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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]

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]

Objective: To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). Design: Dental caries experiences were compared between CWF and non‐CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. Setting and Participants: Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. Intervention: CWF. Main Outcome Measures: Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. Results: Given the total 20‐year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300–499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long‐term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). Conclusions: The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes is more prevalent among Aboriginal and Torres Strait Islander Peoples, especially those living in rural than urban areas. However, little is known about how diabetes is managed in different settings. Objective: To investigate differences in the prevalence of diabetes and the prescription of antidiabetic medications for Aboriginal and/or Torres Strait Islander Peoples living in urban or rural Australia. Design: Cross‐sectional study using de‐identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (60.4% females; mean age 45.2 ± 17.3 years) regularly attending 528 'mainstream' Australian general practices (MedicineInsight) in 2018. Findings: The prevalence of diabetes was 16.0%, and it was more frequent among those living in rural areas (22.0; 95% CI 19.3–24.4) than inner regional (17.6%; 95% CI 16.0–19.2) or major cities (15.8%; 95% CI 14.7–17.0; p < 0.001). The highest prevalence of diabetes was for males living in rural settings (25.0%). Of those with diabetes, 71.6% (95% CI 69.0–74.0) were prescribed antidiabetics, with a similar frequency in urban and rural areas (p = 0.291). After adjustment for sociodemographics, the only difference in diabetes management was a higher prescription of sulfonylureas in rural areas than in major cities (OR 1.39; 1.07–1.80). Discussion: The prevalence of diabetes was similar to other national data, although we found it was more frequent amongst Aboriginal and/or Torres Strait Islander males, especially those from rural areas. Conclusion: Despite current recommendations, one‐in‐four Indigenous Australians with diabetes were not prescribed antidiabetics. The clinical significance of more frequent prescriptions of sulfonylureas in rural locations remains unclear. [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 explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. Setting: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. Participants: Allied health managers employed at the health service were members of an action research group. Design This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. Results: The action research group met 11 times over a 5‐year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. Conclusion: The findings from this comprehensive longitudinal study provide evidence‐based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health. [ABSTRACT FROM AUTHOR]

Objective: Indigenous Australians are nearly three times more likely to have diabetes than non‐Indigenous Australians. The prevalence of diabetes‐related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non‐Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best‐practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. Setting: All states, territories and geographic remoteness categories in Australia. Participants: Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. Design: Semi‐structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. Results: Seven best‐practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. Conclusion: The findings from this study identified seven best‐practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end‐user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best‐practice diabetic retinopathy treatment approaches. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the clinical utility of a model of seven principles for effective visiting primary care services and to determine how it could be conceptualised as a tool for evaluation. Setting: The research was undertaken in the context of visiting primary care services with an agency, Outback Futures, selected as a case study. Participants: Three executive staff with Outback Futures participated in the research. Design: The case study design involved data collection by four group interviews conducted between July and November 2021. The interview data were analysed using thematic analysis. Results: This case study is additional evidence for the clinical utility of the model of seven principles. The results reinforce the importance of a community‐focussed approach to assess the impact of visiting service organisations on rural and remote communities. A comprehensive approach to evaluation is required to justify the investments made and safeguard the health and well‐being of rural and remote residents. A self‐assessment protocol has been established from the model for use by visiting services. Furthermore, three themes were drawn from the data: relationship is fundamental, the importance of co‐design, and being effective as a visiting service is challenging. Conclusion: The model is appropriate for the case study organisation, and has clinical utility and implications for other visiting services. A self‐assessment protocol has been developed. Future research should apply the model and protocol self‐assessment tool in an effort to construct a consistent and credible approach to evaluation of visiting primary care services. [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 describe the development of and key factors for sustaining a rural‐based research team focussed on nutrition and dietetics. Design: A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub‐units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. Setting: University of Newcastle Department of Rural Health across 4 rural sites. Participants: Publicly available data sources from existing team members. Main outcome measures: Staffing levels, research supervision, internal and external grant outcomes and peer‐reviewed journal publications. Result: Academic staffing has increased by 4 full‐time equivalent positions over 18 years, with 6 current higher‐degree research students. Key factors identified in the development of a discipline‐specific research workforce included staff higher degree by research completions, longevity of staff in research‐active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. Conclusion: Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand. [ABSTRACT FROM AUTHOR]