Remote Australia Online

How food is promoted in food retail settings impacts population diet. Foods high in sugar, fat and/or salt are promoted by retailers to attract impulse purchases. To combat the high burden of chronic disease and associated conditions confronting society we examined the impact of restricted retail merchandising (promotion and visibility) of discretionary food and beverages on sales and business outcomes. We conducted a pragmatic randomised controlled trial in partnership with a retail organisation operating stores in remote communities of Australia (the Arnhem Land Progress Aboriginal Corporation). Twenty consenting stores were allocated to the 12-week intervention (7-point Healthy Stores 2020 strategy) or to usual retail practice. Four intervention stores with retail competition implemented a modified 6-point strategy. Weekly sales data were used to assess intervention impact on free sugars (g) to energy (MJ) (primary outcome) derived from all purchased food and beverages. Impact on gross profit and sales of targeted food and beverages was also assessed. Managers of intervention stores were interviewed to determine their views on customer response and impact on retail practice. Free sugars were reduced by a relative 2.8% (95% CI -4.8, -0.7). There were significant reductions in free sugars from targeted beverages (-6.4%; -11.1, -1.5) and soft drinks (-12.5%; -18.1, -6.5). Gross profit was not impacted adversely. Managers mostly viewed the strategy favourably and of benefit to the community. The public health and business relevant gains demonstrated by this novel trial have resulted in ALPA converting their stores to the Healthy Stores 2020 strategy and integrating the strategy in to their nutrition policy. Retail competition impedes complete implementation of the 7-point strategy. Tackling this will require collective agreement by retailers to implement the full strategy and/or government policy power.Restricting merchandising of unhealthy foods can achieve both public health relevant and business relevant gains. Working in partnership with retailers is critical to testing real-world interventions to impact population diet.

Objective: To promote tertiary health careers to rural and remote young people. Design: Qualitative research using large and small group discussions and semistructured interviews. Setting: Fifteen secondary schools in rural and remote Western Australia including five senior secondary schools and 10 district high schools. Subjects: One hundred and twenty students from eight year 10 groups, 35 students from three year 11 groups, 54 students from five year 12 groups, 52 parents, 10 grandparents, 76 teachers and four Aboriginal and Islander Education Officers (AIEO). Results: Students prefer information about the range of health careers to be delivered interactively. Choices to follow a health career at tertiary level were constrained by structural and cultural issues including geographical isolation, financial cost, stereotyping of health professions, insufficient information about the diversity of health careers, obligation to family, community and place and a devalued rural culture. Conclusions: The under representation of rural and remote students in health related university courses needs to be addressed by long-term strategies taking into account both structural and cultural barriers when making career choices. Health policies should include the provision of financial support for rural and remote students and promote a broad range of health careers as challenging and rewarding life choices that offer much needed services to rural communities. What this paper adds: In 1997, only 19.2% of Australian university students came from rural and remote areas, a figure dramatically below the equity reference point of 28.8% of the population living in rural areas derived from the 1996 census data.1 In 2001, the figure remained steady with 19.1% of rural students attending university.2 These data highlight the need for developing higher education opportunities for all Australians regardless of where they live. However, despite ongoing concern about attracting rural and remote students to health careers, limited success has been achieved to date. Barriers to students choosing health careers at tertiary level include lack of information about the range of health careers available, the cost of tertiary education for families, social dislocation and a perceived lack of support structure for students at university. These are underpinned by cultural assumptions about gender, occupational roles in rural communities and professed lack of academic ability. Strategies to overcome barriers must be situated within a broad socio-cultural context to understand the complexity of issues underpinning students? choices.

Quality of life in the first year of cancer diagnosis among Aboriginal and non-Aboriginal people living in regional and remote areas of Australia

Despite numerous equity initiatives aimed at increasing participation in higher education, students from regional and remote communities continue to be underrepresented in Australia. This paper presents a scoping review of empirical studies, published between 1991 and 2016, that examined aspirations for higher education of students from regional and remote areas. Analysis of the 65 articles revealed an emphasis on enablers and barriers to participation in higher education including: cost and distance, supportive environments, attachment to home, schooling and academic achievement, knowledge of pathways, and individual characteristics. However, much of the research offers a homogeneous view of regional and remote communities which elides location-specific characteristics that are powerful in shaping educational aspirations. We argue that there is a critical need for greater understanding of the diversity of experiences, influences, and aspirations among students within rural and remote communities to underpin the provision of appropriate infrastructure and support for their higher education aspirations. We identify some key avenues for further research into the aspirations of students in rural and remote communities and the ways in which this research can inform and improve outreach activities.

This chapter draws on findings from a national study that explores successful numeracy practices in remote and very remote contexts. While there have been many practices identified as contributing to success, this chapter draws on the resources used by teachers to scaffold students' transition from home languages into Standard Australian English (SAE) as they come to learn mathematics. The chapter provides some background into the issues and tensions in teaching mathematics in these settings and then provides practical examples of the strategies used across schools in the study. Two elements of resources are discussed – human resources (as in the local Aboriginal people’s role in scaffolding mathematical learning) and material/pedagogical resources. The participants’ voices will be employed to provide insights into the rationale for such strategies.

As part of a much larger study where spatial reasoning is the focus, this paper draws on the language aspects of this strand of the curriculum. The quarantined part of the project discussed in this presentation is based in remote Indigenous schools. We draw on the challenges of the concept of symmetry and where the language of instruction (and mathematics) is a foreign language. We pose questions of the nuanced, and often complex, language of spatial reasoning and the impact this has on the performance of Indigenous learners when applied to the enacted practices in school mathematics. We conclude by raising concerns and directions of the subsequent phases of the project.

The vocational experiences and skills of young adolescents could be infused into formal education by identifying career competencies to be taught within the academic curriculum. Such curriculum practices that embed educational and career pathways must also include the perspectives of students and the community, particularly those from marginalised groups. Drawing on data from 111 teachers, principals, carers and students, this paper presents research undertaken to co-design career education lesson plans within an infused model of the curriculum for early Middle Year students from regional, rural, and remote Australia. The lesson plans and activities were designed to allow for meaningful self-reflection and goal-setting that could be seamlessly infused into the formal curriculum and help embed early-stage career education. The paper concludes by projecting opportunities and challenges for seamless curriculum integration, while pertinent to the Australian context, can also be read with broader relevance to other educational systems and schools.

OBJECTIVES:  To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences. METHODS: A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data.  Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis. RESULTS: Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives. Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential. CONCLUSIONS: Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable "head, heart and hands" learning and do not create/reinforce inequities.

Previous research published in this journal has already demonstrated that using telehealth-based models of care can have benefits for those residing in rural and remote communities, the health care provider and the system. One study showed that telehealth can be successfully applied to the management of patients with a spinal fracture, which allowed the patient to be cared for in their local rural hospital and offered opportunities for allied health professionals to upskill and work to their full scope of practice, while also providing cost efficiencies for the health service. Another innovative application of telehealth was an integrated approach to oral health in rural aged care facilities with an oral health therapist screening residents using an intraoral camera probe that transmitted a live feed to a dentist in another health care facility.4 With so few dentists living in rural and remote Australia, there is real opportunity to scale up this sort of application of telehealth for other population groups such as Aboriginal and Torres Strait Islander people living in remote communities. In rural and remote education settings, speech pathology teletherapy services have been able to overcome limited connectivity issues by successfully using low-bandwidth videoconferencing facilities.6 These examples demonstrate that telehealth can offer rural and remote communities a more flexible and convenient mode of access to health care, while also upskilling rural health generalists, parents and educators by linking them and their patients or clients to urban-based specialists.

Rural and remote Australia is home to some of the most diverse and culturally rich communities and land in the country. This provides incredible potential to promote the health and well-being of individuals, families and communities from social, economic and ecological standpoints. However, the health and social inequities faced by those living in rural and remote areas are well documented, particularly among Aboriginal and Torres Strait Islander peoples. Access to health services, including primary health care services, can be limited; the influence of social and cultural determinants of health are often poorly addressed; and the attraction, retention and mobility of the health workforce is an ongoing problem. These issues create significant challenges for the rural and remote health promotion community that differ markedly from their urban counterparts. While there have been some important investments in rural and remote health promotion over the past few decades—particularly in relation to mental health promotion strategy development; and settings-based health promotion approaches through sporting clubs, men's sheds and field days—there is still much work to do. While promising workforce initiatives are also underway, such as the federally funded Rural Health Multidisciplinary Training program, a greater emphasis on the non-clinical workforce, and the role that the health promotion community can play within a multidisciplinary team context, is warranted. Similarly, the relative distribution of funds between acute and primary health care contexts remains a significant issue.

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.

Background: Young Aboriginal people are at an important stage in the development of their health and wellbeing. They experience significant morbidity and mortality, and their access to medical services may be limited by geographic remoteness and difficulty obtaining appropriate care. Aboriginal Community Controlled Health Services offer primary health care considered to be more accessible for Aboriginal people. Objective: This study is one component of research aiming to enhance access for young Aboriginal people in a remote area of Western Australia. It aims to add to our previous study focusing on perceptions of local young people, through exploring the understandings of health care staff regarding access for young Aboriginal people. Methods: This qualitative study involved semistructured individual and group interviews with 24 staff who work with young Aboriginal people at a remote Aboriginal Community Controlled Health Service. Transcripts were descriptively coded and thematically analyzed by the research team. Results: Staff identified a number of challenges in working with 16- to 25-year-old Aboriginal people, which revolved around the interface between the service, its staff and the young people. They also suggested strategies designed to engage these young people. The strategies included relationship-building, communication, trust and confidentiality with individuals; and targeted clinics, partnerships, health promotion, and an open door policy by clinics. The strategies used by staff were flexible and expansive in nature. Conclusions: Engagement can be enhanced by a health service willing to "go the extra mile," with a strategic, enveloping and innovative approach, resourcing and the right people with the right attitude.

Oral squamous cell carcinoma is a lethal and deforming disease of rising global significance. Detailed information on contemporary incidence, patient awareness and preventative strategies in Australia remains somewhat lacking, however. Geographic profiling has shown a high burden of disease in regional and remote areas compared with metropolitan districts, with Indigenous Australians in particular exhibiting a high incidence of oral squamous cell carcinoma, reduced access to specialist treatment and ultimately, poor clinical outcomes. Strategies to deliver enhanced preventative techniques, improve diagnostic accuracy and encourage targetted interventional management for high risk populations in regional and remote communities are recommended

This spring, while New South Wales was planning family reunions and haircuts, and counting down till it crossed the “70 per cent double dose” line, and Victorian case numbers were still spiking, another, highly anxious, Delta-time story was unfolding across the Northern Territory. The landing of the virus, vaccines and pandemic misinformation in highly disadvantaged, deeply intercultural and enduringly marginalised, colonised country has been presenting unique immunological, informational, logistical and political challenges. Trust has been a casualty of these factors, vaccine suspicion and “complacency” the fallout. But the practice of what I venture here to call “relational medicine” is showing signs of successfully turning things around in remote Central Australian community settings.

In Australia, the Indigenous population disproportionately resides in more remote parts of the country, and a number of outcomes for Indigenous children decline with remoteness. It is widely accepted that inferior housing conditions, notably crowding, contribute to Indigenous disadvantage in remote communities, and this has become a focus of policy despite limited direct empirical evidence. Data from the Longitudinal Study of Indigenous Children are used to analyse children’s outcomes in the domains of physical health, social and behavioural adjustment, and educational achievement conditional upon remoteness and housing circumstances. For housing, variables relating to housing affordability stress, frequent moves, tenure and dwelling type and a range of measures of crowding are tested. The results suggest variation in housing conditions plays a relatively minor role in children’s physical health and social and emotional development. The most robust associations identified are between homeownership status and educational achievement. However, housing factors are not found to have significant mediating roles in the relationship between remoteness and children’s outcomes. The findings provide grounds for caution that a focus on housing should not distract policy efforts away from other potentially important determinants of the wellbeing of Indigenous children in remote Australia.

Background Pregnancy is a risk factor for the progression of diabetic retinopathy (DR) in women with pre-gestational diabetes. Australian screening guidelines recommend DR screening in the first trimester of pregnancy. The rates of DR screening in pregnant patients with pre-gestational diabetes are unknown in Australia. Aim To determine the rates of DR screening in pregnant women with pre-gestational diabetes at Alice Springs Hospital Diabetes Antenatal Care and Education (DANCE) clinic. Materials and Methods Retrospective review of women with pre-gestational diabetes who attended the DANCE clinic between July 2016 and June 2020. Results There were 146 pregnancies in 144 individual women included in this review. There were 93% (n = 134) who identified as Aboriginal but not Torres Strait Islander. DR screening was performed in 23 (16%) pregnancies, in which DR was present in six (26%) and no retinal abnormality was found in 17 (74%). Of seven (5%) women who had a history of DR, only three had a screen during the pregnancy period. The location of the DR screen included Alice Springs Hospital (17%, n = 4), Alice Springs general practice clinics (35%, n = 8) and remote NT community clinics outside of Alice Springs (39%, n = 9). The trimesters in which women received their DR screens were: trimester 1, 45%, n = 10; trimester 2, 39%, n = 9; trimester 3, 17%, n = 4. Conclusion The minority of pregnant women who attend the DANCE clinic at Alice Springs Hospital received DR screening in adherence with national guidelines.

Allied health professionals are essential to the physical, social and psychological wellbeing of people living in rural and remote Australia. They are integral to the care of rural and remote communities, whose capacity to achieve optimal health outcomes is limited by inequitable access to appropriate health services. They are also integral to the economic development of rural and remote populations particularly in relation to workforce participation and educational outcomes. There is both an undersupply and a maldistribution of allied health services in rural and remote towns of less than 30,000 people that can be addressed by an integrated service and learning pathway linked to more and better structured jobs, greater participation of Indigenous Australians, improved access to workforce data and through national allied health leadership. In Australia, the allied health professions are characterised by a diverse mix of regulated and self-regulated disciplines. Allied health professionals work across a variety of sectors including primary, secondary, tertiary and quaternary health care, aged care, mental health, disability, justice, alcohol and other drugs, early childhood and education. In rural and remote settings, they often work in areas of market failure where service delivery is fragmented and vulnerable to short-term contracts and disparate funding arrangements. Beginning in December 2018, the National Rural Health Commissioner (the Commissioner) has consulted with the allied health sector to develop a set of recommendations aimed at improving the quality of services, and equitable access to and distribution of the regional, rural and remote allied health workforce. While recognising there is unmet need for allied health services across all of regional, rural and remote Australia, the particular focus of the Commissioner’s work has been on improving access to services for populations living in Modified Monash Model 4-7, where the maldistribution is most pernicious. The Commissioner’s work has been framed by the concept of the ‘demographic dividend’ – that an investment in the health of populations leads to improved economic outcomes that produce benefits not only at a local or regional level but at a national level as well.

Indigenous communities in remote Australia face dangerous temperature extremes. These extremes are associated with increased risk of mortality and ill health. For many households, temperature extremes increase both their reliance on those services that energy provides, and the risk of those services being disconnected. Poor quality housing, low incomes, poor health and energy insecurity associated with prepayment all exacerbate the risk of temperature-related harm. Here we use daily smart meter data for 3,300 households and regression analysis to assess the relationship between temperature, electricity use and disconnection in 28 remote communities. We find that nearly all households (91%) experienced a disconnection from electricity during the 2018–2019 financial year. Almost three quarters of households (74%) were disconnected more than ten times. Households with high electricity use located in the central climate zones had a one in three chance of a same-day disconnection on very hot or very cold days. A broad suite of interrelated policy responses is required to reduce the frequency, duration and negative effects of disconnection from electricity for remote-living Indigenous residents.

Introduction Stroke survivors recovering in rural and remote locations often have little or no access to rehabilitation services. The purpose of this study was to review the literature on recovering in rural and remote Australia, from the perspective of stroke survivors. Use of technology to support recovery was also explored. Methods A systematic mixed studies review was conducted and reported according to the ENTREQ and PRISMA statements. MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (ProQuest), Cochrane Library and Google Scholar were searched from inception to May 2021 for studies investigating stroke survivors' perspectives on recovering in rural or remote Australia. Qualitative, quantitative or mixed methods studies were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Studies were not excluded or weighted according to methodological quality. To review the perspectives of stroke survivors on recovering, findings of included studies were mapped to the Living My Life framework and integrated using a convergent qualitative synthesis. The review protocol was registered on PROSPERO (CRD42017064990). Results Eight studies met the inclusion criteria: six qualitative, one quantitative and one mixed methods. Methodological quality of the small number of studies ranged from low to high, indicating further high-quality research is needed. Included studies involved 152 stroke survivors in total. Review findings indicated that recovering was driven by working towards what mattered to stroke survivors, in ways that matched their beliefs and preferences and that worked for them in their world, including use of technology. Conclusion Stroke survivors recovering in rural and remote locations want to live their life by doing what matters to them, despite the challenges they face. They want support in ways that work for them in their environment. Further research is required to tailor support for stroke survivors that is specific to their life in rural and remote locations.

Background/Aims Heart disease is the largest single cause of death and contributes to poor quality of life and high healthcare costs in Australia. There are higher rates of heart disease in rural and remote areas, with the highest rates in Aboriginal and Torres Strait Islander people. Cardiac rehabilitation is known to improve health outcomes for people with heart disease but referral rates remain low (30.2% overall and 46% following acute coronary syndrome) in Australia. Further, access to cardiac rehabilitation in rural and remote areas is affected by there being few centre-based services, and poor use of home-based services. The aim of this protocol is to investigate: (i) understanding of cardiac rehabilitation by health staff, community leaders and community participants discharged from hospital following treatment for heart disease; (ii) access and support for cardiac rehabilitation in rural and remote areas via health service availability in each community. Methods A qualitative case study methodology, using an interpretive descriptive framework, will be used together with content analysis that will encompass identification of themes through a deductive/inductive process. Conclusions To improve access to services and health outcomes in rural and remote areas, a strong evidence base is essential. To achieve this, as well as having appropriate methodology, it is necessary to build relationships and trust with local communities and healthcare providers. This research protocol describes a qualitative community-based case study, together with processes to build sound relationships required for effective data collection through semi-structured interviews or focus groups. Each step of the pre-research planning data collection and analysis is described in detail for the guidance of future researchers.

In the first large scale community study of HTLV-1 prevalence in central Australia we found an adult prevalence of 36.8%, the highest reported worldwide. Prevalence increased with age suggesting that sexual contact may be the predominant mode of transmission. Although a wide range of HTLV-1 proviral loads was found, in nearly 40% of participants this exceeded 1000 copies per 105 peripheral blood leukocytes, a level that has been associated with an increased risk of chronic lung disease and death in this population. The median PVL for participants who were symptomatic with HTLV-1 associated inflammatory diseases was 1.34 log10 higher than that of those who were asymptomatic. These data demand a public health initiative to reduce HTLV-1 transmission among Aboriginal Australians.

Objective: This paper reports on models of health service delivery in remote or isolated areas of Queensland. Background: There is little research that investigates current models of health service delivery in remote or isolated areas of Australia. Design: A multiple case study research design was employed that included interviews and focus groups. Setting: Three types of health care facilities in remote or isolated Queensland. Subjects: Thirty five registered nurses. Results: Findings indicated that nurses and Indigenous health workers are predominantly resident and provide health services in this environment, while medical and allied health care services are usually provided by non resident visiting specialists. Conclusions: Findings suggest that meeting the needs of communities in remote and isolated areas of Queensland requires a change in the focus of health service delivery to accommodate a primary health care philosophy. The introduction of a new model of health service delivery is recommended; however this will only occur if resources are harnessed to prepare staff to reprioritise services offered. Implications for Health Service Management: Supporting community partnerships with shared responsibility between health service providers and community members for increasing primary care prevention practices is advocated.

OBJECTIVE: Oral cancers caused by chewing betel nuts have a poor prognosis. Using a lay health advisor (LHA) can increase access to health care among underprivileged populations. This study evaluated a health belief model (HBM) intervention using LHAs for oral cancer screening (OCS) and mouth self-examination (MSE) in remote aboriginal communities. METHODS: The participants were randomly assigned to intervention (IG; n = 171) and control groups (CG; n = 176). In the IG, participants received a three-chapter one-on-one teaching course from LHAs, whereas those in the CG received only a leaflet. RESULTS: The IG participants were 2.04 times more likely to conduct a monthly MSE than those in the CG (95% confidence interval: 1.31-3.17) and showed significantly higher self-efficacy levels toward OSC and MSE (β = 0.53 and 0.44, effect size = 0.33 and 0.25, respectively) and a lower barrier level for OSC (β = -1.81, effect size = -0.24). CONCLUSION: The LHA intervention had a significantly positive effect on MSE, strengthening self-efficacy and reducing barriers to OCS among aboriginal populations. PRACTICE IMPLICATIONS: The effectiveness of the clinical treatment of underprivileged group can be improved through early diagnosis, which can be achieved using LHAs to reduce barriers to OSC.

The thousands of tiny Aboriginal settlements scattered across of north and west of Australia are extremely peripheral to its southern cities, but central to the debates that rage within these urban centres about the future of the contintent's first inhabitants.

Community nurses have often been ‘touted’ as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.