Remote Australia Online

Objective The shortage of dentists in Outer Regional and Remote areas of Australia and long public dental waiting lists have been the subject of media attention over the last decade. A number of state and federal initiatives were introduced over the years to address these problems. This study aims to gauge whether the waiting lists and shortage of dentists in Outer Regional and Remote areas have seen a positive change over the last decade. Design This evaluation study analysed and compared the number of dentists full-time equivalent per 100 000 population, eligible population and waiting list size (New South Wales and Queensland) at various points in time over the last decade. Setting National. Participants Data were extracted from practitioner registry reports. Main outcome measures Number of dentists practising in Outer Regional and Remote areas of Australia and number of people on the public dental waiting list (New South Wales and Queensland). Results There was a significant improvement in the number of dentists practising in Outer Regional and Remote areas of Australia. The public dental waiting lists in New South Wales and Queensland (as of September 2016) were found to have surpassed their pre National Partnership Agreement levels in 2012. The growth of public dental waiting lists exceeded the growth of the eligible population by a significant margin. Conclusion The dentist-to-population ratios in Outer Regional and Remote areas have seen a significant improvement. The reduction in the number of people on the public dental waiting list was significant, but brief.

Rewards for environmental service provision, couched under market-based instruments, are widely touted in Australia as a means of improving natural resource management while empowering indigenous people. We document here the views of indigenous Australians in a community in Arnhem Land about their motivations for, and ways to provide, such services. Most respondents (93%) said that they ‘look after country’ to fulfil cultural responsibilities. Natural resource management, they said, should be carried out communally, primarily under the direction of elders and family. Sixty percent of respondents preferred direct payments such as cash or salaried remuneration like that commonly offered in return for ranger-like activities such as feral animal/weed control, coastal surveillance and prescribed burning. Some (14%) either did not want or did not need rewards for environmental service provision. Others (19%) preferred rewards in a form that benefited their community or family rather than themselves as individuals. There was agreement that outcomes should be monitored, consistent with the principle that reward payments should be conditional on performance. We suggest that a reward system that is too narrowly defined could thwart the potential for win-win outcomes from indigenous incentive-based natural resource management but that their articulation could allow solutions to be negotiated.

Much of the ill health of Australian indigenous populations can be attributed to diet-related diseases. This community nutrition project is part of a wider renal screening and prevention program based in the Umoona aboriginal community in Coober Pedy in South Australia's far north. The nutrition project facilitates the capacity of the Umoona aboriginal community to identify and redress nutrition-related issues considered important in improving their overall health status. Project nutritionists developed and implemented a specialized nutrition training program with the Umoona aboriginal health workers. The nutritionists were responsive to requests from community groups to provide nutrition expertise and support in program development. Individual nutrition counseling for adults and children taking part in renal health screening was also provided. The aboriginal health workers reported increased nutritional knowledge and confidence in addressing nutrition-related issues within the community after nutrition training. Individual consultations and partnerships formed with community groups have increased awareness and prompted action to address the importance of nutrition in renal disease and overall health in the Umoona community. © 2002 by the National Kidney Foundation, Inc.

This report examines the impact of remoteness and population size on the costs of providing primary health care services in remote Northern Territory Indigenous communities. For remote health clinics servicing a population of similar size, total expenditure increased as remoteness increased. Total expenditure in remote clinics increased with population size, but average per capita expenditure was highest in clinics servicing populations of less than 200 people and lowest for populations of between 600 and 999. Staffing costs comprised over 70% of expenses. The largest non-staffing cost was property management. The higher costs of clinics that are in more remote locations or servicing smaller populations need to be recognised in funding distribution methodologies.What is known about the topic? People in rural and remote locations tend to have poorer health status and poorer access to primary care services than those in urban areas. There has, however, been a lack of information on the relative cost of providing primary care services in remote areas and the nature of those costs, particularly in remote Indigenous communities.What does this paper add? This study analyses the costs of primary care services in Northern Territory remote Indigenous communities and their associations with two key cost drivers: remoteness and population size.What are the implications for practitioners? This paper provides information on the importance of including remoteness and population size in resource allocation formulas for primary care services in remote areas.

Homelessness is often conceptualised as an urban problem. However, significant numbers of people experiencing homelessness live in regional, rural and remote areas, where distances can be considerable and there are fewer housing options and services available to assist them. Drawing on the perspectives of service providers, this paper discusses contested understandings of home and homelessness as well as housing and service provision in two remote Western Australian mining towns. The key findings were that normative policy definitions of homelessness that focused on ‘living in a house’ as a ‘home’ were not always culturally relevant for local Aboriginal communities, and there was limited access to adequate housing options in both communities. Furthermore, ‘top down’ funding and decisions often occurred without community consultation, which fragmented service delivery, limited ‘grassroots’ participation and constrained opportunities for locally relevant service responses. These findings highlight Westernised and urban assumptions underpinning the policy domain in which housing and homelessness responses are determined, emphasising the limits of current conceptualisations for Aboriginal people and service providers working in remote areas.

What future for remote Indigenous Australia? Economic hybridity and the neoliberal turn

Building the research capacity of the vocational education and training (VET) sector is a key concern for the National Centre for Vocational Education Research (NCVER). To assist with this objective, NCVER supports an academic scholarship program, whereby VET practitioners are sponsored to undertake university study at honours’, master’s or doctorate level. Stuart Anderson received an academic scholarship in 2008 to assist with his Master’s of Education at Charles Darwin University. Stuart is a Lecturer and Course Co-ordinator in Alcohol and Other Drugs, Youth Work at Charles Darwin University. His research investigates the flexible delivery of VET in Wugularr, a remote Indigenous community near Katherine in the Northern Territory. As part of its core business, Charles Darwin University offers a range of VET training programs to Wugularr. One of these programs is the Sunrise Health Service’s youth worker training program. This paper evaluates the program from the community’s perspective. The lessons learned, which are applicable to the wider VET sector, are also identified. Key messages Overall, the participants were happy with the teaching and learning provided by the university but were less satisfied with its approach to engaging their community in the process. Building a relationship with the community is vital to improving VET practice in remote communities. This can be achieved by: customising approaches to delivery and assessment so they recognise community languages and support community-oriented activities incorporating digital technologies in teaching and learning understanding that the cultural and family priorities of participants and building their trust tend to come before VET training in the community being in it for the long haul and teaching skills not only applicable to their current workplace but also to the future.

Skin infections are endemic in many in remote Australian Aboriginal communities and have been linked to very high rates of chronic heart and kidney disease in this population. We report the results of a regional collaboration that aimed to reduce skin infections amongst children aged less than 15 years in five remote communities. The program included annual mass scabies treatment days offered to all residents and routine screening/follow-up of children. Trained community workers helped conduct over 6000 skin assessments on 2329 children over a three year period. Of every 100 children seen at the commencement of the study, 47 were found to have skin sores and many had multiple sores. We demonstrate a reduction both in the number of children with skin sores and in the severity of those sores. On average, of every 100 children seen per month, there were 14 fewer children with skin sores and seven fewer children with multiple sores. Overall improvement in treatment uptake was a critical factor. We found no discernible impact against scabies. While the burden of skin infections remains unacceptably high, we believe the results presented here are a good news story for local action to address a serious public health problem.

There is limited epidemiological research that provides insight into the complex web of causative and moderating factors that links housing conditions to a variety of poor health outcomes. This study explores the relationship between housing conditions (with a primary focus on the functional state of infrastructure) and common childhood illness in remote Australian Aboriginal communities for the purpose of informing development of housing interventions to improve child health. The findings add to other evidence that building programs need to be supported by a range of other social and behavioural interventions for potential health gains to be more fully realised.

Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities.Design Qualitative study with semistructured interviews and thematic analysis.Setting Four remote communities in outback Queensland, Australia.Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities.Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health.Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities.

The Whole of Community Engagement (WCE) initiative commenced in July 2014, led by the Office of Pro Vice Chancellor of Indigenous Leadership at Charles Darwin University (CDU). WCE aimed to build the aspiration, expectation and capacity of six remote and very remote Indigenous communities in the Northern Territory to participate and achieve in higher education. Using a place-based, Indigenous-led, community development approach, the initiative developed a model that could be applied by other Australian universities and agencies through engaging closely within Indigenous communities and promoting local level management, leadership, decision-making, research and action. The WCE included participatory action research and developmental evaluation approaches. Campus-based and remote Indigenous community-based staff worked together to identify educational needs, priorities and activities from the ground-up. Some of the main messages communities emphasised were that: Aboriginal leadership and governance in remote education are essential; Education and higher education are a priority for many Indigenous people; Aboriginal cultural knowledge is foundational to other learning; Education should be ‘both-ways’; Education was viewed holistically by Indigenous participants and includes wellbeing, spirituality and livelihood; English language, literacy and numeracy (LLN) is central to progress.

We examine the economic structure of Australian local government areas in the Northern Territory, South Australia and Western Australia using economic base theory and location quotients. Whereas the economic base approach is long established, in this paper we extend the three-staged geospatial visualisation method of Blackwell et al. (2017) to two additional state jurisdictions. Focusing on the economic structure of rangeland local government areas, we find that these vary significantly, implying that no single generic development policy is likely to be effective, but rather these need to be crafted individually. We demonstrate that geospatial visualisations of employment location quotients can identify local economic vulnerability as well as opportunity.

This project explored the potential of the internet to teach instrumental music online to students in regional or remote regions of Western Australia. The project was established on the expectation that, at some time in the not-too-distant future, instrumental music tutors located in the metropolitan regions may have in their normal studio practice, a complement of local, face-to-face students alongside a number of regional students learning their instruments online. For this online development to occur, tutor and student alike must be able to access a learning framework which is effective, simple to use and accessible. Through an action learning program which involved a series of online delivery trials to a small group of students located in various parts of Western Australia, this project attempted to achieve a better understanding of how the learning environment for skills normally physically mediated, can be appropriately 'deconstructed' into various constituent parts, and adapted for internet delivery. A website was established which provided students with a series of 14 graded lessons in instrumental performance supported by lesson notes on technique and music theory and a body of associated learning resources. Each musical exercise was accompanied by video and audio demonstrations. Students were able to access the lessons in either an ordered or an unordered sequence. Hyperlinks to various related resource materials were provided throughout the program to encourage non-linear access to knowledge, to enhance repetition and to encourage 're-learning' to occur. The learning model adopted simple and established technology, with ease of access being the primary consideration. The project did not attempt to evaluate the utility and effectiveness of more advanced technologies, as it was felt that this may interfere with the project's primary objectives. While the study was successful in building an adequate learning environment using skills and technology within reach of the average music tutor, overall the study was not able to conclude that, using the selected learning model, the internet is an effective medium for delivering musical instruction to students isolated by distance. There were difficulties both in finding students who wished to learn through this medium and engaging them in an effective program of learning. This study has found that, within the learning framework developed for this pilot study, increasing the distance between the tutor and the learner has a negative effect on quality of performance, level of engagement and development and refinement of skills and knowledge. Despite using different approaches to engage the students, the barrier of distance was not adequately overcome in this study. This was attributed in part to the preparedness of the learner to make most effective use of this medium, but also to limitations in the available knowledge regarding the best methods to effectively motivate and engage students in this form of learning. Suggestions for further exploration of this learning medium arising from the study included: developing new learning pedagogies for engaging instrumental music students in the learning process a longer time trial - students may need more time to adjust to the new medium and the tools it uses establishing local music networks to provide additional infrastructure and support developing strategies to assist students adjust to the discipline required in online learning creating study groups to enable students to feel a greater sense of commitment as well as a sense of being part of a team building a stronger offline learning structure to compensate for the effect of isolation. Although this project was not obviously successful in terms of student outcomes, there is still reasonable optimism for this form of learning. The delivery trials have confirmed that relevant online learning materials can be adequately prepared and delivered to students by the average musician, and that this situation will inevitably improve. The establishment of a suitable learning pedagogy that aligns with the needs, expectations and preferred learning styles of students in this area of study is the main barrier to be overcome.

We conducted a longitudinal dietary intervention study to assess the impact of a store-based intervention on mediators and moderators and consequent dietary behaviour in Indigenous communities in remote Australia. We assessed dietary intake of fruit, vegetable, water and sweetened soft drink, mediators and moderators among 148, eighty-five and seventy-three adult participants (92 % women) at baseline (T1), end of intervention (T2) and at 24 weeks post intervention (T3), respectively. Mediators included perceived affordability and self-efficacy. Moderators were barriers to eat more fruit and vegetables and food security. Mixed-effects models were used to determine changes in mediators and moderators with time and associations between these and each dietary outcome. Perceived vegetable affordability increased from T1 (19 %; 95 % CI 11, 27) to T2 (38 %; 95 % CI 25, 51) (P=0·004) and returned to baseline levels at T3. High self-efficacy to eat more fruit and vegetables and to drink less soft drink decreased from T1 to T3. A reduction in soft drink intake of 27 % (95 % CI−44, −4; P=0·02) was reported at T3 compared with T1; no changes with time were observed for all other outcome measures. Regardless of time, vegetable intakewas positively associated with self-efficacy to cook and try new vegetables, no barriers and food security. The dietary intervention went someway to improving perceived affordability of vegetables but was probably not strong enough to overcome other mediators and moderators constraining behaviour change. Meaningful dietary improvement in this context will be difficult to achieve without addressing underlying constraints to behaviour change.

OBJECTIVE:To examine the extent and nature of coverage of Aboriginal and Torres Strait Islander nutrition issues in major Australian newspapers over two decades. METHODS:Content and framing analysis of Australian newspaper articles published between 1996 and 2015 that included the terms 'Aboriginal or Indigenous' and 'nutrition or diet' in the headline and/or lead paragraph. Analysis focused on the nature of coverage, trends over time, stakeholder representation and how coverage related to policy. RESULTS:A total of 79 articles were included. Coverage of nutrition fluctuated over time, with peaks in 1998 and 2008. The majority of articles focused on remote Aboriginal communities. Both individual and structural representations of nutrition were used and dietary quality and food insecurity were the most commonly reported nutrition issues. Few articles employed positive representations of Aboriginal peoples. Six policy functions of articles were identified: highlighting problems; reporting government announcements; promoting programs; advocating solutions; critiquing government; and defending policy. CONCLUSION:The coverage of Aboriginal and Torres Strait Islander nutrition in newspapers does not reflect the diversity and strengths of Australia's First Peoples. Implications for public health: This study highlights the role of the media in policy advocacy; however, advocates should ensure that they do not perpetuate negative representations of Aboriginal and Torres Strait Islander peoples.

Of mothers, adoption and orphans: The significance of relatedness in a remote Aboriginal community

Ideas from evolutionary theory and a consideration of social and cultural factors are used to argue that teenage pregnancy in three remote Aboriginal communities represents a strategic response to current environments characterised by pervasive and sustained risk and uncertainty. Ethnographic studies of the communities find that these environments both provoke and enable the reproductive strategies of adolescent boys and girls but raise the question of the effects of father absent socialisation.

The use of washing machines was investigated in two remote Aboriginal communities in the Anangu Pitjantjatjara homelands. The aim was to look both at machine reliability and to investigate the health aspect of washing clothes. A total of 39 machines were inspected for wear and component reliability every three months over a one-year period. Of these, 10 machines were monitored in detail for water consumption, hours of use and cycles of operation. The machines monitored were Speed Queen model EA2011 (7 kg washing load) commercial units. The field survey results suggested a high rate of operation of the machines with an average of around 1,100 washing cycles per year (range 150 and 2,300 cycles per year). The results were compared with available figures for the average Australian household. A literature survey, to ascertain the health outcomes relating to washing clothes and bedding, confirmed that washing machines are efficient at removal of bacteria from clothes and bedding but suggested that recontamination of clothing after washing often negated the prior removal. High temperature washing (>60d̀C) appeared to be advantageous from a health perspective. With regards to larger organisms, while dust mites and body lice transmission between people would probably be decreased by washing clothes, scabies appeared to be mainly transmitted by body contact and thus transmission would be only marginally decreased by the use of washing machines.

Visiting health services are a feature of health care delivery in rural and remote contexts. These services are often described as ‘fly-in fly-out’ or ‘drive-in drive-out’. Posing the question ‘What are the different types of visiting models of primary health care being used in rural and remote communities?’, the objective of this article was to describe a typology of models of health services that visit remote communities. A systematic review of peer-reviewed literature from established databases was undertaken. Data were extracted from 20 papers (16 peer-reviewed papers and four from other sources), which met the inclusion criteria. From the available evidence, it was difficult to develop a typology of services. The central feature of service providers visiting rural and remote districts on a regular basis was consistent, although the service provider's geographical base varied and the extent to which the same service provider should be providing the service was not consistently endorsed. While a clear typology did not emerge from the systematic review, it became apparent that a set of guiding principles might be more helpful to service providers and planners. Focusing policy and decision-making on important principles of visiting services, rather than their typological features, is likely to be of ultimately more benefit to the health outcomes of people who live in rural and remote communities.

Background In Australia’s Northern Territory, the hepatitis B virus (HBV) subgenotype A2 (subtype adw2) vaccine was introduced in 1988 for Indigenous infants. Subsequently, the circulating viral genotype has been identified as subgenotype C4 (subtype ayw3). We assessed HBV vaccine effectiveness (VE) in light of this subtype mismatch. Methods Participants of the Aboriginal Birth Cohort (ABC) study were recruited at birth (1987–1990), with HBV serology obtained at follow-up waves 3 (2005–2007) and 4 (2013–2015). Participants were immune if HBV surface antibody levels exceeded 10 IU/L. We determined the VE against any HBV infection (anti-HBc+) and against chronic infection (HBsAg+ or HBV DNA+), comparing non-vaccinated participants with those fulfilling United States Centers for Disease Control and Prevention (CDC) criteria for full HBV immunisation. Results Of 686 participants in the ABC study, we obtained HBV serology from 388 at wave 4. 181 participants were immune to HBV and 97 had evidence of any infection. Seven participants were chronically infected, of whom five had received three vaccine doses, and anti-HBc seroconversion had occurred subsequent to the three vaccine doses for two of these seven participants. Comparing the 107 participants who had been vaccinated in accordance with CDC recommendations and 127 who had not been vaccinated, VE against any infection was 67% (95%CI, 43–104%). The odds of being anti-HBc+ was 87% lower in participants raised in urban settings compared to those born into families from remote areas (OR, 0.1; 95%CI, 0.03–0.4). Conclusions In a setting where there exists a subtype mismatch between vaccine and circulating genotype, the vaccine was largely effective in preventing chronic infection but sub-optimal against any infection. The implications of a high prevalence of anti-HBc seropositivity in this population are unclear and require further study. The fact that anti-HBc seropositivity was strongly associated with remote dwelling suggests ongoing viral exposure in remote settings.

Part A of this document, the Literature Review, built on the 2012 Working Safe in Rural and Remote Australia Project report, and noted the conclusions of additional available research published from 2011 onwards. National Model Workplace Health and Safety guidelines prompted re-consideration of some pre-2010 research finding and recommendations. Analysis of violent / trauma events involving the remote health workforce over the past 12 months resulted in re-evaluation of what was previously accepted as the major hazards and risks affecting staff safety and security. Part B of this document collated information provided during industry and community consultation. It also reports on findings from the questionnaire completed by 90 currently or recently practicing members of the remote health workforce. This information reinforced many of the priority issues identified in the literature review. Consultation also identified significant safety and security issues not prioritised in research, and provided up to date information about the opinions and motivation of Fly-In Fly-Out RANs, an increasingly significant component of the total remote health workforce. In preparing this report, the project has gathered comprehensive information about issues influencing remote health workforce safety and security. This provides a sobering account of the challenges faced by clinicians and managers. Many of the identified issues canbe responded to positively with limited cost implications, although the contribution of industry stakeholders is required to progres s change. However, other initiatives involve considerable costs. P rocurement, repair and maintenance of facilities, accommodation and equipment will require the contribution of funding agencies. Using the information compiled from the literature review and industry consultation, the project is now well placed to progress with the completion of other outputs .

This paper presents a personal perspective of caring for clients with diabetes on a remote Aboriginal community in the Northern Territory.The state of Aboriginal health in Australia is explored and consideration given to Government recommendations targeting the improvement of health in the Indigenous population. For the remote area nurse, at the grass roots, the application of these recommendations is not always easy.The recommendations can be both impractical and irrelevant in remote areas where resources are often less than ideal.The purpose of this paper is to highlight the dilemmas faced by health care professionals as they endeavour to make a real change to the alarming health status of the Indigenous people of Australia.

Background: Community-based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings.Aim: To identify the factors in an integrated, community-engaged rural placement that may contribute to preparedness for practice (P4P) from the perspective of students and clinicians.Method: Forty-two semi-structured interviews with medical students, supervisors and clinicians analysed thematically.Results: Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to P4P. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement.Conclusions: A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health.

The broad goals of this report are to gain a better understanding of parents’ and carers’ behavioural motivation in relation to education, and to what extent attitudes and beliefs impact on school attendance in remote Indigenous Communities. It also aims to identify how individual families engage with and respond to the Remote School Attendance Strategy (RSAS). This will provide insights into how RSAS and services can better tailor support for people in different contexts, or at different times in their lives. RSAS does not operate in isolation. It works alongside schools, other services and communities. These in turn all interact with families and influence their choices about school attendance. Every community is different and each have their own programs, government policies, schools and services all influencing education outcomes. This report focuses on parents’ and carers’ perspectives of the factors and drivers that influence choices about education. This work builds on the Remote School Attendance Strategy – Interim Progress Report (2015) and Case Study Research for the Remote School Attendance Strategy (2016). As such, it did not include interviews with school staff and other service providers (including RSAS), which was the focus of previous research.

Objective: To assess the knowledge, attitudes and behaviours of remote Aboriginal and Torres Strait Islander youth living in far north Queensland in relation to sexually transmitted infections, HIV/AIDS and safe sex. Methods: Community consultation followed by local recruitment of a sample of young people who, in a facilitated same gender focus group setting, completed a questionnaire followed by open discussion of the issues in a range of remote locations during 2007. Results: The remote living Indigenous youth demonstrated lower levels of knowledge in relation to STI and HIV and higher levels of partner change than was demonstrated in the 2002 national secondary school survey. Despite the high rates of bacterial STI in the region, there was an extremely low level of awareness of personal risk in relation to STI and HIV. Conclusion: There is an urgent need to strengthen school-based sex education and to develop innovative approaches to sexual health promotion in addition to improving clinical sexual health service provision.