Natasha Daureen Frawley, Madison Phung, Benjamin Harrap
Objective
To evaluate the prevalence of low-value care hysterectomy before and after publication of the National Heavy Menstrual Bleeding Clinical Care Standard (HMB Standard) in a regional Victorian hospital. The secondary aim was to assess whether compliance with the HMB Standard improved.
Methods
Retrospective cohort design. All patients booked for a planned benign hysterectomy were included. Manual chart review was undertaken for demographics, surgical planning, procedure, and outcomes to 28 days.
Design Setting
A single regional Victorian hospital within an area identified to be high volume for benign hysterectomy.
Participants
Patients who planned benign hysterectomy in the 10 months prior (Group 1—Control) and 10 months after (Group 2—Post-intervention) publication of the HMB Standard in October 2017.
Main Outcome Measures
Low-value hysterectomy was defined as the proportion of benign hysterectomies performed via the abdominal route in the absence of cancer or a previous caesarean section.
Results
There were 64 patients in Group 1 and 60 in Group 2 included. Low-value hysterectomy proportion had a non-significant change from 9.4% in Group 1 to 11.7% in Group 2, 95% confidence interval = [−0.1303, 0.0857]. Compliance to the HMB Standard had mixed results.
Conclusions
There was no clinically significant change in low-value hysterectomy in the 10 months following publication of the HMB Standard, compared to 10 months prior, in a regional Victorian hospital. Uptake of therapeutic alternatives to hysterectomy was low.
{"title":"Retrospective Cohort Study of Low-Value Hysterectomy Before and After Publication of the National Heavy Bleeding Clinical Care Standard in Regional Victoria","authors":"Natasha Daureen Frawley, Madison Phung, Benjamin Harrap","doi":"10.1111/ajr.70049","DOIUrl":"https://doi.org/10.1111/ajr.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the prevalence of low-value care hysterectomy before and after publication of the National Heavy Menstrual Bleeding Clinical Care Standard (HMB Standard) in a regional Victorian hospital. The secondary aim was to assess whether compliance with the HMB Standard improved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort design. All patients booked for a planned benign hysterectomy were included. Manual chart review was undertaken for demographics, surgical planning, procedure, and outcomes to 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design Setting</h3>\u0000 \u0000 <p>A single regional Victorian hospital within an area identified to be high volume for benign hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients who planned benign hysterectomy in the 10 months prior (Group 1—Control) and 10 months after (Group 2—Post-intervention) publication of the HMB Standard in October 2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Low-value hysterectomy was defined as the proportion of benign hysterectomies performed via the abdominal route in the absence of cancer or a previous caesarean section.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 64 patients in Group 1 and 60 in Group 2 included. Low-value hysterectomy proportion had a non-significant change from 9.4% in Group 1 to 11.7% in Group 2, 95% confidence interval = [−0.1303, 0.0857]. Compliance to the HMB Standard had mixed results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no clinically significant change in low-value hysterectomy in the 10 months following publication of the HMB Standard, compared to 10 months prior, in a regional Victorian hospital. Uptake of therapeutic alternatives to hysterectomy was low.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the preferences of non-metropolitan youth towards mental health service access.
Setting
Tasmania, Australia.
Participants
Youth aged 13 to 25 years (n = 214).
Methods
Choice-based conjoint analysis (CBC) which is a quantitative study design, was employed. In this CBC study, an online survey presented twelve choice sets reflecting seven different mental health service attributes (mental health concern, service provider, cost, wait time, service delivery method, travel time and transport mode), with youth asked to choose their preferred option for access. Choice-based conjoint analysis determined preferred mental health service attributes and the relative weighting of different levels within each attribute.
Results
Of the seven attributes, service provider, cost, wait time and service delivery method were of the highest importance to youth when considering mental health service access. Within the listed health service attributes, youth ranked: psychologists; no cost; no wait time; face-to-face delivery; travel time of 15 min; and travel by private car highest. Various socio-demographic variables were associated with attribute and level choices.
Conclusion
Tasmanian youth prefer to access mental health services when provided in person, by a psychologist, for free and with no waiting time. Further research is required to investigate whether mental healthcare preferences for non-metropolitan youth change depending on geographical location, mental health status, level of mental health literacy, a greater choice of service providers and service delivery methods.
{"title":"Preferences of Non-Metropolitan Youth Towards Accessing Mental Health Services: A Choice-Based Conjoint Analysis","authors":"Edwin Paul Mseke, Belinda Jessup, Tony Barnett","doi":"10.1111/ajr.70052","DOIUrl":"https://doi.org/10.1111/ajr.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the preferences of non-metropolitan youth towards mental health service access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tasmania, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Youth aged 13 to 25 years (<i>n</i> = 214).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Choice-based conjoint analysis (CBC) which is a quantitative study design, was employed. In this CBC study, an online survey presented twelve choice sets reflecting seven different mental health service attributes (<i>mental health concern</i>, <i>service provider</i>, <i>cost</i>, <i>wait time</i>, <i>service delivery method</i>, <i>travel time</i> and <i>transport mode</i>), with youth asked to choose their preferred option for access. Choice-based conjoint analysis determined preferred mental health service attributes and the relative weighting of different levels within each attribute.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the seven attributes, service provider, cost, wait time and service delivery method were of the highest importance to youth when considering mental health service access. Within the listed health service attributes, youth ranked: psychologists; no cost; no wait time; face-to-face delivery; travel time of 15 min; and travel by private car highest. Various socio-demographic variables were associated with attribute and level choices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tasmanian youth prefer to access mental health services when provided in person, by a psychologist, for free and with no waiting time. Further research is required to investigate whether mental healthcare preferences for non-metropolitan youth change depending on geographical location, mental health status, level of mental health literacy, a greater choice of service providers and service delivery methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to elevate the voices of doctors with rural backgrounds by exploring their experience of applying for medicine and identifying learnings that can further widen access for prospective rural applicants.
Methods
This study is part of a larger qualitative study exploring the experiences of medical graduates from Deakin University's rural longitudinal integrated clerkship.
Design
Qualitative interviews. Interviews were audio recorded, transcribed verbatim, and thematically analysed to elicit themes that aligned with the barriers and facilitators to admission to medicine.
Setting
Rural longitudinal integrated clerkship.
Participants
A total of 17 participants self-identified as originating from a rural background.
Main Outcome Measures
Barriers and facilitators to gaining admission to medicine.
Results
Barriers included aptitude tests, visibility and aspiration, and financial issues. Facilitators included equity admission policies, perseverance, and life experience.
Conclusion
Despite gaining admission to medicine, participants described the barriers they overcame and validated the importance of equity processes. Universities have a responsibility to continually review admission policies to ensure they are training a diverse cohort of students who are representative of the communities they serve.
{"title":"‘I Hadn't Ever Really Thought It Was Something That I Could Do’: Rural Background Medical Graduates' Pathways to Medicine","authors":"Jessica Beattie, Marley Binder, Hannah Beks, Lara Fuller","doi":"10.1111/ajr.70047","DOIUrl":"https://doi.org/10.1111/ajr.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to elevate the voices of doctors with rural backgrounds by exploring their experience of applying for medicine and identifying learnings that can further widen access for prospective rural applicants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is part of a larger qualitative study exploring the experiences of medical graduates from Deakin University's rural longitudinal integrated clerkship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative interviews. Interviews were audio recorded, transcribed verbatim, and thematically analysed to elicit themes that aligned with the barriers and facilitators to admission to medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural longitudinal integrated clerkship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A total of 17 participants self-identified as originating from a rural background.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Barriers and facilitators to gaining admission to medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Barriers included aptitude tests, visibility and aspiration, and financial issues. Facilitators included equity admission policies, perseverance, and life experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite gaining admission to medicine, participants described the barriers they overcame and validated the importance of equity processes. Universities have a responsibility to continually review admission policies to ensure they are training a diverse cohort of students who are representative of the communities they serve.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Berneice Fitzpatrick, Susan de Jersey, Shelley Wilkinson, Nicole Ward
Objective
To explore women's knowledge and experience of weight monitoring during pregnancy to inform the development of a model of care that meets demonstrated needs.
Setting
A rural and regional health service in southern Queensland.
Participants
Women (n = 160) who used antenatal care in the health service from June 2018 to October 2022.
Design
An exploratory online survey was sent via short messaging service to women, including quantitative and qualitative questions with free-text options for additional comments. The data were analysed using descriptive statistics.
Results
One in five women could correctly identify the recommended gestational weight gain based on their pre-pregnancy body mass index. Half the women reported knowing weight gain recommendations was useful. A quarter of women had a negative experience with health professionals discussing their weight. One-fifth of women saw a dietitian, and an additional 9% would have liked to use the service, with 14% not knowing it was available.
Conclusion
Women would like to know more about achieving healthy weight gain and receive support to do so. Women report experiencing stigma when discussing pregnancy weight. Whilst the findings are similar to urban women's experience, rural women's ability to access care in the context of a rural setting presents a unique set of barriers. Further investigation is required to gather health professionals' experience in conjunction with the latest evidence to inform improvements to service delivery.
{"title":"Gestational Weight Monitoring in Rural and Regional Populations: Women's Knowledge, Experience and Recommendations for Models of Care","authors":"Berneice Fitzpatrick, Susan de Jersey, Shelley Wilkinson, Nicole Ward","doi":"10.1111/ajr.70042","DOIUrl":"https://doi.org/10.1111/ajr.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore women's knowledge and experience of weight monitoring during pregnancy to inform the development of a model of care that meets demonstrated needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A rural and regional health service in southern Queensland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Women (<i>n</i> = 160) who used antenatal care in the health service from June 2018 to October 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>An exploratory online survey was sent via short messaging service to women, including quantitative and qualitative questions with free-text options for additional comments. The data were analysed using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One in five women could correctly identify the recommended gestational weight gain based on their pre-pregnancy body mass index. Half the women reported knowing weight gain recommendations was useful. A quarter of women had a negative experience with health professionals discussing their weight. One-fifth of women saw a dietitian, and an additional 9% would have liked to use the service, with 14% not knowing it was available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Women would like to know more about achieving healthy weight gain and receive support to do so. Women report experiencing stigma when discussing pregnancy weight. Whilst the findings are similar to urban women's experience, rural women's ability to access care in the context of a rural setting presents a unique set of barriers. Further investigation is required to gather health professionals' experience in conjunction with the latest evidence to inform improvements to service delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew Wang, Maurice J. Meade, Gustavo H. Soares, Pedro H. R. Santiago, Dandara G. Haag, Lisa M. Jamieson
Objective
To determine how access to specialist orthodontic services (SOS) varies across South Australia (SA) according to socio-economic status and remoteness.
Design and Setting
A cross-sectional telephone survey of 92 specialist orthodontic practice locations across SA.
Main Outcome Measures
The number of full-time equivalent (FTE) specialist orthodontists (orthodontists) and auxiliaries working at each location. The ratio of 12-year-old (yo) population to one FTE orthodontist (12yo:1 FTEO) at the local government area (LGA) level to indicate availability of SOS. The average distance required from each LGA to access at least one FTE orthodontist (D1FTEO) as an indication of accessibility of SOS Quantum Geographic Information System (QGIS) 3.24.2-Tisler (https://www.qgis.org). The variance in availability and accessibility of SOS according to remoteness and socio-economic status.
Results
The response rate was 93.48%. The 12 yo:1 FTEO in SA was 564.62. The mean (SD) D1FTEO was 138 km (173 km). Across SA there was a general trend of decreased availability and accessibility of SOS in areas outside of major cities and in areas of lower socio-economic status.
Conclusions
The absence of orthodontists in nonmajor city or poorer locations in SA was not compensated by an increased presence of orthodontic auxiliaries. Further research in other Australian states and territories may be warranted to confirm whether similar shortages in SOS exist in nonmajor city locations or areas of lower socio-economic status.
{"title":"Distribution of Specialist Orthodontic Service Provision Across South Australia According to Socio-Economic Status and Remoteness","authors":"Andrew Wang, Maurice J. Meade, Gustavo H. Soares, Pedro H. R. Santiago, Dandara G. Haag, Lisa M. Jamieson","doi":"10.1111/ajr.70040","DOIUrl":"https://doi.org/10.1111/ajr.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine how access to specialist orthodontic services (SOS) varies across South Australia (SA) according to socio-economic status and remoteness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>A cross-sectional telephone survey of 92 specialist orthodontic practice locations across SA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The number of full-time equivalent (FTE) specialist orthodontists (orthodontists) and auxiliaries working at each location. The ratio of 12-year-old (yo) population to one FTE orthodontist (12yo:1 FTEO) at the local government area (LGA) level to indicate availability of SOS. The average distance required from each LGA to access at least one FTE orthodontist (D1FTEO) as an indication of accessibility of SOS Quantum Geographic Information System (QGIS) 3.24.2-Tisler (https://www.qgis.org). The variance in availability and accessibility of SOS according to remoteness and socio-economic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate was 93.48%. The 12 yo:1 FTEO in SA was 564.62. The mean (SD) D1FTEO was 138 km (173 km). Across SA there was a general trend of decreased availability and accessibility of SOS in areas outside of major cities and in areas of lower socio-economic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The absence of orthodontists in nonmajor city or poorer locations in SA was not compensated by an increased presence of orthodontic auxiliaries. Further research in other Australian states and territories may be warranted to confirm whether similar shortages in SOS exist in nonmajor city locations or areas of lower socio-economic status.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jordan L. Fox, William MacAskill, Matthew McGrail, Diann Eley, Srinivas Kondalsamy-Chennakesavan, Priya Martin
Objective
The purpose of this study was to explore student and supervisor experiences of medical student research activity in a rural area, as well as reasons for interested students not engaging in research and projects being delayed or discontinued.
Setting
One university's rural clinical school programme encompassing four regional training locations.
Participants
Medical students completing their training at a rural location who expressed an interest in participating in extracurricular research, along with supervisors of extracurricular research projects for rural students within the preceding 2 years.
Design
Convergent mixed-methods study involving an online survey with students and semi-structured interviews with supervisors. Thematic analysis was used to analyse the interview data.
Results
Common student participation reasons (n = 14) included gaining new skills, strengthening their curriculum vitae, interest in a future research career, and supervisor encouragement; however, only eight projects were successfully continued thus far. Analysis of the interview data (10 supervisors) led to the creation of three themes and five sub-themes: advantageous partnerships (collegially co-designed, student benefits, and broader benefits), navigating research processes (time constraints and lengthy processes impacting workloads, and support needs), and setting students up for success.
Conclusions
Training or working in a rural area is associated with specific barriers and enablers for medical students participating in research and their supervisors. Time constraints for both students and supervisors were key barriers to project continuation, with successful projects usually having a clear finite timeframe. Targeted strategies specific to rural contexts are needed to maximise rates of project completion and publication.
{"title":"Medical Students' and Supervisors' Experiences of Extracurricular Research at a Rural Clinical School: A Mixed-Methods Study","authors":"Jordan L. Fox, William MacAskill, Matthew McGrail, Diann Eley, Srinivas Kondalsamy-Chennakesavan, Priya Martin","doi":"10.1111/ajr.70044","DOIUrl":"https://doi.org/10.1111/ajr.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this study was to explore student and supervisor experiences of medical student research activity in a rural area, as well as reasons for interested students not engaging in research and projects being delayed or discontinued.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>One university's rural clinical school programme encompassing four regional training locations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Medical students completing their training at a rural location who expressed an interest in participating in extracurricular research, along with supervisors of extracurricular research projects for rural students within the preceding 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Convergent mixed-methods study involving an online survey with students and semi-structured interviews with supervisors. Thematic analysis was used to analyse the interview data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Common student participation reasons (<i>n</i> = 14) included gaining new skills, strengthening their curriculum vitae, interest in a future research career, and supervisor encouragement; however, only eight projects were successfully continued thus far. Analysis of the interview data (10 supervisors) led to the creation of three themes and five sub-themes: advantageous partnerships (collegially co-designed, student benefits, and broader benefits), navigating research processes (time constraints and lengthy processes impacting workloads, and support needs), and setting students up for success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Training or working in a rural area is associated with specific barriers and enablers for medical students participating in research and their supervisors. Time constraints for both students and supervisors were key barriers to project continuation, with successful projects usually having a clear finite timeframe. Targeted strategies specific to rural contexts are needed to maximise rates of project completion and publication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michelle A. Krahe, Stephanie Baker, Leeanna Woods, Sarah L. Larkins
Introduction
Digital transformation can enhance health and healthcare delivery; however, its application in rural, regional, and remote (RRR) areas presents considerable, underexplored challenges. While the benefits of digital health for underserved areas are evident, we must understand and address the challenges to fully realise its impact.
Objective
To synthesise the evidence for factors influencing the implementation of digital health in RRR Australia and recommend implementation strategies to address barriers.
Design
An overview of existing reviews was conducted to identify relevant systematic and scoping reviews. Review quality was assessed using the AMSTAR-2 tool. Barriers and enablers to implementation were mapped using the Consolidated Framework for Implementation Research (CFIR), and strategies to address barriers were identified based on the Expert Recommendations for Implementation Change (ERIC).
Findings
Three reviews met the inclusion criteria; each was focused on telehealth and remote monitoring technologies. Influencing factors were identified across five CFIR domains, encompassing 16 barrier and 12 enabler constructs. While gaps in evidence on health outcomes were noted, the benefits of implementation, such as improved access to services, reduced travel, and enhanced patient satisfaction, were highlighted. The recommended implementation strategies involved tailoring interventions to local needs, fostering local leadership and advocacy, planning and structuring implementation, and mobilising resources.
Conclusion
This study identified key influencing factors and recommended implementation strategies to mitigate barriers. These strategies, if employed, could facilitate the successful implementation of digital health in RRR Australia.
{"title":"Factors That Influence Digital Health Implementation in Rural, Regional, and Remote Australia: An Overview of Reviews and Recommended Strategies","authors":"Michelle A. Krahe, Stephanie Baker, Leeanna Woods, Sarah L. Larkins","doi":"10.1111/ajr.70045","DOIUrl":"https://doi.org/10.1111/ajr.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Digital transformation can enhance health and healthcare delivery; however, its application in rural, regional, and remote (RRR) areas presents considerable, underexplored challenges. While the benefits of digital health for underserved areas are evident, we must understand and address the challenges to fully realise its impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To synthesise the evidence for factors influencing the implementation of digital health in RRR Australia and recommend implementation strategies to address barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>An overview of existing reviews was conducted to identify relevant systematic and scoping reviews. Review quality was assessed using the AMSTAR-2 tool. Barriers and enablers to implementation were mapped using the Consolidated Framework for Implementation Research (CFIR), and strategies to address barriers were identified based on the Expert Recommendations for Implementation Change (ERIC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Three reviews met the inclusion criteria; each was focused on telehealth and remote monitoring technologies. Influencing factors were identified across five CFIR domains, encompassing 16 barrier and 12 enabler constructs. While gaps in evidence on health outcomes were noted, the benefits of implementation, such as improved access to services, reduced travel, and enhanced patient satisfaction, were highlighted. The recommended implementation strategies involved tailoring interventions to local needs, fostering local leadership and advocacy, planning and structuring implementation, and mobilising resources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified key influencing factors and recommended implementation strategies to mitigate barriers. These strategies, if employed, could facilitate the successful implementation of digital health in RRR Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO CRD42024512742</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the above, it is important to qualify these concerns with the observation that the implementation of the NDIS in Australia has resulted in positive benefits for many rural and regional people with disabilities and for their family members and carers [3]. New services have been established in some areas [3, 4]; many people with disabilities have new opportunities in life, as well as greater choice [5], and some enjoy better relationships and greater social participation [3, 6]. The NDIS has also had positive consequences for some family members, including greater workforce participation, engagement in meaningful community roles, increased leisure, as well as reduced financial distress and greater certainty about the future [3].
Unfortunately, these benefits are not uniform. Some people with disabilities and their families/caregivers have drawn little benefit; for some others, the benefits have come in the midst of considerable hardship and unnecessary frustration.
Pim Kuipers: conceptualisation, analysis, writing – review and editing. Jo Spong: conceptualisation, analysis, writing – review and editing.
{"title":"Implementation of the NDIS in Rural, Regional and Remote Areas","authors":"Pim Kuipers, Jo Spong","doi":"10.1111/ajr.70046","DOIUrl":"https://doi.org/10.1111/ajr.70046","url":null,"abstract":"<p>Despite the above, it is important to qualify these concerns with the observation that the implementation of the NDIS in Australia has resulted in positive benefits for many rural and regional people with disabilities and for their family members and carers [<span>3</span>]. New services have been established in some areas [<span>3, 4</span>]; many people with disabilities have new opportunities in life, as well as greater choice [<span>5</span>], and some enjoy better relationships and greater social participation [<span>3, 6</span>]. The NDIS has also had positive consequences for some family members, including greater workforce participation, engagement in meaningful community roles, increased leisure, as well as reduced financial distress and greater certainty about the future [<span>3</span>].</p><p>Unfortunately, these benefits are not uniform. Some people with disabilities and their families/caregivers have drawn little benefit; for some others, the benefits have come in the midst of considerable hardship and unnecessary frustration.</p><p><b>Pim Kuipers:</b> conceptualisation, analysis, writing – review and editing. <b>Jo Spong:</b> conceptualisation, analysis, writing – review and editing.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The rurality gradient, in which health outcomes worsen the greater the distance from metropolitan locations, is well-established and enduring. This health disparity has maintained a strong hold on the attention of many politicians, policy- and other decision-makers and has been the focus of numerous policy imperatives and program and service innovations, all aiming to close the health gap. Yet, despite the best efforts of many talented and committed people, the health inequity gap remains.</p><p>Sometimes, when a problem is complex, intractable, even “wicked”, it can be helpful to step back and examine the construction of the concept that defines the problem. The concept in this case is health inequity or a health “gap”. Considering this gap in some detail may be instructive.</p><p>While there is appropriate sensitivity to “metrocentric” approaches in which programs and services are developed in metropolitan centres and then disseminated to non-metropolitan jurisdictions with little apparent regard for the importance of context, the same sensitivity does not appear to have been applied to the health inequity gap. It seems to be the case that metropolitan standards have become the default benchmark when considering health, education, and other statistics.</p><p>The Australian Institute of Health and Welfare [<span>1</span>] plays an important role in providing current statistics about rural and remote health. When reporting on age, we are informed that “On average, people living in <i>Inner regional</i> and <i>Outer regional</i> areas are older than those in <i>Major cities</i>.” For education, “In 2023, people aged 20-64 living in rural and remote areas were less likely than those in <i>Major cities</i> to have completed Year 12 or a non-school qualification.” There are also numerous health statistics in which metropolitan centres are presented as the comparison standard. In terms of chronic conditions, “people living outside <i>Major cities</i> had higher rates of arthritis, and mental and behavioural conditions, while chronic obstructive pulmonary disease was higher in <i>Outer regional and remote areas</i> compared with <i>Major cities</i>” [<span>1</span>].</p><p>How has the narrative arisen that metropolitan standards are those to which non-metropolitan areas should aspire? Comparisons similar to those prepared by the AIHW are offered in Queensland (QLD) Health's (2022) <i>Rural and Remote Health & Wellbeing Strategy 2022-2027</i>. For example, Queenslanders living outside metropolitan areas have one to 3 years less life expectancy than metropolitan residents and, in 2020, daily smoking prevalence was higher outside major cities [<span>2</span>]. A gap, however, necessarily has two sides. If some catastrophic city-based event were to occur so that people living in major cities started dying at a younger age, the life expectancy gap would close. Conversely, if the gap was flipped so that, due to a series of fortunate events, country pe
{"title":"Why Settle for Equity?","authors":"Timothy A. Carey","doi":"10.1111/ajr.70048","DOIUrl":"https://doi.org/10.1111/ajr.70048","url":null,"abstract":"<p>The rurality gradient, in which health outcomes worsen the greater the distance from metropolitan locations, is well-established and enduring. This health disparity has maintained a strong hold on the attention of many politicians, policy- and other decision-makers and has been the focus of numerous policy imperatives and program and service innovations, all aiming to close the health gap. Yet, despite the best efforts of many talented and committed people, the health inequity gap remains.</p><p>Sometimes, when a problem is complex, intractable, even “wicked”, it can be helpful to step back and examine the construction of the concept that defines the problem. The concept in this case is health inequity or a health “gap”. Considering this gap in some detail may be instructive.</p><p>While there is appropriate sensitivity to “metrocentric” approaches in which programs and services are developed in metropolitan centres and then disseminated to non-metropolitan jurisdictions with little apparent regard for the importance of context, the same sensitivity does not appear to have been applied to the health inequity gap. It seems to be the case that metropolitan standards have become the default benchmark when considering health, education, and other statistics.</p><p>The Australian Institute of Health and Welfare [<span>1</span>] plays an important role in providing current statistics about rural and remote health. When reporting on age, we are informed that “On average, people living in <i>Inner regional</i> and <i>Outer regional</i> areas are older than those in <i>Major cities</i>.” For education, “In 2023, people aged 20-64 living in rural and remote areas were less likely than those in <i>Major cities</i> to have completed Year 12 or a non-school qualification.” There are also numerous health statistics in which metropolitan centres are presented as the comparison standard. In terms of chronic conditions, “people living outside <i>Major cities</i> had higher rates of arthritis, and mental and behavioural conditions, while chronic obstructive pulmonary disease was higher in <i>Outer regional and remote areas</i> compared with <i>Major cities</i>” [<span>1</span>].</p><p>How has the narrative arisen that metropolitan standards are those to which non-metropolitan areas should aspire? Comparisons similar to those prepared by the AIHW are offered in Queensland (QLD) Health's (2022) <i>Rural and Remote Health & Wellbeing Strategy 2022-2027</i>. For example, Queenslanders living outside metropolitan areas have one to 3 years less life expectancy than metropolitan residents and, in 2020, daily smoking prevalence was higher outside major cities [<span>2</span>]. A gap, however, necessarily has two sides. If some catastrophic city-based event were to occur so that people living in major cities started dying at a younger age, the life expectancy gap would close. Conversely, if the gap was flipped so that, due to a series of fortunate events, country pe","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debra Jones, Giti Haddadan, Moira Dunsmore, Anna Williams, Danielle White, Jackie Hanniver, Corey Sclater, Tracy Robinson, Sue Randall
Objective
To explore the experiences of final-year pre-registration nursing students undertaking a longitudinal integrated placement in rural Australia.
Setting
Rural primary health care settings in far west NSW and northwest Victoria, Australia.
Participants
Thirteen final year pre-registration nursing students comprised two pilot cohorts undertaking the placement in semester one (n = 7) and two (n = 6) of 2022.
Design
A descriptive qualitative study design using semi-structured individual interviews with transcripts analysed using reflexive thematic analysis.
Results
Three themes were generated from the data: Experiencing comprehensive care, Making connections and Engaging with complexity. The subtheme of rural curriculum is described for each theme.
Conclusion
Findings highlight the importance of longitudinal integrated placements for student nurse exposure to comprehensive care, mitigating previous experiences of episodic and fragmented care associated with short duration placements across multiple settings. Placement duration enabled students to establish connections with their peers, health care teams, and the communities in which placements were undertaken. Student exposure to complexity-informed practice extended their capacity to interpret and respond to the broader inequities experienced and complexity as it relates to nursing practice in rural contexts. There is an imperative to reframe Australia's commitments to national nursing workforce policy, curriculum and clinical education to transform nursing education and maximise the full potential of our nursing workforce. These reforms must include consideration for the design, implementation, and scalability of rurally embedded longitudinal integrated placements, informed by rural curriculum, to enable the development of a competent future rural nursing workforce to address critical workforce shortages.
{"title":"Reframing Nurse Education in Rural Australia: Implications for Advancing Longitudinal Integrated Placements","authors":"Debra Jones, Giti Haddadan, Moira Dunsmore, Anna Williams, Danielle White, Jackie Hanniver, Corey Sclater, Tracy Robinson, Sue Randall","doi":"10.1111/ajr.70041","DOIUrl":"https://doi.org/10.1111/ajr.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the experiences of final-year pre-registration nursing students undertaking a longitudinal integrated placement in rural Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural primary health care settings in far west NSW and northwest Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Thirteen final year pre-registration nursing students comprised two pilot cohorts undertaking the placement in semester one (<i>n</i> = 7) and two (<i>n</i> = 6) of 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A descriptive qualitative study design using semi-structured individual interviews with transcripts analysed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes were generated from the data: Experiencing comprehensive care, Making connections and Engaging with complexity. The subtheme of rural curriculum is described for each theme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings highlight the importance of longitudinal integrated placements for student nurse exposure to comprehensive care, mitigating previous experiences of episodic and fragmented care associated with short duration placements across multiple settings. Placement duration enabled students to establish connections with their peers, health care teams, and the communities in which placements were undertaken. Student exposure to complexity-informed practice extended their capacity to interpret and respond to the broader inequities experienced and complexity as it relates to nursing practice in rural contexts. There is an imperative to reframe Australia's commitments to national nursing workforce policy, curriculum and clinical education to transform nursing education and maximise the full potential of our nursing workforce. These reforms must include consideration for the design, implementation, and scalability of rurally embedded longitudinal integrated placements, informed by rural curriculum, to enable the development of a competent future rural nursing workforce to address critical workforce shortages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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