Carla J. Walton, Sharleen Gonzalez, Anna Dunbar, Katie McGill
Aims
The aim of this commentary is to consider how telehealth and a collaborative model of service delivery may offer a way of making Dialectical Behaviour Therapy available in rural areas.
Context
Dialectical Behaviour Therapy (DBT) is an effective treatment for Borderline Personality Disorder (BPD). However, there are many barriers to making this sort of therapy available within routine care, particularly in rural areas.
Approach
This commentary provides a summary of the literature relevant to the role that telehealth could play in increasing access to DBT. A new model of care could utilise telehealth services to deliver comprehensive DBT treatment to people with BPD living in rural areas in partnership with community mental health services.
Conclusion
Telehealth and collaborative models of Dialectical Behaviour Therapy delivery should be further investigated, especially to meet the needs of rural mental health care.
{"title":"Telehealth and Collaboratively Delivered Dialectical Behaviour Therapy: An Opportunity for Increasing Access to Effective Treatment for People With Borderline Personality Disorder Living in Rural Areas","authors":"Carla J. Walton, Sharleen Gonzalez, Anna Dunbar, Katie McGill","doi":"10.1111/ajr.70036","DOIUrl":"https://doi.org/10.1111/ajr.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this commentary is to consider how telehealth and a collaborative model of service delivery may offer a way of making Dialectical Behaviour Therapy available in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Dialectical Behaviour Therapy (DBT) is an effective treatment for Borderline Personality Disorder (BPD). However, there are many barriers to making this sort of therapy available within routine care, particularly in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>This commentary provides a summary of the literature relevant to the role that telehealth could play in increasing access to DBT. A new model of care could utilise telehealth services to deliver comprehensive DBT treatment to people with BPD living in rural areas in partnership with community mental health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Telehealth and collaborative models of Dialectical Behaviour Therapy delivery should be further investigated, especially to meet the needs of rural mental health care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761913","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}
Corin Miller, Hayley Smithers-Sheedy, Nan Hu, David Schmidt, Annemarie Christie, Tammy Morris, Lena Sanci, Raghu Lingam
Aims
To explore the role of digital interventions in improving health equity for children and young people (CYP) in rural Australia from a rural generalist's perspective.
Context
Rural Australian CYP experience worse health outcomes than their urban peers and have insufficient access to early intervention and support. Rural paediatric outpatient waiting times as long as 6 years have been reported, with some regions having no services. Digital interventions have expanded since the COVID pandemic, providing new opportunities to improve quality and access to care for CYP in rural settings.
Approach
Here we provide a synthesis of the literature and health policy, from the perspective of a clinician working in rural Australian paediatric care, to describe the role and limitations of digital interventions to support CYP in rural areas.
Conclusion
Digital interventions such as telephone and video consultations, online tools, child-friendly robot ward rounds, and digital GP-paediatrician co-consulting models show great promise in helping to bridge the gap in health outcomes for rural Australian CYP. Models of care that utilise digital components can provide care closer to home for rural families; however, research to evaluate the effectiveness of these models in the Australian context is lacking. Infrastructure challenges, cultural considerations, and patient preferences limit the utility of digital interventions for some populations. A panacea? Unfortunately, not; however, these technologies herald an exciting new phase in healthcare for rural Australian CYP, and digital interventions are likely to play an increasingly important role in increasing access to care for this population.
{"title":"Reducing Health Inequity for Children and Young People in Rural Australia: Are Digital Interventions a Panacea? A Rural Generalist's Commentary","authors":"Corin Miller, Hayley Smithers-Sheedy, Nan Hu, David Schmidt, Annemarie Christie, Tammy Morris, Lena Sanci, Raghu Lingam","doi":"10.1111/ajr.70015","DOIUrl":"https://doi.org/10.1111/ajr.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the role of digital interventions in improving health equity for children and young people (CYP) in rural Australia from a rural generalist's perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Rural Australian CYP experience worse health outcomes than their urban peers and have insufficient access to early intervention and support. Rural paediatric outpatient waiting times as long as 6 years have been reported, with some regions having no services. Digital interventions have expanded since the COVID pandemic, providing new opportunities to improve quality and access to care for CYP in rural settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Here we provide a synthesis of the literature and health policy, from the perspective of a clinician working in rural Australian paediatric care, to describe the role and limitations of digital interventions to support CYP in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Digital interventions such as telephone and video consultations, online tools, child-friendly robot ward rounds, and digital GP-paediatrician co-consulting models show great promise in helping to bridge the gap in health outcomes for rural Australian CYP. Models of care that utilise digital components can provide care closer to home for rural families; however, research to evaluate the effectiveness of these models in the Australian context is lacking. Infrastructure challenges, cultural considerations, and patient preferences limit the utility of digital interventions for some populations. A panacea? Unfortunately, not; however, these technologies herald an exciting new phase in healthcare for rural Australian CYP, and digital interventions are likely to play an increasingly important role in increasing access to care for this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717128","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}
Gustavo Hermes Soares, Pedro Henrique Ribeiro Santiago, Brianna Poirier, Sneha Sethi, Dandara Haag, Madison Cachagee, Emma Flanagan, Yvonne Cadet-James, Joanne Hedges, Lisa Jamieson
Objective
To develop and validate two age-specific, strength-based measures of social and emotional well-being (SEWB) for Aboriginal and Torres Strait Islander children and youth.
Methods
Following development of a conceptual framework comprising six domains of SEWB and identification of existing SEWB tools, an iterative process of item refinement took place. Items were assigned to corresponding SEWB domains, and their content validity and face validity were examined. Community-Controlled Health Services provided expert feedback. Statistical analyses were conducted to assess floor and ceiling effects, item redundancy, network structure, item stability, model fit and reliability. An ant colony optimisation (ACO) algorithm was employed to identify a reduced number of items with adequate model fit.
Design
Data on SEWB were generated as part of the baseline assessment for a national study involving Aboriginal and Torres Strait Islander Communities.
Setting
11 Aboriginal and Torres Strait Islander Communities from six states and territories.
Participants
Aboriginal and Torres Strait Islander children and youth aged 2–18 years.
Main Outcome Measures
Network structure, item stability, model fit and reliability and reduced scales.
Results
Different sets of items were developed to accommodate the needs of different age groups. A total of 235 participants and 162 guardians answered the self-report and the carer-report tool, respectively. A unidimensional structure was identified for both scales. Adequate item stability, model fit and reliability were obtained.
Conclusions
The short versions of the SEWB tools offer a friendly, age-appropriate and time-efficient approach while capturing all relevant domains of SEWB.
{"title":"Community Warriors: Development and Validation of a Social and Emotional Well-Being Tool for Aboriginal and Torres Strait Islander Children and Youth","authors":"Gustavo Hermes Soares, Pedro Henrique Ribeiro Santiago, Brianna Poirier, Sneha Sethi, Dandara Haag, Madison Cachagee, Emma Flanagan, Yvonne Cadet-James, Joanne Hedges, Lisa Jamieson","doi":"10.1111/ajr.70035","DOIUrl":"https://doi.org/10.1111/ajr.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop and validate two age-specific, strength-based measures of social and emotional well-being (SEWB) for Aboriginal and Torres Strait Islander children and youth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following development of a conceptual framework comprising six domains of SEWB and identification of existing SEWB tools, an iterative process of item refinement took place. Items were assigned to corresponding SEWB domains, and their content validity and face validity were examined. Community-Controlled Health Services provided expert feedback. Statistical analyses were conducted to assess floor and ceiling effects, item redundancy, network structure, item stability, model fit and reliability. An ant colony optimisation (ACO) algorithm was employed to identify a reduced number of items with adequate model fit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Data on SEWB were generated as part of the baseline assessment for a national study involving Aboriginal and Torres Strait Islander Communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>11 Aboriginal and Torres Strait Islander Communities from six states and territories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Aboriginal and Torres Strait Islander children and youth aged 2–18 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Network structure, item stability, model fit and reliability and reduced scales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Different sets of items were developed to accommodate the needs of different age groups. A total of 235 participants and 162 guardians answered the self-report and the carer-report tool, respectively. A unidimensional structure was identified for both scales. Adequate item stability, model fit and reliability were obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The short versions of the SEWB tools offer a friendly, age-appropriate and time-efficient approach while capturing all relevant domains of SEWB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707371","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}
The project evaluated multidisciplinary allied health student placements co-located within a rural general practice clinic.
Methods
Occupational therapy, social work and speech pathology placement students under discipline-specific supervision led an allied health clinic model servicing clients with diverse health needs.
Design
A cross-sectional survey design recording interventions, student and stakeholder experiences and client satisfaction was applied.
Setting
General Practice clinics in MMM 4–6 regions in Queensland.
Participants
Between February and July 2024, 10 students completed placements within the student-led clinic, working with clients.
Main Outcomes Measure
Descriptive statistics were used to summarise clients' demographics, satisfaction and the services provided using SPSS version 29.0. Qualitative survey responses were analysed using Nvivo.
Results
Student-led allied health services co-located within a general practice clinic benefited rural communities by providing increased access to allied health services and a holistic approach to health care. Student-led allied health services alleviated the work burden for general practitioners (GPs) in a rural health care setting.
Conclusion
Multidisciplinary allied health student placements within a rural GP clinic benefited rural and remote communities through increased access to allied health services. Further research is needed to investigate interdisciplinary models of care and sustainable funding streams.
{"title":"Allied Health Student-Led Clinics: An Opportunity for Workforce Development","authors":"Taegen Pascoe, Asmita Mudholkar, Stephanie Burke, Kehinde Obamiro, Ines Zuchowski","doi":"10.1111/ajr.70034","DOIUrl":"https://doi.org/10.1111/ajr.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The project evaluated multidisciplinary allied health student placements co-located within a rural general practice clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Occupational therapy, social work and speech pathology placement students under discipline-specific supervision led an allied health clinic model servicing clients with diverse health needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cross-sectional survey design recording interventions, student and stakeholder experiences and client satisfaction was applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>General Practice clinics in MMM 4–6 regions in Queensland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Between February and July 2024, 10 students completed placements within the student-led clinic, working with clients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes Measure</h3>\u0000 \u0000 <p>Descriptive statistics were used to summarise clients' demographics, satisfaction and the services provided using SPSS version 29.0. Qualitative survey responses were analysed using Nvivo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Student-led allied health services co-located within a general practice clinic benefited rural communities by providing increased access to allied health services and a holistic approach to health care. Student-led allied health services alleviated the work burden for general practitioners (GPs) in a rural health care setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multidisciplinary allied health student placements within a rural GP clinic benefited rural and remote communities through increased access to allied health services. Further research is needed to investigate interdisciplinary models of care and sustainable funding streams.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699007","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}
Jenny T. Le, Alison E. J. Mahoney, Jay L. Court, Christine T. Shiner
Introduction
Consumers living in regional, rural, and remote areas of Australia face significant barriers to accessing mental healthcare. Digital mental health interventions (DMHIs) are a promising avenue to improve access to mental health treatment in these areas, but uptake has yet to reach its full potential.
Objective
This study evaluated the perceived barriers and facilitators of engagement with DMHIs for clinicians and consumers in regional, rural, and remote Australia.
Methods, Design, and Participants
We surveyed consumers (n = 896) and clinicians (n = 104) using cross-sectional surveys to examine perceived barriers and facilitators of DMHI use.
Setting
This study was conducted within the context of an established digital mental health service, THIS WAY UP.
Main Outcome Measures
Survey responses were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model, and quantitative analyses of response frequencies partitioned the influence of each factor on engagement with DMHIs.
Results
Clinicians and consumers familiar with DMHIs reported barriers that spanned capability, opportunity, and motivation domains. Lack of consumer motivation was the most frequent barrier perceived by clinicians (51%) and reported by consumers (27%). Consumers valued many accessibility benefits of DMHIs and frequently endorsed the importance of clinicians in facilitating their use of DMHIs by supporting knowledge and motivation.
Conclusions
DMHIs have the potential to alleviate service-related barriers to mental healthcare in regional/remote areas, and successful implementation must consider both clinician and consumer perspectives. Our findings underscore several capability, opportunity, and motivational targets for improving consumer and clinician engagement with DMHI in these areas.
{"title":"Barriers and Facilitators of Digital Mental Health Use in Regional, Rural, and Remote Australia: A Comparison of Clinician and Consumer Perspectives","authors":"Jenny T. Le, Alison E. J. Mahoney, Jay L. Court, Christine T. Shiner","doi":"10.1111/ajr.70011","DOIUrl":"https://doi.org/10.1111/ajr.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Consumers living in regional, rural, and remote areas of Australia face significant barriers to accessing mental healthcare. Digital mental health interventions (DMHIs) are a promising avenue to improve access to mental health treatment in these areas, but uptake has yet to reach its full potential.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluated the perceived barriers and facilitators of engagement with DMHIs for clinicians and consumers in regional, rural, and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods, Design, and Participants</h3>\u0000 \u0000 <p>We surveyed consumers (<i>n</i> = 896) and clinicians (<i>n</i> = 104) using cross-sectional surveys to examine perceived barriers and facilitators of DMHI use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>This study was conducted within the context of an established digital mental health service, THIS WAY UP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Survey responses were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model, and quantitative analyses of response frequencies partitioned the influence of each factor on engagement with DMHIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinicians and consumers familiar with DMHIs reported barriers that spanned capability, opportunity, and motivation domains. Lack of consumer motivation was the most frequent barrier perceived by clinicians (51%) and reported by consumers (27%). Consumers valued many accessibility benefits of DMHIs and frequently endorsed the importance of clinicians in facilitating their use of DMHIs by supporting knowledge and motivation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DMHIs have the potential to alleviate service-related barriers to mental healthcare in regional/remote areas, and successful implementation must consider both clinician and consumer perspectives. Our findings underscore several capability, opportunity, and motivational targets for improving consumer and clinician engagement with DMHI in these areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689913","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}
Nnamdi Mgbemena, Jane Thompson, Uchechukwu Levi Osuagwu
Introduction
Cardiopulmonary rehabilitation participation rates in regional Australia remain poor, with outcomes further worsened by the limited number of cardiopulmonary rehabilitation professionals in these settings.
Objective
This study investigated the role of cardiopulmonary rehabilitation in improving physical and mental health outcomes of participants with heart or lung diseases in a regional NSW centre.
Design
A retrospective study of adults who attended a 1-h session per week cardiac or pulmonary rehabilitation programme at Bathurst Hospital between January 2021 and December 2023.
Main Outcome Measures
Pre- and post-rehabilitation assessments were conducted, which included heart rate, blood pressure, oxygen saturation, waist circumference, rating of perceived exertion, 5-sit-to-stand test (5-STS), 6-min walk test (6MWT), and the patient health questionnaire-9 for assessment of depression (PHQ-9 score ≥ 10 = major depression).
Findings
Data for eligible participants (n = 186, mostly males 57.5%), aged 69 ± 12 years, were analysed. There were statistically significant improvements (pre vs. post) in mean PHQ-9 scores (6.3 vs. 4.2, p < 0.001), 5-STS (15.8 vs. 12.5 s, p < 0.001), 6MWT (328.6 vs. 377.9 m, p < 0.001) and waist circumference (104.7 vs. 103.9 cm, p < 0.03) post-rehabilitation. Compared with pre-rehabilitation measures, the overall proportion with major depression was significantly lower by 50% (25.3% vs. 12.4%, p < 0.05) post-rehabilitation. This decrease was significant for the cardiac (11.6% decrease) and pulmonary (15.4% decrease) rehabilitation participants.
Conclusion
Despite the limiting structure of one session per week for the cardiopulmonary rehabilitation programme at this regional centre, participants showed significant improvements in their mental and physical health at the end of the programme. Funding such organic programmes will yield a greater positive impact on the health of people in this region.
{"title":"Changes in Mental and Physical Health Outcomes Following One Day a Week Cardiopulmonary Rehabilitation in Regional New South Wales","authors":"Nnamdi Mgbemena, Jane Thompson, Uchechukwu Levi Osuagwu","doi":"10.1111/ajr.70033","DOIUrl":"https://doi.org/10.1111/ajr.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiopulmonary rehabilitation participation rates in regional Australia remain poor, with outcomes further worsened by the limited number of cardiopulmonary rehabilitation professionals in these settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the role of cardiopulmonary rehabilitation in improving physical and mental health outcomes of participants with heart or lung diseases in a regional NSW centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective study of adults who attended a 1-h session per week cardiac or pulmonary rehabilitation programme at Bathurst Hospital between January 2021 and December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Pre- and post-rehabilitation assessments were conducted, which included heart rate, blood pressure, oxygen saturation, waist circumference, rating of perceived exertion, 5-sit-to-stand test (5-STS), 6-min walk test (6MWT), and the patient health questionnaire-9 for assessment of depression (PHQ-9 score ≥ 10 = major depression).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Data for eligible participants (<i>n</i> = 186, mostly males 57.5%), aged 69 ± 12 years, were analysed. There were statistically significant improvements (pre vs. post) in mean PHQ-9 scores (6.3 vs. 4.2, <i>p</i> < 0.001), 5-STS (15.8 vs. 12.5 s, <i>p</i> < 0.001), 6MWT (328.6 vs. 377.9 m, <i>p</i> < 0.001) and waist circumference (104.7 vs. 103.9 cm, <i>p</i> < 0.03) post-rehabilitation. Compared with pre-rehabilitation measures, the overall proportion with major depression was significantly lower by 50% (25.3% vs. 12.4%, <i>p</i> < 0.05) post-rehabilitation. This decrease was significant for the cardiac (11.6% decrease) and pulmonary (15.4% decrease) rehabilitation participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the limiting structure of one session per week for the cardiopulmonary rehabilitation programme at this regional centre, participants showed significant improvements in their mental and physical health at the end of the programme. Funding such organic programmes will yield a greater positive impact on the health of people in this region.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689676","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}
Qiang Li, Jocelyn J. Drinkwater, Kerry Woods, Emma Douglas, Alex Ramirez, Angus W. Turner
Objective
Diabetic retinopathy (DR) screening rates are poor in remote Western Australia where communities rely on outdated primary care-based retinal cameras. Deep learning systems (DLS) may improve access to screening, however, require validation in real-world settings. This study describes and evaluates the implementation of a new, mobile DR screening model that incorporates artificial intelligence (AI) into routine care.
Design
Prospective, population-based study.
Setting
The model was co-designed with local Aboriginal communities and implemented in the remote, Pilbara region of Western Australia. A research officer without formal healthcare qualification performed retinal screening aboard a Mercedes Sprinter Van using an automated retinal camera with integrated AI diagnostics. Patients received their diagnosis on-the-spot and completed an evaluation survey. A remote clinician provided supervision and on-the-spot telehealth consultation for referable disease.
Participants
People with diabetes from the Pilbara region.
Main Outcome Measure(s)
Number of people screened, acceptability of AI to patients.
Results
From February to August 2024, DR screening was provided to 9 communities across the Pilbara region. 78 patients provided research consent, of which 56.4% were Aboriginal or Torres Strait Islanders. 10.3% of retinal photos had referable DR and 8.4% of photos were ungradable. 96% of patients were ‘Happy with the use of AI’.
Conclusion
Our new model for AI-assisted DR screening was culturally safe, acceptable to patients and effective, demonstrating an 11-fold increase in screening rates compared to 2023 Pilbara data. In remote Australian settings, AI-assisted DR screening may overcome historical barriers to service provision and improve minimisation of preventable blindness.
{"title":"Implementation of A New, Mobile Diabetic Retinopathy Screening Model Incorporating Artificial Intelligence in Remote Western Australia","authors":"Qiang Li, Jocelyn J. Drinkwater, Kerry Woods, Emma Douglas, Alex Ramirez, Angus W. Turner","doi":"10.1111/ajr.70031","DOIUrl":"10.1111/ajr.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Diabetic retinopathy (DR) screening rates are poor in remote Western Australia where communities rely on outdated primary care-based retinal cameras. Deep learning systems (DLS) may improve access to screening, however, require validation in real-world settings. This study describes and evaluates the implementation of a new, mobile DR screening model that incorporates artificial intelligence (AI) into routine care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective, population-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The model was co-designed with local Aboriginal communities and implemented in the remote, Pilbara region of Western Australia. A research officer without formal healthcare qualification performed retinal screening aboard a Mercedes Sprinter Van using an automated retinal camera with integrated AI diagnostics. Patients received their diagnosis on-the-spot and completed an evaluation survey. A remote clinician provided supervision and on-the-spot telehealth consultation for referable disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>People with diabetes from the Pilbara region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure(s)</h3>\u0000 \u0000 <p>Number of people screened, acceptability of AI to patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From February to August 2024, DR screening was provided to 9 communities across the Pilbara region. 78 patients provided research consent, of which 56.4% were Aboriginal or Torres Strait Islanders. 10.3% of retinal photos had referable DR and 8.4% of photos were ungradable. 96% of patients were ‘Happy with the use of AI’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our new model for AI-assisted DR screening was culturally safe, acceptable to patients and effective, demonstrating an 11-fold increase in screening rates compared to 2023 Pilbara data. In remote Australian settings, AI-assisted DR screening may overcome historical barriers to service provision and improve minimisation of preventable blindness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665430","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}
Lauren G. Staples, Blake F. Dear, Olav Nielssen, Nickolai Titov
Objective
The MindSpot Clinic provides psychological assessment and treatment online or via the telephone to Australian residents. This study examines patient characteristics and treatment outcomes based on geographical location.
Setting
MindSpot Clinic.
Design
Retrospective analysis of patients who started an online assessment between January 2020 and December 2021 and provided a valid postcode that could be categorised as either Major City (n = 34 222) or Regional/Remote (n = 13 408).
Participants
Adults residing in Australia and reporting symptoms of depression or anxiety.
Main Outcome Measures
Demographic and satisfaction questionnaires, K-10, PHQ-9, GAD-7.
Results
Patient distribution was consistent with the national census, with 28% of patients residing in regional or remote locations. Comparison to patients from major cities showed that they were more likely to be residing in areas of high socioeconomic disadvantage. The regional/remote group included a higher proportion of females and a higher proportion of Indigenous patients. Despite baseline differences, online therapist-guided treatment significantly decreased symptoms of anxiety and depression. Results were comparable to the major city group. For both groups, effect sizes were large (> 1.0 at post-treatment), deterioration was low (< 3%) and reliable recovery rates were high (> 85%).
Conclusion
Understanding differences and similarities based on geographic location is important for service provision. The MindSpot Clinic provides access to effective evidence-based psychological care to patients across Australia, and the current results support the continued provision of digital psychology services in regional and remote areas of Australia.
{"title":"Characteristics and Treatment Outcomes for Patients of a Digital Psychology Service in Regional and Remote Parts of Australia","authors":"Lauren G. Staples, Blake F. Dear, Olav Nielssen, Nickolai Titov","doi":"10.1111/ajr.70032","DOIUrl":"10.1111/ajr.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The MindSpot Clinic provides psychological assessment and treatment online or via the telephone to Australian residents. This study examines patient characteristics and treatment outcomes based on geographical location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>MindSpot Clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis of patients who started an online assessment between January 2020 and December 2021 and provided a valid postcode that could be categorised as either Major City (<i>n</i> = 34 222) or Regional/Remote (<i>n</i> = 13 408).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Adults residing in Australia and reporting symptoms of depression or anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Demographic and satisfaction questionnaires, K-10, PHQ-9, GAD-7.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient distribution was consistent with the national census, with 28% of patients residing in regional or remote locations. Comparison to patients from major cities showed that they were more likely to be residing in areas of high socioeconomic disadvantage. The regional/remote group included a higher proportion of females and a higher proportion of Indigenous patients. Despite baseline differences, online therapist-guided treatment significantly decreased symptoms of anxiety and depression. Results were comparable to the major city group. For both groups, effect sizes were large (> 1.0 at post-treatment), deterioration was low (< 3%) and reliable recovery rates were high (> 85%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding differences and similarities based on geographic location is important for service provision. The MindSpot Clinic provides access to effective evidence-based psychological care to patients across Australia, and the current results support the continued provision of digital psychology services in regional and remote areas of Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665428","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}
Cindy Needham, Jane Jacobs, Christina Zorbas, Laura Alston, Tracy Schumacher, Penny Fraser, Ana Horta, Michael Johnstone, Douglas Creighton, Alison Koschel, Leanne J. Brown, Annabelle Williams, Judy Coates, Gina Vereker, Carmen Vargas, Claudia Strugnell, Tari Forrester-Bowling, Kristy A Bolton, Steven Allender
Objective
This report presents the co-design framework for developing, prototyping, testing and implementing a Web-based Platform (WBP) that will use participatory approaches to engage rural communities.The WBP will be used to understand the unique factors influencing access to healthy and unhealthy foods and to generate potential solutions for promoting healthier diets.
Methods
A human-centred design (HSD) approach will be used to ideate, prototype, test and implement the WBP.
Design
Participatory Action Research.
Setting
Two rural local government areas in Australia.
Participants
Participants will include key stakeholders from each local government's relevant public health organisations, in addition to community members.
Main Outcome Measures
Reach (number, cohort representation and geographic spread) of active participants in the co-design process, community members that used the WBP tool and adoption (completion of WBP activities).
Results
A usable platform for communities to generate local solutions to drive change for diverse populations within rural communities in Australia.
Discussion
Significant advances and innovative approaches are needed to address the challenges of accessing healthy food in rural areas.
Conclusions
The resulting WBP has the potential to work at scale for communities in Australia and internationally in designing effective place-based solutions.
{"title":"A Human-Centred Co-Design Framework for Developing a Web-Based Platform to Engage With Rural Australian Communities: Addressing the Complex Issue of Healthy Food Access","authors":"Cindy Needham, Jane Jacobs, Christina Zorbas, Laura Alston, Tracy Schumacher, Penny Fraser, Ana Horta, Michael Johnstone, Douglas Creighton, Alison Koschel, Leanne J. Brown, Annabelle Williams, Judy Coates, Gina Vereker, Carmen Vargas, Claudia Strugnell, Tari Forrester-Bowling, Kristy A Bolton, Steven Allender","doi":"10.1111/ajr.70028","DOIUrl":"10.1111/ajr.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This report presents the co-design framework for developing, prototyping, testing and implementing a Web-based Platform (WBP) that will use participatory approaches to engage rural communities.The WBP will be used to understand the unique factors influencing access to healthy and unhealthy foods and to generate potential solutions for promoting healthier diets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A human-centred design (HSD) approach will be used to ideate, prototype, test and implement the WBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Participatory Action Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Two rural local government areas in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Participants will include key stakeholders from each local government's relevant public health organisations, in addition to community members.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Reach (number, cohort representation and geographic spread) of active participants in the co-design process, community members that used the WBP tool and adoption (completion of WBP activities).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A usable platform for communities to generate local solutions to drive change for diverse populations within rural communities in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Significant advances and innovative approaches are needed to address the challenges of accessing healthy food in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The resulting WBP has the potential to work at scale for communities in Australia and internationally in designing effective place-based solutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665426","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}
Daniel T. Winter, Lauren A. Monds, Nicholas Lintzeris, Paul S. Haber, Carolyn A. Day
<div> <section> <h3> Objective</h3> <p>Whilst prior studies have examined characteristics and barriers for opioid agonist treatment (OAT) clients in regional settings, there are limited studies examining these differences in relation to metropolitan OAT clients. This study aimed to examine key characteristics, including sedating medication and substance use, transport and driving behaviours and differences between OAT clients within regional and metropolitan areas of New South Wales, Australia.</p> </section> <section> <h3> Design</h3> <p>Cross-sectional survey of OAT clients.</p> </section> <section> <h3> Setting</h3> <p>Fifteen public OAT clinics across New South Wales, Australia, between January 2020 and June 2021.</p> </section> <section> <h3> Participants</h3> <p>Survey was completed by 482 people currently receiving OAT.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Self-reported sample characteristics, self-reported sedating medication use and substance use, transportation and driving histories.</p> </section> <section> <h3> Results</h3> <p>Significant differences in OAT pharmacotherapies prescribed between regional and metropolitan participants were noted (aOR = 2.42, 95% CI = 1.42–4.11). Methadone was the most commonly prescribed OAT in both settings (74.1% and 54.4%, respectively). Nearly half (45.6%) of regional participants received OAT from a private dispensary compared to 4.7% in metropolitan areas. While few differences in past-month substance use were noted, reported heroin use was lower (aOR = 0.27; 95% CI = 0.09–0.78) in regional areas. Regional participants were more likely than metropolitan participants to drive a vehicle to dosing (aOR = 2.89, 95% CI = 1.12–7.46) and less likely to take public transport (aOR = 0.41, 95% CI = 0.18–0.93) or active transport (aOR = 3.75, 95% CI = 1.50–9.40). Few differences regarding driving offences, based on geography, were noted.</p> </section> <section> <h3> Conclusions</h3> <p>Key differences with treatment, substance use, transport and driving were noted within this study. It is evident that regional OAT clients more often rely on motor vehicles to complete daily activities. Such challenges related to OAT should be addressed by informed policy and regulatory changes that ensure
{"title":"Examining Differences Among Opioid Agonist Treatment Clients in Regional and Metropolitan Settings of New South Wales, Australia","authors":"Daniel T. Winter, Lauren A. Monds, Nicholas Lintzeris, Paul S. Haber, Carolyn A. Day","doi":"10.1111/ajr.70029","DOIUrl":"https://doi.org/10.1111/ajr.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Whilst prior studies have examined characteristics and barriers for opioid agonist treatment (OAT) clients in regional settings, there are limited studies examining these differences in relation to metropolitan OAT clients. This study aimed to examine key characteristics, including sedating medication and substance use, transport and driving behaviours and differences between OAT clients within regional and metropolitan areas of New South Wales, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional survey of OAT clients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Fifteen public OAT clinics across New South Wales, Australia, between January 2020 and June 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Survey was completed by 482 people currently receiving OAT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Self-reported sample characteristics, self-reported sedating medication use and substance use, transportation and driving histories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences in OAT pharmacotherapies prescribed between regional and metropolitan participants were noted (aOR = 2.42, 95% CI = 1.42–4.11). Methadone was the most commonly prescribed OAT in both settings (74.1% and 54.4%, respectively). Nearly half (45.6%) of regional participants received OAT from a private dispensary compared to 4.7% in metropolitan areas. While few differences in past-month substance use were noted, reported heroin use was lower (aOR = 0.27; 95% CI = 0.09–0.78) in regional areas. Regional participants were more likely than metropolitan participants to drive a vehicle to dosing (aOR = 2.89, 95% CI = 1.12–7.46) and less likely to take public transport (aOR = 0.41, 95% CI = 0.18–0.93) or active transport (aOR = 3.75, 95% CI = 1.50–9.40). Few differences regarding driving offences, based on geography, were noted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Key differences with treatment, substance use, transport and driving were noted within this study. It is evident that regional OAT clients more often rely on motor vehicles to complete daily activities. Such challenges related to OAT should be addressed by informed policy and regulatory changes that ensure","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143645850","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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