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Objective: This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours)., Design: A cross-sectional survey methodology., Setting: Gippsland and the Loddon Mallee regions of Victoria, Australia., Participants: Rural high school teachers., Outcome Measure: A survey that aimed to obtain participants' perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk., Results: Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services., Conclusions: Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas., (© 2022 National Rural Health Alliance Ltd.)

Introduction: Dementias a prevalent chronic healthcare condition affecting 46 million people worldwide and projected to grow in the coming years. Australians living in rural and regional areas often lack access to specialist dementia care, despite greater prevalence relative to metropolitan areas., Objective: This study aimed to explore general practitioners (GP) understanding, confidence and attitudes towards dementia management in the rural context, and design and pilot a dementia-specific training program., Design: A two-stage, mixed methods design, using qualitative and quantitative methods. Sixteen regional GPs from across Victoria participated in scoping semi-structured interviews. Fourteen separate GPs in the St Anthony Family Medical Practice group in the regional Loddon-Mallee area of Victoria completed the pilot training intervention. Pre- and post-training surveys (n = 10), as well as post-training interviews (n = 10), assessed attitude and knowledge changes., Findings: Analysis of semi-structured scoping interviews indicated three themes regarding experience of dementia management, including: (1) attitudes to and experiences of dementia; (2) supporting people living with dementia; and (3) knowledge, education and training of dementia. The pilot dementia-specific training was found to improve attitudes (agreement across 24 best-practice indicators improved from 30% to 79%), knowledge (median increase of 2.5/10) and confidence in managing dementia and disclosing dementia diagnoses (median increase 3/10 and 2.75/10, respectively)., Discussion: General practitioners in this study lacked initial confidence in detecting and managing dementia in a rural primary care setting. A targeted training program showed improvements in these areas., Conclusion: Accessible, locally delivered, dementia education has the potential to improve confidence in early detection and management of people with dementia and thereby may address gaps in access to care for people living with dementia in rural settings., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Introduction: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability., Objective: This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services., Design: A narrative review was conducted using thematic discourse analysis to examine online newspaper content published in Victoria, Australia from 2010 to June 2021., Findings: Local maternity services were a source of community interest for rural people. Coverage of negative outcomes for mothers and babies was highlighted by rural newspapers; however, increased content over the last 12-month period focused on community support for the sustainability of rural maternity services. Recent community support in newspaper articles coincided with maternity services reviews and retaining some of these rural services., Discussion: Community support in media may provide a protective social pressure, leading rural health services to consider this when reviewing the sustainability or closure of rural maternity services., Conclusion: Media attention about sustaining local maternity services by highlighting issues and representing community voices may influence health executive to consider opportunities to remodel and sustain high-quality and safe maternity care in rural settings. Knowing how rural health executives consider media, community pressure, and how it impacts expediency of maternity service closure decisions is unknown and an important gap in knowledge to explore and understand., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

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., (© 2021 National Rural Health Alliance Ltd.)

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., (© 2021 National Rural Health Alliance Ltd.)

Objective: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co-located between child protection practitioners and community health services clinicians., Setting: Rural Northwest Victoria., Participants: Sunraysia Community Health Services and the Department of Health and Human Services., Design: The qualitative design of the project evaluation involved semi-structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID-19., Results: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector-wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area-based stakeholders, but did not translate to increased access to health plans for children., Conclusion: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID-19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area-based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10-year project., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: This paper draws on the principles of suicide risk safety planning to co-design a farming community resource for preventing and managing risks to mental health., Setting: This project was undertaken in the Great South Coast Region of Victoria, Australia., Participants: A working group (n = 6-8) from the Victorian farming community contributed to the iterative co-design and co-production of Steering Straight: My plan to keep on track. Twenty-four members of the farming community pilot tested Steering Straight., Design: Co-design to develop, pilot and refine the resource with working group and target farming community., Results: Steering Straight was viewed positively by the farming community as a tool that prompts prioritising well-being; encourages reflection, planning and concrete steps towards taking action; helps set and meet personal goals; is simple and practical; and identifies pathways to support. Most participants (94%) completed Steering Straight on their own, taking approximately 15-30 min to create their personalised plan. Questions most likely to be filled in related to recognising personal signs of deteriorating well-being and listing and planning enjoyable activities. A majority of participants (67%) kept a hard copy of their Steering Straight plan on hand to refer back to, while 78% expressed a preference for a digital version., Conclusion: The co-design and co-production process resulted in a tailored prevention-focused resource that was accepted and valued by the farming community., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Introduction and Objective: Building rural health workforce research capacity is critical to addressing rural health inequalities. Research training is a mainstay research capacity building strategy. This paper describes the delivery and evaluation of a research training program for rural and regional allied health professions (AHPs)., Design: A mentored research training program was delivered to AHPs employed public health services in rural and regional Victoria, Australia. The program was evaluated using the Evidence-Based Practice Knowledge Attitudes and Practice (EBP-KAP) tool at baseline and 3 months post-training. Semi-structured interviews undertaken at 3 and 16 months post-training explored participants' perspectives of the training, their development and application of EBP and research skills. Survey data were analysed descriptively, and interview data were analysed using a framework approach., Findings: Thirty-four individuals from 14 organisations attended the first workshop and 31 attended the second. Thirty-one participants completed the survey at baseline and nine at 3 months post-training. Sixteen interviews were undertaken with 11 participants, five participating at both time points. Participants had positive EBP attitudes at both time points. Overall, participants' knowledge and incorporation of EBP into their practice, and retrieval of evidence was unchanged 3 months post-training. Themes identified in the interview data were as follows: (1) individual research capacity enhanced through supported practice, (2) organisational factors influence individuals' progression of research and (3) individual contributions towards research capacity within the organisation., Conclusion: A mentored rural research training program promoted the application of EBP skills at the individual level and contributed to organisational research capacity., (© 2022 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities., Design: Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta., Setting: Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield., Participants: All patients seen in consultations over a 3-month period., Main Outcome Measures: Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure., Results: Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre., Conclusions: Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach practice should be encouraged for surgeons in regional centres., (© 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.)

Objective:   This paper provides evidence for the importance of taking an effective history and considering regional differences before formulating national health policies., Design:   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., Setting:   Regional Victoria and Australia as a whole., Participants:   A total of 17 community members from the Gippsland region provided information on taking iodine tablets between the late 1940s and the late 1960s., Main Outcome Measures:   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., Results:   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., Conclusion:   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., (© 2010 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.)

Objective:   This paper provides evidence of environmental iodine deficiency in the Gippsland region., Design:   Quantitative study; water samples were collected from 18 water treatment plants and four rain water tanks across Gippsland and water iodine concentrations were measured., Setting:   Gippsland region of Victoria, Australia., Main Outcome Measures:   This paper reports on the iodine concentration of drinking water from sources across Gippsland and examines the contribution of iodine from water to the Gippsland diet. This study also briefly examines the relationship between the concentration of iodine in water and distance from the sea. The cut-off value for water iodine concentrations considered to be indicative of environmental iodine deficiency is <2 µg L(-1) ., Results:   The mean iodine concentration of water from 18 Gippsland water treatment plants was 0.38 µg L(-1) and would therefore make negligible difference to the dietary intake of iodine. This finding also falls well below the suggested dietary intake of iodine from water estimated by the 22nd Australian Total Diet Study. Our study found no linear relationship between the water iodine concentration and distance from the sea., Conclusion:   As Gippsland has environmental iodine deficiency there is a greater probability that people living in this region are at higher risk of dietary iodine deficiency than those living in environmentally iodine sufficient regions. Populations living in areas known to have environmental iodine deficiency should be monitored regularly to ensure that problems of iodine deficiency, especially amongst the most vulnerable, are addressed promptly., (© 2010 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.)

Objective: This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia., Design: A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift., Setting: Smaller rural hospitals in Victoria., Participants: Registered Nurses (Division 1)., Main Outcome Measure: Observed and reported strategies used to manage deteriorating patients., Results: Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service., Conclusions: We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery.

Objective: This paper explores the psychosocial outcomes for individuals and communities in rural Victoria who experienced the outbreak of Ovine Johne's Disease (OJD)., Design: The study uses a qualitative methodology to analyse the minutes of evidence provided by the inquiry into the control of OJD to identify the psychosocial events, experiences and outcomes associated with the control of this outbreak. The inquiry was undertaken by the Environment and Natural Resources Committee of the Victorian State Government., Setting: Public hearings were undertaken by the committee across several rural Victorian communities and the state capital, Melbourne., Subjects: The transcripts detail 136 submissions from 98 individuals and 23 organisations., Outcome Measures: The analysis aimed to provide insight into the impact of the disease on individuals and communities and also to explore the factors individuals perceived as associated with these outcomes., Results: While the paper identifies that aspects of stock loss associated with the outbreak caused substantial emotional and economic distress, for farmers the most significant finding was the impact of the government control program on individuals, families and rural communities. The control program was perceived as having very limited scientific credibility and its implementation was described as heartless, inflexible and authoritarian. Involvement with the program resulted in farmers reporting emotions, such as, trauma, shame, guilt and stigma. Families became discordant and the sense of community within rural townships fragmented. Psychological outcomes of grief, depression and anxiety emerged as prevalent themes within families and communities., Conclusions: These data highlight the need for significant attention to the management of rural disasters, such as, the OJD program., What This Paper Adds: There is an acknowledgement in the literature that rural disasters have a significant impact on the well-being of individuals, families and communities. The major focus of the previous research has, however, been on the impact of economic losses with less recognition of the other psychosocial loss experiences that accompany the experience of rural disaster. This paper achieves a clear description of the experiences for individuals (trauma, stigma, sense of personal failure, loss of identity, diminished self esteem and family disruption) and communities (destroyed social cohesion, economic disharmony) caught up in the OJD disaster and explores the factors that individuals perceive as responsible for these outcomes. The mental health outcomes for individuals, such as, loss, grief and depression are also explored within this paper. This paper highlights the psychosocial complexity of the experience of rural disaster for individuals and communities significantly extending the current knowledge base in this area.

In Australia "the hospital" has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

This paper reports on a descriptive study into family violence in rural Victoria. Focus groups were held in a number of areas across rural Victoria with a total of 24 community nurse participants. The focus groups were audio-taped and the tapes transcribed to enable the clustering of themes. The dominant themes were: picking up cues, helping and helplessness, holding secrets and quiet resistance. Underpinning all these themes however, was the notion of 'risky business'. All nurses in the study gave examples of situations that they encountered; their ways of helping; of working around a system that is unhelpful; and the ways in which their work while skilled, thoughtful and wise, is also costly in terms of the emotional wounds they carry. Rural nurses work with considerable risk and courage as they engage in the care and support of women experiencing family violence.

This paper reports the findings of a methodological pilot project that examined the availability of safe-sex and safe-injecting products in a rural shire in central Victoria. The study mapped the distribution and audited the availability of condoms, water-based lubricants, needles/syringes and needle disposal units to provide baseline data on access to and the availability of products that are directly related to the prevention of the human immunodeficiency virus, sexually transmissible infections and blood-borne viruses. Clear disparities were observed in the availability and pricing of safe sex/safe use materials between regional centres and outlying areas in the Shire. The findings make it clear that an emphasis on overcoming structural impediments to the adoption of safe sex/safe injecting practices is required.

Rural general practitioners (GPs) traditionally provide the initial care for the very ill and severely traumatised in small and medium-sized rural hospitals. It has been said that these patients would be better managed in a level 1 trauma centre. The present paper will test this hypothesis and shows that the benefits of the expertise available in the large centres may be outweighed by the loss of life in the prehospital phase, most of which occurs before the arrival of the ambulance. General practitioner involvement would enhance the current early retrieval system. Very ill and severe trauma should be assessed and stabilised in the most appropriate local facility. Routine bypassing of local emergency medical services should be avoided. A national standard for training rural GPs in emergency management skills is needed. Emergency facilities and equipment must be maintained and improved throughout rural Australia. These facilities and their staff must be accredited so that the ambulance service can more appropriately determine its transport priorities.

Though it is recognised that a sound knowledge of HIV/STD transmission is insufficient on its own to ensure that young people practise safer sex, knowledge of this sort is a necessary prerequisite to safe sex behaviours. Research on the HIV/STD knowledge levels of young people has shown that, while they have high levels of HIV knowledge, they generally have little idea about the transmission of other STDs. Moreover, most of this research has been conducted with more accessible youth in large urban centres. The research reported in this paper focused on HIV/STD knowledge levels, awareness of safe and unsafe sexual practices, and the information sources accessed by 1168 young people living in small rural towns in Queensland, Tasmania and Victoria. As with mainstream youth, the participants in this study had high levels of HIV knowledge and very low levels of knowledge about the transmission of other STDs, their names and symptoms. Practical knowledge of the safety of sexual practices was good, although a number of students confused high risk practices with high risk groups. Students mainly accessed informal information sources such as parents, peers and magazines and took little advantage of more formal sources even when they were available in their towns. There were few gender differences in levels of knowledge; however, girls accessed more information sources and knew more names of STDs. The implications of these findings are discussed in relation to young people developing critical attitudes towards more informal sources, and the better use of more formal sources.

The Ballarat Health Education Forum has the express purpose of identifying and responding to the educational needs of registered nurses (RNs) in western Victoria. Since the senior nurse members of the forum believed that there was a strong need for management education amongst the nurses involved in middle management in the target region, the total nursing population was surveyed to determine if that perception was shared by RNs themselves. Results of the study confirm that educative programs in management are viewed as a high priority for the professional development of nurses but that family and work commitments are dominant factors which hinder participation. It is argued that education for the managerial role into which many nurses are thrust is sporadic and bereft of appropriate content. Background to the issue of management skills and training among RNs is provided and survey methodology and outcomes are described. The paper discusses the implications of survey outcomes and makes recommendations based on findings.