Remote Australia Online

Author summary Ivermectin is an important drug for the control and treatment of neglected tropical diseases. However, despite numerous studies showing that ivermectin is safe and well tolerated in young children, it is not currently recommended in young children <5 years and <15 kg. Therefore, there are no guidelines for the dose of ivermectin in young or small children. In this study, we firstly determined how much ivermectin is present in blood in children aged 5 years and older. We then used this information to model what happens to ivermectin in childrens’ bodies allowing us to calculate the dose required in children aged less than 5 years and weighing under 15 kg. This study provides a new dosing guideline that can now be tested in clinical studies of children <5 years and <15 kg.

Objective: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland. Methods: A combination of in-depth interviews with health staff and managers and focus groups with health staff and consumers. Results: The tobacco brief intervention initiative resulted in changes in clinical practice among health care workers in all three sites. Although health workers had reported routinely raising the issue of smoking in a variety of settings prior to the intervention, the training provided them with an additional opportunity to become more aware of new approaches to smoking cessation. Indigenous health workers in particular reported that their own attempts to give up smoking following the training had given them confidence and empathy in offering smoking cessation advice. However, the study found no evidence that anybody had actually given up smoking at six months following the intervention. Integration of brief intervention into routine clinical practice was constrained by organisational, interpersonal and other factors in the broader socio-environmental context. Conclusions/implications: While modest health gains may be possible through brief intervention, the potential effectiveness in Indigenous settings will be limited in the absence of broader strategies aimed at tackling community-identified health priorities such as alcohol misuse, violence, employment and education. Tobacco and other forms of lifestyle brief intervention need to be part of multi-level health strategies. Training in tobacco brief intervention should address both the Indigenous context and the needs of Indigenous health care workers

Undiagnosed crusted scabies patients can be index cases in outbreaks of scabies in residential facilities such as nursing homes and can undermine the success of scabies mass drug administration programs, but literature about this debilitating disease is very limited. The study describes a large cohort of patients with crusted scabies who have been treated according to established local guidelines. While the success of the initial clinical response supports the guideline-based treatment regimen for crusted scabies, with only one patient dying with scabies-related sepsis, the subsequent mortality remains high, reflecting the large burden of comorbidities in the cohort. In addition, there was a high rate of recurrent crusted scabies, attributed to new infection with scabies once the cured patients return to their scabies-endemic communities. Crusted scabies can be successfully treated using robust guidelines including multiple doses of ivermectin together with topical therapy. However, community-based initiatives such as support for ‘scabies free zones’ are needed to prevent re-infection and recurrent disease in those individuals who are susceptible to developing crusted scabies. Undiagnosed crusted scabies is a threat to the success of scabies mass drug administration programs and will continue to drive scabies outbreaks in residential facilities.

The COVID-19 pandemic is growing rapidly, with over 37 million cases and more than 1 million deaths reported by mid-October, 2020, with true numbers likely to be much higher in the many countries with low testing rates. Many communities are highly vulnerable to the devastating effects of COVID-19 because of overcrowding in domestic settings, high burden of comorbidities, and scarce access to health care. Access to testing is crucial to globally recommended control strategies, but many communities do not have adequate access to timely laboratory services. Geographic dispersion of small populations across islands and other rural and remote settings presents a key barrier to testing access. In this Personal View, we describe a model for the implementation of decentralised COVID-19 point-of-care testing in remote locations by use of the GeneXpert platform, which has been successfully scaled up in remote Aboriginal and Torres Strait Islander communities across Australia. Implementation of the decentralised point-of-care testing model should be considered for communities in need, especially those that are undertested and socially vulnerable. The decentralised testing model should be part of the core global response towards suppressing COVID-19.

Around age three, First Nations children in remote communities in Australia undertake a major transition from the home to formal schooling. This very important period of child development is typically monitored by non-First Nations educators. Yet these educators typically know little about First Nations child development of children aged birth to seven. The purpose of this review is to demonstrate the importance of describing the process of acquiring social and cultural practices that enable a child to become a dynamic, knowledgeable participant in a First Nations context from a strengths perspective.

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities. Methods: The study consisted of a preand post-study of the effect of a multicomponent tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. Results: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t=-4.5, 95% Cl -33.6-12.5, p 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. Conclusions: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.

This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible educational gaps in clinical knowledge. This was followed by an internal stakeholder forum and a follow-up survey with Torres and Cape Hospital and Health Service staff to gain their perspectives on current service delivery and table ideas for a new ENT health service model. Qualitative data were analyzed inductively and grouped in emerging themes. Quantitative data were imported into tables and analyzed descriptively. PAR allowed for input from 19 PHC clinicians, 10 face-to-face stakeholders perspectives, and 18 stakeholder follow-up survey respondents. Four themes emerged: 1. Training for health workers in ENT management; 2. Improved local service access; 3. New referral pathways to improve continuity of care; and 4. Introduction of telehealth. PAR engaged key stakeholders, identifying gaps in ENT service delivery, and guided the development of the new service model. The inclusion of stakeholders throughout the service redesign process is likely to create a more sustainable model of care which already has local 'buy-in.

Purpose The rollout of individualised disability funding in Australia resulted in an increased demand for services for people with a disability, particularly support for the high percentage of Australians with autism spectrum disorder. Continuing professional development is one way to grow and maintain a skilled workforce; however, face-to-face opportunities can be limited in remote areas of Australia. Technology may provide a low-cost and widely accessible platform for providing education and support for staff in these areas. Design/methodology/approach The current study evaluated a novel webinar training and individual online support program for 36 allied health, education and community support staff. Data were collected via a survey on changes in perceived “knowledge and skills” and “confidence” in supporting children with autism, as well as mode of participation, and accessibility of the program. Findings Participants reported a significant increase in their “knowledge and skills” and “confidence”, in working with children with autism. This increase was positively related to the number of webinars the participants accessed. The mode of webinar access was predominantly via watching recordings of webinars (asynchronous learning). Synchronous learning via individual online sessions was accessed by a small number of participants, mostly allied health professionals. Workload and scheduling were identified as barriers to engaging in the program. The technology platform was found to be accessible and acceptable. Originality/value A predominantly asynchronous mode of delivery was successful, thereby increasing program access and flexibility for remote staff. Technology was not a barrier to accessing the program regardless of remoteness or job role.

OBJECTIVE: To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD). DESIGN: Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners. SETTING: Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services. PARTICIPANTS: Health care practitioners who registered to attend the BEWE training program (n = 31). MAIN OUTCOME MEASURES: Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD. RESULTS: Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation. CONCLUSION: The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.

Context: Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements. Objective: The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare. Findings: Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals. Conclusions: The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.

Service providers have long been aware of the lack of community mental health supports in Western Australia. This project brought together co-design and research processes to examine the need for community mental health supports from a lived experience perspective. Community mental health supports can change an individual’s life trajectory by enabling them to better understand and manage their own personal recovery, and supporting them to live well in the community and stay out of hospital. Increasingly, mental health policy and reform agendas – nationally and worldwide – are calling for the need to expand non-clinical community mental health support. This is based on the understanding that hospital stays, highly qualified clinicians, and medication is not always the answer for everyone, and not always the most cost effective approach. This work combined co-design and research methods to better understand the mental health support needs of Western Australians. In particular, this project considered priority cohorts who are less likely to access support, due to service gaps or additional barriers to engagement. Young people (high school aged and young adults), family members and carers, and individuals with high acuity mental health issues and multiple unmet needs (including co-occurring alcohol and other drug issues), and people living in rural and remote WA engaged in a variety of methods to express their needs and wishes for how their mental health can be better supported.

This chapter attempts to tackle a sweeping assumption that globalisation and technology has created an equal playing field and homogenised users of the Internet and social media. Health services and its online interventions have perceived technology to be culturally blank and therefore may act as an intermediary between the Western biomedical discourse and the assumed ‘hard-to-reach’ Indigenous users. We argue that this is problematic because there is no evidence of the integration of a Western concept of health and wellbeing with Indigenous knowledges. The deficit model continues to frame poor health outcomes in remote Indigenous communities lacking in education and health information despite an acknowledgement of the forces playing in the background—the social determinants of health. We propose a small step forward in this complex problem from a co-design departure, arguing that the digital landscape is constructed by both Indigenous and non-Indigenous users and their perceptions of what it means to be healthy and live well. We bring together an interdisciplinary approach, marrying the public health efforts on the Internet with a grounded abductive approach embracing Indigenous subjectivities through a co-design framework that blurs the boundaries between the intended behaviour change intervention, community consultation, participatory research and design.

Objective: High-quality diets, characterised by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardiometabolic diseases. The current study explores relationships between plasma antioxidants and cardiometabolic risk among Aboriginal people in Australia. Design: As part of a community-driven health promotion programme, we conducted a cross-sectional study including a health-behaviour questionnaire, plasma antioxidants and cardiometabolic risk markers (anthropometric, blood pressure measurements, fasting glucose, glycated Hb (HbA1c), lipids, C-reactive protein and albumin-creatinine-ratio) continuous and categorised into population-specific cut-offs. Antioxidants (β-carotene, β-cryptoxanthin, lycopene, lutein-zeaxanthin, retinol and α-tocopherol measured using HPLC) were applied to a principal component analysis, which aggregated these into a single component. Linear regression models were applied to investigate associations between the antioxidant component and cardiometabolic risk markers. Setting: Community in a remote area in Northern Territory, Australia. Participants: A total of 324 Aboriginal people, mean age 35·5 (range 15–75) years. Results: Antioxidant component levels were higher among individuals with higher self-reported vegetable intake (P < 0·01), higher among individuals with higher self-reported fruit intake (P = 0·05) and lower among current smokers (P = 0·06). Linear regression revealed an inverse association between the antioxidant component and C-reactive protein (β = –0·01, P < 0·01) after adjusting for confounders. Conclusion: Higher plasma antioxidant levels, indicators of diet quality, were associated with lower levels of high-sensitivity C-reactive protein in this Aboriginal population in remote Australia. This association suggests plasma antioxidants may be protective against inflammation; however, longitudinal studies are needed to examine this potentially protective relationship.

Growing investments in food and farmland have raised concerns about the potential implications of the financialisation of the Australian agri-food sector. However, little is known about how these investments are negotiated in practice - what people and tools structure agricultural investments and drive their outcomes. Emerging research on this topic has largely focussed on private sector actors, with the state positioned as a structural driver which, through broad neoliberal policies, creates conditions which promote financialisation. Indeed, the 2015 White Paper on ‘Developing Northern Australia’ articulates a governance rationality that indicates the responsibility for allocation of economic resources should rest with financial investors. Yet excessive attention to this agenda risks underplaying the difficult, uncertain, work of government officials seeking to translate this into practice. This research explores the work of local Northern Territory government officials as they seek to translate two key aspects of the Developing the North program into practice: attracting finance capital, and moderating its activities. An appreciation for the difficult work of translation allows us to move beyond a view of the state as a merely passive actor in financialisation, to consider ways that individuals within government work actively to assemble patterns of financial investment.

What happens if, instead of the Holocaust being the baseline event for understanding cultural trauma, settler colonial examples are recruited to decolonize cultural trauma framings? Here, a partly successful tribunal hearing lodged by Arrernte residents in Santa Teresa, central Australia, over neglected repair and maintenance issues, shows how settler state deployments of the traumatic and the traumatizing also pivot on event models. Such containment tactics enable more perennial forms of cultural trauma to thrive in insidious and distributed ways. This litigation case study highlights the need to decolonize, rather than reproduce, countersovereignty acts of cultural trauma in our conceptual models.

This chapter will offer the reader an outline of the role of a remote area nurse, and of the key health issues facing people in very remote Australia, in particular Aboriginal and Torres Strait Islander peoples. It will also outline cultural adaptation, cultural safety/responsiveness framework that underlie remote nursing practice. This chapter offers the reader an outline of the role of a remote area nurse, and of the key health issues facing people in very remote Australia, in particular Aboriginal and Torres Strait Islander peoples. It outlines cultural adaptation, cultural safety/responsiveness framework that underlie remote nursing practice. Remote area nurses (RANs) have been around for more than one hundred years with the first bush nursing posts established in 1911. RANs, along with Aboriginal and Torres Strait Islander Health Practitioners/Workers are the main health providers in very remote Australia. The key foundations of remote area nursing are cultural safety/responsiveness and Primary Health Care, the later described as an approach or philosophy that permeates the whole healthcare system. Cultural safety is a phrase originally coined by Maori nurses and nursing students who felt that they and their people were unsafe in the mainstream health system.

Author summary Impetigo (skin sores) is a condition that remains of public health interest. Late sequelae of acute rheumatic fever and rheumatic heart disease, combined with a high prevalence in remote Australian Aboriginal communities, Fiji, and other areas of socio-economic disadvantage, mean that impetigo is a substantial contributor to the burden of disease in these settings. Despite decades of study, key quantities of interest from a transmission dynamics perspective—including the force of infection, infectious period and reproductive ratio—have not yet been determined. Such measures are arguably crucial for making informed decisions on future surveillance activities and intervention strategies. Using a series of computational and statistical methods, we find that the infectious period in remote Australian Aboriginal communities is between 12 and 20 days, and that the force of infection varies by setting. Further, we show sampling every 10 days in future surveys is optimal for further refining these estimates.

Published evidence confirms poor access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory. This study aimed to identify the practical causes and recommend improvement. Pathways to wait-listing for a kidney transplant were reviewed to identify potential barriers. Processes were mapped to identify potential problem areas, provide comparison of the actual versus the ideal, identify where data needed collecting and provide clear presentation of the processes. Staff involved in the work-up of patients going for wait-listing were asked to list the barriers. Data were collected for patients from the transplant database between 1 January 2017 to 31 August 2018. Quality improvement statistical processes and charts were used to analyse and present the results. There were 102 patients in the transplant work-up process; 81.4% were Aboriginal and Torres Strait Islander, 71.6% were progressing with the work-up, 28.4% were on-hold. Of the 29 patients on hold, 92.9% were Aboriginal and Torres Strait Islander. Causes of delays to wait-listing included: failure to attend appointments due to competing priorities and communication barriers, access and navigating complex pathways to specialist services, transport, co-morbidities requiring multiple tests and multiple specialty services, and pressures on dialysis and hospital bed capacity. In conclusion, barriers to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians are complex and can be addressed by redesigning healthcare provision, including increasing the Aboriginal and Torres Strait Islander workforce to provide education and patient navigation of the healthcare system and improve communication, streamlining investigations and coordinating specialist services.What is known about the topic? Access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory is poor. Barriers to wait-listing for kidney transplantation can occur anywhere along the pathway of care from a patient’s first contact with the renal service to wait-listing.What does this paper add? Identified barriers to wait-listing for kidney transplantation include health service workforce and resources shortages, patient and health service barriers such as patients’ competing priorities, poor communication between the health service and patients, transport and accommodation for patients from remote communities, complex comorbidities, and access to specialist services.What are the implications for practitioners? Recruitment and retention of Aboriginal and Torres Strait Islander mentors, healthcare workers and patient navigators should be prioritised to provide an effective culturally appropriate service. Effective communication strategies with patients and improved access to streamlined appropriate investigations and collaboration among specialist services will invariably improve access to wait-listing for kidney transplantation.

Background: Australian policies for Aboriginal and Torres Strait Islander well-being outline the importance of local community-based interventions; for adolescents, school-based programs have been identified as beneficial. However, there is a lack of localized data to determine levels of resilience and risk and thus whether programs are effective. This paper describes the challenges and opportunities in collaboratively designing and piloting a localized survey instrument to measure Indigenous students’ resilience and upstream risk factors for self-harm and the resultant instrument.Methods: A participatory action research approach was used to engage education staff, health-care providers, students, and researchers to design and pilot the survey instrument. A six-phased process facilitated survey development: (1) defining the logic and exploring the evidence; (2) understanding and tailoring for context; (3) testing for feasibility and relevance; (4) testing for appropriateness and comprehension; (5) facilitating survey administration; and (6) refining the instrument. Processes in each phase were recorded and transcribed with thematic analysis used to identify key challenges and opportunities arising during development. Results: Four key challenges and opportunities were identified: (1) the relevance of international survey instruments for Indigenous Australian students; (2) accounting for distinct environments; (3) the balance between assessing risk and protective factors; and (4) tailoring for literacy levels and school engagement. The final Student Survey instrument comprised 4 demographic and 56 resilience, risk, service use, and satisfaction questions. The T4S will be administered routinely on annual student intake. Discussion and conclusion: The six-phased participatory processes resulted in a tailored instrument that could identify the critical resilience and upstream risk factors facing a cohort of Indigenous students who attend boarding schools for secondary education. Challenges were resolved collaboratively and the pilot results were directly translated to education practice and its integration with health services. Our results suggest that both the phased process of developing the T4S and the instrument itself can be adapted for other Indigenous adolescent well-being and/or self-harm prevention programs.

Building trust and forging relationships with remote Aboriginal communities is an essential element of culturally informed, reciprocal research. Historically these relationships have been formed over-time where community members and researchers come together face to face to share their knowledge and yarn in both an informal and formal manner. Researchers from Telethon Kids Institute are partnering with local stakeholders and remote Aboriginal communities in the Kimberley, Western Australia (WA) to support healthy skin through the SToP (See, Treat, Prevent skin sores and scabies) Trial. The SToP trial, a collaboration between Telethon Kids Institute, Kimberley Aboriginal Medical Services (KAMS), Nirrumbuk Environmental Health Services and Western Australia Country Health Services (WACHS) – Kimberley is a clustered randomised trial with a stepped-wedge design. SToP trial consultation with stakeholders and communities commenced in 2016 to proceed consenting in 2018 and trial commencement in 2019. Since that time, the SToP trial team have been conducting intermittent fieldwork in nine remote Aboriginal communities in the Kimberley. However, due to the COVID-19 pandemic when Aboriginal health leaders recommended a cessation to research related travel in northern WA from March 11, 2020 to prevent the incursion of COVID-19 into Aboriginal communities with health vulnerabilities, crucial face-to-face yarning was no longer possible. At the time it appeared the existing relationships with communities involved in our research (the SToP trial) would be challenging to maintain without this ability to visit the communities. Fortunately, when tested, this assumption was erroneous. Here we report the successful use of technology to bridge the inability to visit communities in 2020 due to COVID-19. The Telethon Kulunga Aboriginal Unit (Kulunga) and SToP trial team members were able to connect virtually with Community Navigators from the Dampier Peninsula communities. The initial virtual meeting using Microsoft Teams technology involved four Community Navigators and their mentor, three Telethon Kids Institute and five Kulunga staff members. Community Navigators joined Microsoft Teams from their respective communities and Kulunga and Telethon Kids Institute staff joined from their homes. Not only was this an exciting new way of communicating, it enabled existing relationships to continue to be strengthened. Since the initial meeting, the teams have continued to meet virtually, and plan SToP trial health promotion activities including a community-driven, collaborative music video. While the significance of face-to-face yarning can never be overstated, having to adjust to a new way of yarning has reiterated the importance of connection, albeit virtually. Unfortunately, due to technical limitations, intermittent internet connectivity and various other challenges, there has been no opportunity to engage virtually with SToP trial communities in the East Kimberley. However, we continue to seek ways where virtual communication in these communities is possible.

A “diversity as fundamental heterogeneity” approach is required to contest the widely held perspective that Aboriginal children in remote communities in central Australia are growing up in deficit and disadvantage. This article discusses the current language perpetuating the deficit model of Aboriginal child development that is failing to recognise strengths of Aboriginal children growing up in remote communities in central Australia. Through stories about daily life in Papunya, this article argues that to understand and measure Aboriginal child development, it is necessary to also understand the child’s cultural context in which they are living and learning. Participant selection was conducted using key participants who became community researchers in the research project. The main findings were Aboriginal children in Papunya must grow up with a “two-ways” approach to education that prioritises their own culture and language.

A sense of community is of critical importance to educators. Community features heavily in the research literature about student belonging that stems from connections within school, between school and home and to networks beyond the school gates (Watson & Battistich, 2006). Notions of school community are influential in shaping the life and culture of schools, as those who create connection shape what it means to belong, identify and contribute (Allen, Kern, Vella-Brodrick, Hattie & Waters, 2016). Halsey (2018) states that schools are central to community more generally within regional, rural and remote places and act as an anchor point for community to build around. Campbell and Yates (2011) reiterate this by explaining that within rural and remote locations the school is the centre of the community. Community is often prominent in recruitment drives to lure graduate teachers to rural, regional and remote schools (Hazel & McCallum, 2016). This concept is also dominant in our thinking about teachers’ communities of practice and the influence that these have over the nature and products of teachers’ work and lives (Wenger, 2000). Community contributes to notions of what life is like beyond city limits. Community is conceived in various ways but often with some relationship to the glue that binds people together, the bounce that enables people to respond to hardship and adversity, and, the opportunity to connect when coming together is critical. Community captures and communicates a sense of something meaningful, influential and significant.

Australia’s rangeland communities, industries, and environment are under increasing pressures from anthropogenic activities and global changes more broadly. We conducted a horizon scan to identify and prioritise key challenges facing Australian rangelands and their communities, and outline possible avenues to address these challenges, with a particular focus on research priorities. We surveyed participants of the Australian Rangeland Society 20th Biennial Conference, held in Canberra in September 2019, before the conference and in interactive workshops during the conference, in order to identify key challenges, potential solutions, and research priorities. The feedback was broadly grouped into six themes associated with supporting local communities, managing natural capital, climate variability and change, traditional knowledge, governance, and research and development. Each theme had several sub-themes and potential solutions to ensure positive, long-term outcomes for the rangelands. The survey responses made it clear that supporting ‘resilient and sustainable rangelands that provide cultural, societal, environmental and economic outcomes simultaneously’ is of great value to stakeholders. The synthesis of survey responses combined with expert knowledge highlighted that sustaining local communities in the long term will require that the inherent social, cultural and natural capital of rangelands are managed sustainably, particularly in light of current and projected variability in climate. Establishment of guidelines and approaches to address these challenges will benefit from: (i) an increased recognition of the value and contributions of traditional knowledge and practices; (ii) development of better governance that is guided by and benefits local stakeholders; and (iii) more funding to conduct and implement strong research and development activities, with research focused on addressing critical knowledge gaps as identified by the local stakeholders. This requires strong governance with legislation and policies that work for the rangelands. We provide a framework that indicates the key knowledge gaps and how innovations may be implemented and scaled out, up and deep to achieve the resilience of Australia’s rangelands. The same principles could be adapted to address challenges in rangelands on other continents, with similar beneficial outcomes.

INTRODUCTION: Despite reports suggesting an oversupply of pharmacists, there is currently an inadequate supply in rural and remote Australia. This can lead to a reduction in pharmaceutical services for an already vulnerable population. The objective of this study was to identify strategies for increasing the pharmacist workforce and factors associated with retention in rural and remote Australia Methods: Database searches of Ovid Medline (Medline and Embase), CINAHL and Scopus were conducted. Full text of relevant studies conducted in Australia, reported in English and published between 2000 and 2019 were retrieved. The record titles were independently screened by two investigators, after which abstracts of disputed articles were collected for further evaluation. Where agreement could not be reached, a third independent investigator screened the residual articles for inclusion or exclusion. RESULTS: Overall, 13 articles focusing on the pharmacy profession were retrieved. Strategies that have been employed to increase the rural and remote pharmacist workforce include the establishment of pharmacy schools in rural areas, inclusion of rural content in undergraduate pharmacy curriculum, enrolment of students from rural backgrounds, rural placement and employment of sessional pharmacists. Factors associated with retention were personal, workplace or community factors. CONCLUSION: There is limited research focusing on the recruitment and retention of pharmacists in rural and remote Australia. Given that pharmacies in rural and remote areas are very accessible and often function as one-stop health hubs, additional personal, workplace and community support should be provided for rural pharmacists and pharmacy students undergoing placements in rural and remote communities.

Recent research relating specifically to Anangu (Pitjantjatjara and Yankunytjatjara) schools in South Australia and the Northern Territory assert that Aboriginal people living in remote central Australian communities viewed first languages and cultures as central to a good education for their children. The South Australian ten-year Aboriginal Education Strategy (2019-2029) commits to culturally responsive pedagogies (CRP) and bilingual instruction in Anangu schools by 2029. This translation from research to policy has important implications for practice which the authors, five experienced practitioner-researchers in Anangu education contexts, reflect on through a 'practice architectures' lens using a narrative methodology. The article explores the complex space that practitioner researchers negotiate and highlights the shifts required in moving from research-oriented arguments to working collaboratively to enacting research findings in practice. The article concludes with reflections on privileging community voices and demands throughout the research-policy-practice continuum.