An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Accessible information for people with complex communication needs

Information can be empowering if it is accessible. While a number of known information access barriers have been reported for the broader group of people with disabilities, specific information issues for people with complex communication needs have not been previously reported. In this consumer-focused study, the accessibility of information design and dissemination practices were discussed by 17 people with complex communication needs; by eight parents, advocates, therapists, and agency representatives in focus groups; and by seven individuals in individual interviews. Participants explored issues and made recommendations for content, including language, visual and audio supports; print accessibility; physical access; and human support for information access. Consumer-generated accessibility guidelines were an outcome of this study.

Getting it right: participatory information research with people with disabilities

Over the past two decades there has been a growing understanding of consumer requirements and advances in the design and development of accessible technology. However, research over the past decade confirms that significant barriers still exist for people with disabilities. These individuals constitute a diverse group of consumers who experience physical, cognitive, literacy, financial and attitudinal barriers to the use of technology or information. They regard themselves as experts on their access issues yet have been provided with few opportunities to participate in technology research that seeks to explore issues and provide consumer-focused solutions.

In this paper, the benefits of collaborative research and the use of participatory methods in a funded research project on accessible telecommunications information are described. The target consumer group for the project was people with significant communication difficulties, a group who are particularly disadvantaged due to speech, literacy and physical access issues with technology and information. The strategies used to facilitate participation are discussed and criteria from Zarb (1992) and Barnes (2003) are used to evaluate the participatory aspect of the project.

Enhancing email text production for users with motor impairments

People with motor impairments who use a switch device to interface with computers have poor access to affordable software for email communication. The MultiMail email package was developed with government support to provide email access solutions for these users and for others with a range of disabilities. In this paper, the development of accessible on-screen keyboards and a word prediction program which facilitates email text production is discussed. Technology solutions were informed by people with disabilities through focus group and survey data. The resulting cross-disability design of MultiMail provides innovative and cost-free solutions to email text production.

Accessible telecommunications information for people with communication impairment

Study investigating the telecommunication information needs of people with communication disabilities in Australia. Participants were informed about the project through flyers, letters, e-mail, disability agency contacts, and Web sites. A survey with multiple choice and closed and open-ended items was developed. People with communication disabilities used a hard-copy survey format to facilitate completion. Sixty-five participants age eighteen and over from Victoria, Tasmania, South Australia, and Queensland completed the survey. Preliminary results of the study indicated that the participants requested six text-based adaptations: (1) make information clear and easy to read and understand, (2) use larger print, (3) highlight the key points, (4) use dot points, (5) use visual information, such as photos and communication symbols, and (6) provide a range of oral/audio and visual formats for information. The accessibility characteristics requested by the participants called for the development of text and Web-based formats, and for the development of inclusive design guidelines. The authors concluded that further investigation was required to determine the best possible method of making the information accessible.

Redefining brand salience using memory theory and implications for measurement

The concept of brand salience, or brand accessibility in memory, has been prevalent in the area of brand research for several decades. Brand salience has been driven by memory theory and psychological research, but debate has continued over the structure of memory systems, the way in which consumers undertake memory search, and what they do with brand information once it is retrieved. With the rise to prominence of brand equity, brand salience has been subsumed into the awareness category, as an operationalisation of recalling information. This paper looks at redefining brand salience and proposes new methods for measuring brand salience.

Casing out teaching and learning online: enhancing fidelity into the mainstream

In this paper we present the rationale and outcome of a University strategically funded project aimed at developing a broad range of cases illuminating good practices in the development and use of digital media and online technologies at Deakin University. The project is aimed at supporting the ongoing implementation of the University’s suite of e-learning technologies, Deakin Studies Online (DSO). It was seen as a significant strategic academic professional development initiative by the University in bringing together perspectives on effective teaching and learning in the context of various disciplines and professional fields of practice, with DSO possibilities for enhanced teaching/learning quality, efficiency, accessibility and satisfaction. The ‘case’ as a useful means of developing practice is outlined, along with the various project processes involving case selection, development, production and promotion. Finally, reflections on the outcomes of the project are considered. A number of positive though largely unintended consequences are identified

E-governance-inhibitor or facilitator for democracy and citizen empowerment?

Democracies of the globalised world has been have been striving towards citizen empowerment in the recent decade where E-Governance is perceived as a facilitator. Democratic governments in general feel that being accessible online 24/7 to the average citizen not only makes them transparent, but also empowers the average citizen. In this process, citizen data privacy, information sharing across nations and uniform accessibility to electronic services delivery, emerge as pertinent issues. Through a critical discourse analysis, we take a deeper look at the perception of egovernance being a catalyst in empowering citizens in the global progress towards electronic democracies.

'I see nothing has changed': reshaping practitioner concerns about institutional change

My PhD research revealed widespread disquiet that Training Packages are typically written in a complex and abstract institutional language form that excludes all but knowledgeable readers. Many practitioners and participants struggle to understand the units of competency they are trying to work with. In a national VET system which claims that decision making and policy development are based on consultation and research, how can this disquiet go unnoticed? This paper examines a sequence of five texts drawn from the review and development of the Training Package qualifications for VET practitioners. It argues that the impact of an excluding language form has been recognised and then subsumed in two separate review and  development processes. When the first competency standards for workplace trainers and assessors were reviewed in 1997 much of the target population was found to lack awareness, familiarity, experience or expertise in using the standards. Yet the review is reported to have concluded that most users were satisfied with the language used in those standards. When the  Training Package for Assessment and Workplace Training was reviewed in 2001 the complex language was one of the most common issues raised in unprecedented consultations and was identified as a significant accessibility issue. Yet the Training and Assessment Training Package responded by entrenching the use of this language as a compulsory assessable requirement and suggesting that individuals who have difficulty with the language may require training to improve their own (presumed deficient) language and literacy skills. Practitioner input was ‘written down’ but not ‘taken up’. The paper concludes that the concerns expressed by practitioners exposed to public critique fundamental issues about a Training Package that was a ‘lynchpin’ of the VET system and a key component of the ‘rules of the VET game’. But the concerns were reshaped and redefined in a process that was aligned to national VET policy rather than to local needs.

Globalisation, food and health in Pacific Island countries

Pacific Island countries (PICs) are experiencing an epidemic of obesity and consequent chronic diseases. Despite investment in the development of National Plans of Action for Nutrition (NPANs) and interventions to promote healthy eating and physical activity, nutritional status appears to show little improvement. This paper presents a synthesis of the findings from two research papers that were prepared for a 2003 food safety and quality meeting in Nadi, Fiji. The findings indicate that although lifestyle behaviours might be the immediate cause of dietary imbalances, greater attention should focus on omnipresent influences of globalisation as a critical element of the nutrition transition in the Pacific. In particular, those aspects of globalisation mediated through the World Trade Organization (WTO) Agreements that are placing pressures on food security and fostering increased dependence on imported food of poor nutritional quality. Rapid, significant and sustainable improvements in public health in PICs require interventions that can tackle these underlying contributors to ill health. There are opportunities to explore the use of food regulatory approaches to influence the composition, availability and accessibility of food products. Within the context of the WTO Agreements the legitimacy of food regulatory approaches will depend upon the case to demonstrate the relationship between the intervention and the protection of food security and public health nutrition. The challenges in realising these opportunities are: 1) to have the capacity to construct a case, 2) meet the technical and financial demands to administer and enforce regulatory approaches, and 3) to take advantage of opportunities available and to be able to fully participate in the international policy-making process.

New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.

Interventions to reduce harm associated with adolescent substance use

A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated fi ndings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are eff ective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.

Re-imagining science education : engaging students in science for Australia

The author stresses the need for schools and science teachers to develop new approaches to attract the imagination of students in Australia. He believes that changes in the nature of post-industrial societies and in the accessibility of science knowledge and youth expectations are the culprits of crisis in science education. He argues that schools and teachers should re-examine the purposes of school science. He suggests that science re-imagining needs to be supported by national effort, create teacher development and training initiatives and assessment.

Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne

Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8–10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers.

Barriers to pharmacist participation in continuing education in Australia

Background: The pharmacy profession recognises of the need for continuing education (CE), however, the rate of participation in organised CE remains low. Little is known about the reasons for low participation rates in CE, particularly in the Australian context. Aim: This research aimed to identify the barriers to participation of Australian pharmacists in CE. Method: Focus groups were held with Australian community pharmacists, grouped into experienced pharmacists, recently qualified pharmacists, pharmacists with specialist-training needs, and pharmacists practising in rural or remote areas. Focus group transcripts were thematically analysed. Results: Barriers identified by pharmacists included time constraints, accessibility - in terms of travel and cost, relevance, motivation, quality and method of CE delivery. Participants provided ideas to improve uptake of CE. Conclusion: The major barriers identified were time, accessibility and relevance of content. To improve uptake of CE a wider variety of flexibly delivered programs supplemented with in-depth workshops could be utilised.