ORCID Profile
0000-0002-8491-3282
Current Organisation
Cath Cosgrave Consulting
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Publisher: MDPI AG
Date: 24-01-2019
Abstract: Residents of rural and remote Australia have poorer health outcomes than their metropolitan counterparts. A major contributor to these health disparities is chronic and severe health workforce shortages outside of metropolitan areas—a global phenomenon. Despite emerging recognition of the important influence of place-based social processes on retention, much of the political attention and research is directed elsewhere. A structured scoping review was undertaken to describe the range of research addressing the influence of place-based social processes on turnover or retention of rural health professionals, to identify current gaps in the literature, and to formulate a guide for future rural health workforce retention research. A systematic search of the literature was performed. In total, 21 articles were included, and a thematic analysis was undertaken. The themes identified were (1) rural familiarity and/or interest, (2) social connection and place integration, (3) community participation and satisfaction, and (4) fulfillment of life aspirations. Findings suggest place-based social processes affect and influence the retention of rural health workforces. However, these processes are not well understood. Thus, research is urgently needed to build robust understandings of the social determinants of rural workforce retention. It is contended that future research needs to identify which place-based social processes are amenable to change.
Publisher: Wiley
Date: 12-06-2015
DOI: 10.1111/AJR.12205
Abstract: This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia. Semi-structured interviews. Public health sector, rural New South Wales. Five community mental health managers, running services in rural Australia. Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study. Three key retention focussed themes were identified: (i) Staffing is a persistent challenge (ii) Small remote towns pose the biggest challenge and (iii) The decision to stay or leave is complex and multifactorial. The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions.
Publisher: Unpublished
Date: 2019
Publisher: Wiley
Date: 17-10-2022
DOI: 10.1111/AJR.12930
Abstract: 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. 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. Identifying major points of ergence and/or convergence enablers and/or constraints and ways to better navigate and strengthen the co‐production process. Given members of the design working group, erse skills sets ergence 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). When developing a co‐created public health prevention c aign 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.
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/AJR.12717
Abstract: While preparation for professional practice is conceived as placeless, it is enacted in place. Consequently, many professionals find themselves working in conditions significantly different than those they were educated in and for. This is especially relevant for new professionals arriving in rural settings after preparation in urban programs, where metrocentric models of orientation to practice are implicitly privileged. The consequent dis‐join between practice and place often results in new professionals feeling ‘out of place’ and questioning their professional competence. It also results in settings outside the metrocentric norm being viewed as less desirable practice contexts. Negative desirability hinders professional recruitment, while feeling out of place and incompetent hinders professional retention both are longstanding issues in rural communities. Recent developments in professional education and practice standards emphasise adaptability to practise in specific contexts. However, ‘context,’ a primary focus to date for rural preparation is presented as a largely static backdrop that needs to be accommodated to engage in the ‘real practice’ one was trained for. Drawing on the spatial turn in social theory, we argue that place both shapes and is shaped by professionals and their practices and as such, must be engaged with deeply and dynamically. This conceptualisation of the relationship between place and practice has critical implications for professional preparation. As interdisciplinary practitioners and researchers working in erse contexts, we examine ‘place’ from a social constructivist perspective as a focal point for professional preparation.
Publisher: MDPI AG
Date: 11-08-2020
Abstract: Chronic health workforce shortages significantly contribute to unmet health care needs in rural and remote communities. Of particular and growing concern are shortages of allied health professionals (AHPs). This study explored the contextual factors impacting the recruitment and retention of AHPs in rural Australia. A qualitative approach using a constructivist-interpretivist methodology was taken. Semi-structured interviews (n = 74) with executive staff, allied health (AH) managers and newly recruited AHPs working in two rural public health services in Victoria, Australia were conducted. Data was coded and categorised inductively and analysed thematically. The findings suggest that to support a stable and sustainable AH workforce, rural public sector health services need to be more efficient, strategic and visionary. This means ensuring that policies and procedures are equitable and accessible, processes are effective, and action is taken to develop local programs, opportunities and supports that allow AH staff to thrive and grow in place at all grade levels and life stages. This study reinforces the need for a whole-of-community approach to effectively support in idual AH workers and their family members in adjusting to a new place and developing a sense of belonging in place. The recommendations arising from this study are likely to have utility for other high-income countries, particularly in guiding AH recruitment and retention strategies in rural public sector health services. Recommendations relating to community lace will likely benefit broader rural health workforce initiatives.
Publisher: Elsevier BV
Date: 2020
Publisher: MDPI AG
Date: 14-04-2020
Abstract: People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address in idual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.
Publisher: Elsevier BV
Date: 03-2020
Publisher: MDPI AG
Date: 14-04-2021
Abstract: Primary producers face considerable risks for poor mental health. While this population can be difficult to engage in programs to prevent poor mental health, approaches tailored to reflect the context of primary producers’ life and work have been successful. This paper reports on the co-design phase of a project designed to prevent poor mental health for primary producers—specifically, the advantages, challenges and considerations of translating face-to-face co-design methods to an online environment in response to COVID-19 restrictions. The co-design phase drew upon the existing seven-step co-design framework developed by Trischler and colleagues. Online methods were adopted for all steps of the process. This paper models how this co-design approach can work in an online, primary producer context and details key considerations for future initiatives of this type. The development of online co-design methods is an important additional research method for use not only during a pandemic but also when operating with limited resources or geographic constraints. Results demonstrate the following: (i) co-designing online is possible given adequate preparation, training and resource allocation (ii) “hard to reach” populations can be engaged using online methods providing there is adequate early-stage relationship building (iii) co-design quality need not be compromised and may be improved when translating to online and (iv) saved costs and resources associated with online methods can be realigned towards intervention/service creation, promotion and user engagement. Suggestions for extending Trischler and colleagues’ model are incorporated.
Publisher: Emerald
Date: 14-05-2018
DOI: 10.1108/JMHTEP-02-2017-0008
Abstract: Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff turnover of this workforce has been limited. The purpose of this paper is to identify work factors negatively affecting the job satisfaction of early career health professionals working in rural Australia’s public sector CMH services. In total, 25 health professionals working in rural and remote CMH services in New South Wales (NSW), Australia, for NSW Health participated in in-depth, semi-structured interviews. The study identified five work-related challenges negatively affecting job satisfaction: developing a profession-specific identity providing quality multidisciplinary care working in a resource-constrained service environment working with a demanding client group and managing personal and professional boundaries. These findings highlight the need to provide time-critical supports to address the challenges facing rural-based CMH professionals in their early career years in order to maximise job satisfaction and reduce avoidable turnover. Overall, the study found that the factors negatively affecting the job satisfaction of early career rural-based CMH professionals affects all professionals working in rural CMH, and these negative effects increase with service remoteness. For those in early career, having to simultaneously deal with significant rural health and sector-specific constraints and professional challenges has a negative multiplier effect on their job satisfaction. It is this phenomenon that likely explains the high levels of job dissatisfaction and turnover found among Australia’s rural-based early career CMH professionals. By understanding these multiple and simultaneous pressures on rural-based early career CMH professionals, public health services and governments involved in addressing rural mental health workforce issues will be better able to identify and implement time-critical supports for this cohort of workers. These findings and proposed strategies potentially have relevance beyond Australia’s rural CMH workforce to Australia’s broader early career nursing and allied health rural workforce as well as internationally for other countries that have a similar physical geography and health system.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2020
DOI: 10.1186/S12913-020-05669-6
Abstract: Allied health services are core to the improvement in health outcomes for remote and rural residents. Substantial infrastructure has been put into place to facilitate rural work-ready allied health practitioners, yet it is difficult to understand or measure how successful this is and how it is facilitated. A scoping review and thematic synthesis of the literature using program logic was undertaken to identify and describe the contexts, mechanisms and outcomes of successful models of rural clinical placements for allied health students. This involved all empirical literature examining models of regional, rural and remote clinical placements for allied health students between 1995 and 2019. A total of 292 articles were identified however, after removal of duplicates and article screening, 18 were included in the final synthesis. Australian papers dominated the evidence base ( n = 11). Drivers for rural allied health clinical placements include: attracting allied health students to the rural workforce increasing the number of allied health clinical placements available exposing students to and providing skills in rural and interprofessional practice and improving access to allied health services in rural areas. Depending on the placement model, a number of key mechanisms were identified that facilitated realisation of these drivers and therefore the success of the model. These included: support for students engagement, consultation and partnership with key stakeholders and organisations and regional coordination, infrastructure and support. Placement success was measured in terms of student, rural, community and/or program outcomes. Although the strength and quality of the evidence was found to be low, there is a trend for placements to be more successful when the driver for the placement is specifically reflected in the structure of the placement model and outcomes measured. This was seen most effectively in placement models that were driven by the need to meet rural community needs and upskill students in interprofessional rural practice. This study identifies the factors that can be manipulated to ensure more successful models of allied health rural clinical placements and provides an evidence based framework for improved planning and evaluation.
Publisher: Rural and Remote Health
Date: 03-09-2018
DOI: 10.22605/RRH4511
Publisher: Wiley
Date: 04-06-2023
DOI: 10.1111/AJR.13003
Abstract: Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase access to health care for young people, particularly school‐aged young people (12–18 years) living in small rural towns ( people). To determine the extent the Teen Clinic model meets its accessibility objective and to determine the barriers and enablers to sustainable delivery of the Teen Clinic service. A multimethod case study approach was used to assess access (multidimensional framework for patient‐centred access) and determine the barriers and enablers to sustainable delivery. Data collection included a survey of young people in the included rural communities and key stakeholder interviews. The survey of young people indicated Teen Clinic model was accessible across multiple dimensions. From a practice perspective, accessibility was achieved by varying from usual care to a nurse‐led, young person‐centred drop‐in model. This required skilled nurses working at the top of their scope however, unpredictable demand and patient complexity made accounting for the time and therefore funding somewhat complex. The Teen Clinic model meets its objective of increasing healthcare access for young rural people. Relational and cultural factors were more important facilitators of practice integration than organisational processes. A key challenge to the ongoing provision of Teen Clinic was dedicated sustainable funding. Teen Clinic is an integrated primary healthcare model that increases access for young people in small rural communities. Sustainable implementation would benefit from dedicated funding.
Publisher: Unpublished
Date: 2016
Publisher: Wiley
Date: 14-07-2023
DOI: 10.1111/AJR.13015
Abstract: There is limited research on how supporting a peer through a traumatic event is experienced by adolescents. The aim of this research was to understand the personal and interpersonal processes of adolescents supporting a peer who experienced a traumatic event based on youth definitions. In‐depth qualitative interviews were conducted with 22 adolescents aged 14–19, residing in Gippsland, Victoria, Australia. A constructivist grounded theory methodology was used to develop a substantive theory. The substantive theory ‘Foundations of Support’ was developed which explained the support process phenomena. Specifically, adolescents who had shared responsibility for supporting their peers went back to life as normal, whereas adolescents who maintained sole responsibility experienced mental health problems. The ‘Foundations of Support’ grounded theory highlights the importance of adolescents having strong connections to their trusted others, such as family, friends and community. This theory implies that facilitating connections with positive supports such as place and community are essential in guiding adolescents back to their foundations of support. Without strong connections, adolescents are at risk of maintaining sole responsibility, losing their sense of identity and feeling alienated within their community.
Publisher: Wiley
Date: 12-09-2023
DOI: 10.1111/AJR.13039
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16128
Abstract: Objective The aim of the present study was to identify factors affecting the job satisfaction and subsequent retention of Aboriginal mental health workers (AMHWs). Methods Five AMHWs working in New South Wales (NSW) for NSW Health in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews to understand how employment and rural living factors affected workers’ decisions to stay or leave their CMH positions. Results Using a constructivist grounded theory analysis, three aspects negatively impacting the job satisfaction of AMHWs were identified: (1) difficulties being accepted into the team and organisation (2) culturally specific work challenges and (3) professional differences and inequality. Conclusions Policy and procedural changes to the AMHW training program may address the lower remuneration and limited career opportunities identified with regard to the Bachelor Health Sciences (Mental Health) qualification. Delivering training to increase levels of understanding about the AMHW training program, and cultural awareness generally, to CMH staff and NSW Health management may assist in addressing the negative team, organisational and cultural issues identified. What is known about the topic? The Bachelor Health Sciences (Mental Health) qualification and traineeship pathway undertaken by AMHWs differs significantly from that of other health professionals working in NSW Health’s CMH services. The health workforce literature identifies that each health professional group has its own culture and specific values and that forming and maintaining a profession-specific identity is an extremely important aspect of job satisfaction for health workers. What does the paper add? AMHWs working in rural and remote NSW CMH services commonly experience low levels of job satisfaction, especially while undertaking the embedded training program. Of particular concern is the health sciences qualification not translating into NSW Health’s ‘professionalised’ workplace, as well as having negative effects with regard to remuneration and career opportunities within NSW Health. In addition, role challenges involving cultural differences and managing additional professional and personal boundaries negatively affects the job satisfaction of AMHWs. What are the implications for practice? The current structure of the AMHW training program creates workplace conditions that contribute to job dissatisfaction among rural and remote-based AMHWs. Many issues could be rectified by NSW Health making changes to the degree qualification obtained under the training program, as well as raising the level of understanding about the program and Indigenous cultural awareness generally among CMH staff and NSW Health management.
Publisher: figshare
Date: 2020
Publisher: Informa UK Limited
Date: 02-01-2015
Location: Australia
Start Date: 2019
End Date: 2021
Funder: Foundation for Rural & Regional Renewal
View Funded ActivityStart Date: 2019
End Date: 2019
Funder: Winston Churchill Memorial Trust
View Funded ActivityStart Date: 2012
End Date: 2016
Funder: Department of Education, Employment and Workplace Relations, Australian Government
View Funded ActivityStart Date: 2018
End Date: 2019
Funder: Department of Health, State Government of Victoria
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Queensland University of Technology
View Funded ActivityStart Date: 2017
End Date: 2019
Funder: University of Melbourne
View Funded ActivityStart Date: 2015
End Date: 2015
Funder: University of New England
View Funded ActivityStart Date: 2020
End Date: 2022
Funder: Foundation for Rural & Regional Renewal
View Funded Activity