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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]

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: 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]

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]

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]

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]

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]

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]

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]

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]

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: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. Design: A cross‐sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi‐squares. Setting: An Australian regional university. Participants: First year occupational therapy, physiotherapy and speech pathology students. Main outcome measures: Factors influencing the first 6 weeks at university. Results: One hundred and forty‐three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature‐aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. Conclusion: Orientation week activities assist students transition into university and age‐appropriate and family‐friendly activities should be considered for mature‐age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success. [ABSTRACT FROM AUTHOR]

Objective: The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. Design: A qualitative study involving thematic analysis of interview data. Setting: A regional local government area in Victoria, Australia. Participants: Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. Main outcome measures: Barriers and enablers to the creation of advance care planning documents. Results: The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service‐patient relationship and advance care planning. Conclusion: Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long‐term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end‐of‐life care. A potential solution was seen in the pending linkages to the national electronic patient record. [ABSTRACT FROM AUTHOR]

Objective: To improve understandings of the enablers and barriers to maintaining good quality of life for people dying, caring and grieving in rural areas. Design and setting: In‐depth interviews designed on participatory research principles were held with bereaved carers living in a small community in rural Tasmania. Participants had cared for someone until their death within the 3‐year period prior. Participants: Nineteen participants comprising 18 bereaved former carers and one person with a life‐limiting illness, and all but four were over retirement age. Study aim: To explore experiences of end‐of‐life care in a rural community. Results: Participants discussed the challenges they experienced during end‐of‐life caring, including transport into the city for treatment, and access to basic and specialised services. However, they also reported positive aspects of formal and informal palliative care, and described experiences of personable, expert, flexible and innovative caregiving. Conclusions: The rural location enabled personalised and innovative expressions of care. This research adds new insight into rural end‐of‐life palliation, as a complex intersection of supererogation, innovation and place‐driven care. [ABSTRACT FROM AUTHOR]

Objective: To examine rural pharmacists' perspectives on their roles in oral health in rural communities and collaborations with dental practitioners. Design: A qualitative research study using face‐to‐face, semistructured interviews. Interview data were thematically analysed with the assistance of Nvivo 10. Setting: Eleven rural communities across rural Tasmania. Participants: Twenty community pharmacists. Results: Five major themes emerged: (i) barriers for patients to access dental services; (ii) oral health presentations to rural pharmacies; (iii) roles of pharmacists in oral health care (subthemes: advice; health promotion; and referrals); (iv) collaborations with dental practitioners; and (v) oral health education and training. Conclusion: This study suggests that rural community pharmacists had advisory and referral roles in oral health and acknowledged that they could play a greater role in oral health promotion. It was suggested that oral health could be incorporated into existing pharmacy health promotion and surveillance activities. There was a lack of collaboration between pharmacists and dentists or dental services and limited oral health education and training provided to pharmacists. Stronger collaboration between pharmacists and dental practitioners and better oral health training for pharmacists may enhance their role in promoting oral health within rural communities. [ABSTRACT FROM AUTHOR]

Objective Improving the quality and safety of health care in Australia is imperative to ensure the right treatment is delivered to the right person at the right time. Achieving this requires appropriate clinical governance and support for health professionals, including professional supervision. This study investigates the usefulness and effectiveness of and barriers to supervision in rural and remote Queensland. Design As part of the evaluation of the Allied Health Rural and Remote Training and Support program, a qualitative descriptive study was conducted involving semi-structured interviews with 42 rural or remote allied health professionals, nine operational managers and four supervisors. The interviews explored perspectives on their supervision arrangements, including the perceived usefulness, effect on practice and barriers. Results Themes of reduced isolation; enhanced professional enthusiasm, growth and commitment to the organisation; enhanced clinical skills, knowledge and confidence; and enhanced patient safety were identified as perceived outcomes of professional supervision. Time, technology and organisational factors were identified as potential facilitators as well as potential barriers to effective supervision. Conclusions This research provides current evidence on the impact of professional supervision in rural and remote Queensland. A multidimensional model of organisational factors associated with effective supervision in rural and remote settings is proposed identifying positive supervision culture and a good supervisor-supervisee fit as key factors associated with effective arrangements. [ABSTRACT FROM AUTHOR]

The article presents a report on health and environmental impacts of a regional Australian Men's Shed program. Topics discussed include Australian health promotion program and its impact on the health and environmental sustainability; health problems experienced by the people in the country; and analysis of the human–environmental relationships.

Objective: To evaluate clinicians' perceptions of what helps and hinders the delivery of mental health care across a service network in a rural setting. Design: Qualitative, semistructured interviews were conducted with 10 individuals who work in one rural mental health care service network. Setting: A regional centre in rural South Australia involving representatives of the mental health team, general practice, hospital, community health and nongovernment organisations. Results: Clinicians' perceptions of barriers and enablers to working within their mental health care network were explored. Participants showed a strong shared commitment to effective mental health care delivery and a good understanding of the services that each offers. Interview data suggested that working relationships between local services could be perceived as stronger when a personal or historical element is recognisable. Similarly, the notion of familiarity and community involvement were perceived as facilitators in this network. A perceived barrier for participants was the failure to attract staff with mental health experience, leading to dependence upon the dedication and commitment of existing service providers. Conclusions: Collaboration is especially necessary in rural areas, where access to health care services is known to be difficult. The informality of relationships between service providers was shown to be the main facilitator in the network. This is both a strength as it promotes the communication between services and service providers that is essential for successful collaboration, yet is also a threat to the sustainability of the network based on the difficulties of staff recruitment and retention to rural settings. [ABSTRACT FROM AUTHOR]

Objectives: The study was designed to explore the lived experience of Asian migrants' health care-seeking behaviour in Tasmania, to discern the acculturation process by which Asian migrants are enabled to use the health system and to identify strategies, which assist migrants to understand and use the health system better. Methods: Qualitative research was adopted. Semistructured interviews were conducted with 36 Asian migrants residing in North, South and North West Tasmania, which were recruited through purposive sampling. Results: Six main themes emerged from the interviews: the acculturation process, interactions with the health care system, access issues, culturally appropriate health care, positive health care in Tasmania and suggestions for improving health care. Conclusions: The findings indicated that Asian migrants' views affected their health care-seeking behaviours because of the lack of information, poor communication, limited access and choices in Tasmania. Interestingly, those married to local Tasmanians had the shortest trajectory to health system acculturation. The study recommended developing health and well-being for Asian migrants by increasing access to information regarding navigating the health system and improving access to and awareness of language services. In addition, ensuring adequate, appropriately written, culturally specific and congruent information should be available to assist migrants' transition into a new health care system. Lastly, greater cultural awareness within the health profession to meet the needs of culturally specific individuals and communities is required when they seek care. [ABSTRACT FROM AUTHOR]