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Publisher: Elsevier BV
Date: 09-2021
Publisher: Informa UK Limited
Date: 12-08-2013
Publisher: Wiley
Date: 10-2015
DOI: 10.1111/AJR.12239
Publisher: Inishmore Laser Scientific Publishing Ltd
Date: 23-03-2018
Publisher: SAGE Publications
Date: 18-07-2013
Abstract: Australian rural general practitioners (GPs) require public health knowledge. This study explored the suitability of teaching complex public health issues related to Aboriginal health by way of a hybrid problem-based learning (PBL) model within an intensive training retreat for GP registrars, when numerous trainees have no PBL experience. A mixed method evaluation. Pre-training surveys on PBL experience and post-training semi-structured telephone interviews exploring the impact of the model and its desirability. Thematic and discourse analysis of interview statements, coded independently by two researchers. Seventeen GP trainees and four tutors participated. Six main themes emerged: experience PBL impact learning modalities educational needs educational expectations and educational planning. No discernable differences were identified between Australian and international graduates, the knowledge impact of the hybrid model or desirability of the problem. While scabies offers a suitable scenario to explore rural public health complexities, a tension regarding the desire for intensive learning and PBL format needs to be addressed to increase trainees’ satisfaction. A reduction in the number of PBL sessions, PBL instruction and highly structured PBL groups will assist. Trainees value mixed modality education, including PBL, so a tailored hybrid PBL is worth consideration.
Publisher: Wiley
Date: 08-2016
DOI: 10.1111/AJR.12318
Publisher: Wiley
Date: 08-07-2022
DOI: 10.1002/HPJA.515
Abstract: Rural Australians experience significant barriers in accessing mental health services, some of which may be overcome by increasing mental health literacy in rural communities. This paper evaluates Mental Health Support Skills (MHSS), short training courses developed by the Rural Adversity Mental Health Program (RAMHP). MHSS was designed to build the capacity of community members and gatekeepers to identify people with mental health concerns and link them to appropriate resources or services. Program data from April 2017 to March 2020 were analysed to assess the reach and outcomes of MHSS training. Training feedback was collected through a post‐training survey, completed directly after courses, and a follow‐up survey two months after training. An app used by RAMHP coordinators (the trainers) recorded the geographic and demographic reach of courses. MHSS was provided to 10,208 residents across rural New South Wales. Survey participation was 49% (n = 4,985) for the post‐training survey and 6% (n = 571), for the follow‐up survey, two months post‐training. The training was well‐received and increased the mental health understanding and willingness to assist others of most respondents (91%‐95%). Follow‐up survey respondents applied learnings to assist others 53% (n = 301) asked a total of 2,252 people about their mental health in the two months following training. Those in clinical roles asked a median of 6 people about their mental health, compared to 3 for those in nonclinical roles. Most follow‐up survey respondents (59%, n = 339) reported doing more to look after their own mental health in the two months after training. These results are encouraging as they suggest that short‐form mental health training can be an effective tool to address poorer mental health outcomes for rural residents by improving the ability of participants to help themselves and the people around them. Serious consideration should be given to short mental health courses, such as MHSS, to increase literacy and connection to services, especially in rural areas.
Publisher: Public Library of Science (PLoS)
Date: 2015
Publisher: BMJ
Date: 11-12-1982
Publisher: Wiley
Date: 06-2010
Publisher: MDPI AG
Date: 20-09-2021
Abstract: There is great potential for human-centred technologies to enhance wellbeing for people living with dementia and their carers. The Virtual Dementia Friendly Rural Communities (Verily Connect) project aimed to increase access to information, support, and connection for carers of rural people living with dementia, via a co-designed, integrated website/mobile application (app) and Zoom videoconferencing. Volunteers were recruited and trained to assist the carers to use the Verily Connect app and videoconferencing. The overall research design was a stepped wedge open cohort randomized cluster trial involving 12 rural communities, spanning three states of Australia, with three types of participants: carers of people living with dementia, volunteers, and health/aged services staff. Data collected from volunteers (n = 39) included eight interviews and five focus groups with volunteers, and 75 process memos written by research team members. The data were analyzed using a descriptive evaluation framework and building themes through open coding, inductive reasoning, and code categorization. The volunteers reported that the Verily Connect app was easy to use and they felt they derived benefit from volunteering. The volunteers had less volunteering work than they desired due to low numbers of carer participants they reported that older rural carers were partly reluctant to join the trial because they eschewed using online technologies, which was the reason for involving volunteers from each local community.
Publisher: Ubiquity Press, Ltd.
Date: 09-02-2023
DOI: 10.5334/IJIC.6998
Abstract: Introduction: Adverse childhood experiences (ACEs) are associated with health and social problems in later life, with an early intervention highly desirable for better outcomes.Description: The Family-Referral-Services-In-Schools (FRSIS) is an early-intervention case management program for children and families with complex unmet needs, providing access to family support, housing, mental health care, and/or drug and alcohol services. The in-school trial setting was aimed at improving service uptake which was low in its community counterpart.Discussion: FRSIS was a well-regarded intervention that reduced barriers to access for vulnerable families. The school setting and non-government agency service provision led to increased acceptability and trust. The program reached 5% of the student population. Support was tailored to family need, which was often complex and involved both children and caregivers. Initially, the multi-agency partnership and governance oversight group ch ioned the service and enabled the pilot to be established, however funding uncertainty and competing priorities saw leadership support ebb away despite operational success.Conclusion: The FRSIS model breaks down numerous barriers to accessing care for vulnerable families by its generalist nature and tailored approach and represents a high-trust approach to brokering appropriate care. Consistency in leadership support was a missed opportunity for program sustainability.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12889-019-7961-0
Abstract: The mental wellness of children and adolescents in rural Australia is under researched and key to understanding the long-term mental health outcomes for rural communities. This analysis used data from the Australian Rural Mental Health Study (ARMHS), particularly the parent report Strengths and Difficulties Questionnaire (SDQ) measure for children under 18 years old and their reporting parent’s demographic information to compare this s le’s mental wellness scores to the Australian norms and to identify what personal, family, community and rurality factors contribute to child mental wellness as pertaining to the SDQ total and subdomain scores. Five hundred thirty-nine children from 294 families from rural NSW were included. SDQ scores for each child as well as personal factors (sex and age), family factors (employment status, household income and sense of community of responding parent), community SES (IRSAD) and rurality (ASCG) were examined. Children and adolescents from rural areas had poorer mental wellness when compared to a normative Australian s le. Further, personal and family factors were significant predictors of the psychological wellness of children and adolescents, while after controlling for other factors, community SES and level of rurality did not contribute significantly. Early intervention for children and families living in rural and remote communities is warranted particularly for low income families. There is a growing need for affordable, universal and accessible services provided in a timely way to balance the discrepancy of mental wellness scores between rural and urban communities.
Publisher: MDPI AG
Date: 10-2020
Abstract: A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.JEN.2010.11.005
Abstract: Mental health is a national priority in Australia, and the need is greatest where access to specialist care is poorest, in the rural and remote regions of the nation. The Mental Health Emergency Care-Rural Access Project (MHEC) was developed to provide 24-hour access to mental health specialists in rural and remote New South Wales using video conferencing equipment. An evaluation of the service activity of MHEC using a concurrent mixed methods approach. Use of the service increased from a low base to around 60 video assessments per month at the end of the study period. Use of video assessments was greatest in the remote zone (30.7 video assessments/10,000 population/year). The number of people referred to a mental health inpatient unit declined (50 fewer patients, representing a decrease from 73% to 52% of all admissions between 2008 and 2009). Both patients and providers found the service helpful. Most patients (81%) stated that they would recommend or use the service again. This service is well positioned to have an increasing effect on emergency nursing and patient outcomes, as well as potentially on transportations. Continued use of MHEC suggests that video conference technology is acceptable and offers responsive specialist emergency mental health care to rural and remote communities.
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/AJR.12194
Publisher: Wiley
Date: 06-08-2007
Publisher: Rural and Remote Health
Date: 04-02-2018
DOI: 10.22605/RRH4208
Publisher: Unpublished
Date: 2020
Publisher: Wiley
Date: 27-11-2020
DOI: 10.1111/AJR.12671
Publisher: Rural and Remote Health
Date: 04-09-2019
DOI: 10.22605/RRH5217
Publisher: OMICS Publishing Group
Date: 2017
Publisher: Rural and Remote Health
Date: 28-02-2020
DOI: 10.22605/RRH5616
Publisher: IGI Global
Date: 2010
DOI: 10.4018/978-1-60960-034-1.CH015
Abstract: The MHEC-RAP project involves the innovative application of video conferencing to mental health assessment in rural NSW. The preliminary evaluation findings of the project are presented. Mental health emergencies in rural and remote settings cause particular problems and are not amenable to conventional health service solutions. Patients and local health care staff may be isolated from specialist mental health staff and from acute inpatient services. Decisions to transport patients for specialist assessments or treatment may be required at night or at weekends and may involve families, police, ambulance services and local health staff. Such decisions need to be made promptly but carefully and the ability to obtain a specialist assessment may assist in making a decision about how best to care for the patient bearing in mind the need to provide a responsive, high quality and safe service to patients and local clinicians. In this chapter we examine a novel approach which uses audio-visual technology to conduct remote emergency mental health patient assessment interviews and provide consultations to local clinicians in rural communities in western NSW. The Mental Health Emergency Care – Rural Access Project or ‘MHEC-RAP’ was developed in 2007 following a series of consultations held in rural towns and implemented in 2008 within the Greater Western Area Health Service (GWAHS), New South Wales, Australia. GWAHS is a primary ex le of a rural and remote health service. It serves 287,481 people (8.3% of whom are Indigenous Australians) in an area that is 445,197sq km or 55% of the state of New South Wales (Australian Bureau of Statistics, 2001 Greater Western Area Health Service, 2007, 2009). The communities within GWAHS are mostly small, the towns are widely dispersed and local services are “limited by distance, expense, transport, and the difficulty of recruiting health professionals to these areas” (Dunbar, 2007 page 587). The chapter focuses on the design of the service, its implementation and its performance in the first year. We conclude with a discussion about the service, its broader relevance, transferability and its sustainability.
Publisher: Wiley
Date: 21-03-2012
DOI: 10.1111/J.1440-1584.2012.01256.X
Abstract: The objective of this study is to develop a framework to measure the impact of primary health care research, describe how it could be used and propose a method for its validation. Literature review and critical appraisal of existing models of research impact, and integration of three into a comprehensive impact framework. Centre of Research Excellence focusing on access to primary health care services in Australia. Not applicable. Not applicable. The Health Services Research Impact Framework, integrating the strengths of three existing models of research impact. In order to ensure relevance to policy and practice and to provide accountability for funding, it is essential that the impact of health services research is measured and monitored over time. Our framework draws upon previously published literature regarding specific measures of research impact. We organise this information according to the main area of impact (i.e. research related, policy, service and societal) and whether the impact originated with the researcher (i.e. producer push) or the end-user (i.e. user pull). We propose to test the utility of the framework by recording and monitoring the impact of our own research and that of other groups of primary health care researchers.
Publisher: Springer Science and Business Media LLC
Date: 11-04-2011
Publisher: Wiley
Date: 22-05-2015
DOI: 10.1111/AJR.12209
Publisher: Wiley
Date: 19-04-2018
DOI: 10.1111/AJR.12406
Abstract: Although mental health literacy has increased in recent years, mental illness is often under-recognised. There has been little research conducted on mental illness in rural areas however, this can be most prominent in rural areas due to factors such as greater stigma and stoicism. The aim of this study is to create a profile of those who are most and least likely to self-identify mental health problems among rural residents with moderate- to-high psychological distress. Secondary analysis of a longitudinal postal survey. Rural and remote New South Wales, Australia. Four-hundred-and-seventy-two community residents. Participants completed the K10 Psychological Distress Scale, as well as the question 'In the past 12 months have you experienced any mental health problems?' The characteristics of those who reported moderate/high distress scores were explored by comparing those who did and did not experience mental health problems recently. Of the 472 participants, 319 (68%) with moderate/high distress reported a mental health problem. Reporting a mental health problem was higher among those with recent adverse life events or who perceived more stress from life events while lower among those who attributed their symptoms to a physical cause. Among a rural s le with moderate/high distress, one-third did not report a mental health problem. Results suggest a threshold effect, whereby mental health problems are more likely to be acknowledged in the context of additional life events. Ongoing public health c aigns are necessary to ensure that symptoms of mental illness are recognised in the multiple forms that they take.
Publisher: Springer Science and Business Media LLC
Date: 11-09-2009
Publisher: Emerald
Date: 06-1992
DOI: 10.1108/02621719210018226
Abstract: Looks at how a regional health authority is setting about development of high quality managers through partnership with a small graduate business school in creating a new MBA (focused on health service needs) alongside existing programmes that will allow breadth of contact between students from different sectors.
Publisher: Ubiquity Press, Ltd.
Date: 2019
DOI: 10.5334/IJIC.4624
Publisher: AMPCo
Date: 30-07-2018
DOI: 10.5694/MJA17.01200
Abstract: To investigate general and drought-related stress experienced by farmers at both the personal and community levels, and whether socio-demographic and community factors influence this stress. Multivariate analysis of data from the Australian Rural Mental Health Study (ARMHS), a longitudinal cohort study (2007-2013). Non-metropolitan New South Wales. Subset of 664 ARMHS participants (at baseline) who identified as living or working on a farm. Personal drought-related stress (PDS), community drought-related stress (CDS), and general psychological distress (K10 score). Farmers who were under 35, both lived and worked on a farm, experienced greater financial hardship, and were in outer regional, remote or very remote NSW reported PDS particularly frequently. Of these factors, only being under 35 and increased remoteness were associated with higher incidence of CDS. Mild wet weather during the prior 12 months reduced PDS and CDS but increased general distress. Moderate or extreme wet weather did not affect PDS or general distress, but moderate wet weather was associated with increased CDS. Drought-related stress and general psychological distress were influenced by different socio-demographic and community factors. Farmers in NSW experience significant stress about the effects of drought on themselves, their families, and their communities. Farmers who are younger, live and work on a farm, experience financial hardship, or are isolated are at particular risk of drought-related stress. Medical practitioners who provide assistance to farmers and farming communities can contribute to initiatives that relieve stress about drought.
Publisher: Wiley
Date: 04-03-2008
Publisher: Wiley
Date: 09-09-2013
DOI: 10.1111/MEDU.12271
Publisher: JMIR Publications Inc.
Date: 19-05-2022
DOI: 10.2196/33023
Abstract: Informal carers play a significant role in supporting people living with dementia however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. This study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and in idual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a erse rural landscape in Australia. This protocol provides an ex le of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. Australian New Zealand Clinical Trials Registry ACTRN12618001213235 rjvrasf RR1-10.2196/33023
Publisher: Wiley
Date: 24-05-2012
Publisher: Wiley
Date: 25-01-2011
Publisher: MDPI AG
Date: 25-08-2023
DOI: 10.3390/GERIATRICS8050085
Abstract: Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers’ perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers’ social support and appeared to ease caregiver demand.
Publisher: Wiley
Date: 12-09-2019
DOI: 10.1111/AJR.12560
Abstract: Rural mental health outcomes have been persistently poorer than those in larger cities suggesting that the prevailing investments to improve matters are not working. Mental health researchers and service providers from New South Wales, Victoria, Western Australia and the Australian Capital Territory met in Orange in October 2018 to explore issues pertaining to rural mental health and well-being. The group recognised and acknowledged that rural residents experience a series of interconnected geographical, demographic, social, economic and environmental challenges which are not addressed adequately by the current mix of services. This declaration has been endorsed by those listed below and we welcome further support. We list ten interrelated problems and ten solutions. As a group, we take this declaration as an opportunity to invite discussion about how we can collectively improve the mental health of rural residents through research, service design and delivery. We invite the reader to consider endorsing this declaration. A short summary of supporting evidence is available online at www.crrmh.com.au/.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 25-03-2011
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 24-09-2009
Publisher: Wiley
Date: 10-11-2021
DOI: 10.1111/AJR.12814
Abstract: Suicide prevention remains a priority in rural and remote Australia, where suicide rates continue to be higher than those in urban communities. This commentary describes the Good SPACE suicide prevention program, and the lessons learned from delivering this program over a 14‐year period. The Good SPACE program has been operating in rural New South Wales since 2007. The program focuses on educating rural community members to recognise the signs of suicide vulnerability, and how to take appropriate action if they encounter someone considering suicide. Communities are selected to receive Good SPACE training in consultation with key stakeholder organisations, or by request from communities. Across the life of the program, key challenges in its administration have included short‐term funding arrangements and staff turnover. Strengths have included the ability to adapt content to meet the needs of rural communities (eg from an initial focus on helping farmers during periods of drought, to a broader focus on all rural residents and a wider range of adversities). As the program moves forward, emphasis will be placed on harder‐to‐reach populations, including males and those with lower mental health literacy. The Good SPACE program has ongoing funding to adapt its content and continue administration through the Rural Adversity Mental Health Program ( www.ramhp.com.au/ ). The lessons learned throughout the life of the program might be of use to other organisations aiming to provide community‐based education programs in rural and remote communities.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.HEALTHPLACE.2017.03.004
Abstract: Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community-based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients' and stakeholders' needs and that build on success and increased trust may be more effective than those imposed from the 'top down' that pay insufficient attention to local contexts.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/PY11150
Abstract: Community primary health care nurses in rural and remote settings are required to provide palliative care as part of their generalist role. They have limited access to specialist medical and nursing support and sometimes there are no resident GPs. A study consisting of a mailed survey and follow-up interviews was conducted to explore the experiences of these nurses and to determine how personally and professionally equipped they felt for palliative care service provision. Most participants were registered nurses experienced in nursing and in rural and remote settings, who juggled multiple generalist work roles. They had only occasional palliative care patients, and more than half had provided palliative care for a friend or family member. Some nurses found palliative care rewarding, others preferred not to have to do it. However, even those who did not enjoy working with palliative care patients often went beyond the ‘call of duty’ to support a home death if that was what the patient wanted. Three-quarters had attended palliative care education in the last 2 years but 88% wanted more education. Barriers to education included competing work roles, work load, geographical isolation and lack of backfill. Support from managers and peers was considered important, as was accessing timely and relevant clinical support.
Publisher: Wiley
Date: 12-01-2012
DOI: 10.1111/J.1365-2923.2011.04102.X
Abstract: Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students' attitudes towards rural practice. Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio-cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students' rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings. The longitudinal placement enabled students to achieve personal goals, and enhanced self-efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice. The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students' intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service-led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.
Publisher: Wiley
Date: 10-2010
Publisher: Ubiquity Press, Ltd.
Date: 2018
DOI: 10.5334/IJIC.3943
Publisher: JMIR Publications Inc.
Date: 18-08-2021
Abstract: nformal carers play a significant role in supporting people living with dementia however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. his study’s aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app—the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and in idual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. etween August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. he Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a erse rural landscape in Australia. This protocol provides an ex le of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. ustralian New Zealand Clinical Trials Registry ACTRN12618001213235 rjvrasf R1-10.2196/33023
Publisher: MDPI AG
Date: 30-09-2019
Abstract: In 2015–2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing initiative. This paper describes the process and achievements of the initiative called ‘Our Healthy Clarence’. Key stakeholders were interviewed at year two and relevant documents reviewed. Data were analysed using document and thematic analysis. Our Healthy Clarence was established following community consultation, including forums, interviews, surveys and workshops. It adopted a strengths-based approach to suicide prevention, encompassing positive health promotion, primary and secondary prevention activities, advocacy, and cross-sectoral collaboration. A stakeholder group formed to develop and enact a community mental health and wellbeing plan. Factors contributing to its successful implementation included a collective commitment to mental health and wellbeing, clarity of purpose, leadership support from key local partners, a paid independent coordinator, and inclusive and transparent governance. Stakeholders reported increased community agency, collaboration, optimism and willingness to discuss mental health, suicide and help-seeking. Our Healthy Clarence draws ideas from mental health care, community development and public health. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community scale.
Publisher: Ubiquity Press, Ltd.
Date: 14-10-2009
DOI: 10.5334/IJIC.328
Publisher: Public Library of Science (PLoS)
Date: 03-01-2017
Publisher: Wiley
Date: 06-2013
DOI: 10.1111/AJR.12051
Publisher: Wiley
Date: 26-01-2014
DOI: 10.1111/AJR.12095
Publisher: Wiley
Date: 02-2013
DOI: 10.1111/AJR.12012
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/AJR.12099
Publisher: Wiley
Date: 25-03-2009
Publisher: Wiley
Date: 24-06-2013
Abstract: Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational therapy practice in rural and remote Australian settings is sparse. Providers of private occupational therapy services in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings. Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents. There is a potential market failure of private occupational therapy in rural and remote areas, impacting on people who need these services and on workforce replacement. Contributing factors include population imbalance between cities and regional/remote areas, financial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regional/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private providers to overcome barriers to providing student placements and recognising rural practice as a specialist field.
Publisher: Wiley
Date: 08-2014
DOI: 10.1111/AJR.12131
Publisher: Wiley
Date: 10-2016
DOI: 10.1111/AJR.12333
Publisher: Wiley
Date: 06-2016
DOI: 10.1111/AJR.12305
Publisher: Ubiquity Press, Ltd.
Date: 14-09-2016
DOI: 10.5334/IJIC.2505
Publisher: Wiley
Date: 27-07-2015
DOI: 10.1111/AJR.12226
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/IJIC.5617
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 2011
Publisher: American Meteorological Society
Date: 15-07-2021
Abstract: Drought is a global threat to public health. Increasingly, the impact of drought on mental health and wellbeing is being recognised. This paper investigates the relationship between drought and wellbeing to determine which drought indices most effectively capture wellbeing outcomes. A thorough understanding of the relationship between drought and wellbeing must consider the: (i) three aspects of drought (duration, frequency and magnitude) (ii) different types of drought (e.g. meteorological, agricultural, etc.) and (iii) the in idual context of specific locations, communities and sectors. For this reason, we used a variety of drought types, drought indices, and time windows to identify the thresholds for wet and dry epochs that enhance and suppress impacts to wellbeing. Four postcodes in New South Wales (NSW), Australia are used as case studies in the analysis to highlight the spatial variability in the relationship between drought and wellbeing. The results demonstrate that the relationship between drought indices and wellbeing outcomes differs temporally, spatially and according to drought type. This paper objectively tests the relationship between commonly used drought indices and wellbeing outcomes to establish if current methods of quantifying drought effectively capture wellbeing outcomes. For funding, community programs and interventions to result in successful adaptation, it is essential to critically choose which drought index, time window and wellbeing outcome to use in empirical studies. The uncertainties associated with these relationships must be accounted for and it must also be realized that results will differ based on these decisions.
Publisher: Royal Society of Chemistry (RSC)
Date: 2017
DOI: 10.1039/C7NR05174C
Abstract: Using ultrafast degenerate pump-probe spectroscopy, we have investigated the ultrafast exciton dynamics of monolayer MoSe
Publisher: Wiley
Date: 11-1984
Publisher: Springer Science and Business Media LLC
Date: 21-09-2016
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH13050
Abstract: Objective To evaluate a rural emergency telepsychiatry program, the Mental Health Emergency Care–Rural Access Program (MHEC-RAP), which aims to improve access to emergency mental health care for communities throughout western New South Wales (NSW). Methods A descriptive analysis of service activity data from the introduction of the MHEC-RAP in 2008 to 2011 using Chi-squared tests and linear regression modelling to assess change and trends over time. Result There were 55 959 calls to the MHEC-RAP, 9678 (17%) of these calls initiated an MHEC-RAP service (~2500 each year). The use of video assessment increased over 18 months, then levelled off to an average of 65 each month. Health care provider use increased from 54% to 75% of all contacts, and 49% of MHEC-RAP patients were triaged ‘urgent’. Most (71%) were referred from the MHEC-RAP for outpatient care with a local provider. The proportion of MHEC-RAP patients admitted to hospital initially increased by 12%, then declined over the next 2 years by 7% (by 28% for admissions to a mental health inpatient unit (MHIPU)). Conclusion The MHEC-RAP is well established. It has achieved acceptable levels of service activity and continues to be as used as intended. Further research is required to confirm how the MHEC-RAP works in terms of process and capacity, how it has changed access to mental health care and to document its costs and benefits. What is known about the topic? Rural and remote communities have poorer access to and use of mental health services. Telehealth care is a reliable and accepted means for providing non-urgent mental health care. What does this paper add? The MHEC-RAP is a practical and transferable solution to providing specialist emergency mental health care, and support for local providers, in rural and remote areas via telehealth. There is a possible impact upon the problem of recruiting and retaining a mental health workforce in rural and remote areas. What are the implications for practitioners? Providing reliable remote access to specialist mental health assessment and advice while supporting providers in rural communities can result in better outcomes for patients and services alike.
Publisher: Wiley
Date: 25-03-2011
Publisher: Cambridge University Press (CUP)
Date: 10-1984
Publisher: Wiley
Date: 02-2015
DOI: 10.1111/AJR.12180
Publisher: Wiley
Date: 12-2008
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY11155
Abstract: This evaluation of the Researcher Development Program (RDP) in NSW and ACT aimed to determine whether the RDP was effective in assisting novice researchers to undertake primary health care research. In mid-2008, 47 participants of the NSW and ACT RDP during 2005–07 were invited to participate in a postal survey. The survey included questions regarding previous research training and experience, outcomes during and after participation in the program, and organisational aspects of the program. Follow-up interviews were conducted with selected participants. Interview questions covered time in the program, supervision, organisational support and placement outcomes. Thirty-seven participants responded to the survey and 23 (62%) participants took part in the semi-structured interviews. Seventy-eight per cent of survey respondents felt that the RDP helped them move from novice to a more experienced researcher with effective supervision identified by participants as a key element in determining the success of the program. Many felt that time allocation was inadequate and 20% thought their capacity to maintain their workload was adversely affected by participating. Outcomes were considerable given the modest nature of the program. Notable outcomes were that most participants published their research and presented their research at a conference. Furthermore, one-fifth of survey respondents had enrolled in higher degrees. Several interviewees reported that their research led to changes in practice. Most respondents found the RDP valuable and considered that undertaking the program increased their research knowledge.
Publisher: MDPI AG
Date: 02-10-2020
Abstract: Drought is a threat to public health. In idual and community adaptive capacity is crucial when responding to the impacts of drought. Gaps remain in the understandings of the relationship between wellbeing and adaptive capacity, and whether increased wellbeing can lead to improved adaptive capacity (or vice versa). This paper explores the relationship between drought, wellbeing and adaptive capacity to provide insights that will inform actions to enhance adaptive capacity, and hence increase opportunities for effective drought adaptation. The theory of salutogenesis and the associated sense of coherence (SOC) are used to measure adaptive capacity and to explain why some in iduals remain well and adapt to adversity while others do not. An online survey of rural residents (n = 163) in drought-affected New South Wales (NSW), Australia, was conducted from November 2018 to January 2019. Linear regression was used to model the relationships between SOC, sociodemographic factors, drought and wellbeing. Findings demonstrate that SOC is strongly correlated with wellbeing. Drought condition did not influence adaptive capacity, although adaptive capacity and drought-related stress were only weakly correlated. Increased wellbeing was found to be associated with stronger adaptive capacity and therefore, an in iduals’ capacity to cope with adversity, such as drought.
Publisher: Public Library of Science (PLoS)
Date: 21-07-2021
DOI: 10.1371/JOURNAL.PONE.0245271
Abstract: Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
Publisher: Informa UK Limited
Date: 24-11-2015
DOI: 10.1080/13607863.2014.981744
Abstract: Older adults are the fastest growing age group in Australia, necessitating an increase in appropriate mental health services in the coming years. While Internet-delivered mental health treatments have been established as acceptable and efficacious among younger s les, little research has explored whether they would be similarly useful in older populations. The participants were part of the Australian Rural Mental Health study, which explores mental health and well-being in residents of non-metropolitan New South Wales. A postal survey was used to assess knowledge of and intentions to use Internet-delivered mental health treatments. Demographics, mental health, and frequency of Internet use were also measured. The survey was completed by 950 adults aged 50-93. The s le was largely unfamiliar with Internet mental health services, with 75% reporting that they had never heard of them and a further 20% not knowing any details of what they involved. Intentions to use these services were also low, at 13.5% however, this increased with level of familiarity. Respondents with higher psychological distress, higher education, and more frequent Internet use were significantly more likely to consider using Internet treatments. Among older adults, overall awareness of Internet-delivered mental health treatments appears to be limited however, higher familiarity contributes to higher intentions to use these treatments. Importantly, respondents with higher distress and greater computer literacy were more likely to consider mental health treatments delivered via the Internet. Future research exploring strategies to increase the promotion of these services to older s les may further improve their perceptions and use.
Publisher: BMJ
Date: 31-10-2016
DOI: 10.1136/OEMED-2016-103602
Abstract: To investigate patterns of alcohol use within the coal mining industry, and associations with the personal, social, workplace and employment characteristics. 8 mine sites across 3 eastern Australian states were surveyed, selected to encompass key geographic characteristics (accessibility and remoteness) and mine type (open cut and underground). Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) to determine: (1) overall risky or hazardous drinking behaviour and (2) frequency of single-occasion drinking (6 or more drinks on 1 occasion). A total of 1457 employees completed the survey, of which 45.7% of male and 17.0% of female participants reported levels of alcohol use within the range considered as risky or hazardous, considerably higher than the national average. Hierarchical linear regression revealed a significant contribution of many in idual level factors associated with AUDIT scores: younger age, male, current smoking status illicit substance use previous alcohol and other drug use (AOD) problems and higher psychological distress. Workplace factors associated with alcohol use included working in mining primarily for the high remuneration, and the type of mining, with underground miners reporting higher alcohol use than open-cut miners. Our findings provide support for the need to address alcohol use in the coal mining industry over and above routine on-site testing for alcohol use.
Publisher: Wiley
Date: 25-01-2011
Publisher: Wiley
Date: 12-2016
DOI: 10.1111/AJR.12342
Publisher: Wiley
Date: 08-2013
DOI: 10.1111/AJR.12067
Publisher: Wiley
Date: 20-07-2011
Publisher: Wiley
Date: 18-02-2015
DOI: 10.1111/AJR.12142
Abstract: To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82) most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56% n = 102) of the articles addressed rural health issues Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1-19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2-5 universities/organisations but only 5% of articles included an author from more than one UDRH. Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.
Publisher: Wiley
Date: 12-03-2013
DOI: 10.1111/MEDU.12097
Abstract: There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning.
Publisher: MDPI AG
Date: 16-08-2019
Abstract: Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains h ered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated.
Publisher: Informa UK Limited
Date: 10-1992
DOI: 10.1080/00185868.1992.10543711
Abstract: Although the concept of the managed market system arose in the United States, it has taken hold elsewhere, notably in England, where changes to the National Health Service have been forthcoming from the conservative government. In this article, the author examines some of these developments.
Publisher: Wiley
Date: 10-2013
DOI: 10.1111/AJR.12068
No related grants have been discovered for David Perkins.