to classify the vegetation communities occurring on the lake shores. Seven vegetation communities, with a total of 50 vascular plant species, were identified. More than half of the species recorded were herbs. Those communities occurring on highly saline soils close to the shallow hypersaline ground-water-table included the halophytic genera Halosarcia and Frankenia. Communities on less saline soils and at greater elevations were more diverse. It was concluded that depth to ground-water and soil texture were likely to be key factors in determining the distribution of vegetation communities along the shores. The findings of the study have implications for the design of rehabilitation programmes for shores disturbed by mining activity.

The interaction between Australia's Eurocentric education and the complex culture of remote Indigenous communities often results in Indigenous disempowerment and educational underperformance. This paper reports on a mathematics-education research project in a remote community to support Indigenous teacher assistants (ITAs) in mathematics and mathematics tutoring in an attempt to reverse Indigenous mathematics underperformance. It discusses teachers' and ITAs' power and authority within school and community, describes the project's design, and summarises the project's results in terms of affects and knowledge. It draws implications on the relation between ITA professional development (PD), affect, esteem, knowledge, authority, teacher-ITA partnerships, and enhanced Indigenous mathematics outcomes.

Soils of arid and semi-arid Australia are typically low in both N and P relative to arid zones elsewhere. We examined relative limitations of N and P on productivity of two native perennial grasslands of sub-tropical, semi-arid, north-west Australia. Effects of single and combined additions of N (50 kg ha−1) and P (25 kg ha−1) on growth and plant nutrients were documented over 2 years. Addition of N alone significantly increased total cover, above-ground biomass, N concentrations and N content, in the first year following above-average summer rains. These effects persisted into the second growing season but were of reduced magnitude. Addition of P alone increased P concentrations and aboveground P content but had negligible effects on biomass, indicating luxury consumption. Combined addition of N and P had similar effects to addition of N alone, strengthening the argument that N and not P was limiting to growth. Nitrogen limitation was clearly indicated by low N to P ratios (<7) in aboveground plant components.

Australian copyright law and Indigenous Cultural and Intellectual Property (ICIP) have always sat uncomfortably together, each with their own internal logic and legitimacy, but forcing certain arrangements and compromises when applied to specific contexts. The collection of Indigenous language materials into a digital archive has required finding means to observe and respect these two incongruent knowledge traditions. The Living Archive of Aboriginal Languages, an open online repository containing thousands of books in dozens of languages from Indigenous communities of Australia’s Northern Territory, offers opportunity to explore how the need to attend to both knowledge traditions led to specific decisions and practices. In particular, where the Australian copyright law was satisfied, additional steps were needed to respectfully incorporate Indigenous perspectives. This paper outlines the negotiations and compromises inherent in seeking a solution which observes and respects both Indigenous and western knowledge practices in a unique collection of cultural heritage materials.

Central Australia (CA) has an arid environment characterised by low and unpredictable rainfall, high temperatures and high evaporation rates. Within this desert context reliable water features, sustained mainly by natural groundwater discharge, provide distinct and isolated habitats for both aquatic and terrestrial species, even where these features are only minimally inundated. CA water features are varied, and include springs, waterholes and seepages that provide refuge for relict, endemic, and widely dispersed species confined to discontiguous habitats. They have been well known to Aboriginal people for thousands of years, and are often sites of great cultural significance. In spite of their biological, cultural and economic importance, the physical and ecological characters of many waterbodies are not well known. CA has experienced some of the most rapid rates of warming observed on the Australian continent. Successfully managing the consequences of climate change in CA will depend, in part, on developing a better understanding of the factors that influence long-term biodiversity in these aquatic systems. Because isolated CA waterbodies are at the forefront of continental warming, they could provide insights into how climate change will potentially impact other arid zone aquatic ecosystems.

We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered ?out of balance,? and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.

Three introduced predators, the dingo (Canis lupus dingo), the fox (Vulpes vulpes) and the feral cat (Felis catus) are widespread throughout the arid interior of Western Australia. While the dingo has been present for an estimated 3500–4000 years, the fox and the feral cat are relatively recent arrivals and have been implicated in the modern decline and in some cases extinction of arid zone fauna, especially medium size mammals. This paper reports on a long-term, large-scale project aimed at developing control strategies for these introduced predators. Broad area control of foxes and dingoes in the Gibson Desert using 40–60g dried meat baits impregnated with the poison sodium monofluoroacetate (1080) and delivered by aircraft at a density of 5baitskm−2 proved to be highly effective. Following a single aerial baiting of some 1600km2, foxes and dingoes were virtually eradicated from a core area for up to 15 months, but feral cats appeared to increase in abundance. Two aerial baitings (each 400km2) carried out during periods of below average rainfall using a small (about 30g) fresh meat bait developed to be attractive to feral cats reduced their abundance by an estimated 75% and 100% when baits were delivered at a density of 10 and 22km−2, respectively. A third aerial baiting at a density of 11baitskm−2 carried out during a period of above average rainfall reduced feral cat density by only 25% when surveyed 3 months after baiting. Baiting density, frequency and season are key factors likely to affect the impact of baiting on feral cat populations. Preliminary studies reveal that the home range of feral cats in this environment varies from about 700 to 1200ha. Reptiles and small native mammals form the major dietary items of feral cats and the seasonal variation in abundance of these items is likely to affect bait uptake. These observations have important implications for control strategies.

Rural Australians are shown to have poorer health and mental-health outcomes compared with their metropolitan counterparts, particularly for diabetes. Individuals with diabetes often meet criteria for comorbid mental-health conditions, such as anxiety and depression. Psychological treatment, as an adjunct to medical care, for individuals with diabetes is shown to improve overall health and wellbeing. This article describes a 38-year-old male who was referred to a very remote primary health care service by his diabetes educator for strategies to reduce work-related stress and improve his diabetes mismanagement. Mindfulness-based cognitive behavior therapy techniques were used, over six sessions, in the context of a rural and very remote community. Pre- and post-intervention measures showed a reduction in anxiety, distress, and improvement in his perception of his quality of life. Clinical implications for psychological treatment of diabetes and comorbid mental-health issues in rural and remote communities are discussed.

Revegetation of disturbed land, particularly in arid environments, is often hindered by low seedling establishment. Information on seed biology and germination cues of keystone species is lacking, particularly in arid Australia; a major zone for mining developments. This study investigated seed characteristics and germination of 18 common species required for rehabilitation of disturbed areas at Shark Bay Salt in the Shark Bay World Heritage Area, Western Australia. Untreated seeds of seven species (Aphanopetalum clematideum, Atriplex bunburyana, Austrostipa elegantissima, Melaleuca cardiophylla, Pembertonia latisquamea, Rhagodia baccata, Salsola tragus) exhibited high germination percentages. Seeds of two species (Acacia tetragonophylla, Stylobasium spathulatum) had low imbibition, which increased with hot-water treatment, hence require scarification for germination. Gibberellic acid, smoke water and karrikinolide (a butenolide isolated from smoke) substantially increased germination percentages of three species (Anthocercis littorea, Diplolaena grandiflora, Solanum orbiculatum). Seeds of the remaining six species (Dioscorea hastifolia, Eremophila oldfieldii, Nitraria billardierei, Ptilotus exaltatus, Thryptomene baeckeacea, Zygophyllum fruticulosum) had low germination percentages regardless of treatment. Most species germinated equally well at 26/13°C and 33/18°C, however seven species had improved performance at 26/13°C. This study is significant to land managers and conservation agencies with an interest in optimising germination of arid zone seeds for restoration.

The home range of red kangaroos, Macropus rufus, and euros, M. robustus erubescens, was studied by radio-tracking in contiguous sites in semi-arid northwestern New South Wales, Australia. This paper reports the results for red kangaroos. In the short term, red kangaroos were sedentary in home ranges of 259–516 ha for week-long periods in summer and winter. Males and females did not differ significantly in home-range area but female home range increased with body weight. There was an altitudinal shift in home range between summer and winter related to thermoregulation. Home range also tended to positively correlate with vegetation cover. In the long term, a few individuals moved distances of 25 km or more. Following a prolonged dry spell, a more global shift of the population occurred to localised rainfall 20–30 km east of the study site. Widespread rainfall saw the return of at least females to their former home ranges. Movement patterns in red kangaroos are complex but the population is not generally nomadic.