Remote Australia Online

The caries experience of Aboriginal children in Western Australia (WA) and elsewhere in Australia is more than twice that of non-Aboriginal children. Early childhood caries (caries among children <6 years) has a significant impact on the quality of life of children and their caregivers, and its management is demanding and commonly undertaken under general anesthesia. A randomized controlled trial using a minimally invasive dentistry approach based on Atraumatic Restorative Treatment (ART) in metropolitan Perth, WA, has demonstrated a significant reduction in the rate of referral to a dental specialist for dental care among children with early childhood caries, potentially reducing the need for treatment under general anesthesia. The tested approach was clinically successful and was without adverse effects on child dental anxiety. The model of ART-based primary care requires further testing and development if similar outcomes for Aboriginal children in remote and rural settings are to be achieved.The study aims to develop, implement, and evaluate a remote primary care model to deliver effective primary dental services, encompassing treatment and preventive services, to Aboriginal preschool children (based on minimally invasive approaches including ART).This is a two-arm parallel cluster randomized controlled study in which a test group will be provided with the intervention treatment at the start of the study and a control group will be provided with the intervention treatment 12 months after study commencement (delayed intervention). Participating communities, stratified by size of community (ie, number of children in the sample frame) and baseline caries experience, will be randomly assigned using a computer-generated block randomized list into immediate (test group) or delayed intervention (control group; provided with standard care). Informed consent will be obtained from all participants. Aboriginal research assistants will explain the study to the parents and assist the parents in completing the questionnaires. Participants in the randomized study will be examined at baseline and at 12 months follow-up by a calibrated examiner. Test group participants will subsequently be contacted and appropriate appointments coordinated for treatment. Control group participants will be provided with standard preventive care by the Aboriginal Health Workers and managed for treatment as per standard procedures.Community consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants.The significance of the study lies in its holistic approach to testing the model of care. Clinical evaluations as well as oral health‒related quality of life evaluations will be undertaken. Cost-effectiveness and cost-utility evaluations will assist in the development of policy options for oral health services for rural and remote communities. The elicitation of caregiver perspectives through focus group interviews will supplement the clinical, psychosocial, and cost-utility evaluations and provide a richer evaluation of the intervention.

his paper seeks to explore the risks of providing preservice teachers with professional experiences in remote communities. In particular this paper focuses on the risks associated with this kind of professional experience. Twelve pre-service teachers were interviewed whilst on a three-week practicum around Katherine and in Maningrida in the Northern Territory during 2012. The dangers outlined in this paper relate to the way their experiences continued to be mediated by stereotypes and perpetuating colonial practices. The pre-service teachers' limited understandings of Indigenous knowledges and languages are discussed before exploring the vexed issue of reverse culture shock that some of the participants identified when they returned home. The paper concludes by exploring the notion of "allies" as a way to negotiate the problematic nature of this work.

Background: Skin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory. Methods and results: Pre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3–13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7–0.9). Conclusion: The association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.

Since the advent of European settlement, indigenous Australians have been subject to continual change and entrenched inequality. This has been their shared experience even as regional histories have diverged. These essays address the lives of indigenous Australians through a focus on the person. Various contexts are described including family and community groups, regional diaspora and inter-racial relations, along with a striking range of experience, from indigenous heavy metal gangs and rebellious, forthright women to the social dynamics of childhood and the effects of long-term unemployment. Issues are discussed against a backdrop of different regions including the remote north, the desert center, and the densely populated southeast of Australia.Convinced that accounts of indigenous Australians must become more dynamic and diverse, People and Change traces the development of Australianist ethnography as a tool for understanding personhood and places this research in a comparative and theoretical perspective. The collection provides new and nuanced insights on the past, the present and likely trajectories of indigenous Australians today.

Background E-health is increasingly being identified as a cost-effective method to deliver health services and remote monitoring in rural and remote areas. There is a paucity of research that identifies successful implementation of e-health and remote monitoring in rural communities. Objective To identify the evidence relating to the impact of e-health on rural and remote communities and residents. Design A systematic, rapid review of grey and published peer-reviewed literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI Health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms used included telemedicine, telehealth, e-health, regional, rural and remote communities; New South Wales, Australia, and other Organisation for Economic Co-operation and Development countries. Electronic health records and health informatics were excluded. Results The search yielded 105 articles and reports. Following removal of duplicates, initial screening and full text screening, 19 articles remained: 16 peer-reviewed publications and three grey literature. This included two systematic reviews, one literature review, six descriptive reviews of services and nine reviews of specific interventions and identification of barriers and facilitators to implementation of an intervention. There was evidence that e-health can increase access to services across a range of medical specialties without any detrimental effects and improve opportunities for professional development. Conclusion E-health has the potential to increase access to services in rural and remote communities. The evidence shows that it is as safe, effective and reliable as most conventional methods for interacting with patients while enabling people to stay within their own communities.

This paper describes a prolonged outbreak of APSGN in a remote Aboriginal community in 2005 that has experienced outbreaks in 1980, 1987, 1994 and 2000 and the interventions undertaken to limit further cases. Introduction: Acute post-streptococcal glomerulonephritis (APSGN) is an inflammatory disease of the kidneys following Group A streptococcal (GAS) infections. Clinical characteristics are oedema, hypertension and glomerular haematuria with reduced serum complement levels.1 Some evidence suggests that recurrent or persistent episodes of APSGN are associated with the high prevalence of end stage renal disease in Indigenous Australians.2, 3Sporadic cases of APSGN occur throughout Northern Territory (NT) with outbreaks every 5-7 years across the Top End.4 Targeted public health interventions are recommended to treat skin sores due to Group A Streptococcus (GAS), prevent further cases and halt outbreaks.5, 6 In 2000, 7 communities in the Top End experienced outbreaks and implemented such interventions.7From October 2004 an increase in notifications of APSGN in the NT was detected but cases appeared unrelated and from separate communities. Given this increase in sporadic cases, staff at the Centre for Disease Control (CDC) became concerned that the current outbreak case definition was not sufficiently sensitive to allow timely interventions. Therefore, in early January 2005, a more sensitive outbreak case definition was trialled. The definition was changed from 3 unrelated possible cases in 1 month,6 to 1 confirmed and 1 possible case in 3 weeks. The alternative recommended definition, 2 unrelated clinical cases of APSGN in a week,6 remained unchanged. From 1 January 2005 the revised case definitions for diseases notifiable in the NT were also introduced. The diagnostic criteria for APSGN have not significantly changed from the previous definitions, however “subclinical cases” are now referred to as “probable cases” and “clinical cases” are now referred to as “possible cases” (see Table 1).

The complexity associated with reducing inequality in Indigenous education incorporates a multitude of causal factors. Issues associated with education delivery and outcomes in remote Indigenous communities are endemic nationally, yet the communities of the Northern Territory are uniquely disadvantaged due to their geographical and cultural isolation. By looking at the factors affecting the quality and continuity of teachers in remote Indigenous communities, as well as the need for institutional collaboration, targeted recruitment strategies and a reorientation of expectations, this article will consider one strategy developed in order to recruit and retain effective teachers in these communities.

Inclusive design in architecture describes an approach that aims to encourage broad participation in design decisions. In Australian Aboriginal communities the practice of inclusive design is challenged by a complex policy environment, by language barriers, by cultural differences, by economic disadvantage, by time and by distance. The importance of inclusive design in Aboriginal communities is heightened because of these challenges. Here, architectural projects - regardless of the building typology - are not simply about new buildings. They carry with them the added burdens of addressing health, employment and equity in disadvantaged and often marginalized places. Through the experiences of a small Australian architectural practice working with Aboriginal people in Central Australia, this paper will look at established paradigms of designing with Aboriginal communities and posit the notion of 'storytelling' as a methodology of design practice and reconciliation.

Tangentyere Design Tangentyere Design is an Aboriginal owned architectural practice based in central Australia. As an enterprise of its parent organisation, Tangentyere Council, its mission is to promote—within the built environment—the social and cultural aspirations of Indigenous peoples. This article highlights the challenges faced by a not-for-profit entity working in a commercially competitive environment, and examines the concepts of cultural agency and social enterprise through its building projects and advocacy efforts.

In 2016, a review of funding for Aboriginal and Torres Strait Islander programs in Australia reported that, of the 1082 programs funded annually with $5.9 billion of government funding, less than 10% had been subjected to any sort of evaluation.1 Anecdotal evidence indicates that there is a similar paucity of health services evaluation throughout rural and remote Australia. Furthermore, there is a well-documented geographic disparity in health outcomes with people in metropolitan centres enjoying better health than people who have rural and remote addresses.2 Given the persistent health disparities experienced by Aboriginal and Torres Strait Islander Australians, those Aboriginal and Torres Strait Islander people who live in rural and remote locations experience a double-disadvantage. When the concept of evidence-based healthcare is understood, the reasons for the absence of a rampant pandemic of evidence-based practice in rural and remote settings can be more easily appreciated. The JBI model of evidence-based healthcare articulates the integration of: the best available evidence; knowledge of the context in which the care is delivered; client preferences; and the professional judgement of the health professional.3 Two of these components are particularly relevant in rural and remote settings. Firstly, context is crucial, particularly in remote settings, where personal, family, and other social relationships are the bedrock of communities and English might not be the main language spoken. In the Warlpiri language of central Australia, for example, wajampa is the word for “anxiety” but also means: worry; concern; upset; sorrow; and grief.4 Also, there are different words for “anxious for” and “anxious over”. Moreover, wajampa-wajampa means “determined to kill” and “relentless” as applied to hunting as well as “a worrier”.4 Furthermore, there are five different words for “worry” (of which wajampa is one), four different words for “worry about”, and still different words for “worry about someone” and “worry about something”.4 A mental health professional, therefore, who is working in the community of Yuendumu where Warlpiri is widely spoken, will need to have a nuanced understanding of context if they are referred someone for treatment of their “anxiety disorder”. Secondly, despite the acknowledged importance of patient preferences, they are not routinely sought or used to guide treatment decisions in healthcare.5 Our failure to pay close attention to patient preferences has led to the global phenomenon of inappropriate health care which currently accounts for billions of wasted dollars globally.6 The extent to which the role of patient preferences is overlooked or minimized in health service delivery has prompted a call to adopt a “patient-perspective” model of health care rather than the standard patient-centered approach which emphasizes position (the center) rather than preferences.5 In rural and remote areas, context and patient preferences can be tightly interrelated. The impact of context and patient preferences, therefore, may be felt most strongly outside of metropolitan centres where health services can be provided, wholly or in part, by a visiting workforce with varying levels of knowledge about the local area and its people. These important factors affect not only the implementation of evidence-based practice but also the way in which “evidence” is understood. Evidence includes, not only evidence of effectiveness, but also evidence of feasibility, appropriateness, and meaningfulness.3 Understanding the FAME (feasibility, appropriateness, meaningfulness and effectiveness) approach to evidence can help explain why the transfer of services from urban to nonurban settings is not always straightforward. What is feasible and appropriate in a city, for example, will not necessarily be feasible and appropriate outside the city. Rather than focusing on the transfer of practices, therefore, it is imperative that policy makers and service providers pay attention to important principles of service delivery. It is entirely possible to endorse the principle of high quality, evidence-based service provision while also recognising that, in order to incorporate this principle, different practices will need to be adopted and adapted to the local context. In late 2017 and early 2018, I undertook a four-month Fulbright Scholarship at the Center for Behavioral Health Innovation (BHI), Antioch University New England.7 The center works with underserved communities in a variety of locations including rural areas of New Hampshire, to improve service provision by embedding ongoing monitoring and evaluation within the routine practices of service providers. This work lies at the nexus of different initiatives such as routine outcome monitoring (ROM),8 continuous quality improvement (CQI),9 and the use of patient experience data.10 In this approach, it is understood that the effectiveness of a program is not a property of the program itself. Rather, effective outcomes are created through the interaction between the service provider and the service recipient. Outcomes should be negotiated at the outset between the service provider and service recipient (that could, for example, be a school community) with subsequent service provision being continually monitored and adjusted to ensure the ongoing and sustained feasibility, appropriateness, meaningfulness, and effectiveness of the program or intervention. Thus, evaluation is considered to be more of a learning process to ensure that services are delivered flexibly and responsively for the benefit of service recipients, rather than a decision-making tool to determine the effectiveness or otherwise of a service. Unless we can begin to rethink the way we currently approach the accumulation and implementation of evidence in rural and remote settings, we will never “close the gap” on the health disparities that exist. We must hold a hard line regarding the important principles of high-quality service provision and incorporate these principles in policy documents and routine practices. Above all, it is important to recognize that, to apply the principle of evidence-based health care ubiquitously, we must vary our practices in whatever way we need to so that people who choose residences away from the city can enjoy the same standard of health that city dwelling citizens take for granted.

Visiting services address the problem of workforce deficit and access to effective primary health care services in isolated remote and rural locations. Little is known about their impact or effectiveness and thereby the extent to which they are helping to reduce the disparity in access and health outcomes between people living in remote areas compared with people living in urban regions of Australia. The objective of this study was to answer the question “What is the impact or effectiveness when different types of primary health care services visit, rather than reside in, rural and remote communities?”

The rates of bronchiectasis for Indigenous children from remote Australian communities are unacceptably high, with one study showing 14.7/1000 Aboriginal children. Children with bronchiectasis need to be identified early for optimisation of medical treatment. Under-reporting of cough is common. Bronchiectasis should be suspected in children with recurrent bronchitis or pneumonia, and when, despite appropriate therapy, pulmonary infiltrates or atelectasis persist 12 weeks beyond the index illness. During acute infective episodes, oral antibiotics and chest physiotherapy to clear the airways should produce prompt resolution; otherwise, hospitalisation is necessary. Management follows the cystic fibrosis model of regular review, encouragement of physical activity, optimising nutrition, maintenance of immunisation and avoidance of environmental toxicants, including passive smoke exposure. Successful management and prevention of bronchiectasis will require improvements in housing, nutrition, and education, as well as access to comprehensive healthcare services, with coordination between primary and hospital-based healthcare providers

The Indigenous population is a small minority in most areas of Australia, except the Northern Territory where Indigenous people make up roughly a quarter of the population. Indigenous people have lower educational achievement when compared to non-Indigenous people in Australia, with almost half as many of Indigenous having completed Year 12 or equivalent as non-Indigenous in 2016. The focus of this study was to identify factors that may be influencing the lower educational attainment of Indigenous students. Factors related to increased Indigenous presence in a school were expected to predict lower educational attainment. Full or partial support for some of the hypotheses was found, with the percent of Indigenous students, student to teacher ratio, attendance rates, and school location being associated with educational attainment. The attendance rate of students was associated with the socioeconomic score, student to teacher ratio, and location of schools. The results of the analysis may not be representative due to large amounts of missing data, which excluded most schools in very remote locations.

Wadeye is one of the largest Indigenous communities in the Northern Territory. Over the past decade, the community has attracted much negative media attention because of the amount of violence that has occurred. This violence has often been portrayed as the result of gang activity. This paper examines how gangs operate in the Wadeye community and provides some insight into the perceptions of gang members on their relationships with community authority structures and family support mechanisms. The researchers found that the criminal aspects of gang membership may be less important than factors such as identity construction, experiments with leadership and preservation of knowledge about culture and history.

OBJECTIVE: This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners. METHOD: A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model. RESULTS: Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 2(1/2) day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation. CONCLUSION: The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.

This chapter claims mobile phones as technologies of creative mediation and world-making. Specifically, it explores their aesthetics as an increasingly significant and generative texture of contemporary society among Yolngu Aboriginal families in the Northern Territory of Australia. Arguing that mobile phones enable forms of “connectivity” and sensuous two-way relationships that exceed the reach of the mostly linguistically oriented literature in this field, the chapter shows how mobile phones have become a means by which Yolngu observe, respond, and participate in the global via YouTube and other forms of social media – a vital means by which they simultaneously claim and perform a distinctiveness and commonality.

The objective of this study was to determine long-term immunity to hepatitis B virus (HBV) in a cohort of adolescents who received plasma-derived HBV vaccine in 1989 and 1990 in a remote Australian Aboriginal community. This was done using a serological survey; primary outcome measures were cut-off titres of HBsAb, and the presence of HBcAb and/or HBsAg. Of 37 adolescents in the cohort, 4 (11%) had evidence of active infection, one with abnormal liver enzymes, 7 (19%) had evidence of past infection, 15 (41%) were HBsAb positive in low titre and 11 (30%) were classed as immune. It was concluded that there was relatively poor long-term serological immunity to HBV vaccination in this group; a finding which is in keeping with similar studies in Indigenous and remote populations elsewhere. This finding raises the concern that a significant proportion of Aboriginal adolescents in other remote communities (vaccinated in 1989 and 1990) were not adequately protected by the vaccine. If so, there will be an unexpected burden of chronic HBV infection in these settings and a substantial group who are non-immune, despite having received complete HBV vaccination courses as infants. The authors recommend followup serosurveys in remote Aboriginal communities to identify people with low HBsAb titres, especially those without an adequate anamnestic response to another dose of HBV vaccine. In addition, community-based active surveillance programs will be required to detect people with chronic HBV infection and provide access to monitoring and appropriate treatment.

INTRODUCTION: As part of an oral health service for Aboriginal people in central northern New South Wales (NSW), Australia, oral health promotion was identified as a priority by the local Aboriginal community. The objective of this study was to collaborate with local Aboriginal communities to determine (1) the oral health needs of Aboriginal children aged 5-12 years, (2) the oral health knowledge and attitudes towards oral health of parents/guardians and (3) the perceived barriers and enablers towards oral health promotion for school children by local school staff and community health workers. The results of this collaboration will inform a community-owned oral health promotion program. METHODS: Aboriginal children aged 5-12 years enrolled in local schools received a dental screening by a single examiner. The number of decayed, missing and filled teeth of primary and permanent dentition (dmft/DMFT), plaque and gingivitis were recorded. Children completed a questionnaire assessing current oral hygiene practices, dental history and information on their diet. Parents/guardians completed a questionnaire assessing oral health knowledge and attitudes towards oral health. School staff and community health workers completed a questionnaire assessing attitudes, barriers and enablers towards implementing an oral health promotion program in schools. RESULTS: Eighty-eight children, representing 94% of those eligible, were screened, and 78 (82%) completed a questionnaire. The mean dmft/DMFT score was 5.3. Risk factors for dental caries identified included lack of toothbrush ownership (35%), minimal fluoride toothpaste use (24%), limited daily tooth brushing (51%) and frequent consumption of sugary foods (72%) and soft drinks (64%). Questionnaires were completed by 32 parents/guardians and 39 school and community health workers. Parents/guardians had limited oral health knowledge. School and health staff were willing to support a health promotion program to improve dental health of children. CONCLUSION: Aboriginal children living in rural and remote communities in NSW experience high rates of dental caries. Oral health promotion is urgently required to reduce the burden of dental caries and should address oral hygiene behaviours, fluoride use and access to healthy foods and drinks. Note: This article uses the term 'Aboriginal people' when referring to the first peoples of Australia. This term is inclusive of Australian Aboriginal and Torres Strait Islander people.

Bilingual and Indigenous language and culture programmes have run in remote Australian schools with significant and continuing local support. Developments such as the new national Indigenous languages curriculum offer a further opportunity to broaden and sustain Indigenous language teaching and learning activities in these schools. However, over the last two decades, increasing government attention to poor outcomes on national standardised literacy and numeracy assessments has markedly restricted the scope for Indigenous languages. This paper draws on a model of ideological and implementational spaces to discuss competing discourses in top-down and bottom-up policy. Data from an ethnographic study on education stakeholders in remote locations in Australia's Northern Territory revealed incongruities between local discourses that emphasise bi- and multilingualism, local identity and knowledge and community language maintenance and institutional discourses, which foreground a uniform model of education, with English literacy the dominant measure of educational success. The study also revealed that principals, teachers, and community members in some schools work together to develop vibrant, though often fragile, programmes. In addition to this, community members outside school systems are increasingly finding and taking up the spaces that allow innovative Indigenous language and cultural teaching and learning.

Discourses of global citizenship are increasingly embedded in the education policies of higher education institutions in Australia. Programmes that involve students working in culturally diverse communities are seen as pivotal to producing graduates who are ethical and productive global citizens. In this chapter, we focus on a global experience programme based at a metropolitan university in Australia where pre-service teachers (PSTs) undertake placements in remote Indigenous communities in the Northern Territory. We draw on data from interviews with PSTs that centred on their motivations for participating in the programme and their subsequent reflections. Utilizing postcolonial scholarship to examine this data, we highlight the “shine” and “shadow” of global citizenship education as PSTs make meaning of their experiences and position themselves as becoming-teachers.

Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)–focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Study type: Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. Methods: We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. Results: A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document’s values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Conclusion: Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.

Background: Suicide rates are higher in rural and remote areas of Australia compared with major cities. Aim: To evaluate the impact of a brief, community-based suicide prevention educational intervention on the attitudes and confidence of rural South Australian health and human service professionals. Method: Participants attended a 1-day suicide prevention education program, and completed a survey at four time points: baseline (T1), immediately pretraining (T2), immediately posttraining (T3), and 4-month follow-up (T4). Main outcome measures were self-reported attitudes and confidence when working with people vulnerable to suicide. Results: A total of 248 people attended the training, with 213 participants completing the survey at T1, 236 at T2, 215 at T3, and 172 at T4. There were significant improvements in 11 of the 14 attitude items between T2 and T3 (immediate change), and between T1 and T4 (maintained change). Further, there were significant improvements in all four confidence items between T2 and T3, and T1 and T4. Limitations: Despite the repeated-measures design, findings are limited by the lack of a control group. Conclusion: Findings extend the international evidence by indicating the value of brief suicide prevention education for improving health and human service professionals' attitudes and confidence in rural Australia.

BACKGROUND: Researchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings. METHODS: The Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal people were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced. RESULTS: Interviews with Aboriginal leaders (n = 20) were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research-finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity-two-way learning; and Reaching consent. CONCLUSION: The project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent.

There is significant evidence that culture-aligned economies are more effective in engaging remote-living Indigenous Australians in work long-term. Despite this evidence, governments remain resistant to investing substantially in these economies, with the result that low employment rates persist. This article argues that governmental systems of organisation are not designed to support non-mainstream economies and this position is unlikely to change. Similarly, the commercial sector lacks confidence that investing in culture-aligned economies will generate financial returns. This article presents a localised, pragmatic approach to Indigenous business support that works within existing systems of government, business and culture. Most unsuccessful programs fail to recognise the full suite of critical factors for sustained market engagement by both business and Indigenous people. This article reports on work to bring all critical factors together into a business support framework to inform the design and implementation of an aquaculture development program in a remote Indigenous Australian community.

Purpose – The purpose of this study is to explore Australian Indigenous women’s customary use of marine resources and views on aquaculture as a development opportunity. The value participants placed on economic, social and cultural outcomes were explored, as were benefit sharing, governance and business considerations. Design/methodology/approach – Using a form of action research, workshops were conducted with a focus group of Indigenous women and interviews with men and women living on a remote island off northern Australia. Multimedia materials and a game were used to elicit a deeper understanding and facilitate discussion. Findings – Women preferred aquaculture options respectful of culture and accommodating cultural and family obligations, that engage young adults in meaningful work, improve access to sea country and provide local foods and support economic development. Participants placed significant dependence on their governance body to support businesses and expressed disparate views on profit sharing. Women continue to engage in customary harvesting and fishing but various limitations impact on this. Research limitations/implications – Conclusions based on one case study need to be confirmed in other communities. Future research should include a broader representation of youth and strategies to improve people’s understanding of aquaculture operations and business management. Social implications – This research improves our understanding of Indigenous women’s preferred economic development pathways and their advocacy role within the community. These findings are relevant for policy-makers, businesses, other Indigenous communities and researchers. Originality/value – This paper seeks to recognise and integrate Indigenous women’s economic and cultural aspirations within development policy. Such a place-based, gender-based consultative process is generally lacking in the Australian Indigenous policy arena.