Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.

What's needed to increase research capacity in rural primary health care

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main  outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians’ research  involvement. The results showed that popular delivery modes for research training and support were courses and “one-to- one” advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian  consultations on research needs in primary health conducted with a diverse  range of clinicians at the clinician level. It will direct future research capacity  building efforts towards maximising face-to-face discipline specific options and  minimising technology use.

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery

Why did they leave and what can they tell us? Allied health professionals leaving rural settings

The aim of this paper is to explore the lack of retention of allied health professionals in rural areas in Victoria, Australia. A structured telephone interview was used to elicit responses from 32 allied health professionals from south-west, central-west and north-east Victoria about their working experiences and reasons for resignation. The data revealed that work experiences in rural areas can be summarised within three domains: organisational, professional and personal/community. Under the organisational domain the participants were mainly focussed on the way in which their work arrangements require them to be both more generalist in their approach to day-to-day work, and more expansive in shouldering management style functions in the workplace. Under the professional domain there were three major issues; clinical, career and education/training. The personal/community domain focussed on issues to do with their affinity for their workplace as well as their location in a rural place. The attempts by government to address some of the leading factors for retention of allied health professionals are perhaps too narrowly focussed on the public sector and could encompass a wider approach.

What is known about the topic? Although recruitment and retention of allied health professionals in rural areas is widely discussed, the professionals have not been interviewed about their experiences once they have left rural employment.

What does this paper add? This paper provides detailed insights into the reasons why allied health professionals leave their positions in rural areas and the positive and negative aspects of living and working in a rural area. The results of this study contribute to the development of better policy models for recruitment and retention of allied health professionals in rural areas.

What are the implications for practitioners? The factors that influence whether allied health professionals stay or leave rural areas is of concern for health policy makers at state and federal levels. This paper provides information for the extension and development of programs to attenuate rural leakage of professionals.

Researching maternal, neonatal and child health service use in rural and pastoralist Ethiopia: A key informant research approach

Like many nations in sub-Saharan Africa, Ethiopia has both a high neonatal mortality rate and maternal mortality ratio and is unlikely to meet Millennium Development Goals 4 and 5 by 2015. This working paper examines how Key Informant Research (KIR) in rural and pastoralist Ethiopia will identify facilitators and barriers to the use of maternal, neonatal and child health services. The methodology is informed by Participative Ethnographic Evaluation Research (PEER) and Key Informant Monitoring (KIM). Key Informant Research (KIR) training will provide research skills to Health Extension Workers (HEWs) and Non-government organisation (NGO) staff to enable them to develop research questions, collect data and participate in preliminary data analysis. This will enable the identification of strategies that improve the identification of risk, enhance early referral, increase access, affordability and acceptability of skilled birthing services in rural and pastoralist Ethiopia.

Comparing subjective well-being and health-related quality of life of Australian drug users in treatment in regional and rural Victoria

The aim of this study is to examine the self-reported subjective well-being and health-related quality of life (HRQOL) of alcohol and other drug users and to examine whether subjective well-being in this sample would be predicted by either HRQOL and/or severity of dependence.

Inequity in health: older rural driving and dementia

Introduction The number of drivers with dementia is expected to increase exponentially over the coming decades. Most individuals with moderate-to-severe dementia (table 1) are unfit to drive.1 Drivers with moderate-to-severe dementia have higher rates of MVCs than age-matched controls.2 Identifying and preventing these individuals from driving is crucial, particularly in urban areas. The density of cars and pedestrians, and the complexity of traffic typically place greater demands on drivers in urban areas, and, therefore, require greater reactivity and forward planning than in rural environments.3 ,4 The ability to drive is a critical means of maintaining one's social inclusion, and is commonly a practical necessity. Therefore, decisions about the entitlement to drive should not unfairly restrict mobility or unnecessarily compound the disadvantages experienced by older people with mild cognitive impairment and early dementia (table 1), particularly as diagnoses are now being made earlier.1 This paper describes the difficulties inherent in addressing the question of when and in what circumstances a diagnosis of dementia might render a person unfit to drive and focuses on those who live in rural areas. We examine the consequences of dementia diagnosis on driving, driver testing requirements and licensing procedures, and the impacts of driving cessation. We then discuss how living in rural areas may alter the level of risk of drivers with dementia and practical implications for licensing policies.