Remote Australia Online

This article outlines the development of 'Yuwaya Ngarra-li' (YN), a holistic, community-led partnership with a university that aims to realize Aboriginal Elders' vision for wellbeing in their community. The Dharriwaa Elders Group (DEG), a community-controlled organization in Walgett, a remote town in New South Wales (NSW), Australia, invited the University of New South Wales (UNSW) to partner with them to progress their long-held vision for systemic change. This partnership aims to improve the environment, life pathways, and wellbeing of Aboriginal people living in Walgett through collaboration on evidence-based initiatives, research and building local community capabilities and control. YN builds on decades of strong advocacy, community development, and participatory research that has focused on addressing structural injustices and inequity through centering Indigenous knowledges, worldviews, and rights. This innovative partnership is contributing to the evidence base for community-led solutions, with implications for research, policy and practice.

Objective Off-road riding of quad bikes and motorcycles is common among children across rural and remote Australia, but is a significant source of injury and hospitalisation. An in-depth analysis of paediatric off-road vehicle crashes was undertaken to inform injury prevention countermeasures by characterising injury patterns and sources of injury. Design This is a prospective in-depth case series. Participants Participants are children aged 16 and under who have been hospitalised due to injury sustained from the use of an off-road motorcycle or quad bike in New South Wales, Australia. Interventions Crash investigation techniques (medical data, structured interview, vehicle and crash site inspection) were used to ascertain details of the crash event, protective gear, injury information and contributory factors. Results Thirty children were recruited, 27 boys and 3 girls, ranging in age from 4 to 16 years, having crashed on off-road motorcycles (n = 27) or quads (n = 3). Most (73.3%) were participating in unstructured social riding. A total of 67 separate injuries were observed, with overall Injury Severity Scores between 1 and 35. There were high rates of wearing helmets and motorcycle-specific garments. The most commonly injured areas were the upper and lower extremities. The most common sources of injury were from impacting the ground, obstacles/other riders or the vehicle. Conclusion This study demonstrates the patterns of riding and injury in rural paediatric off-road vehicle riders, occurring despite high rates of helmet/protective gear use. This underscores the need for investigation into the injury mitigation and fit properties of protective gear and the inherent risks for physically and developmentally maturing children.

Background Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities. Aim This study aimed to evaluate the spectrum of hepatitis B virus (HBV) care provided to a remote Aboriginal community. Measures studied included screening, seroprevalence, vaccination rates and efficacy, and HCC risk and surveillance adherence. Methods A retrospective audit of HBV care received by all permanent residents currently attending a remote Aboriginal Health service. This study was endorsed by both the local Aboriginal Health service and the Aboriginal Health Council of South Australia. Results A total of 208 patients attended the clinic, of whom 52% (109) were screened for HBV. Of these, 12% (13) had CHB and 20% (22) had evidence of past infection. Similarly, of the 208 attending patients, complete vaccination was documented in 48% (99). Of the 33 patients with post-vaccination serology, 24% (8) had sub-therapeutic (<10 IU/mL) levels of HBsAb. Sub-therapeutic HBsAb was independently associated with higher Charlson Comorbidity scores (Odds Ratio=17.1, 95% CI 1.2-243.3, P=0.036). Definitive breakthrough infection was identified in 6% (2) patients. One HBsAg positive patient was identified as needing HCC surveillance, but had not undertaken HCC surveillance. Conclusion Opportunities to improve the quality of CHB care through increased HBV vaccination, screening, and adherence to HCC surveillance were identified. High rates of subtherapeutic vaccine responses and documented breakthrough infection raises concerns about the effectiveness of current CHB vaccines in this population. This article is protected by copyright. All rights reserved.

This chapter applies a remote lens to the experience of rural students in higher education. Students from remote locations are usually subsumed within the regional students’ cohort for policy and support purposes. In a country as vast as Australia, their location and previous educational experience may mean that they face unique challenges undertaking university (Cassells et al., 2017). Their expectations and support needs may differ from their regional and metropolitan peers, as evidenced by the fact that currently remote students have one of the highest attrition rates for any undergraduate cohort in Australia. Without dedicated policy and practical support, these students may struggle to achieve their higher education goals.

This article outlines an early childhood leadership model that senior Anangu and Yapa (Aboriginal) women, living semi-traditional lifestyles in the remote desert regions of central Australia, have identified as a positive and important way forward for their children, families, governments and related professionals. The initiative 'Warrki Jarrinjaku Jintangkamanu Purananjaku (Warrki Jarrinjaku), Warlpiri for 'working together everyone and listening' ' is a collaboration between senior Anangu and Yapa women from the central desert, Waltja Tjutangku Palyapayi Aboriginal Organisation (Waltja) and the Australian Government Department of Families, Housing Community Services and Indigenous Affairs (FaHCSIA). It is also known as the Aboriginal Child Rearing Strategy (ACRS). This article also discusses some of the key findings from the Warrki Jarrinjaku ACRS project and explores its emerging influence in early childhood practice within Australia and internationally.

This paper presents the results of archaeological fieldwork conducted at the request of elders from Barunga, a remote Aboriginal community in the Northern Territory, Australia. The aim of the project was to use archaeological methods to help people from the community relocate and identify each person buried in the Barunga Graveyard and to develop a system where this information would not be forgotten. In the past, the location of burials and the identities of the buried have been known only through memory, as well as repeat visits to the graveyard. Overcrowding within the graveyard has made this practice difficult. To add to this problem, the vast majority of graves of Aboriginal people in remote Northern Territory communities are not recorded in any register. While there is a legislative requirement for a burial register to be kept in non-Aboriginal communities, this has not been a requirement for those within Aboriginal communities. Instead, families must rely on the memories of those in attendance at the burial, and in time the remembering generation also dies and the identities of people in these graves become more and more blurred. This makes it difficult to mourn properly, or to care for that person by caring for their grave. During our fieldwork, we located 175 graves, and we identified 85 individuals. Of those that could be identified, 29 were identified by an associated plaque or headstone, and 56 were identified through oral histories that were recorded during several field visits with elders from the community. Beyond the archaeological results of this research, we found there is an opportunity to build sustainable development in this community that would see local people employed to locate and identify currently unidentified burials. Drawing on comparative cases from other countries such as India, this study addresses the challenge identified by UNESCO (United Nations Educational, Scientific and Cultural Organisation (UNESCO) (2015) introducing cultural heritage into the sustainable development agenda. Retrieved February 19, 2020, from http://www.unesco.org/new/en/culture/themes/culture-and-development/hangzhou-congress/introducing-cultural-heritage-into-the-sustainable-development-agenda/), to identify the concrete actions needed to integrate cultural heritage conservation and promotion into the sustainable development debate.

As outlined in our Interim Report (Rennie et al, 2016a), the particulars of how people in remote Aboriginal communities access the internet provide important context to the research findings. Internet access is predominantly mobile-only in these communities, and pre-paid credit is preferred to post-paid billing. Facebook and AirG/Divas Chat dominate social media use, although Snapchat is also popular with children. With this in mind, we found that:•In the communities and towns where our research took place, people were not necessarily using device and platform settings in ways that might help them avoid online harm. Social obligations can influence how people use devices, and this can lead to problems with privacy. For example, the sharing of devices (sometimes without permission) can lead to privacy issues.•Inappropriate or offensive use included “swearing” (see page 13), teasing, and bullying, which can incite further arguments and fighting offline, particularly when tied to prior hostility, or when communication breaches cultural protocols. When conflicts occur online, we heard, they can escalate quickly.•The filming of offline fights, which are then shared online, was a cause for concern amongst some community members, who saw them as perpetuating hostilities that might otherwise get resolved.•Fight videos are wrongly portrayed as riots or gang-style violence by the mainstream media. We show that these fights need to be understood within the historical context of remote Australia, including traditional forms of dispute resolution and Outback amateur boxing. Social media platforms amplify these fights and bring them to a wider audience, which may result in hate speech. Current platform moderation methods appear to be insufficient. Financial security needs, such as identifying scams and fraud, and managing credit and finances, are significant. Financial literacy programs should consider addressing cyber safety issues as part of the training they provide.•A participant’s level of digital capability and cyber safety awareness generally corresponded to the length of time they had been using the internet. We found differences in awareness between age and gender groups, suggesting the need for different approaches and resources for these groups. There is an ongoing need for straightforward, accessible information, including basic help with using mobile devices and social media accounts. Older people in particular were not confident with devices. Others were aware of how to manage prepaid credit, set passwords and passlocks, block and report people on AirG/Divas Chat and Facebook, and adjust device privacy settings. The fact that some people knew how to use device privacy settings, but were choosing not to, indicates the differences between online privacy and Aboriginal notions of privacy. However, practices are constantly changing in response to technology. This report identifies several approaches to addressing cyber safety in Aboriginal communities:•Mediation of various kinds is generally accepted as necessary to avoid further conflict. Mediation that includes community Elders was considered most effective. Older people in particular may need digital skills training in order to feel empowered to manage problems.•Identifying “trusted flaggers” within communities and organisations to work with social media companies may produce better moderation outcomes on certain types of content.•Other measures currently being enacted include temporary removal of internet access, either by controlling when and where services are available, or by removing trouble-makers from the community.

Objective Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population. Design Single-centre retrospective study using prospectively collected data from January 2009 to December 2018. Setting Australian regional intensive care unit. Participants All critical care admissions for patients aged over 18 years for whom postcode data were available were included. Outcome measures Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis. Results Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2 years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity. Conclusion Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.

Objective To review Australian literature on initiatives used to provide support for pre-registration health students undertaking a rural placement. Design A scoping literature review. Setting Rural, regional and remote areas of Australia. Participants Publications were sourced from scientific databases including Ebscohost and CINAHL. Grey literature and journal citations were searched to identify other relevant articles. Main outcome measure Identification of the various initiatives used to support students, evaluation of the success of these initiatives, and the feasibility and sustainability of implementing these initiatives. Results There were 36 articles included in the final analysis. The findings identified support initiatives specific to individual professions, not on supporting health students as a whole cohort. The key findings were grouped into identification of support initiatives and the alignment of these to students feeling a sense satisfaction, belonging and connectedness. Constraints to support health students undertaking rural placements identified disparity and inequity of support initiatives available for health students with medical students provided more support than other health students. Conclusion This review highlights the importance of students developing a sense of belonging and building connections to community, which are strongly aligned with rural placements and student satisfaction. The need for socio-cultural, organisational and institutional support is linked to higher student satisfaction and intention to practice rurally. A centralised collation of support initiatives would benefit students, higher education institutions and stakeholders in their efforts to attract students to undertake rural placements and be immersed in these unique learning experiences.

Maternal urogenital human papillomavirus (HPV) infection may place neonates at risk of HPV acquisition and subsequently lower respiratory infections as HPV can influence development of immunity. The respiratory HPV prevalence is not known in remote-dwelling Aboriginal infants, who are at high risk of respiratory infection and where the population prevalence of urogenital HPV in women is high. These data are necessary to inform HPV vaccination regimens. A retrospective analysis using PCR specific for HPV was performed on 64 stored nasopharyngeal swabs from remote-dwelling Aboriginal infants < 6 months of age, with and without hospitalised pneumonia. HPV DNA was not detected in any specimen. Despite the negative result, we cannot exclude a role for HPV in respiratory infections affecting infants in this population; however, our data do not support HPV as an important contributor to acute respiratory infection in remote-dwelling Aboriginal children.

Indigenous Australian children are more likely to score below the national literacy and numeracy benchmarks and less likely to access quality early childhood education and care than non-Indigenous Australian children. The Early Years Learning Framework positions children as competent and capable agents of their own learning, and recognises their existing funds of knowledge. Despite this, the early literacy preschool experiences for many Indigenous children in remote communities incorporate a range of approaches that are not always culturally relevant, adopting literacy programs originating in the USA in the mid-twentieth century. This chapter presents a critical analysis of the interconnections between these models, broader ECEC pedagogies, and Indigenous pedagogies, to understand effective approaches that encourage Indigenous children’s cultural identity whilst becoming literate in today’s global society.

Background: The demographic of Northern Territory prison population differs than elsewhere in Australia and the prevalence of hepatitis B and hepatitis C may therefore be somewhat different from other jurisdictions. There has been no study which has specifically described the serological results of a large proportion of prisoners in Northern Territory correctional facilities over an extended period of time. Methods: This retrospective longitudinal study reviewed serological results and testing rates for hepatitis B, and hepatitis C performed in correctional facilities in the Northern Territory of Australia between July 1st, 2003 and June 30th, 2017. Results: The proportion of positive records over 14 years for hepatitis B surface antigen (HBsAg) was 641/12,066 (5.3, 95% CI 4.9–5.7), for hepatitis B core antibody (anti-HBc) 4937/12,138 (40.1, 95%CI 39.8–41.6), for hepatitis B surface antibody (anti-HBs) 6966/13,303 (52.4, 95% CI 51.5–53.2), and for hepatitis C antibody 569/12,153 (4.7, 95% CI 4.3–5.1). The proportion of prisoners tested for hepatitis B and hepatitis C has decreased since 2015, while a high proportion of prisoners remain non-immune to hepatitis B. Conclusion: There is a relatively high proportion of positive serological markers of hepatitis B, and a lower proportion of positive hepatitis C serology in the Northern Territory’s correctional facilities compared to overall Australian rates. As the proportion of prisoners tested for hepatitis B and C has decreased recently, and a high proportion of prisoners remain non-immune to hepatitis B, there are opportunities to increase testing and vaccination rates in this population.

Objective To explore pharmacist and stakeholder perspectives of pharmacists providing expanded services in rural community pharmacies. Design A descriptive qualitative study with an ethnographic lens of rural culture collected data via in-depth semi-structured interviews with stakeholder representatives and rural and remote pharmacists. Setting Regional, rural and remote practice settings as defined by the Modified Monash Model MM3-MM7. Participants Twelve rural or remote pharmacists and eight stakeholder representatives from various government and professional organisations participated in the study. Main outcome measure Macro-, meso- and micro-level perspectives of pharmacists providing expanded pharmacy services in rural community pharmacies. Result At the macro-level, both pharmacists and stakeholders agreed that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. The meso-level revealed that pharmacist participants expected expanded practice to improve rural pharmacist recruitment and retention through improved professional satisfaction. The importance of effective collaboration and coordination with other health care providers in a community was described by pharmacists and stakeholders to ensure success of expanded services. All participants agreed that sustainability of these services relied on appropriate remuneration. At the micro-level, expanded pharmacy services are expected to save consumers? time and money as patients are redirected into appropriate health care settings. Conclusion Enablers and barriers across policy, health professional, consumer and community levels need to be addressed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities.

The workplace challenges of correctional officers have been well documented. Yet little is known about how such stressors impact the wellbeing of correctional officers from minority cultural-subgroups. This study explored Indigenous Australian correctional officers' social and emotional wellbeing (SEWB) when managing workplace adversity. Specifically, the study sought to identify culturally-specific stressors, protective factors and associated response tendencies to gain a more robust understanding of the factors that impact Indigenous officers' wellbeing in the workplace. In total, 15 Indigenous Australian correctional officers from the Northern Territory participated in the study through focus groups or semi-structured interviews. Thematic analysis of participant data revealed that Indigenous correctional officers' SEWB is influenced by four broad categories: cultural connection, morale, social functioning and somatic health. Results are discussed in terms of common themes, future research and implications for assisting the SEWB of Indigenous officers.

Since 2006, Aboriginal land in the Northern Territory (NT) has been subject to a range of land tenure reforms, mostly government-initiated. The most momentous are three different leasing regimes that apply to remote communities – s.19 leasing over individual lots, and two different forms of township leasing over whole communities. These reforms have modified the rights of Aboriginal traditional owners and reframed their relationship to community residents; impacted on the role and jurisdiction of the land councils and created and funded new land rights institutions; and resulted in a significant new rental stream for Aboriginal landowners. This paper examines the extensive and varied impacts of these three leasing models on the governance of the land rights system and remote communities, and the changing governance dynamic between traditional owners and community residents. These governance impacts are invisible in official discourse, as are the voices of Aboriginal people themselves. This paper first summarises the external governance environment that shaped the reforms, demonstrating that land tenure reform in the NT since 2006 has largely been a tool of government, not a tool for Aboriginal landowners. However, the most recent of the three leasing reforms – community-entity township leasing – represents a departure from this unilateral approach by government as it was initiated by Aboriginal interests and appears to be a welcome option for some traditional owners and community residents. The paper comments on both the process of the tenure reforms as well as their outcomes.

Objectives: To explore the acceptability of a novel, outreached-based approach to improve primary and primordial prevention of Strep A skin sores, sore throats and acute rheumatic fever in remote Aboriginal communities. Methods: A comprehensive prevention program delivered by trained Aboriginal Community Workers was evaluated using approximately fortnightly household surveys about health and housing and clinical records. Results: Twenty-seven primary participants from three remote Aboriginal communities in the Northern Territory consented, providing 37.8 years of retrospective baseline data and 18.5 years of prospective data during the study period. Household members were considered to be secondary participants. Five Aboriginal Community Workers were trained and employed, delivering a range of supports to households affected by acute rheumatic fever including environmental health support and education. Clinical record audit and household self-report of Strep A infections were compared. No association between clinical- and self-report was identified. Conclusions: Ongoing participation suggests this outreach-based prevention program was acceptable and associated with improved reporting of household maintenance issues and awareness of prevention opportunities for Strep A infections. Implications for public health: Biomedical, clinic-based approaches to the management of Strep A infections in remote communities can be usefully augmented by outreach-based supports delivered by Aboriginal Community Workers responding to community needs.

The sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.

Rural, regional and remote residents draw on diverse assets, and develop or maintain their livelihood strategies, within the context of broader social, political, ecological and other factors. Social work practice in rural and remote Australia takes place in dynamic settings where there are ongoing and dynamic struggles over resources and to attain ecologically, economically, politically and socially sustainable livelihoods. Systems theory in social work focuses attention on the ‘person in environment’, and articulates levels of practice from individual, family, group and community to policy-making and advocacy. One of the tools for understanding ‘rural and remote Australian regions as dynamic socio-ecological systems’ is the sustainable livelihoods approach. In approaching a rural, regional or remote community, social workers are called on to have a broad analysis of the historical, social, economic, ecological and political background of a specific place. Fly-in/fly-out health, recreation and social work services were evident.

High rates of non-permanent residents have implications for securing funding for ongoing education, health and other social services in these areas. The costs of land, size of land, planning rules and costs of linking amenities to land for residential development can make private developers and investors reluctant to invest in housing in various rural, regional and remote areas. In rural, remote and regional settlements, there are various significant impediments to housing supply, both for the private rental market and home ownership. Government policies have a critical role to play in rural, remote and regional housing, and the impact of these policies over time has at times been positive, negative or both. Regional, rural and remote housing availability and affordability are impacted by the diversity of geography, recent housing changes like the resources boom, the sea- and tree-change phenomenon, rapid rises in housing prices and the slow and low level of wage rises in relation to accommodation costs.

Recent research has shown the potential of portable and handheld NIR instruments to monitor and measure the composition of fruits and vegetables. Current research has also shown the possibility of using portable instruments as tools to monitor composition along the entire food value chain. The objective of this study was to evaluate two sample presentation methods (dry powder and fruit puree) to measure total soluble solids (TSS) and moisture (M) in wild harvested Kakadu plum (KP) (Terminalia ferdinandiana, Combretaceae). Kakadu plum is an endemic plant of Australia that contains high concentrations of vitamin C, ellagic acid as well as other bioactive compounds. These properties make this plant of high economic and social importance for the Aboriginal communities of Australia. Fruit samples were wild harvested in January 2020 from locations in the Kimberley region (Western Australia, Australia) and analysed using both reference and NIR spectroscopic methods. The SECV and RPD values in cross validation were 0.65% (RPD: 2.2) and 0.22% (RPD: 4.2) to predict M and TSS in the KP dry powder samples. The SECV and RPD values obtained in cross validation for the KP fruit puree samples were 0.56% (RPD: 2.8) and 0.24% (RPD: 3.8) for M and TSS, respectively. The results of this study demonstrated the ability of NIR spectroscopy to measure M and TSS in wild harvest fruit. These findings can be also utilised by the Aboriginal communities to develop a grading/sorting system to rapidly screen and evaluate relevant chemical parameters associated with fruit quality and safety.

This study identified and quantified hydrolysable tannins (HTs) in Terminalia ferdinandiana Exell (Kakadu plum) fruit, freeze dried powder extracted with 80% aqueous acetone (AA) and 80% aqueous acidified ethanol (AAE), using UHPLC–Q/Orbitrap/MS/MS. The vitamin C and ellagic acid were quantified by UHPLC-PDA. A total of seven HTs were identified: corilagin, 3,4,6-tri-O-galloyl-β-d-glucose, elaeocarpusin, chebulinic acid, chebulagic acid, helioscopin B, and punicalagin, with five classified as ellagitannins. The two extracts AA and AAE, comprised of gallic acid (2.5 and 2.2 mg/g DW), punicalagins α and β (2.8 and 1.3 mg/g DW), respectively, and both contained ellagic acid (~4 g/100 g DW). These extracts showed high antioxidant properties and strong antimicrobial effects against methicillin-resistant Staphylococcus aureus clinical isolate, Staphylococcus aureus, and Shewanella putrefaciens. These results suggest that Kakadu plum fruit is a rich, edible source of ellagitannins, ellagic acid and vitamin C with potential applications in food, cosmetic and nutraceutical industries.

Background Real-time video counselling for smoking cessation uses readily accessible software (e.g. Skype). This study aimed to assess the short-term effectiveness of real-time video counselling compared to telephone counselling or written materials (minimal intervention control) on smoking cessation and quit attempts among rural and remote residents. Methods An interim analysis of a three-arm, parallel group randomised trial with participants (n = 655) randomly allocated to; 1) real-time video counselling; 2) telephone counselling; or 3) written materials only (minimal intervention control). Participants were daily tobacco users aged 18 years or older residing in rural or remote areas of New South Wales, Australia. Video and telephone counselling conditions offered up to six counselling sessions while those in the minimal intervention control condition were mailed written materials. The study measured seven-day point prevalence abstinence, prolonged abstinence and quit attempts at 4-months post-baseline. Results Video counselling participants were significantly more likely than the minimal intervention control group to achieve 7-day point prevalence abstinence at 4-months (18.9% vs 8.9%, OR = 2.39 (1.34–4.26), p = 0.003), but the video (18.9%) and telephone (12.7%) counselling conditions did not differ significantly for 7-day point prevalence abstinence. The video counselling and minimal intervention control groups or video counselling and telephone counselling groups did not differ significantly for three-month prolonged abstinence or quit attempts. Conclusion Given video counselling may increase cessation rates at 4 months post-baseline, quitlines and other smoking cessation services may consider integrating video counselling into their routine practices as a further mode of cessation care delivery. Trial registration www.anzctr.org.au ACTRN12617000514303.

Purpose Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place. Methods An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service. Results Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship. Conclusions An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities. Implications for rehabilitation Co-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities. Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.

Performances of Aboriginal musical traditions have become widespread in various national and international spaces and are key ways in which Aboriginal people from distinct regions project their specific identities to a broader world. Warlpiri people, from the remote settlement of Yuendumu in the Tanami desert of Australia, have in the last few decades increasingly gained interest in performing their ceremonial songs and dances in intercultural spaces and to audiences with little understanding of the religious importance. Against a historical backdrop of settlement history and the shifts that have occurred to public ceremonial forms during this period (Dussart 2004), we analyse a recent performance of a purlapa at the Aboriginal Tent Embassy in Canberra. We suggest that Warlpiri people are using these performance opportunities to engage a broader world in specific aspects of their identities?being recognised as global citizens?whilst also maintaining important links to their specific cultural heritage.