To explore the experience of local residents when accessing primary care across different levels of rurality.
Four discrete regional, rural, and remote communities in Queensland, Australia, categorised by the Modified Monash Model classification.
Residents from a regional centre (n = 15), a small rural town (n = 9), and two remote or very remote communities (n = 6).
Semi-structured interviews using thematic analysis with both deductive and inductive coding.
Common challenges across all levels of rurality included limited primary care provider availability, long wait times, and disrupted care continuity, though their impact varied by the level of rurality. Regional centre residents predominantly experienced availability and timeliness challenges, while the small rural town residents faced availability, timeliness, and geography challenges. The remote and very remote communities experienced interconnected challenges, including a lack of permanent primary care providers, extensive travel, disrupted care continuity, and poor understanding of the community culture by some primary care providers. A key finding was ‘geographic fragility,’ which increased with the level of rurality, where remote community residents had to weigh up whether their health needs justified the burden of accessing primary care.
This study highlights the need for nuanced, context-specific approaches for improving primary care access across different levels of rurality, with particular attention to geographic fragility in remote and very remote communities. Policy implications include developing targeted workforce strategies, addressing timeliness challenges, and implementing flexible service models to ensure equitable access to primary care for all Australians.
Aboriginal and Torres Strait Islander Peoples share rich cultural traditions unrivalled across the world; however, the continued impact of colonisation led to sustained, profound trauma that has spanned generations. With Aboriginal and Torres Strait Islander people presenting to hospital emergency departments (ED) for self-harm and suicidal behaviours at a rate 2.9 times higher than non-Indigenous people, there is a need to develop culturally appropriate interventions to address this growing problem.
This paper sought to describe the co-design process of culturally adapting a brief therapeutic intervention for Aboriginal and Torres Strait Islander young people who display self-harm and/or suicidal behaviours. The adaptation focus was Therapeutic Assessment (TA), a brief intervention provided to young people who present to the ED with self-harm.
The process was split into two phases located in Geraldton and Meekatharra, two communities in the Mid-west of Western Australia.
In phase one, three male Aboriginal young people (aged between 16 and 19 years old) and eight Aboriginal Elders participated in two yarning circles run on one day. In phase two, 26 Aboriginal young people (aged between 12 and 25 years old), five Aboriginal senior members of the community and one Aboriginal carer participated in a combination of small yarning circles and/or single interviews.
This paper describes the elements of the culturally safe process of adapting a brief intervention for Aboriginal and Torres Strait Islander young people experiencing self-harm and/or suicidal behaviours.
Two points are important to note. The first is that implementing a culturally safe process can be an outcome in itself, and second, that the principles supporting cultural safety can assist in evaluating how non-Indigenous researchers implement this process.
A major challenge in developing the psychology workforce is the time and cost of training and supervising provisional psychologists. CoreConnect was a pilot training programme provided for provisional psychologists, employed by one of four partnering organisations based in regional NSW. This study aimed to explore key stakeholders' perceptions of their outcomes and experiences with CoreConnect and collate recommendations for continuous improvement.
Community-based mental health services in Central West NSW, including private practices, not-for-profit and NSW Health organisations.
The study utilised a sample of 17 provisional psychologists, seven clinical supervisors and six employers involved with CoreConnect.
A qualitative descriptive approach was utilised. Data were collected using open-ended surveys and semi-structured interviews over the initial 12 months of the training programme.
Thematic analyses of interview transcripts and survey questions provided five key themes. CoreConnect was perceived to support the provisional psychologists' professional growth and confidence, accelerate their learning and applicability of skills to their professional practice, and promote peer connection and networking. CoreConnect was perceived to increase the attraction, recruitment and retention of provisional psychologists within participating organisations and enabled time and cost savings for supervisors and employers. Recommendations for improving CoreConnect were identified.
Key stakeholders indicated CoreConnect produced valued learning and professional outcomes for provisional psychologists, provided time and cost savings for supervisors and employers and assisted organisations to more efficiently develop and train their provisional psychologists. The CoreConnect model is likely to be useful for supporting mental health workforce development across Australia.
To understand how rurality and socioeconomic deprivation intersect to influence health outcomes for Māori (Indigenous population) and non-Māori in Aotearoa New Zealand (NZ).
Firstly, Census 2018 was used to describe population-level distributions of NZ's 4.7 million residents by rurality [measured using the Geographic Classification for Health (GCH)], socioeconomic deprivation [using NZ's Deprivation Index (NZDep)], and ethnicity (Māori and non-Māori). Secondly, using the national Mortality Collection as the numerator and Census-based population estimates as the denominator, rural: urban mortality rate ratios (MRRs) for Māori and non-Māori, adjusted for NZDep, were estimated from multivariate Poisson regression models.
For the NZ population, rurality and socioeconomic deprivation were found to intersect differently for Māori and non-Māori. Of the 160 170 all-cause deaths in 2014–2018, 64% were 75 years or older. Almost half (46%) of the deaths in those under 75 years were considered amenable. For Māori and non-Māori aged 45–59 years, higher rates of mortality (all-cause and amenable) for rural residents, compared to urban, were attenuated when adjusted for socioeconomic deprivation. In those under 45 years, rural: urban disparities in mortality (all-cause and amenable) remained; for example, for Māori the crude amenable MRR was 1.31 (95% CI 1.17, 1.47) and the adjusted, 1.26 (95% CI 1.13, 1.41); for non-Māori, the respective estimates were 1.45 (95% CI 1.33, 1.58) and 1.46 (95% CI 1.33, 1.59).
Māori ethnicity, living in rural areas and socioeconomic deprivation frequently co-exist. Rural–urban disparities in all-cause and amenable mortality evident in younger age groups, particularly those under 45 years of age, cannot be explained by ethnicity or socioeconomic deprivation.
This qualitative research study investigated the lived experiences of postnatal support received by mothers in rural North Queensland and how health service delivery is affected.
Postnatal mothers, aged over 18, who live in rural or remote areas based on the Modified Monash Model (MMM) 4–7 in North Queensland were eligible for the study.
This study was grounded in a constructivist paradigm and employed a qualitative research design utilizing semi-structured interviews. Data was analyzed using reflexive thematic analysis informed by a feminist theoretical framework. Participant interviews were conducted via Microsoft Teams videoconferencing software.
Three themes were generated from the data that provide insight into the postnatal social support available to participants and how this could inform woman-centred rural health service delivery: (1) marry the farmer, marry the farm (2) connection, continuity and clinical handover and (3) rebuilding the village.
Women experienced many challenges ranging from social isolation to broader health system and workforce issues that undermined access to healthcare during their transition to motherhood. Continuity of care and health professionals having ‘rural cognisance’ is highly valued among mothers. Health professionals working with rural mothers should be informed about local and online opportunities for social connection. Rural mothers are resilient, building their own support network, despite health system failings. The narratives of rural mothers highlight significant deficiencies in the existing service models and underscore the necessity for systemic reforms that prioritise woman-centred care.
Rural mothers' postpartum experiences are shaped by isolation, limited healthcare access and structural challenges. While rural mothers demonstrate resilience, the ongoing emphasis on self-reliance obscures urgent systemic failings and highlights the pressing need for inclusive, woman-centred rural maternal health policy and service reform.
Community Health Workers (CHWs) play an important role in delivering primary health care (PHC) services in rural and remote areas. Community perceptions regarding CHWs impact the acceptance, satisfaction and utilisation of health care services. This subsequently affects overall health outcomes and equity within the system. However, the various factors influencing these perceptions are still dispersed across different studies.
To identify and synthesise the factors influencing community members' perceptions of PHC services delivered by community health workers in rural areas.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines, a Systematic Review was conducted.
A thorough search across seven databases for English-language peer-reviewed publications from 1990 to 2024 yielded 4996 records. Following screening of titles and abstracts, we reviewed 231 full texts and ultimately included 30 articles for in-depth appraisal.
Articles from 15 countries identified three interconnected thematic clusters affecting community perception: (1) structural and service delivery cluster, including CHW accessibility, service availability and healthcare quality; (2) trust cluster, such as trust, competency and confidentiality and (3) identity and sociocultural cluster, including CHWs' gender and CHWs from the same community.
Incorporating identified factors into the training curriculum for CHWs, their capacity to meet community expectations and build trust can be enhanced. These insights can be used to align services with community needs. This systematic review identified important factors for improving CHWs' delivery of PHC services in rural areas that ensure these services are sustainable and responsive to community needs.
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