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Objective: To identify and assess the drivers and barriers to recruiting and retaining doctors in rural communities of high‐income countries. Design: A systematic review and thematic analysis. Setting: Publications were sourced from medical and scientific databases online. Participants: Qualitative, mixed‐methods and review studies from peer‐reviewed journals published since 2000 that discussed recruitment or retention of doctors to rural areas in high‐income countries. Main outcome measures: Identification and assessment of themes in the literature pertaining to recruitment and retention of rural doctors. Recurrent themes were assessed for relevance and applicability to current rural shortages. Results: A thematic analysis was completed on 41 papers assessed as in scope of the review. Papers were scrutinised for relevance to established rural recruitment and retention strategies. Key themes were rural background, education and training, personal and professional circumstances, and integration with the community. Conclusion: While rural origin has long been promoted as the key factor for recruiting rural doctors, initiatives targeting only these individuals ignore a potentially larger cohort of future rural doctors. Rurally focused medical education and training need to encompass students and doctors from all backgrounds. The major barriers to rural recruitment are family‐unit considerations for partners and children, concerns over isolation and a poor perception of rural practice. Attracting doctors to practise rurally is only half the challenge however, and strategies to retain rural doctors need a greater focus on personal and professional support networks and community integration. Additional strategies are needed to retain international and bonded doctors restricted to rural areas. [ABSTRACT FROM AUTHOR]

Introduction: Student‐led clinics can provide health services to marginalised groups where service offerings are sparse or difficult to access, such as rural areas. Offering these services to children and young people can promote health and well‐being by addressing the individual challenges and the social determinants of health. There is uncertainty, however, as to whether student‐led clinics can meet Australian accreditation standards for health professionals completing degree programs. Objective: This study aims to determine the capacity for health student placements in school‐based student‐led clinics to meet accreditation standards. Design: A systematic scoping review was conducted based on Arksey and O'Malley's framework and the PRISMA‐ScR statement. Setting: Several databases were examined, including Ebsco (Academic Source and CINAHL), ProQuest (PsycINFO, ERIC) and grey literature sources along with a desktop review of accreditation standards across seven health disciplines. Two independent reviewers screened eligible studies. Findings: The search retrieved 1037 records with 65 full‐text papers assessed for eligibility. Eleven papers met the inclusion criteria. Based on the evidence, both nursing and exercise and sports science accreditation standards were best suited to student‐led clinics. Discussion: Although broad categories of work‐integrated learning activities were applied, it appears feasible to expect accreditation standards for health disciplines at an Australian university to be a good fit for health student‐led school‐based clinics. Conclusion: Increasing health student placement opportunities within student‐led clinics can improve the health and well‐being of children and young people in regional, rural and remote (RRR) areas of Australia who may otherwise have limited access to allied health services. [ABSTRACT FROM AUTHOR]

Introduction: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. Objective: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. Design: A systematic scoping review of peer‐reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). Findings: Thirty‐two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. Discussion: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient‐centred care for elderly populations in rural and remote areas. Conclusion: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents. [ABSTRACT FROM AUTHOR]

Objective: To explore the benefits and challenges of electronic prescribing (e‐prescribing) for general practitioners (GPs) and pharmacists in regional New South Wales (NSW). Methods: This qualitative study utilised semistructured interviews conducted virtually or in‐person between July and September 2021. Setting and Participants: General practitioners and pharmacists practising in Bathurst NSW. Main Outcomes: Self‐reported perceived and experienced benefits and challenges of e‐prescribing. Results: Two GPs and four pharmacists participated in the study. Reported benefits of e‐prescribing included improvement in the prescribing and dispensing process, patient adherence, and prescription safety and security. The increased convenience for the patients was appreciated particularly during the COVID‐19 pandemic. Challenges discussed were how the system was perceived to be unsafe and insecure, costs of messaging and updating general practice software, utilisation of new systems and patient awareness. Pharmacists reported the need for education to patients and staff to minimise the impact of inexperience with the novel technology on workflow efficacy. Conclusion: This study provided first insight and information on the perspectives of GPs and pharmacists 12 months after the implementation of e‐prescribing. Further nationwide studies are required to consolidate these findings; provide comparisons with the system's progress since conception; determine whether metropolitan and rural health care professionals share similar perspectives; and shed light on where additional government support may be required. [ABSTRACT FROM AUTHOR]

Introduction: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence‐based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well‐established barriers to mental health help‐seeking and improve outcomes for this at‐risk group. Objective: This paper describes the findings of a co‐design phase informing the development of a peer (farmer)‐led approach for delivering BA for farmers living with depression or low mood. Design: This qualitative study used a co‐design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. Findings: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context—tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. Discussion: Findings suggest BA could be a contextually appropriate model of support for the farming community—given its practical and solution‐focused approach—and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. Conclusion: Insights gained through co‐design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood. [ABSTRACT FROM AUTHOR]

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Design: Qualitative thematic analysis using semi‐structured telephone interviews. Twenty‐one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work‐life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high‐volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages. [ABSTRACT FROM AUTHOR]

Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

Objective: Inter‐professional education is a growing area of importance that enables training of health care professionals and students to develop skills in collaborative clinical practice, a critical aspect of disability care. However, research is limited on appropriate on‐site inter‐professional training for the rural and remote disability workforce. This paper aims to explore the features of an effective inter‐professional training approach for rural disability workforce. Setting: Riverland, South Australia. Participants: Clinical educators, allied health professionals, health and service providers and students. Design: A qualitative‐explorative research design, involving focus group discussion and a thematic analysis method were employed in this study. Participants of the focus group discussion completed a capacity building training program centred on inter‐professional education, cultural‐safety and the National Disability Insurance Scheme. National Disability Services Social Impact Measurement Tool was used to evaluate and explore the features of effective inter‐professional training program for existing and emerging disability workforce in rural regions. Results: Four themes emerged from data analysis: inter‐professional education focus; structured inter‐professional training; building collaborative learning environment; and culturally appropriate care practice. Inter‐professional supervision was identified as a key enabler for capacity building in an area with limited health workforce. Inter‐agency collaboration and professional network were identified as important elements to support disability health workforce retention and the transition from novice to practitioner. Prior knowledge about the needs of persons with disability and empathetic relationships influenced the quality of practice. Conclusion: In situ training programs, which provide real‐life rural practice context and harness inter‐agency collaboration, improve effectiveness of rural disability workforce readiness for practice. [ABSTRACT FROM AUTHOR]

This paper provides evidence for the importance of taking an effective history and considering regional differences before formulating national health policies. Qualitative study; the data collection technique included manual searches of rare book collections, a search of the Victorian Public Record Office and Australian Archives files and a local media appeal for information about iodine and iodine supplementation in Gippsland and other regions of Australia. Regional Victoria and Australia as a whole. A total of 17 community members from the Gippsland region provided information on taking iodine tablets between the late 1940s and the late 1960s. Information from the community members who took iodine tablets, archival material, published papers in journals on iodine deficiency disorder in Gippsland, government reports and meeting minutes regarding distribution of iodine supplementation in Gippsland. Taking an effective history is vital to planning national health interventions. It might not be adequate to just search electronic databases. A thorough search of archival and hard copy material and consultation with members of the population can help find key historical data that can inform better health policy action. There is strong historical evidence of dietary iodine deficiency in the Gippsland region and in a number of other regions across Australia. Government and health authorities should undertake regular iodine status monitoring in these regions. Considering regional difference is important when making national health policy. [ABSTRACT FROM AUTHOR]

Objective: This paper reports findings from a study that sought to better understand the experiences of parents and their children with emergent mental health challenges following the parent's participation in a nurse-led therapeutic group. Design: This was an explorative qualitative study using semi-structured interviews which were then thematically analysed. Setting: Findings from this single-site study are drawn from regional Australia. Participants: Twenty parents and seven of their children aged between 13 and 24. Interventions: Family systems based therapeutic group intervention delivered to the parents of young people attending headspace. Main outcome measure: In line with qualitative research approaches, the participants lived experience was the outcome measure. Result: Three key themes were found in the data: (a) improved parent-child relationships, (b) understanding and being understood and (c) multi-generational perspectives. Conclusion: Regional and remote regions are challenged with comparatively fewer and less diverse services for youth mental health than in urban centres. Findings from this exploratory study highlight that young people can experience therapeutic gains where their parents are the recipients of the intervention. Recommendations from these findings include pursuing further research on the therapeutic gains of parental family system-based groups. [ABSTRACT FROM AUTHOR]

Introduction: The disparity in mental health outcomes compared with non‐Indigenous Australians means that there is an urgent need to develop an evidence base around how services can better support Aboriginal and Torres Strait Islander communities. A critical first step is to embed cultural safety into research methodologies. Objective: Here, we aim to establish the foundation of a research project through co‐designing a qualitative interview with Aboriginal and Torres Strait Islander consumers and community members about experiences of cultural safety with mainstream mental health services. Design: Voices of Aboriginal and Torres Strait Islander peoples must be empowered across all stages of research. An Aboriginal‐led research team conducted focus groups to understand clear, sensitive, and culturally appropriate ways of asking about experiences in mental health care, to co‐design an interview on this topic. Participants were Aboriginal and Torres Strait Islander consumers of mental health services, carers, mental health workers, Elders and Cultural Healers, living in Metropolitan and Regional Western Australia. Findings: Results suggest that Indigenous governance, together with investing in ongoing, and meaningful cultural awareness and cultural safety training (cultural awareness being a first step towards safety) for non‐Indigenous researchers, together with taking the time to build respectful partnerships with communities through ongoing consultation, were appropriate and comprehensive methods of co‐designing an interview. Discussion: The process of working with Aboriginal and Torres Strait Islander peoples in research is as important as the outcome. Aboriginal and Torres Strait Islander leadership, self‐determination, and relationship building with communities are essential. Conclusion: Empowering co‐design methodologies are flexible, iterative, and ensure that the experiences and views of participants are valued, leading to more meaningful results. [ABSTRACT FROM AUTHOR]

Objective: To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives. Design: Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis. Setting: Interviews of people across Australia. Participants: Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life. Main outcome Measure: Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020). Results: Policy changes surrounding border closures negatively impacted people's wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures. Conclusion: Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people's physical, financial, and emotional state. [ABSTRACT FROM AUTHOR]

Objective: This paper explores women's experiences of drought in Australia. Despite the significance of drought for rural life in Australia, there is little research seeking to understand its psychological consequences. There is also a need to recognise gendered experiences of drought and for research that addresses its long-term effects as people age in prolonged drought-affected areas. Design: The study explores longitudinal qualitative data collected by the Australian Longitudinal Study on Women's Health. Free-text comments ( n = 217), collected via mailed survey at five time points (1996, 1998, 2001, 2004, 2007) from the same 77 women, were subjected to a narrative analysis. Participants: Participants from the Australian Longitudinal Study on Women's Health who were aged 45-50 when the study began in 1996. Results: Findings indicate that drought has an impact on women as they age, particularly in reference to menopause, access to support systems and retirement. Conclusion: This study concludes that the experience of drought cannot be disentangled from the realities of gender and ageing. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on findings related to intersectoral collaboration stemming from an evaluation of a dementia awareness resource for use in remote Aboriginal communities*. The resource includes a DVD in English and three (3) Aboriginal languages of the Northern Territory. Design: A qualitative evaluation was conducted in four Northern Territory Aboriginal communities/organisations where the resource had been implemented by external dementia educators. The method included five focus groups with Indigenous aged care workers, community members and aged care service users ( n = 26), individual interviews with health care professionals and service coordinators ( n = 5), and observation. Data were analysed thematically. Results: Specific findings relating to intersectoral collaboration as a key enabling factor of effective dementia awareness and care are discussed in this paper. In addition to context variables such as understaffing and under-resourcing, there might be a lack of knowledge or interest on the part of some health practitioners concerning clients with dementia within remote communities. Conclusion: Dementia awareness in remote communities needs to be tackled from a 'whole system' perspective and not be the exclusive domain of the aged care services. Strategies that increase the critical mass of informed caregivers as well as health professionals will contribute to better services. [ABSTRACT FROM AUTHOR]

Objective: To explore rural residents' experiences of access to maternity care with consideration of the policy context. Design: This paper describes findings from focus groups with parents which formed part of case study data from a larger study. Setting: Four north Queensland rural towns. Participants: Thirty-three parents living in one of the four rural towns. Main outcome measures: Identifying prevalent themes in case studies regarding rural parents' expectations and experiences in accessing maternity care. Results: Parents desired a local, safe and consistent maternity service. Removing or downgrading rural services introduced new barriers to care for rural residents: (i) increased financial costs; (ii) family issues; and (iii) safety concerns. Conclusions: Although concerns about rural residents' health status and health care access have received significant policy attention for over a decade, many of the problems which prompted these policy initiatives remain today. Current policy approaches should be re-evaluated in order to improve rural Australians' access to vital health services such as maternity care. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. Objective The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers ( AHWs) and registered nurses ( RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. Design The design used a qualitative approach and discussion schedule to elicit responses. Setting The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. Participants The participants were experienced diabetes educators ( RNs and AHWs), managers and students currently enrolled in the course (n = 17). Results The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. Conclusion The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues. [ABSTRACT FROM AUTHOR]

Objective To obtain information about aged care services in rural New South Wales public hospitals, and to describe key operational aspects of their service delivery models. Design A mixed methods design was used to combine data collected from: (i) a survey of public hospitals and (ii) qualitative site visits in a sample of eleven rural sites. Setting Rural public hospitals in NSW, Australia. Participants Qualitative data were collected from multidisciplinary clinicians, managers and community service providers who participated in site visits in 2010 and from surveys of NSW public hospitals in 2009/10 about aged care and dementia services. Results Survey and site visit findings demonstrated that rural hospitals have fewer secure beds for managing patients with disturbed behaviour due to dementia and delirium and fewer speciality aged care staff than metropolitan hospitals. Site visit participants also described how secure environments can aid care for people with dementia even in the absence of clinical specialists. Conclusion The care of people with dementia in rural hospitals is constrained by access to specialist aged care staff and the physical environment of the hospital. Clinicians are adept at maximising resources to manage diagnosis and transitions for people with dementia. Further understanding of how key operational aspects of clinical leadership and environmental modifications impact on a range of patient outcomes would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth. Objective: The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth. Design: This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story‐based interviews. Participants narrated their stories of birthing away from home by telephone interview. Findings: Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby. Discussion: Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences. Conclusion: Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women. [ABSTRACT FROM AUTHOR]

Introduction: A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. Objective: To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. Design/Setting/Participants: Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. Findings: Eight themes were identified: (1) donor's emotional well‐being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well‐being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. Conclusion: Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group. [ABSTRACT FROM AUTHOR]

Objective: To identify challenges and strategies to improve the provision of end‐of‐life (EOL) cancer care in an underserved rural and regional Australian local health district (LHD) from the perspective of general practitioners (GPs) and specialist clinicians while exploring the benefits of adopting a generalist health care approach to delivering EOL care in rural and regional communities. Setting: Rural and regional Australia. Participants: General practitioners and palliative care and cancer care specialists (medical and nursing) involved in the provision of EOL care to people with advanced cancer in the rural and regional areas of an Australian LHD. Design: Qualitative descriptive study involving 22 participants in four face‐to‐face and online focus groups. Thematic analysis of the transcripts identified key issues affecting EOL care for people with advanced cancer in rural and regional areas of the LHD. Results: Four themes including geographical remoteness, system structures, medical management and expertise and training emerged from the focus groups. Key barriers to effective EOL care included insufficient remuneration for GPs and other clinicians (especially home visits), resource limitations, limited community awareness of palliative care and lack of confidence and training of clinicians. Continuity of care was identified as an important facilitator to effective EOL care. Participants suggested greater Medicare rebates for palliative care and home visits, adequate equipment and resources, technology‐enabled clinician training and greater rural‐based training for specialist PC clinicians may improve the provision of EOL care in regional and rural communities. Conclusions: Rural‐based clinicians delivering EOL cancer care appear to be disproportionately affected by geographical challenges including resource and funding limitations. A multi‐pronged strategy aimed at greater interdisciplinary collaboration, community awareness and greater resourcing and funding could help to improve the provision of EOL care in underserved rural and remote communities of Australia. [ABSTRACT FROM AUTHOR]

Objective: Over 34% of New Zealand (NZ) adults are classed as obese, which reduces quality of life for many individuals. Those living in rural areas, high‐deprivation communities, and indigenous Māori populations are more likely to experience obesity and related co‐morbidities than other cohorts. General practice is positioned as most suitable to deliver effective weight management health care; however, little is understood about the rural general practitioner (GP) experience in NZ, despite having the majority of patients at high risk of developing obesity. The aim of this study was to investigate rural GP perspectives on barriers to delivering weight management. Design: Qualitative descriptive design guided by Braun and Clarke (2006) using semi‐structured interviews and analysed using deductive reflexive thematic approach. Setting: Rural Waikato general practice which has significant rural, Māori and high‐deprivation communities. Participants: Six rural Waikato GPs. Results: Three significant themes were identified: communication barriers, rural health care barriers, and social and cultural barriers. GPs reported not wanting to jeopardise the doctor‐patient relationship by discussing weight. GPs felt unsupported by the health system through lack of rurally appropriate obesity intervention options, funding and resources. The unique rural lifestyle and health needs were reportedly not understood at the wider health system level, making the role of a rural GP working in high‐deprivation communities more difficult. Additional barriers to delivering effective weight management included factors outside the clinical practice such as obesity stigma, an obesogenic environment and sociocultural factors shaping rural patients' lives. Conclusion: Rural GPs have a lack of weight management referral options that are considered effective for their patients, as the options available reportedly do not cater for their patients' unique rural health needs. GPs position addressing the individualised and complex weight management health issue as challenging. Navigating stigma, wider sociocultural issues, and limited intervention options were difficult and found to be questionable to achieve in a short 15‐min consult. There is a need for rural health support in the form of funding, staff (indigenous and non‐indigenous), and rurally feasible resources to improve health outcomes and reduce inequity. Effective primary care weight management strategies need to be appropriate for high‐deprivation rural communities, including tailored, affordable and reliable interventions that GPs can offer patients if future weight management efforts are to be successful in this space. [ABSTRACT FROM AUTHOR]

Objective: To explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS. Setting: Rural areas of New South Wales classified as Modified Monash Categories 3–7. Participants: Semistructured interviews were conducted with seven purposively sampled participants who self‐identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW. Design: Data collection and analysis were guided by hermeneutic phenomenology. Findings: We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control. Discussion: The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need. [ABSTRACT FROM AUTHOR]

Introduction: Family carers play a crucial role in dementia care. As the condition progresses, people with dementia become increasingly dependent on their carers for all areas of daily living. The risk of carer burnout is significant. One of the more stressful events for family carers is when hospital admission is required for the person they care for. Living in regional Australia adds complexity to the experience. Hospital and health services in regional Australia could use a greater understanding of the issues associated with hospital care to inform patient and carer management, improve outcomes for this population and support the goal of 'ageing in place'. Objective: To explore the experience of carers of people with dementia in regional Australia when hospital care or treatment was required for the person they provide care for. Design: Six family carers living in regional Australia participated in this interpretative phenological study. Individual, semistructured interviews were held and transcribed verbatim shortly after. Data analysis occurred via three key processes: reading and highlighting, coding and grouping, which yielded the major themes and subthemes of the study. Findings: Three major themes and nine subthemes emerged from data analysis. The major themes were: (i) support and supply of specialist care; (ii) travel needs and negotiations; and (iii) empathy and experience make a difference. Discussion: Findings from this study highlight aspects of care that healthcare providers can address to improve outcomes for patients with dementia and their carers. Carers need opportunities to seek clarification and provide input on care plans. Good communication, involvement and relationship building between healthcare staff and carers are vital to achieving optimal patient outcomes. Staff training supporting understanding of appropriate dementia care is essential for improved patient and carer outcomes. Conclusion: Factors related to regional location, including lack of specialist care and support, compound carers' challenges. Healthcare provider education on dementia care and dementia‐friendly processes in hospitals will support optimal patient and carers outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Secondary prevention is essential in reducing recurrence of diabetes‐related foot disease (DFD) but is frequently poorly implemented in clinical practice. Objective: To explore the perceptions of people with diabetes‐related foot disease (DFD) on their self‐perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. Design: Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi‐structured interviews. Interviews were audio‐recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. Findings and discussion: Participants had high self‐perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. Conclusion: People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support. [ABSTRACT FROM AUTHOR]

Objective: To assess awareness, needs and use of Australian Government‐funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. Design: Mixed‐method study. Setting: Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). Participants: Fifty Aboriginal peoples aged 50–89 years (68% females) interviewed between August 2020 and October 2021. Main Outcome Measures: Participant awareness, needs and unmet needs. Results: 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2–6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. Conclusion: Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision‐making. [ABSTRACT FROM AUTHOR]

Objective: Expansion of opportunities for ophthalmology training beyond the 'big smoke' is anticipated to support the future distribution of ophthalmologists in regional, rural and remote areas of Australia. However, little is known about what enables supervision outside of metropolitan tertiary hospital settings that would contribute to positive training experiences for specialist medical trainees and encourage them to leave the 'big smoke' once qualified. The aim of this study was therefore to explore the perceived enablers of ophthalmology trainee supervision in regional, rural and remote health settings across Australia. Setting: Australia. Participants: Ophthalmologists working in regional, rural or remote health settings with experience and/or interest in supervising ophthalmology trainees (n = 16). Design: Qualitative design involving semistructured interviews. Results: Seven key enablers of ophthalmology trainee supervision in regional, rural and remote health settings were identified: adequate physical infrastructure, resources and funding to host a trainee; availability of online curriculum and teaching resources so as to ensure equity of training opportunities; pre‐established training posts, driven by supervision 'champions'; a critical mass of ophthalmologists to help share the supervisory load; relationships and support between training posts, the training network and the Specialist Medical College; alignment of trainee competence and attitude with the needs of the training setting; and the recognition of reciprocal benefits for supervisors through supporting trainees, including workforce support and renewal. Conclusion: With training experiences beyond the 'big smoke' anticipated to influence future ophthalmology workforce distribution, implementation of enablers of trainee supervision should occur in regional, rural and remote health settings wherever possible. [ABSTRACT FROM AUTHOR]

Objective: The primary aim is to explore rural clinicians' self‐reported knowledge, skills and attitudes in the decision‐making process for requesting aeromedical retrieval of patients with suspected appendicitis. A secondary aim is to understand the supports and barriers of rural clinicians experience in this clinical scenario. Setting: Clinician interviews conducted face‐to‐face in three rural hospitals in Central Queensland. Participants: Rural doctors and nurses. Design: A five‐part qualitative content analysis. Results: The majority of 44 participants identified the strong and effective teamwork. The decision to request aeromedical retrieval was a shared, joint process and identified a supportive collegial culture which supported the asking of questions and not expecting to have all the answers. Perceived barriers were lack of receiving clinicians understanding of transfer agreements, and data connectivity. Clinician pessimism was identified for perceived patient outcomes. Discussion Effective teamwork can nurture trust and collaboration across multiple health service roles. High job satisfaction may counter the physical isolation in some rural environments. Fragmentation of care is the unintended consequence of interhospital transfer and may impact rural clinicians' perception of patients' outcomes and hinder receiving clinicians' understanding of rural service limitations. Conclusion: Future work in the area of linked electronic medical records could remove a barrier for rural clinicians and improve their reflective practice by challenging their perception of definitive patient outcomes. Increased awareness by receiving clinicians of the limitation of rural services, may minimize communication barriers and thereby, improve timely patient care transfers. [ABSTRACT FROM AUTHOR]

Introduction: The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. Objective: To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. Design: Qualitative design involving semi‐structured in‐depth interviews with thirty‐two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n = 8), STP supervisors and clinical tutors (n = 16), and other stakeholders (n = 8). Findings: Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. Discussion: The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. Conclusion: Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer‐term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees. [ABSTRACT FROM AUTHOR]

Objective: This study explored experiences of rural cancer patients who were receiving treatments by remote video‐assisted chemotherapy (RVAC) or participating in clinical trials remotely. Setting: Participants lived in Coonabarabran or Dubbo in western NSW. Participants: Seven cancer patients undergoing treatment for breast, bladder or colon cancer, renal cell carcinoma or lymphoma. Design: Appreciative inquiry informed this qualitative study. Semi‐structured interviews were conducted between July 2018 and January 2019 and thematically analysed. Results: The patient experience of teleoncology was overwhelmingly positive. Patients explained the value of relationships that developed with the local and virtual care team. Patients felt they received better care if they saw the same oncologist for the duration of their treatment and felt RVAC had accommodated this. Teleoncology allowed patients to remain independent because they were able to maintain their usual support mechanisms including family, friends and health care team. Patients described the reduced physical and emotional travel burden in addition to reduction in travel time and cost. Conclusions: These findings highlight the acceptability of teleoncology for rural patients as chemotherapy can be added to the health care and social and emotional supports, which exist in their hometown. Expansion of teleoncology should be codesigned with local communities with a focus on establishing care teams with consistent staffing to build trust between the treating team and the patient. These relationships improve the patient experience and enhance patient independence, which is a desirable attribute of cancer survivorship. Recruitment to clinical trials using teleoncology is acceptable and should be factored into trial development. [ABSTRACT FROM AUTHOR]

Objectives: To co‐create a culturally responsive student‐implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service. Design: Co‐creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed‐method pre/postdesign. Setting: The service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia. Participants: Co‐creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co‐creation of the day‐to‐day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator. Findings A reciprocal learning service model was co‐created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community‐based services. Conclusion: The co‐created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required. [ABSTRACT FROM AUTHOR]

Introduction: Investigating how co‐designed knowledge can be translated to co‐produce a public health capacity‐building solution for difficult‐to‐engage population groups drawing on the co‐production experience of a prevention‐focused, capacity‐building mental health solution targeting primary producers. Design: A qualitative study undertaken in rural and regional Victoria involving members of the design working group including project team (7px), digital design team (5px), marketing team (3px), and funding partner representatives. The study design involved reflective practice to collect data to identify the phases of co‐production and assess the design working group members' experiences. The analysis involved inductive coding using Braun and Clarke's thematic analysis. Objective: Identifying major points of divergence and/or convergence; enablers and/or constraints; and ways to better navigate and strengthen the co‐production process. Finding: Given members of the design working group, diverse skills sets divergence was experienced in all co‐production phases. Divergence was also experienced between the project team and the funding partner given the uniqueness of working conditions and requirements of workers in the primary production industry. The project team applied an iterative development process to project management; encouraging iterative cycles to create/test/revise among the teams, and with the funding partner, until each was satisfied with the end result (convergence). Discussion & Conclusion: When developing a co‐created public health prevention campaign it is critical that the project team focuses on relationship building among the members of the design working group and ensures adequate resourcing, development of shared understanding of project goals and target audience, ongoing communication, and a commitment to working iteratively. [ABSTRACT FROM AUTHOR]

Objective: To explore participant experiences of an online co‐design process to develop a web‐based preventative mental health and well‐being intervention targeting primary producers in rural Australia. Setting: Rural Victoria, Australia. Participants: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co‐design and beta testing processes for a primary producer platform. Design: A qualitative study using semi‐structured phone‐based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. Results: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co‐design participation, (3) experiences of the co‐design process, (4) maintaining a shared vision and goals and (5) acting on the co‐design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co‐design using face‐to‐face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face‐to‐face. Conclusions: Using an online co‐design method to develop a preventative mental health and well‐being web‐based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co‐design process and identify opportunities to improve participant engagement and experience with the online format. [ABSTRACT FROM AUTHOR]

Background: The legacy of colonisation, assimilation, racism and victim blaming has created inequality in health for Aboriginal people, reflected in their oral health status. Despite the existence of community dental services, oral disease levels continue to be of concern. This study, initiated by a rural Victorian ACCHO (Aboriginal Community Controlled Health Organisation), aimed to consult their community about the barriers to and enablers of oral health and understand their lived experiences with dental services. Methods: Using an Aboriginal knowledge framework and collaborative approach involving an Aboriginal researcher and Community Mentor, this study consulted an ACCHO community about their oral health. Following community engagement, 21 community members participated in digitally recorded yarning circles and semi‐structured interviews. Results: Themes emerging from the data included dental care history and past experiences involving pain and shame, the value of having community‐centred services and engagement with patients and the community. Discussion: Experiences of dental care are often related to pain driving attendance resulting in experiences that multiply fear and anxiety. While community‐based care was considered a strength, approaches to individual dental care often resulted in increasing shame and diminishing trust. Increasing cultural safety and participatory approaches to designing and delivering dental care may increase engagement and trust. Conclusions: Important gaps in cultural and clinical understanding between the community and dental service providers have been identified. These findings will be used to inform the delivery of dental services and to develop oral health promotion programs at the ACCHO, and cultural safety preparation for student dental practitioners. [ABSTRACT FROM AUTHOR]

Objective: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ. Setting: Four focus communities in R&R areas of NQ. Participants: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). Design: A qualitative descriptive case study, with data collection via semi‐structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities. Results: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post‐discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community‐based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre‐based CR services; lack of awareness, or acceptance of telephone support services. Conclusion: To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in‐service education, is required to developing a model of care that focuses on self‐management and education: Heart: Road to Health. [ABSTRACT FROM AUTHOR]

Objective: To understand the experience of rural Aboriginal and Torres Strait Islanders in engaging with oral health care services and programs in order to support the development of oral health services and prevention programs that better meet their needs. Design: The study used a qualitative research design, which aims to describe participants' lived experience of engaging with oral health services and prevention programs in a rural Aboriginal and Torres Strait Islander community. Focus group discussions and in‐depth interviews were conducted with 27 participants. The 15 transcribed discussions were analysed using a 6‐step phenomenological process. Setting: A rural community in Queensland, Australia, with a predominantly Aboriginal population. Participants: Participants were purposively recruited from established health and community groups. Main outcome: System‐level barriers to accessing and engaging with oral health services and prevention influence how communities manage oral health and seek treatment. Results: The study identified 4 main themes describing the community's experience: service location and the efforts required to access oral health services; the financial burden of accessing oral health care and practising prevention; lack of confidence in oral health services; and the avoidance or delaying of accessing care for dental problems. Results confirmed a high burden of oral disease but limited attendance at an oral health facility and difficulties engaging in preventative oral health behaviours. Treatment seeking was usually instigated by the experience of pain and typically at a tertiary health facility. Conclusion: Aboriginal and Torres Strait Islanders in rural communities experience a high burden of oral disease but have limited engagement with oral health services. This is associated with system‐level barriers to accessing and engaging with oral health services and prevention. [ABSTRACT FROM AUTHOR]

Objective: To assess implementation of in‐patient cardiac rehabilitation (Phase‐1‐cardiac rehabilitation), impact on people in rural and remote areas of Australia and potential methods for addressing identified weaknesses. Design: Exploratory case study methodology using qualitative and quantitative methods. Qualitative data collection via semi‐structured interviews, using thematic analysis, augmented by quantitative data collection via a medical record audit. Setting: Four regional hospitals (2 Queensland Health and 2 private) providing tertiary health care. Participants: (a) Hospital in‐patients with heart disease ≥18 years. (b) Staff responsible for their care. Outcome Measures: Implementation of Phase‐1‐cardiac rehabilitation in tertiary hosptials in North Queensland and the impact on in‐patients discharge planning and post discharge care. Recommentations and implications for practice are proposed to address deficits. Results: Phase‐1‐cardiac rehabilitation implementation rates, in‐patient understanding and multidisciplinary team involvement were low. The highest rates of Phase‐1‐cardiac rehabilitation were for in‐patients with a length of stay three days or more in cardiac units with cardiac educators. Rates were lower in cardiac units with no cardiac educators, and lowest for in‐patients in all areas of all hospitals with length of stay of two days or less days. Low Phase‐1‐cardiac rehabilitation implementation rates resulted in poor in‐patient understanding about their disease, treatment and post‐discharge care. Further, medical discharge summaries rarely mentioned cardiac rehabilitation/secondary prevention or risk factor management resulting in a lack of information for health care providers on cardiac rehabilitation and holistic health care. Conclusion: Implementation of Phase‐1‐cardiac rehabilitation in regional hospitals in this study fell short of recommended best practice, resulting in patients' poor preparation for discharge, and insufficient information on holistic care for health care providers in rural and remote areas. These factors potentially impact on holistic care for people returning home following treatment for heart disease. [ABSTRACT FROM AUTHOR]

Objective: Individuals with head and neck cancer residing in rural areas face numerous challenges accessing post‐acute rehabilitation services, including speech pathology services. In order to inform future service enhancements, the key issues impacting access to, and the provision of, speech pathology head and neck cancer services in rural areas was explored through the perspectives of patients, carers, speech pathology clinicians and service managers. Setting: A rural health referral network in Queensland consisting of tertiary, regional and remote hospitals. Participants: Twenty‐eight participants, including 12 speech pathology staff/managers and 16 consumers (people with head and neck cancer/carers). Design: Qualitative methodology using semi‐structured interviews was analysed using content analysis. Results: Two themes were identified from the consumer group including (a) navigating health services for head and neck cancer management and (b) burden of accessing head and neck cancer care. Speech pathology staff/managers interviews raised 3 themes: (a) transfer of care and access to local services, (b) workforce and workload and (c) travelling impacts the service our patients can receive. An integrative theme across both groups highlighted the perceived disparity in health care access that existed for people with head and neck cancer in rural areas. Conclusions: In rural areas, consumers face multiple barriers navigating the head and neck cancer treatment pathway, while health services encounter specific challenges ensuring access and equity in care. Despite the complexities, possible avenues for service change and service enhancement are proposed. Speech pathology services in rural areas need to proactively evaluate services and address existing disparities in order to enact positive change for people with head and neck cancer living outside metropolitan locations. [ABSTRACT FROM AUTHOR]

Objectives: To explore the process of learning for allied health students providing a student‐implemented service for older Yolŋu in remote East Arnhem, Northern Territory, Australia. Design: An exploratory qualitative study following an 8‐week student‐implemented service. Setting: Nhulunbuy and Yirrkala and surrounding remote Aboriginal communities of the East Arnhem Region of the Northern Territory. Participants: Data were collected from: 4 students who implemented the service; 4 professional supervisors, 3 placement coordinators, a Yolŋu cultural consultant and a care manager from a local community organisation, all of whom supported implementation of the service; and 7 older Yolŋu and their families who were recipients of the service. Interventions: A student‐implemented service for older Yolŋu delivered by allied health students from James Cook University. Clinical, cultural and pastoral supervision and support was provided by Flinders University, James Cook University, Indigenous Allied Health Australia and 2 Yolŋu cultural consultants and 2 local community organisations. Main outcome measures: Semi‐structured interviews with those who implemented, supported and received the service. Data were analysed thematically using an inductive approach. Results: 'Learning to connect and connecting to learn' described how allied health students were learning to provide a service for older Yolŋu. Four interrelated processes connected their learning: 'preparing and supporting', 'bonding and responding', 'growing and enriching' and 'working and weaving'. Conclusion: The co‐created student‐implemented service provided a unique learning opportunity for allied health students on how to provide a culturally safe service in a remote Aboriginal community in northern Australia. [ABSTRACT FROM AUTHOR]

Introduction Providing an emphasis on Indigenous health in medical undergraduate education is seen as a high priority by Australian medical organisations. A regional North Queensland medical school asked local Indigenous people to list personal attributes they want to see in graduate doctors who choose to practise in their remote community. Methods This 2011 pilot study used a participatory action research design, with 13 local Indigenous health professionals, elders and community members from Mount Isa participating as co-researchers in ' Yarning Circles' discussing desired medical graduate attributes. Medical school co-researchers inductively extracted themes from the discussions via a qualitative 'grounded theory' approach. Results Eight major subtopics were identified by the Mount Isa Indigenous community around desired skills, knowledge and attitudes for graduate doctors: provision of quality patient care; culturally appropriate communication; medical knowledge; culturally appropriate knowledge; knowing the local health system; a positive personality; a positive attitude to working with Indigenous peoples; and a desire to engage with the Indigenous community. Discussion Effective communications with Indigenous patients and working in remote Indigenous communities requires doctors to have appropriate clinical skills, medical knowledge, knowledge about how local health systems operate, familiarity with significant Indigenous health issues such as child safety and alcohol management, and positive attitudes to working with, learning about and providing an advocacy role for Indigenous peoples. Conclusions Findings have implications for enhancing the professional behaviours and engagement of James Cook University medical students in Indigenous communities while on rural placement and after graduation, and for Australian medical and health practitioners more broadly. [ABSTRACT FROM AUTHOR]

Despite significant efforts at a primary care level, at least 35% of people with diabetes fail to meet health targets. It is assumed that these poor results are a consequence of the patient not understanding their disease or not caring. This study seeks to understand what really lies behind poor control. A qualitative study using semistructured interviews was conducted in a primary care setting in rural Western Australia. People living with diabetes for at least two years were specifically selected on the basis of whether they had either 'good' (HbA1c < 7%) or 'poor' (HbA1c > 8%) control. Interviews revealed that people understood only too well their disease and their responsibilities. Frequently, either they did not choose to make diabetes a priority in their lives or were unable to make appropriate lifestyle changes which were demanded for good blood sugar control. Their life/social stresses often influenced their glucose control. Poor control in our study was not related to lack of knowledge but more to how diabetes was prioritised in their lives. Attention to the patients' priorities is required to accomplish improved glycaemic control. [ABSTRACT FROM AUTHOR]

Objectives: To understand the experience of audiologists in managing and treating ear‐related ear, nose and throat conditions in rural areas, and to identify the compounding factors that influence patient outcomes and potential targets for intervention. Design: A focus group was conducted using a qualitative descriptive approach. Responses were audio‐recorded, transcribed and thematically analysed. Setting: The focus group was conducted in the rural town of Mildura in the state of Victoria, Australia. Participants: A sample of 19 audiologists from Victoria participated, of which 14 were rurally based and 5 were metropolitan‐based. The length of participants' professional experience ranged from 1 to 43 years. Results: Long wait lists, and a lack of locally based ear, nose and throat surgeons were identified as barriers to the treatment of ear‐related ear, nose and throat conditions. Open communication between health services and efficient care for time‐sensitive conditions were seen as outcomes of good practice. Hand hygiene, nose‐blowing, reducing tobacco smoke exposure and promoting the use of noise protective equipment were the 4 community health campaigns mentioned to support ear care for those residing in rural areas. Additional themes of ear conditions, treatment, management and primary health care were identified. Conclusion: Improving referral pathways for the treatment of ear‐related ear, nose and throat conditions, and providing education about ear, nose and throat assessment and treatment in primary health care settings could increase appropriate referrals, improve patient outcomes and reduce wait periods for treatment. [ABSTRACT FROM AUTHOR]

Objective: To gain new insight into contextual factors shaping how physical ill health acts as a stressor in rural suicides—informing the development of appropriate targeted interventions. Design: Retrospective cohort study. Setting: Non‐metropolitan Victoria, Australia. Sample: 802 rural (non‐metropolitan) suicide deaths between the years 2009 and 2015. Main outcome measure: Qualitative data from the Victorian Suicide Register relating to physical ill health of suicide decedents. Results: Thematic analysis identified 4 themes: (a) 'living with physical ill health in a rural area' highlights both practical and cultural challenges associated with managing physical ill health within the context of life in a rural setting; (b) 'causes and experience of chronic pain' highlights rural risk factors for chronic pain, how pain was experienced and treatment managed; (c) 'when living an independent, contributing life is no longer possible' describes the debilitating physical and mental outcomes of chronic ill health and pain; and (d) 'the cumulative impact of physical ill health and other factors on suicide risk' highlights the complexity of risk factors—in combination with (or as a result of) physical ill health—that contribute to a suicide death. Conclusion: Identified themes suggest pathways to improve understanding and support for those experiencing physical ill health and associated suicide risk. These supports include contextually and culturally appropriate rural services to provide effective and necessary treatment, pain relief and mental health support; acknowledgement and response to a culture of alcohol misuse as an (ultimately ineffective) coping strategy; proactive psychosocial support mechanisms; and alternative approaches to support including consideration of innovative peer support models. [ABSTRACT FROM AUTHOR]

Objective: To examine Australian Aboriginal Elders' (Elders) views on their contributions to and their potential to contribute to the well‐being of their community. Design: Participatory action research methodology was employed. Data collection methods included yarning interviews and group circle discussions. Data were thematically analysed. Setting: The project was undertaken in collaboration with Elders from a discrete Aboriginal community in rural/remote Tasmania, an island state in southern Australia. Participants: Twelve Aboriginal community Elders. Intervention: N/A. Main outcome measures: N/A. Results: Elders were promoting cultural well‐being through interconnected themes of mentoring, cultural healing and seeking balance between health services and the community's cultural foundation. Cultural values, identity, community cohesion and connections to country were further embedded in these themes. Conclusion: The study findings draw attention to the age‐old wisdom of Aboriginal Elders, who actively promote cultural well‐being as a main determinant of community health. [ABSTRACT FROM AUTHOR]

Objective: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non‐Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. Design: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. Setting: Western New South Wales. Participants: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non‐Aboriginal; n = 28). Main outcome measures: Identified barriers and enablers and regional strategies for improving career pathways. Results: Aboriginal people interested in pursuing a career in health face barriers in: pre‐employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. Conclusion: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self‐determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members. [ABSTRACT FROM AUTHOR]

Objectives: Melbourne Dental School's (MDS) rural dental clinical placement program operates in two Victorian rural areas and offers final year dental students an integrated program of practical clinical experience and rural lifestyle exposure. The objective of this study was to understand the student's experiences to determine whether they increased the likelihood of them seeking rural employment after graduation. Design: The University of Melbourne final year dental students attended 5‐week mandatory rural clinical placements in 2018 and 2019. At the completion of their placement, students were invited to complete an anonymous questionnaire about their experiences, which had both quantitative and qualitative questions. This study examined the qualitative data using thematic analysis to identify common themes. Setting: Rural clinical dental placements at Goulburn Valley Health and Latrobe Community Health Service. Participants: Final year Dentistry and Oral Health students. Interventions: Clinical placementevaluation questionnaire. Main outcome measures: To examinedentalstudents interest in rural practicepost rural clinical placement. Results: Of the 129 students who completed the survey, 116 completed the open‐ended questions and four themes were identified. Rich clinical experience; social capital; rural life and infrastructure. High levels of satisfaction were reported across all themes. Conclusion: This study demonstrated the rural clinical program to be a positive and enjoyable placement which increased dental students' clinical practice experience and their interest in considering rural practice upon graduation. Exposure to rural lifestyle and supportive clinical and social relationships were shown to be important influences. The current survey can benefit from refinement and further research following up MDS graduate workplace locations is recommended. [ABSTRACT FROM AUTHOR]

Objective: To investigate the experiences of audiologists and audiometrists working in regional and remote areas of Australia. Design: A qualitative design, using telephone and videoconference semi‐structured interviews and thematic analysis. Setting: Regional and remote locations across Australia Participants: 5 audiologists and 2 audiometrists, 6 female and one male. Interventions: None. Main outcome measures: Insights into the experiences of audiologists and audiometrists working in rural Australia. Results: Core themes that emerged from analysis were (a) professional isolation and increased scope of practice, (b) the importance of social and professional networks, (c) variable access to professional support, (d) challenges in the recruitment and retention of clinicians, and (e) tensions between service provision and profitability. Conclusion: This study provides valuable insights into both the rewarding and challenging aspects of working as an audiologist or audiometrist in regional and remote areas. This study emphasised the need to address these challenges in order to attract more audiological professionals to work and stay in regional and remote areas of Australia. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. Design: qualitative research study. Setting: rural, remote and urban locations across Australia. Participants: Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. Methods: Participants were recruited for semi‐structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. Main outcome measures: The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. Results: 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. Conclusion: The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed. [ABSTRACT FROM AUTHOR]

Objective: This evaluation considered the potential of We‐Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales. Design: A mixed methods approach included surveys, in‐depth interviews and workshop observations. Setting: Aboriginal suicide prevention training in rural New South Wales, Australia. Participants: Attendees at We‐Yarn training. Intervention: We‐Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non‐Aboriginal facilitator. We‐Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness. Main outcome measures: Pre and post‐workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content. Results: We‐Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training. Conclusion: We‐Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre‐existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important. [ABSTRACT FROM AUTHOR]

Objective: To improve the leadership capacity of existing Queensland Rural Generalists and support the emerging leaders needed to assume future leadership roles. Design: A customised leadership program for medical Rural Generalists, embedded in professional standards, was developed and delivered during 2016‐2018. Pre and post‐program and individual module evaluations from two Program cohorts were analysed. Qualitative, semi‐structured phone interviews (n = 30) discussing participant views on leadership in a rural context and their Program experience were also conducted. Setting: The Rural Generalist Leadership for Clinicians Training Program runs over twelve months and includes three residential modules as well as online learning sets. Participants: Forty‐four participants completed the Program and obtained Associate Fellowship of the Royal Australasian College of Medical Administrators. Interventions: Development and delivery of the Rural Generalist Leadership for Clinicians Training Program. Main outcome measure(s): Participant's ability to apply Program learning in a rural leadership context. Participant views on leadership in a rural context. Results: Participants indicated they benefited most from the 'understanding self' and management aspects of the Program such as finance, budgeting, and understanding and navigating broader health system governance. They greatly valued the opportunity to enhance their professional networks and relationships and have since developed a regular forum to assist in the transition from individual leadership development to the development of the broader workforce and organisation. Conclusion: The results of this study suggest that further attention and investment in medical leadership is warranted to support and enable the Rural Generalist workforce to continue to meet the complex, context‐specific needs of the communities within which they deliver vital health services. [ABSTRACT FROM AUTHOR]