Remote Australia Online

Increased scrutiny and contestation over recent water allocation practices and licencing decisions in the Northern Territory (NT) have exposed numerous inadequacies in its regulatory framework. Benchmarking against the National Water Initiative shows that NT lags behind national standards for water management. We describe key weaknesses in NT?s water law and policy, particularly for Indigenous rights and interests. NT is experiencing an acceleration of development, and is conceptualised as a 'hydrological frontier', where water governance has institutionalised regulatory spaces of inclusion and exclusion that entrench and (re)produce inequities and insecurities in water access. Regulations demarcate spaces in which laws and licencing practices provide certainty and security of rights for some water users, with opportunities to benefit from water development and services, while leaving much of NT (areas predominantly owned and occupied by Indigenous peoples) outside these legal protections. Water allocation and planning, as well as water service provision, continue to reinforce and reproduce racialised access to (and denial of) water rights. Combining an analysis of the law and policies that apply to water for economic development with those designed to regulate domestic water supply, we present a comprehensive and current picture of water insecurity for Indigenous peoples across the NT.

Introduction A better understanding of the predictors of compassion satisfaction and compassion fatigue in health care workers in rural and remote communities is needed to inform preventative interventions for this sector of the health workforce. Objective To identify predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations. Design A scoping review informed by Arksey and O'Malley's five-stage framework and the scoping review protocol of the PRISMA-ScR statement. Findings The search yielded 946 articles, and 34 full texts were screened for eligibility, leaving 12 studies meeting the inclusion criteria. No studies on workers providing rehabilitation services were identified. Three studies assessed possible predictors of compassion satisfaction and compassion fatigue in health care workers, and all studies evaluated burnout. The most studied predictor variables were age, gender, profession and workload. Discussion This study identified potential risk and protective factors for health care workers that are likely relevant to those providing rehabilitation services in rural locations. Little is known about possible predictors of compassion satisfaction and compassion fatigue in professionals working in rural and remote areas outside of medicine and nursing or health care workers in rural community-based settings. Conclusion Research examining predictors of compassion satisfaction and compassion fatigue in rehabilitation health care workers working in rural and remote locations is scant. Research that identifies risk and protective factors in this rapidly growing sector of the health care workforce is needed to inform the development of interventions that promote professional quality of life.

This paper reports on the design requirements for Australian Aboriginal houses. Unfortunately, funding agencies and architects in the Indigenous housing sector consistently continue to provide houses to Indigenous people that are equipped for relatively small nuclear families, which results in a lack of fit between the housing designs and the Aboriginal domiciliary behaviours; yet government agencies are often guilty of imposing the former on the latter. Although this housing sector has frequently involved public servants, builders, engineers and architects since the 1960s, there has been negligible involvement by interior designers. Nevertheless, an understanding of the culturally distinct Aboriginal domiciliary behaviour should inform the process of the interior design of remote-area Aboriginal houses. There is potential for interior designers to expand their professional involvement in Aboriginal housing provision, provided that a sound and sensitive cross-cultural design methodology can be acquired and applied within the context of all-too-often constrained budgets and mainstreaming policies of government, which typically may mitigate against such involvement.

Programmes to recognise and manage the prevalence of chronic disease represent a sea change in healthcare for Indigenous Australians, writes Wendy HoySince the late 1980s chronic non-communicable disease (hypertension, type 2 diabetes, kidney disease, cardiovascular disease, and chronic lung disease) has appeared among Aboriginal people living in remote areas of Australia in proportions sometimes described as “epidemic.” Transitional and minority populations worldwide are experiencing the same phenomenon, said to represent the major global health challenge of the 21st century.In Aborigines, these conditions have arisen because of rapid changes in epidemiology and health services. Sharp reductions in infant and childhood deaths in the past 45 years mean more Aboriginal people are surviving to adult life and adult life expectancy has, more recently, also been increasing as preventable and treatable problems such as infections and malnutrition are mitigated. Regrettably, a background of pervasive disadvantage persists, characterised by poverty, poor diet, lack of exercise, poor housing, poor education, lack of training and employment opportunities, along with high rates of cigarette smoking, and misuse of alcohol and other substances.However, awareness and management of these chronic diseases in Aboriginal people in remote areas have been transformed since the late 1990s.

Objectives To describe trends in ages and causes of death in a remote-living Australian Aboriginal group over a recent 50-year period.Design A retrospective observational study, from 1960 to 2010, of deaths and people starting dialysis, using data from local clinic, parish, dialysis and birthweight registers.Setting A remote island community in the Top End of Australia’s Northern Territory, where a Catholic mission was established in 1911. The estimated Aboriginal population was about 800 in 1960 and 2260 in 2011.Participants All Aboriginal residents of this community whose deaths had been recorded.Outcome measures Annual frequencies and rates of terminal events (deaths and dialysis starts) by age group and cause of death.Results Against a background of high rates of low birth weight, 223 deaths in infants and children and 934 deaths in adults (age > 15 years) were recorded; 88% were of natural causes. Most deaths in the 1960s were in infants and children. However, over time these fell dramatically, across the birthweight spectrum, while adult deaths progressively increased. The leading causes of adult natural deaths were chronic lung disease, cardiovascular disease and, more recently, renal failure, and rates were increased twofold in those of low birth weight. However, rates of natural adult deaths have been falling briskly since 1986, most markedly among people of age ≥45 years. The population is increasing and its age structure is maturing.Conclusions The changes in death profiles, the expression of the Barker hypothesis and the ongoing increases in adult life expectancy reflect epidemiological and health transitions of astonishing rapidity. These probably flow from advances in public health policy and healthcare delivery, as well as improved inter-sectoral services, which are all to be celebrated. Other remote communities in Australia are experiencing the same phenomena, and similar events are well advanced in many developing countries.

Barker et al. proposed that low birth weight predisposes to higher death rates in adult life. We previously confirmed this fact in a cohort of young adults who were born in a remote Australian Aboriginal community between 1956 and 1985. We now present data in these same people with four more years of follow-up and a greater number of deaths. The fates of participants were documented from age 15 years until death, start of dialysis, or until the end of 2010 and causes of death were derived from clinic narratives and dialysis records. Rates of natural deaths were compared by birth cohorts and birth weight, and hazard ratios were calculated using Cox proportional hazards methods, by birth weight and adjusted for birth cohort and sex. Over follow-up of 19,661 person-years, 61 people died of natural causes between age 15 and the censor date. Low birth weights (< 2.5 kg) were associated with higher rates of natural death, with HR (95% CI) 1.76 (1.1–2.9, P=0.03), after adjustment for year of birth and sex. The effect was particularly prominent for deaths at <41 years of age, and with deaths from respiratory conditions/sepsis and unusual causes. A predisposing effect of low birth weight on adult deaths was confirmed. This phenomenon, occurring in the context of dramatically improved survivals of lower birth weight infants and children since the early 1960s, helps explain the current epidemic of chronic disease in Aboriginal people. Birth weights continue to improve, so excess deaths from this source should progressively be minimized.

Objectives: To investigate the association between low birthweight (LBW; <2,500 grams) and cardiovascular disease (CVD) hospitalisations in adult life in a remote Indigenous Australian community. Methods: This was a prospective cohort of 852 participants with recorded birthweight using community-wide health screening examinations conducted between 1992 and 1999 and hospitalisation records up to 2012. Cox proportional hazard models assessed the association between LBW and hypertension, major CVD (heart failure, myocardial infarction and stroke) and any CVD hospitalisations. Results: There were 236 participants (28%) who had a low birthweight. The LBW group had a higher risk of developing any CVD (HR = 1.43, 95%CI 1.01-2.03), major CVD (HR = 1.51, 95%CI 0.93-2.47) and hypertension (HR = 1.83, 95%CI 1.09-2.96) than the normal birthweight (NBW) group (≥2,500 g). Women with LBW had more than 2.6 times the risk of a hospitalisation associated with hypertension compared to their NBW counterparts (HR = 2.61, 95%CI 1.38-4.93), but this relationship was not seen in men. Conclusions and implications: LBW increased the risk of cardiovascular disease hospitalisations in adult life in this group. Further CVD prevention initiatives should continue to include LBW as a key predictor of CVD in this community. The mechanisms of gender influence on the hypertension relationship are unknown and require further investigation in indigenous populations worldwide.

Low birth weight and large adult waist circumference increase the risk of cardiovascular disease in remote indigenous Australians — An 18year cohort study

Rates of cardiovascular and renal disease in Australian Aboriginal communities are high, but we do not know the contribution of inflammation to these diseases in this setting. In the present study, we sought to examine the distribution of C-reactive protein (CRP) and other markers of inflammation and their relationships with cardiovascular risk markers and renal disease in a remote Australian Aboriginal community. The study included 237 adults (58% of the adult population) in a remote Aboriginal community in the Northern Territory of Australia. Main outcome measures were CRP, fibrinogen and IgG concentrations, blood pressure (BP), presence of diabetes, lipids, albuminuria, seropositivity to three common micro-organisms, as well as carotid intima-media thickness (IMT). Serum concentrations of CRP [7 (5-13) mg/l; median (inter-quartile range)] were markedly increased and were significantly correlated with fibrinogen and IgG concentrations and inversely correlated with serum albumin concentration. Higher CRP concentrations were associated with IgG seropositivity to Helicobacter pylori and Chlamydia pneumoniae and higher IgG titre for cytomegalovirus. Higher CRP concentrations were associated with the following: the 45-54-year age group, female subjects, the presence of skin sores, higher body mass index, waist circumference, BP, glycated haemoglobin and greater albuminuria. CRP concentrations increased with the number of cardiovascular risk factors, carotid IMT and albuminuria independently of other risk factors. These CRP concentrations were markedly higher than described in other community settings and are probably related, in a large part, to chronic and repeated infections. Their association with markers of cardiovascular risk and renal disease are compatible with the high rates of cardiovascular and renal disease in this community, and provide more evidence of strong links between these conditions, through a shared background of infection/inflammation. This suggests that a strong focus on prevention and management of infections will be important in reducing these conditions, in addition to interventions directed at more traditional risk factors.

Remote-living and Indigenous Australians can experience menstrual health and hygiene challenges. The topic is not often openly discussed as it is considered private 'women's business'. We were invited into a remote Indigenous town and community to discuss the lived experience of menstruation with female students as well as clinical, educational and community workers. Our yarning circles and interviews collated 16 barriers in four clusters: structural living situation; knowledge, culture and behavior; discomfort and public life; and finances. Targeted efforts by relevant organizations, including schools and government agencies, were identified by participants to better support menstrual health and hygiene without associated pain, ranging moods and a sense of shame.

BACKGROUND: Rituximab, an anti-CD20 B-cell depleting monoclonal antibody, is increasingly prescribed off-label for a range of autoimmune diseases. There has not previously been an audit of off-label rituximab use in the Northern Territory, where the majority of patients are Aboriginal. AIMS: To evaluate retrospectively off-label rituximab use in autoimmune diseases in the Top End of the Northern Territory. METHODS: We performed a retrospective audit of 8 years of off-label rituximab use at the Royal Darwin Hospital, the sole tertiary referral centre for the Darwin, Katherine and East Arnhem regions. Electronic and paper records were reviewed for demographic information, diagnosis/indication for rituximab, doses, previous/concomitant immunosuppression, clinical outcomes and specific adverse events. RESULTS: Rituximab was prescribed off-label to 66 patients for 24 autoimmune diseases. The majority of patients (62.1%) were Aboriginal and 60.6% female. The most common indications were refractory/relapsing disease despite standard therapies (68.7%) or severe disease with rituximab incorporated into an induction immunosuppressive regimen (19.4%). Systemic lupus erythematosus was the underlying diagnosis in 28.8% of cases. A clinically significant response was demonstrated in 74.2% of cases overall. There were 18 clinically significant infections; however, 13 were in patients receiving concurrent immunosuppressive therapy. There was a total of nine deaths from any cause. CONCLUSION: Rituximab has been used off-label for a range of autoimmune diseases in this population with a high proportion of Aboriginal patients successfully and safely in the majority of cases.

Sufficient, well-maintained housing infrastructure can support healthy living practices for hygiene, safety and nutrition. This article focuses on the relationship between housing and health through a case study in the remote Barkly region in the Northern Territory, Australia. A research partnership between Anyinginyi Health Aboriginal Corporation and academic researchers employed a mixed methodological approach, involving interviews with residents, clinical and outreach staff, and clinical database analysis. The results revealed much higher levels of crowding in remote communities and in Tennant Creek than officially recorded, with up to 22 residents in surveyed households. Interviews with clinicians and public health staff highlighted the impact of crowding on infection transmission, poor sleep and reduced personal safety, and damage to health hardware. The database analysis detailed the types of preventable, hygiene-related infectious diseases that dominated, with over half of the total infectious disease diagnoses being skin, respiratory and ear, nose and throat infections. Repeated infection likely contributes to increased rates of chronic kidney and rheumatic heart diseases. The combined overall findings highlight the parallel conditions of the prevalence of hygiene-related infectious diseases, crowding and environmental health issues (including health hardware). No objective evidence of direct causal relationships was obtained due to the small scale and methodological limitations of the study. More complex future research is outlined in order to understand how to further investigate the burden of disease that the affects morbidity and mortality of Aboriginal Australians, and underlies the urgency for housing policy reform and funding to upgrade housing.

Objective To explore rural motor vehicle collision (MVC) fatalities by trends over time, mode of transport, age, state, sex, and Aboriginal and Torres Strait Islander status. Design A retrospective total population-based time series was conducted using the Australian Bureau of Statistics (ABS) death registration data. Setting All statistical local area (SLA) within Australia from 2006 to 2017. Participants Australian residents whose deaths were registered with the ABS between 01 January 2006 and 31 December 2017 where the underlying cause of death was related to unintentional transport accidents. Main outcome measures Fatality rates were determined using population data collected from the 2006, 2011 and 2016 census. Trends over time by rurality were analysed by financial year. Rates of transport deaths by vehicle type were determined by rurality. Risk ratios were calculated to compare demographic groups based on sex, Aboriginal and Torres Strait Islander status and age. A 3-year scorecard was organised by state and rurality using 99.7% confidence intervals. Results Motor vehicle collision fatalities increase with increasing remoteness. Females, children from 0 to 14 years, pedestrians, and Aboriginal and Torres Strait Islander peoples are at a significantly higher risk of fatal MVCs than their respective metropolitan counterparts. The 3-year scorecard indicates that road fatality rates in the NT, WA, and all rural and remote areas required immediate attention and targeted action. Conclusions There is a need for investment in MVC fatality prevention in rural Australia from inner regional to remote areas in order to meet the road safety targets established by the National Road Safety Strategy.

INTRODUCTION: The main objective of this study is to describe incidence rates of low-speed vehicle run-over (LSVRO) events among children aged 0-14 years residing in Queensland from 1999 to 2009. A second objective was to describe the associated patterns of injury, with respect to gender, age group, severity, characteristics (host, vehicle and environment), and trends over time in relation to geographical remoteness. Final results are hoped to inform prevention policies. METHODS: In this statewide, retrospective, population-based study, data were collected on LSVRO events that occurred among children aged 0-14 years in Queensland from 1999 to 2009 from all relevant data sources across the continuum of care, and manually linked to obtain the most comprehensive estimate possible of the magnitude and nature of LSVRO events to date. Crude incidence rates were calculated separately for males and females, for fatal events, non-fatal events (hospital admissions and non-admissions, respectively), and for all LSVRO events, for each area of geographical remoteness (major cities, inner regional, outer regional, remote/very remote). Relative risks and 95% confidence interval were calculated, and trends over time were examined. Data on host, injury and event characteristics were also obtained to investigate whether these characteristics varied between areas of remoteness. RESULTS: Incidence rates were lowest among children (0-14 years) living in major cities (13.8/100 000/annum, with the highest recorded incidence in outer regional areas (incidence rate =42.5/100 000/annum). Incidence rates were higher for children residing outside major cities for both males and females, for every age group, for each of the 11 years of the study, and consequences of LSVRO events were worse. Young children aged 0-4 years were identified as those most at risk for these events, regardless of geographical location. Differences were observed as a function of remoteness category in relation to injury characteristics (eg injury type), and host characteristics (eg sociodemographic status), but there were no observed differences in environmental characteristics (eg time of day, day of week). Heavy vehicles such as four-wheel drives, utilities, trucks and tractors were more frequently involved in LSVRO events that occurred outside major cities. CONCLUSION: The results confirmed that children of all ages and genders residing outside of major cities in Queensland are more at risk of being involved in an LSVRO incident, and experience more severe consequences compared to children in major cities. Future research should address the specific risk factors and focus on engaging rural communities to assist in the prevention of LSVRO incidents.

Spatial remoteness in the sense of great distances between population centres and limited access to public services is an on-going problem in Australian local government, where there exist large, sparsely populated regions dominated by the 'tyranny of distance'. From a public policy perspective, it is important to understand the impact of remoteness on local authorities. Accordingly, in this paper, we estimate the relationship between remoteness and financial sustainability using a 2014?2018 sample of Australian local governments. In general, we find only limited empirical evidence for a relationship between geographical remoteness and financial sustainability as we have proxied it.

In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures; to identify Northern Territory expenditure for primary health care; and to provide a three-to five?year development budget. Approximately 2100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services. (Aust N Z IPublic Health 1998; 22: 133?9)

With regards to end-of-life care, there is scant published research that looks specifically at the provision of palliative care services for Indigenous people. In addition, for Indigenous people in the rural and remote areas there is only limited literature that focuses on the problems associated with geography. To address the hiatus in the literature on Aboriginal, rural and remote palliative care, the following article provides findings from a two-year research project, funded by Australia's National Health and Medical Research Council (NH&MRC), which developed an innovative model for Indigenous palliative care. The data was collected through a qualitative methodology (descriptive phenomenology) which involved open-ended in-depth interviews, audio-recorded, transcribed verbatim and thematically analysed. The sub-set of findings from the study presented in this paper examine issues in relation to the many practical obstacles in relation to palliative care service provision to Indigenous people in the rural and remote areas. The findings are a testament to the ingenuity and dedication of those who provide end-of-life care for Aboriginal peoples in rural and remote locations. The information about the many obstacles associated with equipment, power, transport, distance and telephone access provide important insights to inform the development of health policy planning and funding. The topic is specifically relevant to nurses as further findings from the study indicate that clinic and community nurses are key health professionals providing care to Indigenous people in the rural and remote areas.

This chapter examines the changing presence of the state experienced in the lower gulf region of Queensland during the 20 years from 1992 when the High Court made its historic Mabo decision2 and negotiation of the Gulf Communities Agreement (GCA)3 commenced in earnest. Martin notes that the GCA’s ‘formal signing followed protracted regional negotiations, initially outside the ambit of the Native Title Act 1993 (Cth) (“the Act”) and involving the broader Gulf Aboriginal community’ (1998: 4). The 20 years under discussion covers the period of these negotiations, mine construction and commissioning and the production phase until the final (i.e. 15-year) review of that agreement as zinc production began to wane. The GCA is central to this case as the legislated mechanism for dealings between the signatories—namely the Queensland Government, the mining company and the designated ‘Native Title Groups’.4 This period, encompassing the major landmarks in the planning, commissioning and operating of this large mine, provides clear illustration of the leverage of diverse regional actors, both Indigenous and non-Indigenous groups of residents and various sections of government, to procure the state’s active presence and state action in the region. It also reveals that initial active engagement by the state faded to less direct involvement after production was underway and royalties were flowing. Our research investigates how the state presence was experienced and understood among Aboriginal people with respect to Century Mine and how that changed over time. We present the argument in three main sections, beginning by sketching the background to the Century case and the economic and Indigenous context. The main body of the chapter follows and details a sequence of phases of the state’s role in two pertinent policy areas: regional economic development and Indigenous affairs. It makes considerable reference to the GCA as a significant formal expression of the state’s ‘presence’ in the mining project since this agreement departed from the usual Indigenous benefit agreement configuration by including the Queensland Government as an active party rather than being confined to community and company undertakings (Scambary 2009). The evidence to underpin this argument is drawn largely from secondary sources and from a series of studies conducted by the authors in the region during the period under review (1992–2012). These studies employed diverse qualitative methods and allowed us to examine aspects of the state–community–company relationships that rely on the memories and perceptions of those directly involved in historic events.5 The final section of the chapter discusses the sequence of phases in relation to governance theories and concludes by noting the disparate views revealed about how present the state should be in a development like Century Mine and the critical, yet fragile, role that formal agreements can play in engaging the state and compelling its presence in mining-induced development—especially in peripheral localities.

Objectives To measure rates of detection via screening, perceived self-imposed delays in seeking medical attention, and support seeking in a sample of regional and remote people with a cancer diagnosis and to test whether an association exists between these behaviours and minimising problems and resignation, a need for self-control and reliance and fatalism. Correlations and binary logistic regressions were conducted to test the associations between demographic characteristics, attitudes and behaviours. Results Females were more likely to have had their cancer detected via screening (OR = 10.02, CI = 3.49-28.78). Younger participants (r = -0.103, p = 0.009) were slightly more likely to seek at least one form of support and online support was sought more often by younger patients (r = -0.269, p < 0.001), females (r = 0.152, p < 0.001), those from higher socio-economic (SES) areas (r = 0.100, p = 0.012), and those with higher education levels (r = 0.247, p < 0.001). Younger (r = -0.161, p < 0.001), and female (r = 0.82, p = 0.013), participants were also slightly more likely to seek support specifically through cancer support groups. No significant relationships between minimising problems and resignation, needs for control and self-reliance or fatalism and detection via screening, support seeking, or perceived self-imposed delays to seeking medical attention were apparent, with the exception that those with higher fatalism (predetermined health) were slightly less likely to report seeking support or information online (OR = 0.79, CI = 0.65-0.95) and slightly more likely to report using Cancer Council's support services (OR = 1.24, CI = 1.02-1.52). Conclusions Strategies to improve the accessibility and appropriateness of support available for regional and remote cancer patients should consider interventions that remove barriers to access associated with age, gender, and education as opposed to those which address the attitudinal traits measured here.

ISSUE ADDRESSED: In Australia, food sovereignty of traditional landowners has been marginalised by the globalisation of food systems and resulted in limited opportunities for children to experience familiar bush tucker foods as healthy choices, particularly in a school environment. Superhero Foods(®) themed teaching resources focus on the development of nutrition education materials that included traditional Aboriginal foods together with contemporary foods readily available in regional/remote communities. METHODS: Consultation with an Aboriginal expert and Aboriginal artist; local, regional/remote teachers and stakeholders informed the development of tailored resources including food cartoon characters, school lesson plans and a storybook. The latter was guided by a resource development model. Users of the resources were surveyed to ascertain the useability, alignment with the Australian Dietary Guidelines, cross-curricular learnings and cultural relevance. RESULTS: Respondents across regional/remote and urban locations completed a lesson plan and food character (clipart) survey (N = 51) and storybook survey (N = 14). Respondents advised the resources were relevant, enjoyable, engaging and culturally appropriate for all students regardless of Aboriginality. The resources provided learning opportunities for all children to enhance knowledge about Aboriginal culture and bush foods. Independent evaluation has further indicated the translation of messaging into student's knowledge and learning. CONCLUSIONS: Key enablers to the success of the resource included; free online access, the highly engaging nature of the resources and adaptability to be implemented across a number of Aboriginal language groups in WA. Ensuring visual representation of healthy choices was fundamental to reinforcing nutrition messaging. Superhero Foods resources are a positive and important inclusion in the health promotion toolbox for Aboriginal children. SO WHAT?: Superhero Foods are novel nutrition education resources depicting Aboriginal foods and Aboriginal children. These food literacy resources will engage children's understanding of Aboriginal culture, improve food literacy and strengthen equitable access for regional and remote communities.

The experience of transitioning to boarding schools away from home for Aboriginal secondary school students from regional and remote communities in Australia has not received the attention it deserves (Calma, 2009; Dodson, 2009). The weight of public discourse and a paucity in research provided strong testimony for undertaking the current study. Moreover, it was evident the voice of those Aboriginal students undertaking the experience was absent from this public dialogue and the literature. This qualitative research investigated from a social constructionist perspective how 32 male Aboriginal secondary school students from regional and remote communities constructed meaning and understanding around the experience of studying away from home at five boarding schools located in Perth, Western Australia (WA). While students’ experiences with being away at boarding school were explored, it also investigated how meaning was constructed around the experience of having a child away from home for 11 parents and the experience for 16 staff employed at boarding schools in supporting students. Congruent with the assertions of the National Health and Medical Research Council (NHMRC, 2003) this research was supported by an Aboriginal Advisory Group. A narrative interviewing style was used to collect data from student, parent, and staff informants. Thematic analysis of the data revealed three major themes emerged for student informants, these were 1) Decision Making and the sub-themes of Choice-Less Choice and Opportunity 2) Organisational Climate and the sub-themes of School Environment and Belonging, Culture Shock, Homesickness, Identity and Rites of Passage, Code-Switching, Teachers, Academic Expectations, Residential Life, and Friendships and Peer relations, and 3) Relational Change and the sub-themes of Family Dynamics, Friendships at home, and Cultural Connectedness. For parent informants the following major themes emerged from the data 1) Access, Standards and Quality, and the sub-themes of Declining Local Schools, Opportunity, and Worldliness 2) Parental Agency and the sub-themes of Parent-School Connection, Parenting Style, Communication, and Milestones and Siblings, and 3) Cultural Heritage and the sub-theme of Maintenance and Transmission. Finally, for staff informants the following major themes were identified 1) Indigenous Education and the sub-themes of Social Responsibility and Opportunity 2) Academic and Social Determinants and the sub-themes of Culture Shock, Homesickness, Friendships and Peer Support, Literacy and Numeracy, and Prejudice, Stereotypes, and Racism 3) Relationships and the sub-themes of Staff-Student Relationship, Staff-Parent Relationship, and School-Community Relationship. The key findings from each informant group are reviewed. However, to provide a wider discussion of informant’s experiences and constructions of the transition experience, attention is also drawn to meta-themes that were evident across the student, parent, and staff informant groups. The findings of this research are discussed in relation to policy and practice implications pertinent to boarding schools in WA. The strengths and limitations of the current research are considered and future research directions are suggested. This research offers a unique contribution to current understandings of the transition experience to boarding school for male Aboriginal secondary school students from regional and remote communities.

Aboriginal women experiencing sexual violence may not always access support services when needed, nor receive the most appropriate support when they do. Recent research suggests place-based, Aboriginal-led initiatives to respond to family and sexual violence in Aboriginal communities offer the best chance for developing effective responses. This article describes an innovative participatory action research project aiming to improve service delivery for Aboriginal women from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) region in remote central Australia. Over a series of workshops co-researchers worked intensively at the interface of knowledge systems creating a unique and safe space for exploring this issue. The process elicited learnings that have the potential to transform practice and was itself a trauma-informed healing opportunity for participants. The project was led by Aboriginal women who wished to share what was done so that others may benefit from working in this way.IMPLICATIONS Participatory action research can be an effective approach to improving service delivery for Aboriginal women who have experienced sexual violence.By working at the cultural and knowledge interface of Aboriginal and Western standpoints, and utilising contextually relevant means of engagement, deeper understandings of sexual violence and healing are the result for participants.Deeper intercultural understandings have the potential to lead to innovations in service delivery.

Aim: The aim of this study is to explore pharmacist perspectives of the implementation of a community pharmacy-based ear health service in rural communities. Method: A community pharmacy-based health service model was designed and developed to provide an accessible ear care service (LISTEN UP – Locally Integrated Screening and Testing Ear aNd aUral Program) and pharmacist’s perspectives of the implementation of LISTEN UP were explored. Thematic analysis was conducted and data coded according to the Consolidated Framework for Implementation Research. Results: A total of 20 interviews were conducted with 10 pharmacists, averaging 30 min. Visualistion of the ear canal was reported as the greatest advantage of the service, whilst the time required for documentation reported as a complexity. The number of pharmacists working at one time and the availability of a private consultation room were identified as the two limiting factors for execution. On reflection, the need for government funding for service viability and sustainability was highlighted. Discussion/Conclusion: Expanded pharmacy practice is emerging for the Australian pharmacy profession. Rural community pharmacists are recognised as integral members of healthcare teams, providing accessible medication supply and health advice to seven million people in Australia who call rural and remote regions home. However, there are no structured models supporting them to provide expanded services to improve health outcomes in their communities. This study provides lessons learnt to guide future design and development of expanded models of pharmacy practice.

This article presents the findings of a literature review of research on teacher preparation for rural settings. In the past there has been little or no preparation of teachers for rural teaching, with the emphasis placed on supporting beginning teachers once they commenced; now there is a strong movement to prepare preservice teachers adequately before their first teaching appointment. However, what has become clear is that the focus of research has been predominantly on primary and secondary education. In the authors’ search they have not been able to identify a substantial body of literature about the preparation of early childhood educators for rural practice. The discussion considers the relevance of the findings for the early childhood sector, exploring possibilities for future research both in early childhood settings and in teacher education in general in light of government agendas and policy initiatives. [Author abstract]

Mobile apps have the potential to support collaborative fieldwork even where web connectivity is unreliable or unavailable. To explore this potential, we developed portable network infrastructure and custom-made field tool apps. We deployed this solution in remote communities in the far north of Australia, in connection with co-located cooperative language work. Throughout a series of visits, we worked with community members to iterate the designs, optimising their suitability for the tasks and the context. We found that custom toolmaking provides the benefits of digital collaboration tailored for the specific needs of the environment and community. However, we argue that it is activity design – not the technology itself – that must be foregrounded, placing fieldworkers in the driving seat of innovation in digital fieldwork practice.