Remote Australia Online

Objective The aim of this study was to identify an Aboriginal community’s aspirations for health service improvement during implementation of the Commonwealth’s Health Care Homes (HCH) reform.Methods This study was a qualitative study consisting of Aboriginal-controlled phenomenological enquiry in a large Aboriginal community in north-central Arnhem Land.Results A representative sample of 60 Aboriginal health service users identified shortcomings in their current experience of primary health care, including low cultural security. These shortcomings reduced access to care. Participants described several ways that care could be reorientated to match their needs during HCH implementation. Principally, patients voiced the need for: (1) restructuring care teams to foster culturally secure relationship-based care; and (2) reorientating the Aboriginal Health Practitioner role from acute care to strength-based competencies as the focal point of care continuity: self-management support, care coordination and navigation, health coaching and cultural mentorship for non-Aboriginal staff.Conclusions For HCH to be successful, service providers need to engage with service users to identify and implement patient-centred strategies to improve access, acceptability and patient activation.What is known about the topic? Success of the Commonwealth’s HCH reform is contingent on improving care access and patient activation to better manage chronic conditionsWhat does this paper add? This is the first opportunity that this Aboriginal community has had to articulate their aspirations for high quality healthcare. Beyond the strong alignment with the HCH building blocks, their care preferences posit practical and achievable workforce and delivery system reforms that may improve primary health care in other remote Aboriginal communities.What are the implications for practitioners? The long-term success of the HCH reform will require iterative engagement with service users to identify and implement patient-centred strategies to improve access and acceptability of care. Service model alignment with patient care preferences will improve patient activation and is particularly important when working with vulnerable populations.

The impacts of free-roaming canids (domestic and wild) on public health have long been a concern in Australian Indigenous communities. We investigated the prevalence of zoonotic helminth diseases in dogs and sympatric dingoes, and used radio telemetry to measure their spatial overlap, in an Aboriginal community in the Wet Tropics of Australia. Samples collected from dingoes and dogs showed high levels of infection with the zoonotic hookworm, Ancylostoma caninum. Dingoes were also positive for A. ceylanicum infection (11.4%), but dogs were infection free. Whipworm, Trichuris vulpis, infection was far more prevalent in necropsies of domestic dogs (78.6%) than dingoes (3.7%). Dogs were free from Dirofilaria immitis infection, while dingoes recorded 46.2% infection. Eleven dingoes and seven free-roaming domestic dogs were fitted with Global Positioning System collars and tracked over an extended period. Dingo home-ranges almost completely overlapped those of the domestic dogs. However, dingoes and dogs did not utilise the same area at the same time, and dogs may have avoided dingoes. This spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of parasites between dogs and dingoes. Tracking and camera traps showed that the community rubbish tip and animal carcasses were areas of concentrated activity for dogs and dingoes.

A small body of research has demonstrated the dramatic social, settlement and demographic effects of Indigenous female flight from remote communities in Alaska, Canada, and the Northern Sparsely Populated Areas of Europe. In the Northern Territory of Australia, remote Indigenous settlement patterns are highly similar to these areas but neither research nor policy have had anything to say about whether female flight has or might also impact there. This paper applies quantitative tests to thirty years of Census data to look for evidence of precursors in the Northern Territory and discusses the demographic and policy implications in light of the findings.

Cardiovascular diseases are the leading cause of mortality in Indigenous Australians. Indigneous Australians present at a younger age and have a greater incidence of cardiac risk including smoking and diabetes than non-Indigenous Australians. Access to specialist health services is an important determinant of health care outcomes for these patients. We describe an innovative and successful for model for providing Outreach Cardiac Specialist services to Indigenous communities in rural and remote locations. The approach involves a step-wise process of a) community engagement, b) delivering recovery interventions to improve health outcomes, c) building community capacity to self manage chronic illness and promoting health and well being with the aim of d) community self governance of chronic disease and health promotion. Key elements to this process are community participation in the program, disease self-management led by local health care workers, open access that is all-inclusive utilising community-generated referral, and the translation of scientific knowledge of disease processes into community understanding and making culturally relevant connections. Specialist cardiac services and point of care diagnostics have been provided to 18 sites across rural and remote Queensland. More than 1400 episodes of care have been provided to Indigenous Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions. Traditional values can work harmoniously with an inclusive medical approach in this relational model.

The prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) coinfection is high in certain Indigenous Australian populations, but its impact on HTLV-1 has not been described. We compared 2 groups of Indigenous adults infected with HTLV-1, either alone or coinfected with HBV. The 2 groups had a similar HTLV-1 proviral load, but there was a significant increase in clonal expansion of HTLV-1–infected lymphocytes in coinfected asymptomatic individuals. The degree of clonal expansion was correlated with the titer of HBV surface antigen. We conclude that HTLV-1/HBV coinfection may predispose to HTLV-1–associated malignant disease.

In 2009, a nursing education model was locally designed and delivered to support the interest of a group of Aboriginal community members living in a rural and remote town in Queensland, specifically to prepare for entry into further nursing education. Named ?Tjirtamai? by the traditional owners of the area, the program was offered in recognition of the challenges faced by Aboriginal people when they enter nursing education courses and as a way to increase the local number of Aboriginal nurses. This program, while funded by the Government, had unprecedented support and involvement from both the local Aboriginal and wider community. The model offered multiple exit points, assistance with financial and other known challenges for Aboriginal and Torres Strait Islander students, and included contextualised literacy and numeracy. Of the 38 Aboriginal students who enrolled in the course, 26 students completed. Of those students, 18 have since enrolled in a bachelor degree in nursing while another 4 enrolled in a diploma of nursing. This paper provides an overview of the course and its outcomes.

In high-income countries, obesity disproportionately affects those from disadvantaged and rural areas. Poor diet is a modifiable risk factor for obesity and the food environment a primary driver of poor diet. In rural and disadvantaged communities, it is harder to access affordable and nutritious food, affecting both food insecurity and the health of rural residents. This paper aims to describe the food environment in a rural Australian community (approx. 7000 km2 in size) to inform the development of community-relevant food supply interventions. We conducted a census audit of the food environment (ground truthing) of a local government area (LGA). We used the Nutrition Environment Measurement tools (NEMS-S and NEMS-R) to identify availability of a range of food and non-alcoholic beverages, the relative price of a healthy compared to a less healthy option of a similar food type (e.g., bread), the quality of fresh produce and any in-store nutrition promotion. Thirty-eight food retail outlets operated at the time of our study and all were included, 11 food stores (NEMS-S) and 27 food service outlets (NEMS-R). The mean NEMS-S score for all food stores was 21/54 points (39%) and mean NEMS-R score for all food service outlets was 3/23 points (13%); indicative of limited healthier options at relatively higher prices. It is difficult to buy healthy food beyond the supermarkets and one (of seven) cafés across the LGA. Residents demonstrate strong loyalty to local food outlets, providing scope to work with this existing infrastructure to positively impact poor diet and improve food security.

This Northern Territory (NT) study aims to build on a previous study of the food qualities of native rices, by undertaking a preliminary assessment of the market for wild rice food products and an estimation of the costs involved in a small scale pilot harvest. In order to do this, the project brings together Traditional Owners and enterprise developers, researchers and potential product buyers. Australian native rices (Oryza rufipogon and O. meridionalis) are an abundant and widespread resource on floodplains across monsoonal Australia , where remote and rural communities are keen to expand economic opportunties. Native Australian rice has been harvested and consumed by Indigenous people until historical times (Ashwin 1930; Fukiwarra 1985). Previous RIRDC-funded work on the grain properties of Australian native rices indicates that native rice collected from the wild is nutritious and has suitable cooking qualities as a food product (Wurm et al. 2012). Wild rice is a likley candidate for a investigation of product and market development, in line with a growing number of native species that are finding niche markets (Gorman and Whitehead 2005).

The art, design and cultural expression of Australia’s First Nations people is a powerful means of communication and education. The stories and knowledge behind Aboriginal and Torres Strait Islander artwork bridge gaps in language, history and understanding with the wider Australian community. While the art and design of Aboriginal and Torres Strait Islander people is an act of maintaining and sharing cultural expression, it is also a means of economic independence. Products that include Aboriginal and Torres Strait Islander art and design generate benefits for manufacturers and retailers of these products as well as for the artists, their families and communities. Download the paper <a href="https://www.nintione.com.au/wp-content/uploads/2018/09/1.-Licensing-ATSIArt-Overview.pdf">1. Licensing ATSIArt - Overview</a>.

This paper reports on the use of touch screens to display simple talking books in a minority Indigenous Australian language. Three touch screens are located in an informal context in a remote Indigenous Australian community. The popularity of the computers can be explained by the form of the touch screen and by the intertextual and hybrid nature of the talking books. The results suggest the Kunibídji choose to transform their own culture by including new digital technologies which represent their social practice.

Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia.

Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.

Australia is a wealthy developed country. However, there are significant disparities in health outcomes for Aboriginal infants compared with other Australian infants. Health outcomes tend to be worse for those living in remote areas. Little is known about the health service utilisation patterns of remote dwelling Aboriginal infants. This study describes health service utilisation patterns at the primary and referral level by remote dwelling Aboriginal infants from northern Australia.

Anticipating the looming crisis in access to dental services in rural and remote areas, the Western Australian Centre for Rural and Remote Oral Health developed an undergraduate rural placement program to provide dental students of The University of Western Australia opportunities for direct experience of rural and remote practice during the final year of the undergraduate curriculum. The Rural, Remote and Indigenous Placement program started in 2002 and, to the end of 2005, had placed 78 final year dental students in supervised clinical practice in rural, remote or Indigenous practice. In this study, the evolution of the program (2002-2005) is described and student evaluation of the program is reported. While involved in the rural placement program, students were assessed by experienced dental practitioners and provided program evaluation. This structured feedback allowed continuous improvement of the program. Data from each year's graduates was also analysed to examine the question of influence of placements on practice location during the first 6 months after graduation. Although it will be many years before the effects of outplacement programs can be specifically attained, the evidence to date indicates that the program may be a valuable tool among the plethora of strategies being investigated to augment Australia's rural oral health workforce.

Remote Avant-Garde: Aboriginal Art under Occupation

This article reports on a study undertaken in three Indigenous communities in the West Kimberley region of Western Australia (WA) intended to develop diversionary strategies for young people with fetal alcohol spectrum disorder (FASD). Rates of FASD in the West Kimberley were comparable to those of high-risk populations internationally and there are concerns that youths with FASD are being enmeshed in the justice system. Further, under WA law they are at risk of being held in indefinite detention if found unfit to stand trial. Besides recommending legislative reform, the authors urge a ‘decolonising’ approach, meaning maximum diversion into community owned and managed structures and processes, able to offer a culturally secure environment for stabilising children with FASD. The study calls for reform of police diversionary mechanisms and the creation of mobile ‘needs focused’ courts, offering comprehensive screening and rapid entry into oncountry programs with strong Aboriginal community involvement.

The interviews and discussions which are the main focus of this paper were conducted with five experienced teachers involved with Aboriginal education in remote rural schools in the Northern Territory – the minimum experience being five continuous years and the most being 15 years. Although the teachers have had greater experience working in the southern regions of the Northern Territory, many have experience in the Top End, interstate or overseas experience in indigenous and special education. As all ofthe teachers are stationed in the Northern Territory and all are currently teaching or supporting teachers in remote Aboriginal schools, the discussions regarding Aboriginal teacher training specifically concerned courses offered by Batchelor College and predominantly by the Remote Access Teacher Education Course (RATE).

Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community.

Background: In 2012 the Northern Territory Department of Health commenced the Chronic Conditions Management Model - strengthening cardiovascular disease prevention in remote Indigenous communities. Interventions included providing regular functional reporting and decision support to frontline primary health care teams.

CONTEXT: In July 2005 the National Rural Health Alliance released a discussion paper on advanced nursing practice in rural and remote areas of Australia. The paper called for more debate and research about advanced nursing practice roles, especially on how the roles contribute to quality care and patient health outcomes. Monash University School of Rural Health, Victoria, Australia, completed two studies exploring the role and practice of remote area nurses working autonomously in bush nursing centres in East Gippsland, Victoria. The studies confirmed the nursing role as advanced and expanded, and the care effective and of high quality. The studies also revealed the contribution of the remote area nurse to quality care involved more than demonstrating effective healthcare delivery and evidence based clinical practice. The significance of context emerged as an important determinant. ISSUE: Articulating measures for quality care in Australian remote health practice is problematic. The concept 'quality' is multidimensional and time and context specific. Current Australian health service and professional competency standards fail to combine external structural and organisational factors, and the social and economic situation of a given remote community. Together, these factors create the context, and influence practice and remote health service delivery. It is accepted that context shapes remote nursing practice, however the term 'context' is commonly interpreted as an environmental, structural or geographical construct. These terms are valid; however, they do not describe other drivers that impact on remote area nursing and service delivery. In practice, therefore, to what extent does context influence the contribution of remote nursing roles to quality care? LESSONS LEARNED: Four core drivers that model the remote area nursing context were identified: the system, the organisation, the community and the individual. An integrated conceptual model consisting of the core drivers is presented, and this provides a broad framework to illustrate factors influencing the delivery of quality remote health care, in an attempt to crystallise the role of context. Central to the model is the remote area nurse. This article outlines the core drivers and discusses how these drivers impact on remote area nursing practice in Victoria and the provision of quality care. The model is transferable to other remote nursing contexts and provides an alternative approach to evaluate the contribution of a remote area nursing role. Enhancing our understanding of the influence of context may assist in identifying relevant indicators to measure the quality of remote health care delivered by nurses in advanced practice roles.

Australia is rapidly losing its Indigenous multicultural and multilingual identity. This vast continent has lost 90 per cent of its Indigenous languages and cultures, without adequate documentation, and risks losing the rest by 2050 if action is not taken. There are formal, accredited linguistics courses designed specifically for Indigenous Australians to document and maintain their traditional languages. This research assessed the relevance of linguistic training for Indigenous Australians in remote communities and whether it provides the necessary skills for Indigenous Australians to document and maintain their languages in their particular workplace or community. The study found that Indigenous Australians come from a diversity of areas across the vast continent of Australia, live a diversity of lifestyles, have a diversity of linguistic attitudes and have access to different and often limited resources and support to meet their goals of documenting their endangered languages. As a result, standardised formal training is generally unlikely to provide the necessary linguistic skills needed for their particular community or workplace. However, by matching linguistic training with individual language community's linguistic situation, targeted training could increase the documentation of Australia's Indigenous languages.

INTRODUCTION: Recruitment and retention of allied health professionals (AHPs) to remote and rural Australia is challenging and correlates with poorer health status of remote and rural residents. While much has been written about the recruitment and retention problem, this study took a new approach by reviewing the literature describing the motivation of AHPs to work in remote and rural areas and then analyzing the findings from the perspective of motivation theory using Herzberg's extrinsic and intrinsic classification. Intrinsic motivation incentives are known to contribute to job satisfaction and come from within the individual, for example the pleasure derived from autonomy or challenge at work. In contrast, extrinsic motivation incentives are provided by the job and include such factors as salary and professional development provisions. Extrinsic incentives are important because they prevent job dissatisfaction. Job satisfaction has been shown to be linked with increased retention. METHOD: Thirty-five articles, including 26 from Australia, met the inclusion criteria. The key findings related to motivation from each article are outlined and the results classified into the extrinsic-intrinsic framework. The incentives are then further analyzed as having a positive or a negative influence. RESULTS: In total, 38 different incentives were described a total of 246 times. Of the total, almost half (n=115) comprised extrinsic incentives with a negative influence, with poor access to professional development, professional isolation and insufficient supervision the most frequently reported. Rural lifestyle and diverse caseloads were the most frequently mentioned positive extrinsic incentives, while autonomy and community connectedness were the most cited positive intrinsic incentives. Negative intrinsic incentives were mentioned least frequently (n=18); however, of these, feeling overwhelmed and that your work was not valued by the community were the most commonly reported. CONCLUSIONS: The results demonstrate the significant burden of extrinsic incentives with a negative influence that are perceived by AHPs in remote and rural areas. The high turnover rate of AHPs in remote and rural areas is likely to be, in part, due to the job dissatisfaction from these disincentives. More positive intrinsic incentives were reported than negative. This suggests the potential for intrinsic incentives, known to contribute to job satisfaction, to be mediating the extrinsic disincentives. The policy implications of this work include the importance of addressing extrinsic disincentives. Simultaneously, the existing intrinsic incentives need to be nurtured and developed. Organizations that implement strategies to enhance both extrinsic and intrinsic motivation incentives are more likely to successfully address their AHP workforce shortage.

Background: Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). Methods: A randomly selected sample (n = 161; 80 males, 81 females aged 13–36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited sample (n = 104; 53 males, 51 females aged 13–36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. Results: Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations; suicidal ideation; and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline (P = 0.003). The reduction was evident in females generally (P = 0.008) and older males (aged = 16 at baseline) (P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes; memory disruption; difficulties controlling use; and auditory and visual hallucinations. Conclusions: Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes.

Whites see us as crows, sitting in the nest with mouths open, waiting for the mother and father crow to come along. Those government fellas pretend to ask, but really tell us. They've had their minds made up all the time (Yanni Lester, cited by H. Penny, 1982).

As part of strategies to improve dog and community health in rural and remote Indigenous communities, this study investigated preferences and impacts of dog health education programs. Semistructured interviews with 63 residents from five communities explored learning preferences. Though each community differed, on average yarning was preferred by most (68.4%) respondents, followed by visual (65.0%) and practical learning (46.9%). Text-based and computer/screen-based learning were important to 16.2% and 14.6% of respondents respectively. With paper-based visual and text resources, respondents reported a preference for locally made (28/36 or 78%) over mainstream resources. Twenty eight residents involved in the creation of locally made resources reported satisfaction, knowledge exchange, and displayed enthusiasm for the process. Colour resources were more successful than black and white resources or word of mouth in terms of program advertising, alerting 67% (10/15) of respondents compared to 6% to 24% for programs using word of mouth. Dog health programs that incorporated education programs based on these identified preferences achieved significantly better results in terms of improvements in mange prevalence and average condition score, partly through increased community understanding and engagement with the program. Thus, culturally appropriate and locally relevant education programs can significantly improve the success of dog health programs.