Remote Australia Online

Aboriginal and Torres Strait Islander people living in rural and remote Australia have lower vaccine coverage rates and experience higher rates of notification and hospitalisations for vaccine preventable diseases than non-Aboriginal people. This paper explores important public health and research activities being undertaken in the Northern Territory to reduce this disparity in vaccine program performance, with a particular focus on rotavirus, meningococcal, human papilloma virus and COVID-19 vaccines.

Introduction: Remote Area Nurses (RANs) in Australia frequently encounter hazards that contribute to violence in the work place. Resources to deal with this problem are limited. Methods: Adopting a risk management approach and using the Delphi method, a panel of expert RANs (n=10) from geographically diverse communities across Australia, identified and prioritised hazards that increase the risk of violence to nurses. Results: This descriptive study found that RANs encounter a wide variety of hazards from a variety of sources. Environmental hazards are complicated by living in remote areas and practicing in different locations. Relationships between the nurse and the community can be complex and lack of experience and organisational support may contribute to an increased risk of violence. Hazards prioritised as 'major' or 'extreme' risks included: clinic maintenance and security features, attending to patients at staff residences, RAN inexperience and lack of knowledge about the community, as well as intoxicated clients with mental health issues. A work culture that accepts verbal abuse as 'part of the job' was identified as a significant organisational risk to RANs. A lack of action from management when hazards are identified by clinic staff and insufficient recognition of the risk of violence by employers were also significant hazards. Conclusions: Further consideration of the hazards described in this study following the risk management process, may provide opportunities to reduce the risk of violence towards RANs. Proposed control measures should be developed in consultation with RANs and the remote communities they work in.

We tested a telemedicine model of care to initiate continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) living in remote Western Australia.A prospective study comparing telemedicine for CPAP initiation in a remote population versus standard face-to-face CPAP initiation in a metropolitan population. The primary outcome was average nightly CPAP use in the final week of a CPAP trial.A total of 186 participants were allocated to either telemedicine (n = 56) or standard care (n = 130). The average distance from the study center for the telemedicine group was 979 km (±792 km) compared to 19 km (±14 km) for the standard care group. The CPAP trial duration in the standard care group was less than the telemedicine group (37.6 vs 69.9 days, p < .001). CPAP adherence in the telemedicine group was not inferior to standard care (Standard 4.7 ± 0.2 h, Telemedicine 4.7 ± 0.3 h, p = 0.86). No differences were found between groups in residual apnea-hypopnea index, symptom response, sleep specific quality of life at the end of the trial, and continued CPAP use (3–6 months). Participant satisfaction was high in both groups. Total health care costs of the telemedicine model were less than the standard model of care. An estimated A$4538 per participant in travel costs was saved within the telemedicine group by reducing the need to travel to the sleep center for in-person management.In remote dwelling adults starting CPAP for the treatment of OSA, outcomes using telemedicine were comparable to in-person management in a metropolitan setting.

The Royal Institute for Deaf and Blind Children (RIDBC) in Sydney, Australia has demonstrated an ongoing commitment to innovation in the field of hearing impairment. RIDBC has created a unique program known as RIDBC Teleschool which successfully utilises videoconferencing technology to provide specialist hearing support and associated therapies to children living in rural and remote areas of Australia, including children in Indigenous communities. The high rate of hearing loss in Indigenous communities has led to the implementation of hearing screening programs in many areas of Australia. However, access to therapy support after screening is a critical intervention component which is often lacking in screening programs. RIDBC Teleschool uses a telehealth model to address this unmet need.

In early 2022, the Northern Territory published a new Remote Rent Framework, to come into effect from 5 September 2022. This radical new policy abolishes income-based rent setting in public housing in remote Aboriginal communities and Town Camps in Alice Springs and Tennant Creek. Urban public housing remains subject to income-based rent setting. The new rent setting framework seeks to simplify the system while increasing the rental revenue received from remote public housing tenants. If the new rent setting framework is successful in increasing rent revenues accruing to the public housing authority, it will do so at the cost of further impoverishing remote public housing tenants. Redistributing funds from remote community residents to the housing authority will transfer the cost of supplying housing away from the fiscally constrained Northern Territory Government and onto impoverished Aboriginal citizens. The abolition of income-based rent setting in remote public housing alone is arguably a form of indirect discrimination and is out of step with current Commonwealth Government moves to terminate a swathe of programs that discriminate against Indigenous residents of remote communities. We urge the Northern Territory government to halt its implementation of the new remote rent framework until it can be properly assessed and communicated clearly to remote public housing tenants and Aboriginal representative bodies.

As the last vestiges of the remarkable, Indigenous-controlled, Community Development Employment Projects (CDEP) scheme was removed, Australia entered a post-CDEP era in 2013. In its place, in remote areas only, the rigid and externally imposed Community Development Programme (CDP) has been installed. The CDEP scheme had been a successful work-creation strategy that produced positive social, economic, and political outcomes for First Nations citizens across Australia. In contrast, the CDP has operated like Work-for-the-Dole on steroids and its introduction has seen high numbers of unemployed Indigenous participants exit the welfare system altogether. In this article, I look at how we got here. Guided by postcolonial theory and implementing the toolkit provided by Carol Bacchi's ?What's the Problem Represented to be?? approach, I pay close attention to the way in which Indigenous policy has been represented over the past 25?years. In particular, I examine the construction of the problem of ?Aboriginal welfare dependency? by the Liberal/National Coalition Government led by Prime Minister John Howard between 1996 and 2007. This interconnected problem representation, I argue, has been instrumental in changing the way Indigenous affairs is thought about, with concrete implications for policy today.

Pulmonary Hypertension (PH) is a common and debilitating medical condition with high mortality. PH research has traditionally focused on Pulmonary Arterial Hypertension (PAH) and its management in expert PH centres. Other forms of PH such as PH associated with cardiac or respiratory disease are more common, less well-understood and associated with higher mortality. Epidemiology of PH in disadvantaged, remote and rural regions, remains largely undocumented. In this review, we discuss the unique challenges in identifying PH in rural and disadvantaged populations using the Top End region of the Northern Territory of Australia as an example. We propose a simple diagnostic approach, ideally suited to regions where resource allocation is scarce, using clinical skills, echocardiography, and an escalation algorithm. The brief history, epidemiology and current literature on PH are summarized to inform the busy clinicians. We highlight two case examples from the Top End to illustrate the challenges and potential solutions. This article is protected by copyright. All rights reserved.

Since the beginning of the 19th century, the natural environment of the planet has been placed under the dire threat of climate change. This has been caused by greenhouse gas (GHG) emissions from the burning of fossil fuels. GHG emissions threaten to alter the planet’s ecosystems disastrously and permanently. Statistics reveal that Australian individuals are among the highest GHG emitters on the planet, and that the transport sector contributes nearly one-fifth of the nation’s GHG emissions. It is suggested that significant reductions in Australian GHG emissions are urgently required, and it is considered that those reductions might be helped by a transition to electric vehicles (EVs) in the transport sector. This paper looks at the consumption of motor vehicle fuels in Australia’s transport sector and suggests how a reduction in GHG emissions might be achieved. It suggests that the electrification of Australian motor vehicles could eliminate up to 20 per cent of existing Australian GHG emissions. The paper presents further findings from a case study that was conducted on a Mitsubishi Outlander Plug-in Electric Hybrid Vehicle (PHEV) in remote Western Australia from 2016–17. That study is updated and extended in this paper to October 2021. The paper uses published statistical data from the Organisation for Economic Co-operation and Development (OECD) and Australian government agencies to support its findings, conclusions and suggestions for further research. It looks at the rate of transition to electric vehicles and concludes that, while the transport sector’s growing contribution to Australia’s overall GHG emissions could be significantly reduced by the transition to electric vehicles, there is some way to go. The paper suggests that there are significant economic factors inhibiting the adoption of electric vehicles in Australia. However, rising fuel prices could encourage the transition away from vehicles powered by environmentally damaging internal combustion engines towards electric vehicles in Australia.

This article describes the research process used to develop and evaluate an Internet-based resource aimed at improving access by health professionals to Australian Aboriginal cultural knowledge specific to pregnancy and childbirth. As a result of the research, women's stories from Maningrida were recorded and presented on the `Birthing Business in the Bush Website' which provided a platform for Aboriginal Australian women from Maningrida to present cultural and other information to maternity care practitioners. In particular, this article describes the development of the participatory action research combined with an Aboriginal research process, and how this was guided by the Aboriginal co-researchers and participants.

OBJECTIVE: Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. DESIGN: Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners. SETTING: Primary health care clinics, in communities of 150-1500 residents across Australia. PARTICIPANTS: A total of 24 nurses participated in this study. RESULTS: Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion. CONCLUSION: Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist-generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

Nurse practitioners for rural and remote Australia: creating opportunities for better health in the bush

This paper explores the political economy of Australia's prison industrial complex and its severe impact on Indigenous communities. Taking a historical perspective, the paper moves between a broader analysis of the forced extraction of Indigenous labour by the state and private enterprise and the violence against Indigenous people which accompanies it.

University students who live and work in regional, rural and remote areas face challenges in studying at a distance from their institution's metropolitan or satellite campus. For mature-aged students in particular, relocating to a city campus is unrealistic, due to their family and employment commitments, and travel time and costs. A pragmatic alternative embraced by high proportions of mature-aged students is to study online. However, learning online has welldocumented difficulties. This article explores the online learning experiences of mature-aged university students in regional and remote Australia via students' individual stories in the form of three vignettes. Bronfenbrenner's ecological systems model is employed to analyse the vignettes for systemic and structural factors that condition the students' experiences. This theoretical frame affords new insights into the challenges of learning online. We found that influences beyond the actions of individual students and staff, such as students' internet access and the casualisation of the university workforce, help explain why staff working 'on the ground' may not always be able to provide 'quality' curriculum and support for online students. Placing experiences of individual students within larger contexts uncovers how institutional elements and broader higher education policy can influence the learning for students studying online.

From the perspective of urban planning, the history of the Town Camps of Mparntwe (Alice Springs) has made them a unique form of urban development within Australia; they embody at once a First Nation form of urbanism and Country, colonial policies of inequity and dispossession, and a disparate public and community infrastructure that reflects the inadequate and ever-changing funding landscape it has been open to. While these issues continue, this paper discusses the resilience of these communities through the Local Decision Making agreement, signed in 2019 between the Northern Territory Government and Tangentyere Council. One thing that has been critical to translating and communicating local decisions for government funding has been the establishment of an inclusive and robust process of participatory mapping – Mapping Local Decisions - where both the deficiencies and potential of community infrastructure within each Town Camp is being identified. As local community knowledge is embedded within these practices, so too are issues of health, accessibility, safety and a changing climate similarly embedded within the architectural and infrastructure projects developed for government funding. Being conceived and supported by local communities, projects are finding better ways to secure this funding, building on a resilience these communities have for the places they live.

The definition of the 'family' by the Australian Bureau of Statistics (ABS) takes the nuclear family as their starting point. Using an anthropological approach to kinship, this paper argues that the nuclear family structure is not a 'natural' outcome of Aboriginal Australian kinship systems, and explores the implications of this for the quality of Indigenous household data in the national Census. The purpose of the research as explored in this article is twofold: to evaluate the ABS Indigenous Enumeration Strategy and to assess the quality of the data that were collected. The paper focuses on the responses to the questions designed to elicit information about family and household structure. These data are supplemented by genealogical information that the author collected in the course of independent anthropological fieldwork.

To enhance the accessibility and acceptability of evidence-based parenting programs in Indigenous communities, there is a need to build a confident and skilled workforce within these diverse settings. For training to be effective, the complex histories, traditional values and practices of the communities in which a program will be delivered must be appreciated. In this paper, we investigate the efficacy of a community-adapted, professional training program to deliver the evidence-based Indigenous Triple P - Positive Parenting Program (Triple P) in remote Aboriginal communities in the Fitzroy Valley, Western Australia. Extensive consultation with community leaders, a project advisory group, and local Aboriginal organizations and service providers guided modifications to the program. Repeated measures analyses were used to assess parent coach (N = 38) knowledge and confidence prior to and immediately post training and at an accreditation workshop two months following training. Parent coaches who completed the tailored Triple P practitioner training reported high rates of satisfaction with the training, a significant increase in capacity to deliver parenting support, significantly increased confidence in their parent consultation skills, and significantly increased perceived empowerment within communities, the workplace and home. These results were maintained at two months post-training. Qualitative results indicate that training was well received and beneficial. Post-training support by an experienced Triple P practitioner residing in the community for an extended period was critical to supporting program implementation and sustainability.

Service providers commonly understand development projects in Indigenous Australia to play out at the intersection of a pre-existing binary between Indigenous and non-Indigenous groups. It follows that effective development practice is seen to depend on building partnerships across the 'intercultural' divide. Instead of taking this assumption as a baseline from which analysis proceeds, I draw on Karen Barad's theory of 'intra-action' to show how an Indigenous/non-Indigenous binary is continually produced in the context of a development NGO working in Central Australia. Based on fieldwork as a volunteer within this NGO, I demonstrate how the 'intra-action' of community development process produces forms of difference and relatedness for non-Indigenous NGO staff, and for the Aboriginal community. I argue that in spite of calls for deeper engagements, the community development apparatus continually performs separateness as the ethical framework on which the project proceeds. The paper contributes to debates around 'intercultural' anthropology and presents a non-normative account of development practice in Australia.

INTRODUCTION: On a background of high rates of severe otitis media (OM) with associated hearing loss, children from the Torres Strait and Cape York region requiring ear, nose and throat (ENT) surgery, faced waiting times exceeding three years. After numerous clinical safety incidents were raised, indicating a failure of the current system to deliver appropriate care, the governing Hospital and Health service opted to deliver surgical care through an alternate process. ENT surgeries were performed on 16 consented children from two remote locations via the private health care system, funded by a health provider partnership. METHODS: We examined the collaboration processes alongside clinical findings from this ENT surgery. Collated patient data, included patient demographics, clinical and audiometry presentation features were reviewed and compared pre and post-operatively. Cost savings associated with the use of TeleHealth post-operatively were briefly examined. RESULTS: Surgeries were successfully completed in all 16 children. The reported mean waitlist time for ENT surgery was 1.2 years. Pre-surgery pure-tone average hearing thresholds were reported at left: 30.9 dB, right: 38.2 dB. The majority of presentations were for bilateral OM with Effusion (69%). Post-surgical follow up indicated successful clinical outcomes in 80% of patients and successful hearing outcomes in 88% of patients. Mean difference pure-tone average hearing thresholds, left: 8.4 dB and right: 11.2 dB. Furthermore, the majority of patients reported improved hearing and breathing. The use of TeleHealth for post-operative review enabled a minimum cost saving of AUD$21,664 for these 16 children. Overall, a high level of staffing resources was required to successfully coordinate this intense surgical activity. CONCLUSION: This innovative approach to a health system crisis enabled successful ENT surgical and hearing outcomes in 16 children, whose waitlisted time grossly exceeded state health recommendations. Using private health facilities funded by a health partnership, while unlikely to be a suitable model of care for routine service delivery; may be applied as an adjunct service model when blockages and delays lead to sub-standard service provision. This approach may be applicable to other health care facilities when facing extended elective surgery wait times in ENT or other specialty areas.

Issue addressed: It is well-established that health education and promotion programs work best when they have been tailored to meet local contextual needs. In this brief report we describe a health education program and how it identified and incorporated local priorities into its delivery in two remote Aboriginal communities in the 'Top End' of the Northern Territory. Methods: During the first visit to each community team members met with local stakeholders and ran an inaugural HealthLAB session. Fieldnotes were taken during or directly after each interaction. At the end of each day team members debriefed regarding their fieldnotes. After both trips had been completed, priority areas were extracted from fieldnotes and synthesised. Results: Although some health priorities were congruent across all groups, Community Members and Childcare staff tended to identify practical solutions while School and Clinic staff were focused on the clinical outcome. Community Members were particularly focused on the wider social and systemic factors impacting health. Conclusion: In response to the need for practical support, HealthLAB modified their health education packages to upskill mothers and sports coaches to provide brief health education sessions to local children and young people. So what? It is recognised that many health promotion programs focus on individual behaviours without creating supportive environments. While it was out of scope for HealthLAB to address physical environmental factors, by building local capacity and knowledge to deliver health education, the program can contribute to a healthier and supportive social environment.

For Australian university students living out of reach of a campus and studying online, the growing presence of Regional University Centres (RUCs) is changing their student experience for the better. People from regional areas of Australia are historically under-represented at university. Those who begin university are at higher risk of not completing their qualifications than students from metropolitan areas. COVID-19 restrictions in the past two years have added to the continued growth in regional students studying their degrees online. A recent survey of students attending a Country Universities Centre (CUC) within their local community shows these centres to be highly effective in supporting regional students. The participants overwhelmingly reported improvements not only in their academic progress and results, but also in their motivation, confidence, and likelihood of completing their qualification.

BACKGROUND: A healthy start predicts better health in later life. Many remote-living Aboriginal and Torres Strait Islander Australian families lack access to consistent, culturally-safe health services. This paper presents a study of implementation of the Baby One Program (BOP). The BOP was designed as a family-centred, Indigenous Healthworker-led, home-visiting model of care focused on promoting family health to give children the best start to life. It was developed by Aboriginal community-controlled Apunipima Cape York Health Council and delivered in Queensland Cape York remote communities. We aimed to determine how the BOP was implemented, enablers, strategies used and formative implementation outcomes. METHODS: The qualitative approach utilised theoretical and purposive sampling to explore people's experiences of a program implementation process. Data were generated from semi-structured interviews with four family members enrolled in the BOP and 24 Apunipima staff members. In addition, twenty community members, including two program users, participated in a men's community focus group. The findings are presented according to themes arising from the data. RESULTS: The BOP was rolled out in nine remote Cape York communities between July 2014 and December 2015 and there was high uptake. Indigenous Healthworkers were supported by midwives and maternal and child health nurses to deliver health education to 161 eligible families. The key to effective implementation of family-centred care appeared to be the relationships formed between health practitioners, especially Indigenous Healthworkers, and families. The data revealed the following themes: challenging environments for new families and valuing cultural ways, resourcing program delivery, working towards a team approach, negotiating the cultural interface, engaging families, exchanging knowledge through 'yarning', strengthening the workforce, and seeing health changes in families. Healthworker education and training, and knowledge exchange between Healthworkers, midwives and nurses was critical to program effectiveness. The program continues to grow despite substantial logistic, financial and practical challenges. CONCLUSIONS: This study describes an evolving process and explores how health providers connect with families and how the program responds to family and cultural issues. Program development is ongoing; strengthened by more community-level involvement, embedded strategies for ongoing self-evaluation and continuous quality improvements that are responsive to family needs.

Summary Background Australian First Nations children are at very high risk of early, recurrent, and persistent bacterial otitis media and respiratory tract infection. With the PREVIX randomised controlled trials, we aimed to evaluate the immunogenicity of novel pneumococcal conjugate vaccine (PCV) schedules. Methods PREVIX_BOOST was a parallel, open-label, outcome-assessor-blinded, randomised controlled trial. Aboriginal children living in remote communities of the Northern Territory of Australia were eligible if they had previously completed the three-arm PREVIX_COMBO randomised controlled trial of the following vaccine schedules: three doses of a 13-valent PCV (PCV13; PPP) or a ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; SSS) given at 2, 4, and 6 months, or SSS given at 1, 2, and 4 months followed by PCV13 at 6 months (SSSP). At age 12 months, eligible children were randomly assigned by a computer-generated random sequence (1:1, stratified by primary group allocation) to receive either a PCV13 booster or a PHiD-CV10 booster. Analyses used intention-to-treat principles. Co-primary outcomes were immunogenicity against protein D and serotypes 3, 6A, and 19A. Immunogenicity measures were geometric mean concentrations (GMC) and proportion of children with IgG concentrations of 0·35 μg/mL or higher (threshold for invasive pneumococcal disease), and GMCs and proportion of children with antibody levels of 100 EU/mL or higher against protein D. Standardised assessments of otitis media, hearing impairment, nasopharyngeal carriage, and developmental outcomes are reported. These trials are registered with ClinicalTrials.gov (NCT01735084 and NCT01174849). Findings Between April 10, 2013, and Sept 4, 2018, 261 children were randomly allocated to receive a PCV13 booster (n=131) or PHiD-CV10 booster (n=130). Adequate serum samples for pneumococcal serology were obtained from 127 (95%) children in the PCV13 booster group and 126 (97%) in the PHiD-CV10 booster group; for protein D, adequate samples were obtained from 126 (96%) children in the PCV13 booster group and 123 (95%) in the PHiD-CV10 booster group. The proportions of children with IgG concentrations above standard thresholds in PCV13 booster versus PHiD-CV10 booster groups were the following: 71 (56%) of 126 versus 81 (66%) of 123 against protein D (difference 10%, 95% CI −2 to 22), 85 (67%) of 127 versus 59 (47%) of 126 against serotype 3 (−20%, −32 to −8), 119 (94%) of 127 versus 91 (72%) of 126 against serotype 6A (−22%, −31 to −13), and 116 (91%) of 127 versus 108 (86%) of 126 against serotype 19A (−5%, −13 to 3). Infant PCV13 priming mitigated differences between PCV13 and PHiD-CV10 boosters. In both groups, we observed a high prevalence of otitis media (about 90%), hearing impairment (about 75%), nasopharyngeal carriage of pneumococcus (about 66%), and non-typeable H influenzae (about 57%). Of 66 serious adverse events, none were vaccine related. Interpretation Low antibody concentrations 6 months post-booster might indicate increased risk of pneumococcal infection. The preferred booster was PCV13 if priming did not have PCV13, otherwise either PCV13 or PHiD-CV10 boosters provided similar immunogenicity. Mixed schedules offer flexibility to regional priorities. Non-PCV13 serotypes and non-typeable H influenzae continue to cause substantial disease and disability in Australian First Nation's children. Funding National Health and Medical Research Council (NHMRC).

This thesis examines the explanatory power of social capital theory as an aid to understanding disadvantaged socio-economic circumstances prevailing in many contemporary remote Aboriginal communities. The term ‘social capital’ refers to social resources that fuel human cooperation such as relationships, civic engagement, support and norms of reciprocity and trust. There are several strands of ‘social capital’ theory, but it is Putnam’s take that is my main focus. His ‘Bowling Alone: America’s Declining Social Capital’ (1995) analysed the state of community relatedness in the United States. By contrast my thesis explores the extent to which a social capital framework might be useful in seeking to understand the nature of connections between Aboriginal people in remote Australia. How is social capital formed and eroded in this vastly different context? The contemporary relevance of the thesis is that it is occurring against the backdrop of widespread concern about wellbeing and cohesion in remote communities. By seeking to explain the phenomena through a social capital analytic lens, the thesis provides a relational perspective on Aboriginal advantage and disadvantage. The focus is on the quality and nature of relationships. The significance of social capital theory is that it purports to account for “why some societies or groups work better than others, despite having comparable economic or material resources” (Cox & Caldwell, 2000: 58). It is the development of an understanding of remote Aboriginal community disadvantage through the prism of a social capital theoretical framework that is this study's original contribution to knowledge. While the concept is not new, its application in this context is. The thesis occupies contentious intellectual territory because ‘social capital’ is a ‘white western’ concept that may have little cross-cultural applicability or resonance. Yet despite limitations, it is nevertheless argued the concept provides useful analytical insights into the functioning of remote Aboriginal communities. A perspective informed by theorising about social capital, at least as Robert Putnam understands that term, might guide strategies that make for ‘stronger’ (thriving and prosperous) communities

INTRODUCTION: Health promotion is a key component of comprehensive primary health care. Health promotion approaches complement healthcare management by enabling individuals to increase control over their health. Many primary healthcare staff have a role to play in health promotion practice, but their ability to integrate health promotion into practice is influenced by their previous training and experience. For primary healthcare staff working in rural and remote locations, access to professional development can be limited by what is locally available and prohibitive in terms of cost for travel and accommodation. This study provides insight into how staff at a large north Queensland Aboriginal community controlled health service access skill development and health promotion expertise to support their work. METHODS: A qualitative exploratory study was conducted. Small group and individual semi-structured interviews were conducted with staff at Apunipima Cape York Health Council (n=9). A purposive sampling method was used to recruit participants from a number of primary healthcare teams that were more likely to be involved in health promotion work. Both on-the-ground staff and managers were interviewed. All participants were asked how they access skill development and expertise in health promotion practice and what approaches they prefer for ongoing health promotion support. The interviews were transcribed verbatim and analysed thematically. RESULTS: All participants valued access to skill development, advice and support that would assist their health promotion practice. Skill development and expertise in health promotion was accessed from a variety of sources: conferences, workshops, mentoring or shared learning from internal and external colleagues, and access to online information and resources. With limited funds and limited access to professional development locally, participants fostered external and internal organisational relationships to seek in-kind advice and support. Irrespective of where the advice came from, it needed to be applicable to work with Aboriginal and Torres Strait Islander remote communities. CONCLUSIONS: To improve health outcomes in rural and remote communities, the focus on health promotion and prevention approaches must be strengthened. Primary healthcare staff require ongoing access to health promotion skill development and expertise to increase their capacity to deliver comprehensive primary health care. Practice-based evidence from staff working in the field provides a greater understanding of how skill development and advice are accessed. Many of these strategies can be formalised through organisational plans and systems, which would ensure that a skilled health promotion workforce is sustained.

Background There is sparse evidence in the literature in relation to indications and outcomes among adult Indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between Indigenous and non-Indigenous patients were assessed. Methods Self-reported Indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between Indigenous and non-Indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes. Results Of the 403 patients, 111 (28%) were Indigenous and Indigenous patients were younger (mean difference 11?years) and higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, though Indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, Indigenous patients had higher presence of S. Pneumoniae (30% vs 9%), while non-Indigenous patients had higher presence of P. Aeruginosa (43% vs 11%) and of mycobacteria (15% vs 4%). There were no significant difference between Indigenous and non-Indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%). Conclusions This study has demonstrated that adult Indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and to demonstrate differing microbiology with no significant difference in the outcomes for lung malignancy. Ethnic status or remoteness should not preclude Indigenous patients to undergo a FB if clinically indicated. This article is protected by copyright. All rights reserved.