Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.

Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.

Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.

Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.

'You're no-one if you're not a netball girl' : rural and regional living adolescent girls' negotiation of physically active identities

Despite the widely articulated health implications of physical inactivity, declines in youth participation levels, particularly for adolescent girls, have fuelled social and moral panics about the importance of regular physical activity. Recent attempts to explain these participation trends have focused on the institutional and cultural discourses that are drawn on to construct particular identities and social practices connected with sport, physical education and leisure interests. In this paper we report on the findings of data collected through interview and focus group sessions with 138 females ranging from 14 to 16 years of age across six rural and regional communities in the state of Victoria, Australia. Adopting a feminist poststructuralist methodology and drawing on the work of Foucault, we explore the impact that dominant discourse-power relations operating in the context of rural and regional sport and physical education can have in the negotiation of physically active identities for adolescent girls.

Back to the future : building future mentoring capacity in physical education teacher education students

For Physical Education Teacher Education (PETE) graduates returning to rural and regional areas early in their career, opportunities to move into leadership positions often exist despite their limited experience. Considering this, the provision of learning and assessment initiatives that prepare graduates for futures beyond the boundaries of a subject teacher, in this case, a pre-service teacher mentor, are warranted in regional teacher education programs.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Factors influencing mathematics and science teachers' self-assessment as teaching 'out-of-field' in rural and regional schools

Teaching 'out-of-field' occurs when teachers teach a subject for which they have no disciplinary or methods qualification. The incidence of out-of-field mathematics, science and technology teaching are particularly high in rural and regional areas. Given that mathematics and science are key areas of policy concern, there is an urgent need to understand teachers‟ position in this increasingly common practice in order to provide appropriate system responses. This paper asks the question, how are mathematics and science teachers‟ professional identities influenced by having to teach out-of-field? Twenty teachers who had taught science or mathematics at some time in their career, two school leaders, and two support staff, took part in semi-structured interviews, which I then transcribed. This paper reports on a thematic analysis of a subset of the data that isolated factors influencing teachers‟ self-assessment of themselves as out-of-field or in-field. Excerpts from the interviews are used to introduce and contextualise these factors within rural and regional settings. These factors are used to generate a theoretical model, the Boundary Between Fields (BBF) Model, that enables analysis of the impact of these factors on identity construction during a boundary crossing event. The Model highlights the influence of support mechanisms, contextual factors and personal resources on the nature of teachers‟ negotiation of subject boundaries and its impact on professional identity. This innovative model provides a platform for re-conceptualising these experiences as opportunities for professional learning occurring within schools as communities of practice, where teachers are supported and enabled to expand their professional identity. These findings provide insight for policy-makers, school leaders and teacher educators, into the complexity of the issue for teachers, as well as the conditions required for such teaching to be considered learning opportunities.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.

Context matters: SETE mapping of teacher education in diverse contexts

The Studying the Effectiveness of Teacher Education (SETE) project (2010- ) investigates, as a priority, how well equipped teacher education graduates are to meet the requirements of diverse school settings. This paper outlines notions of diversity as reflected in large-scale longitudinal data sets including quantitative teacher and principal surveys (n=5,000+), national audit of teacher education programs (n=500+), and analysis of data from intensive case studies which track 170 graduate teachers through the first three years of their teaching career.

A randomised group comparison controlled trial of 'preschoolers with autism': a parent education and skills training intervention for young children with autistic disorder

Aim
To determine the effect of parent education on adaptive behaviour, autism symptoms and cognitive/language skills of young children with autistic disorder.

Method
A randomised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample. Two rural and two metropolitan regions were randomly allocated to intervention groups (n = 70) or control (n = 35). Parents from autism assessment services in the intervention regions were randomly allocated to parent education and behaviour management (n = 35) or parent education and counselling (n = 35).

Results
Parent education and behaviour management resulted in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour. Parent education and behaviour management was superior to parent education and counselling. We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children.

Factors influencing students’ decisions about post-year 10 education

This paper reports pilot data from an instrument devised as part of a large ARC funded project that aims, among other things, to investigate factors that influence the decisions of students in rural and/or disadvantaged areas to continue their schooling beyond Year 10. One section of the pilot student questionnaire comprised 42 items designed to reflect dimensions believed to influence these decisions. Participants responded on 5-point Likert scales indicating the extent of their agreement from Strongly Disagree to Strongly Agree with each of the items. We were interested in the extent to which the data supported the theoretical structure that underpinned the structure of the questionnaire and in testing the appropriateness of the language used. The large scale data collection will survey students from Years 5 to 11 with as few adaptations for differences in literacy levels across that range as possible. To this end, the pilot questionnaire was administered to Year 5 (n = 44) and Year 9/10 students (n = 50) with identical wording for both grade levels. A factor analysis of the complete data set (n = 94) provided initial evidence that being happy at school; having family support to continue with education, and appropriate curriculum options and extra-curricular activities, perceiving oneself as a high achiever both in general and in relation to mathematics, having teacher and peer support to continue, being positive about English, planning to be an apprentice, and having a job type in mind are dimensions worthy of further exploration in the larger study.

Mathematical thinking of preschool children in rural and regional Australia : research and practice

At what age do young children begin thinking mathematically? Can young children work on mathematical problems? How do early childhood educators ensure young children feel good about mathematics? Where do early childhood educators learn about suitable mathematics activities?

A good early childhood start in mathematics is critical for later mathematics success. Parents, carers and early childhood educators are teaching mathematics, either consciously or unconsciously, in any social interaction with a child.

Mathematical Thinking of Preschool Children in Rural and Regional Australia is an extension of a conference of Australian and New Zealand researchers that identified a number of important problems related to the mathematical learning of children prior to formal schooling. A project team of 11 researchers from top Australian universities sought to investigate how early childhood education can best have a positive influence on early mathematics learning.

The investigation complements and extends the work of Project Good Start by focusing attention on critical aspects of parents, carers and early childhood educators who care for young children. Early childhood educators from regional and rural New South Wales, Queensland and Victoria were interviewed, following a set of structured questions. The questions focused on: children’s mathematics learning; support for mathematics teaching; use of technology; attitudes to mathematics; and assessment and record keeping.

The researchers also reviewed research focusing on the mathematical capacities and potential foundations for further mathematical development in young children (0–5 years) published in the last decade and produced an annotated bibliography. This should provide a good basis for further research and reading.

Based upon the results of this investigation, the researchers make 11 recommendations for improving the practices of early childhood education centres in relation to young children’s mathematical thinking and development. The implications for policy and decision makers are outlined for teacher education, the provision of resources and further research.