Remote Australia Online

INTRODUCTION: After-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia. AIM: To review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities. METHODS: The proposed scoping review will be conducted using the Arksey and O'Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders' perceptions and benefits and challenges of the services.

Background: Aboriginal people in the Northern Territory (NT) suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. As there are few dialysis services in remote areas, many Aboriginal people are required to relocate often permanently, to access treatment. Missing dialysis treatments is not uncommon amongst Aboriginal patients but the relationship between location of dialysis service and dialysis attendance (and subsequent hospital use) has not been explored to date. Aim: To examine the relationships between location of dialysis service, dialysis attendance patterns and downstream health service use (overnight hospital admissions, emergency department presentations) among Aboriginal patients in the NT. Methods: Using linked hospital and dialysis registry datasets we analysed health service activity for 896 Aboriginal maintenance dialysis patients in the NT between 2008 and 2014. Multivariate linear regression and negative binomial regression analyses explored the associations between dialysis location, dialysis attendance and health service use. Results: We found missing two or more dialysis treatments per month was more likely for Aboriginal people attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. However, we found higher dialysis attendance and lower health service utilisation for those receiving care in rural and remote settings. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, among Aboriginal people from remote areas, those dialysing in remote areas had lower rates of hospitalisations (IRR 0.56; P < 0.001) when compared to those who relocated and dialysed in urban areas. Conclusion: There is a clear relationship between the provision and uptake of dialysis services in urban, rural and remote areas in the NT and subsequent broader health service utilisation. Our study suggests that the low dialysis attendance associated with relocation and care in urban models for Aboriginal people can potentially be ameliorated by access to rural and remote models and this warrants a rethinking of service delivery policy. If providers are to deliver effective and equitable services, the full range of intended and unintended consequences of a dialysis location should be incorporated into planning decisions.

The overarching objective of the Fellowship entitled ‘You going to uni?’: Exploring how regional, rural and remote people navigate into and through university’, was to explore risks to university completion for those in regional, rural and remote locations of Australia. While the original proposal focused on regional students, the participation of some from remote regions broadened this focus. However, to also be inclusive of rural students, the acronym ‘RRR’ will be adopted throughout the report, as widely accepted when referring collectively to regional, rural and remote1 (Roufeil and Battye, 2008). Where appropriate, however, distinctions will be made between these groupings. The problem motivating the Fellowship inquiry was the consistently low rates of university completion for RRR students over the past decade. According to Australian Bureau of Statistics (ABS) data (2021), the proportion of RRR people with a degree qualification remains half that of people in major cities. Thus, the aim of the fellowship was to understand what factors contribute to this persistent disparity, and by taking a strengths-based approach to also capture what enables students to persist.

Context and issues: The introduction of individualised funding under the National Disability Insurance Scheme in Australia aimed to increase individual choice and control over how people received disability supports. An increase in the allied health disability workforce was anticipated; however, disability workforce sector reports have consistently indicated difficulties in attracting and retaining sufficient allied health staff to satisfy current and future demand. Autism spectrum disorder is the most prevalent primary diagnosis of participants receiving individualised funding to date and requires support staff to have specialised skills and experience. Given that overall staff attraction and retention issues are reported to be exacerbated in regional and remote areas of Australia, it is important to seek innovative ways of supporting individuals on the autism spectrum in their local communities. Technology has the potential to provide a timely and low-cost alternative that extends access to specialist services for people in remote locations. The current project aimed to identify the feasibility, essential requirements and potential barriers in delivering therapy support to regional and remote participants on the autism spectrum via video-conferencing technology. Lessons learned: A multidisciplinary team (speech pathologist, occupational therapist, psychologist and a special educator) were recruited and trained to deliver tele-therapy services to 16 participants on the autism spectrum, in collaboration with their families and local support teams. Participants resided in two northern, nine western and one southern regional area in New South Wales (NSW), Australia. There were three sets of siblings. One participant resided on remote Lord Howe Island off the coast of northern NSW. Researchers used semi-structured telephone interviews to gain insight into the program from key stakeholder groups including parents, education staff, allied health professionals and tele-therapists. A general inductive approach to data analysis was used under five project evaluation areas. The evaluation focused on five areas including: development of the tele-health delivery team, understanding the role of collaboration, examining the need for autism-specific support, establishing the need for in-person contact and identifying barriers to success. The project evaluation found that investment in staff training and support was key to building a competent tele-therapy team and delivering successful tele-therapy services under a sustainable model. For many families and support team members, collaboration was reported as an important part of the tele-therapy program, with families and teachers finding it helpful to work together with the same information. The evaluation confirmed that access to autism-specific knowledge and support was novel and regarded as beneficial for families and support teams living in regional and remote areas. There were mixed responses to the inclusion of in-person support as part of a tele-therapy service. While some families felt a tele-therapy service was no different to in-person services, other families and tele-therapists indicated that the addition of at least one in-person session would help to increase rapport. Barriers within the tele-therapy model included scheduling and local staff changes, as well as the delivery of intervention requiring physical support. Technology was not seen as a barrier in the current study. This research adds to the growing body of information supporting the use of tele-practice for geographically isolated regions. Ideally, tele-therapy should not replace in-person services; however, it is necessary when no other comparable service option is available locally. Larger scale research is needed to compare blended, online and in-person models so that an optimal ratio can be established.

Aim: The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018–2019. Background: Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child’s life. Methods: The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead. Findings: Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects. The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities.

In central Australia, an area that is endemic for the human T-cell leukaemia virus type-1 (HTLV-1), the prevalence of Strongyloides stercoralis and its association with other health conditions are unknown. A cross-sectional community-based survey was conducted in seven remote Aboriginal communities in central Australia, from 2014 to 2018. All residents aged ≥10 years were invited to complete a health survey and to provide blood for Strongyloides serology, HTLV-1 serology and HTLV-1 proviral load (PVL). Risk factors for Strongyloides seropositivity and associations with specific health conditions including diabetes and HTLV-1 were determined using logistic regression. Overall Strongyloides seroprevalence was 27% (156/576) (children, 22% (9/40); adults (≥15 years), 27% (147/536), varied widely between communities (5–42%) and was not associated with an increased risk of gastrointestinal, respiratory or dermatological symptoms. Increasing age, lower HTLV-1 PVL (<1000 copies per 10^5 peripheral blood leucocytes) compared to the HTLV-1 uninfected group and community of residence were significant risk factors for Strongyloides seropositivity in an adjusted model. A modest reduction in the odds of diabetes among Strongyloides seropositive participants was found (aOR 0.58, 95% CI 0.35, 1.00; p = 0.049); however, this was lost when body mass index was included in the adjusted model (aOR 0.48, 95% CI 0.48, 1.47; p = 0.542). Strongyloides seropositivity had no relationship with anaemia. Exploring social and environmental practices in communities with low Strongyloides seroprevalence may provide useful lessons for similar settings.

Background: The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. Methods/design: The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. Discussion: There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world.

The abuse of technology by perpetrators of domestic violence is ‘spaceless’; however, in this article, we argue that experiences of and responses to digital coercive control are shaped by both the place (geographic location) and space (practical and ideological features of a location) that a victim/survivor and criminal justice agency occupy. We examined this issue by conducting interviews and focus groups with 13 female victim/survivors in regional, rural and remote Australia. All participants had contact with police as part of their help-seeking for domestic violence, and some suggested that officers sometimes paralleled perpetrator behaviours, resulting in a narrowing of women’s ‘space for action’. We conclude that, in the interests of protecting and empowering women, socio-spatial frameworks must be considered by practitioners and researchers, and there should be a concerted effort to expand resourcing and training for justice agencies beyond the cityscape.

Introduction As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. Objective To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. Design Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. Findings 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. Discussion Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. Conclusion Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.

INTRODUCTION: Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. METHODS: Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. RESULTS: The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. CONCLUSIONS: The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

INTRODUCTION: Rural health workforce issues are a priority area for the Australian Government and substantial funding has been provided for rural education programs to address health workforce disparities across Australia's rural and remote communities. The Australian Government established a Rural Health Strategy in 2001 and as a result there are now 14 rural clinical schools in Australia. The 2008 Urbis Report highlighted the lack of research on rural programs and workforce outcomes, essential to ensuring that educational efforts, resources and funding are being concentrated appropriately. This study examined the Australian National University (ANU) Medical School's 4 year rural program to identify the impact of elective and compulsory program components on student intentions to practice in a rural and remote location post-graduation. The study also explores factors that affect student decisions to apply for year-long rural placements. METHODS; ANU Medical School's graduating cohort of 2008 fourth year medical students completed an anonymous and voluntary online survey questionnaire. Survey sections included student demographics, compulsory and elective components of the ANU rural program, and an overall evaluation of the ANU rural curriculum. The survey contained a mixture of forced-answer questions and open-ended commentary. Quantitative data were analyzed for descriptive and frequency statistics using EpiInfo V3.5.1 (http://wwwn.cdc.gov/epiinfo/ http://wwwn.cdc.gov/epiinfo/). Qualitative data were reviewed and consistent themes among responses extracted. RESULTS: In total, 40 students from a cohort of 88 (45%) responded, with 26 respondents (65%) indicating that at medical school commencement they considered working in a rural or remote area. At the end of their medical education, 33 respondents (82%) indicated their intention to spend some time in their careers working in a rural or remote area. Students from non-rural backgrounds had greater positive change in their intentions to practice rurally as a direct effect of ANU rural programs when compared with students from rural backgrounds. More than 70% of students believed the amount of rural focus in the curriculum was correct, 75% believed that they will be better medical practitioners because of the program, and 85% found the curriculum was delivered effectively. Students who undertook elective rural programs such as a year-long rural placement were more likely to have future rural career intentions when compared with students undertaking compulsory rural components. Compulsory components, however, had a strong influence on students applying for elective programs. Regarding application for the year-long rural placement, students reported clinical exposure was the most encouraging factor, and time away from family and friends, and lack of spousal and family support were the most discouraging factors. CONCLUSION: Rural programs at the ANU, and medical school exposure to rural health experiences is important in influencing students' perceptions of a career in rural and remote health. This study provides evidence that both compulsory and elective components contribute to a successful holistic rural program which nurtures the rural interest of all students. Overall, students at the ANU medical school were satisfied with the rural curriculum. The results confirm that there is difficulty in recruiting students with family commitments into year-long rural placement programs, despite incentives. Those students who select long-term rural study for reasons other than an interest in a career in rural health end the program with positive rural intentions.

Summary Background Benefits of breastfeeding on infant growth in children born to mothers with gestational diabetes mellitus (GDM) are uncertain. Objectives To describe growth trajectories between birth and 14 months according to breastfeeding and maternal hyperglycaemia in pregnancy, and assess associations between breastfeeding and 14 month growth outcomes among children born to mothers with GDM. Subjects/methods Data on 258 Aboriginal and Torres Strait Islander infants from the PANDORA study born to mothers with normoglycaemia (n = 73), GDM (n = 122), or with pre-existing type 2 diabetes (n = 63) in pregnancy were assessed. Infant weight and BMI growth trajectories according to predominant breastfeeding at 6 months and hyperglycaemia in pregnancy were developed using mixed-effect models and cubic splines. Associations between breastfeeding and 14-month growth outcomes (z-scores: weight-for-age, weight-for-length and BMI) were evaluated using linear regression in a subgroup of infants born to mothers with GDM. Results Predominantly breastfed infants had lower BMI trajectories compared to those not predominantly breastfed, irrespective of maternal hyperglycaemia in pregnancy status (p < 0.01 for all groups), and lower weight trajectories among those born to mothers with GDM (p = 0.006). Among offspring of women with GDM, predominant breastfeeding was only associated with lower weight-for-age at 14 months, however adjusting for maternal obesity, smoking, and parity attenuated observed associations. Maternal obesity remained significantly associated with greater infant growth. Conclusions Predominant breastfeeding was associated with reduced growth among children born to women with and without hyperglycaemia in pregnancy. However, among children exposed to GDM in utero, maternal obesity largely explained this association.

The proposed study was developed in response to increased suicide risk identified in Aboriginal and Torres Strait Islander students who are compelled to attend boarding schools across Queensland when there is no secondary schooling provision in their remote home communities. It will investigate the impact of a multicomponent mentoring intervention to increase levels of psychosocial resilience. We aim to test the null hypothesis that students’ resilience is not positively influenced by the intervention. The 5-year project was funded by the Australian National Health and Medical Research Council from December 2014.

Aim: To trial the Brigance developmental screening tool as an instrument for identifying Australian Aboriginal children at risk of developmental disability and requiring diagnostic developmental assessment. Methods: We conducted a cross-sectional study of Australian Aboriginal children, aged 3-7 years, resident in three remote communities in the Northern Territory. Following informed consent, children were screened by a paediatrician using the Brigance screen. Results: There were 195 children identified as eligible, and 124 (64%) participated. All children screened, scored below the cut-off for detecting children likely to have developmental disabilities or academic delays. Furthermore, all children scored below the at-risk cut-offs that indicate high probability of disabilities in at-risk children. Conclusions: The Brigance screen identified all children in these high-risk Aboriginal communities as well behind their age peers. Language and cultural relevance, and the method of administration limit the use of this screening tool. However, we cannot ignore the uniformly poor performance on a mainstream tool used with children expected to succeed in a mainstream educational setting. Recommendations include adapting an appropriate instrument to guide developmental surveillance and monitoring in remote Australian Aboriginal communities. This study further supports the pressing need for quality early childhood services that address the significant risk confronting Aboriginal children and prepare them in a way that ensures school and future success.

As part of ongoing quality assurance, the effectiveness of the school screening program in meeting the health needs of Aboriginal children in a rural district in the Northern Territory Top End was evaluated. The major health problems of Aboriginal children were analysed for their suitability for screening programs. A prospective cross-sectional study used routinely collected field data from the school screening program in 1993. To ascertain follow-up, children who had failed screening tests had their clinic notes reviewed. A total of 774 children from 11 remote communities were screened. The results confirmed high level of disease, with rates for anaemia, malnutrition and trachoma reaching 39%, 22% and 26% respectively. Nearly one-third failed the hearing screening, urinalysis was abnormal in 19%, 3% failed visual acuity and 6% were considered to have abnormal heart auscultation. Many of the major health problems did not meet the recommended criteria for screening programs and others would be better dealt with by ongoing surveillance rather than a single screening. Some abnormalities found on screening were inadequately investigated and/or treated. This evaluation has demonstrated a limited role for school screening in identifying and meeting the health needs of Aboriginal children living in remote areas. In collaboration with the NT Department of Education, a school-age child health policy, including a new school-age child health surveillance program, is being developed. This promotes greater participation by communities, families and schools with the aim of improving the health and learning outcomes for all school-age children in the NT.

Background/Aims: Fetal alcohol spectrum disorders (FASD) are associated with problematic behaviours, but little is known about the behavioural challenges of remote Australian Aboriginal children. Behaviour was investigated in remote Australian Aboriginal children assessed for the Lililwan Project. We hypothesised that behaviour would be poorer in children with FASD compared to those without FASD. Methods: Children (n = 108) were assessed using the parent/carer-rated Child Behavior Checklist (CBCL), and teacher-rated Teacher Report Form (TRF). Proportions scoring within “Normal/Borderline/Clinical” ranges were determined. Chi-square and Mann-Whitney U tests were used to compare scores and frequencies of Critical Items (highly concerning specific behaviours) for FASD versus Non-FASD groups. Results: Participants were aged 7.4–9.6 years, and 21 had an FASD. Ninety-seven parents/carers completed the CBCL, and 106 teachers completed the TRF. Academic performance was the most common “Clinical” problem (73%). TRF scores were lower in the FASD group on 13 scales encompassing Attention, Academic performance, Adaptive functioning, Social, Thought, Post-traumatic stress and Total problems, and Sluggish cognitive tempo (p < 0.012). More FASD children had scores in the “Clinical” range in 9 of 26 TRF scales (p < 0.012). Of the Critical Items, speaking about suicide was more frequent in the FASD (14.3%) than Non-FASD group (1.2%; p = 0.03). “Attacks” (aggressive behaviour) was the most prevalent Critical Item endorsed by teachers (FASD: 38.1%; Non-FASD: 17.6%; p = 0.07). There were no significant differences between groups in CBCL scores. Conclusion: In the first investigation of the behavioural profile of remote Australian Aboriginal children, FASD was associated with greater impairment. Academic performance was alarmingly poor, with 73% scoring in “Borderline/Clinical” ranges (<16th percentile). Support is urgently needed to help teachers manage the behavioural challenges in children with FASD, as is access to adequate mental health services.

Introduction: Indigenous populations are amongst the most marginalised worldwide, which affects their health and well-being. Well-intentioned researchers from non-Indigenous backgrounds often approach communities to conduct research with the intent to help improve health opportunities and outcomes, however there are few publications reflecting on or evaluating the consent process for research with Indigenous communities (1). If community engagement and consent-seeking is not done in a culturally respectful, empowering way, it may do the community a disservice. Recruitment rates may be affected, results may be biased, and the research will be unlikely to achieve the intended positive, long lasting benefits for the community. Methods: The Picture Talk Project was invited by Aboriginal leaders of the Fitzroy Valley in the Kimberley, Australia. Non-Aboriginal researchers worked in collaboration with local Aboriginal leaders to evaluate the preference and understanding of the consent process for research, discuss past experiences, and make recommendations for the future. Local Aboriginal Community Navigators interpreted language and culture throughout the research process. Leaders were interviewed and Aboriginal community members participated in focus groups. Transcripts were analysed through NVivo10 qualitative software using grounded theory through inductive and deductive coding and themes are synthesised with supportive quotes highlighted. A detailed description of The Picture Talk Project research protocol has been published (2). Findings from interviews with community leaders have been reported (3). Results from the focus groups and final conclusions are now reported. Results: A total of 6 focus groups were formed, each comprising 3 to 8 participants. Participants were from all 4 main major language groups of the Fitzroy Valley, male and female, and from a variety of age groups, educational backgrounds social standing, and communities (with variable remoteness from Fitzroy Crossing). The six key themes identified for research in Aboriginal communities were: Reputation and trust is essential; The Community Navigator is Key; Pictures give words meaning (Milli milli vs Pictures); Consensus is achieved in circles through sharing stories; Signing consent; Research is needed in the Valley. We will present practical advice about how to conduct respectful research in remote Aboriginal communities. Conclusion: Culturally appropriate research is needed in Aboriginal communities and must be guided by Aboriginal people to enable researchers to navigate through another world view of knowledge.

We established a culturally appropriate, community-based women's health service in Yuendumu, Northern Territory, to improve women's health and to remedy the low rate of cervical screening. During the 16 months of the program 419 cervical smears were taken, increasing coverage of the women eligible from 51 to 78 per cent Acceptance of the program was excellent, with only 2 per cent of the women approached refusing to have a smear. Over 70 per cent of the Pap smears were done by the nursing staff in the clinic; quality control was good, with 9 per cent of smears reported as having no endocervical cells. Sixty-four per cent of screened women had normal smears and 0.9 per cent showed evidence of cervical intraepithelial neoplasia (CIN). Three women were referred for treatment of CIN, two for CIN I and one for CIN III. The program illustrates how a combination of community involvement, staff stability, teamwork, and cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community.

We assessed the effects of an organised cervical screening program, using a population-based cervical cytology register, for Aboriginal women in the Fitzroy Valley, a remote part of the Kimberley region of Western Australia. Comparison of age-specific screening rates in the area during 1987-88, 1990-92 and 1993-94 showed that establishing the program in late 1989 was accompanied by dramatic increases in cervical screening rates, ranging from two- to over fourfold, with the largest increases in women aged 50 years and over. Following the departure of the coordinator in early 1993, screening rates decreased to between 76 per cent and 29 per cent of their 1990-92 levels, with the largest decreases occurring in the 40-49 and 60-69 years age groups. Rates were still above 1987-88 levels for most age groups. Of 545 women screened during 1991-92, 65 per cent had undergone a second Pap smear within the follow-up period of two to four years. Among women recommended for a repeat smear in two years, the probability of having a second smear was negatively associated with age (log-rank statistic = 35.58, 4 df, P < 0.0001). Follow-up of smears recommended for repeat in 12 months or earlier was less adequate in 1993-94 (46 per cent) than in 1991-92 (75 per cent). The program was successful in recruiting a large proportion of eligible women within a relatively short time, but coverage, especially of older women, was not sustained after a decline in the functioning of the recall system owing to staffing and organisational changes.

Introduction. We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. Methods. Descriptive exploratory study using semi-structured telephone interviews of doctors and nurses in Australian emergency departments (EDs), stratified to represent states and territories and rural or metropolitan location. Content analysis of responses developed themes and sub-themes. Results. Of 39 doctors and 32 nurses responding to email invitation, 20 doctors and 16 nurses were interviewed. Major themes were resources/environment, staff and patient issues. Clinicians noted lack of access in rural areas to psychiatric support services, especially alcohol and drug services, limited referral options, and a lack of knowledge, understanding and acceptance of mental health issues. The clinicians suggested resource, education and guideline improvements, wanting better access to mental health experts in rural areas, better support networks and visiting specialist coverage, and educational courses tailored to the needs of rural clinicians. Conclusion. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Improvements would better enable access to support and referral services, and educational opportunities.

This project reviewed all of the Bushfire and Natural Hazard CRC (CRC) publications hosted on the CRC website to identify outputs that could be of interest in addressing the issue of how to best manage fuel to reduce bushfire risk into the future. We identified 12 projects part of five research clusters involving a wide range of actors: Prescribed burning and catchment management, Economics and strategic decisions, Bushfire predictive services, Governance and institutional knowledge, Understanding and enhancing resilience which could offer potential synergies with the Mechanical Fuel Load Reduction (MFLR) Utilisation Project. The most relevant outputs were summarised in conceptual diagrams (mind-maps), and possible utilisation for the MFLR milestones was highlighted in each section.

Background: Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results: Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacterial taxa that included Corynebacterium, Alloiococcus, Staphylococcus, Haemophilus, Turicella, Streptococcus, and Pseudomonas. Within-subject microbiota similarity (between ears) was significantly greater than inter-subject similarity, regardless of differences in ear disease (p = 0.0006). Longitudinal analysis revealed changes in diagnosis to be associated with more pronounced changes in microbiota characteristics, irrespective of time interval. Ear microbiota characteristics differed significantly according to diagnosis (P (perm) = 0.0001). Diagnoses featuring inflammation with tympanic membrane perforation clustering separately to those in which the tympanic membrane was intact, and characterised by increased Proteobacteria, particularly Haemophilus influenzae, Moraxella catarrhalis, and Oligella. While nasopharyngeal microbiota differed significantly in composition to ear microbiota (P (perm) = 0.0001), inter-site similarity was significantly greater in subjects with perforated tympanic membranes, a relationship that was associated with the relative abundance of H. influenzae in ear samples (rs = − 0.71, p = 0.0003). Longitudinal changes in ear microbiology reflected changes in clinical signs and treatment. Conclusions: Children attending the ear and hearing clinic in a remote Aboriginal community present with a broad spectrum of OM conditions and severities, consistent with other remote Aboriginal communities. Ear microbiota characteristics align with OM diagnosis and change with disease course. Nasopharyngeal microbiota characteristics are consistent with the contribution of acute upper respiratory infection to OM aetiology.

The need for cultural safety in the delivery of health and disability services to Aboriginal people is being increasingly recognised. Those delivering services in remote communities face the challenge of providing culturally safe and responsive services with limited resources and a host of geographical and infrastructure challenges. Earlier research identified the importance of sharing knowledge and working together to deliver services to Aboriginal people (Anangu) with disabilities in Central Australia, and workers are also bound by funding and policy guidelines as they deliver services. However, little is known about how workers navigate these different social and cultural expectations and accountabilities when working with Anangu. Interviews were conducted with 47 workers from 16 service provider agencies responsible for delivering services to Anangu with disabilities from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Lands. Workers invested significant time and energy in strategies to navigate these different contexts, much of which was not formally acknowledged or supported at a system level. Strategies employed included: fostering cultural knowledge and collaborative relationships, delivering creative and flexible services, and critical reflection on practice. Cultural safety and responsiveness of workers is important and warrants investment of time and effort. However, relying on workers to "soften the edges" and create an ostensible fit between bureaucracy and meeting the needs of Anangu with disabilities creates unrecognised burden for workers and fails to address the systemic beliefs, values and social and economic disadvantage that underpin an inadequate support system.

Sustainable luxury has often been seen to offer both environmental sustainability and the possibility for innovative entrepreneurial development of natural and cultural heritage. The possibility and challenges of sustainable luxury tourism for Indigenous groups have been discussed by Poelina and Nordensvärd (2018) at some length by including a cultural governance perspective that brings culture and nature together. They stressed how protecting our shared human heritage and human culture can be aligned with a new wave of sustainable luxury tourism. To achieve this, we need to create links to both management and protection of landscapes and ecosystems as vital parts of heritage protection and social development. This chapter explores how and why we need to integrate social sustainability into sustainable luxury tourism, where we can foresee potential pitfalls and conceptualise nature-based and Indigenous tourism to empower local Indigenous communities and provide them with sustainable employment, economic development and community services. The sustainable tourism model provides brokerage necessary to strengthen their capacity for innovation, entrepreneurship and transformational change. This transformational change requires tourist visitors and non-Indigenous tourism operators to be open to a new experience with Indigenous guides and tourism operators to see, share and learn how to feel ‘Country’ (Poelina, 2016; Poelina & Nordensvärd, 2018). We will use Martuwarra (Fitzroy River) and its communities in Kimberley (Western Australia) as a case study to develop a sociocultural sustainable luxury tourism framework that includes governance, legal and management and social policy perspective.

This submission aims to draw further attention to interlinkages between the NIAA’s policy work around digital inclusion and the rollout of social policies (including by the NIAA and Department of Education, Skills and Employment [DESE]) that affect as well as demand digital inclusion, and which disproportionately impact Indigenous peoples and communities. We also seek to draw greater attention to the importance of Indigenous data sovereignty regarding the NIAA’s call for further data on Indigenous digital inclusion — something that the NIAA Discussion Paper does not address. As the scope of the NIAA’s Digital Inclusion Plan is regional and remote Australia, our predominant focus here is on the impacts of social policies in these areas. However, we also acknowledge that some of the policies we refer to operate Australia wide and thus also affect those living in urban areas.