Review of rural and regional alcohol research in Australia

INTRODUCTION: Alcohol is the most commonly used drug within Australia. Recently, there have been indications that there is a greater incidence of high-risk drinking within rural populations as compared with their urban counterparts. High-risk drinking is associated with numerous conditions, such as diabetes, heart attack and cancer, as well as acute harms such as assault, suicide and road accidents. The objective of this article is to review the current research and relevant data pertaining to alcohol use and alcohol-related harms within rural Australia. METHODS: This paper is a systematic review of 16 databases, including PubMed, PsycINFO and Google Scholar. RESULTS: Overall, 18 studies describing alcohol consumption or alcohol-related harms were found. Approximately half of these studies were large-scale national population surveys, which were therefore limited in their representativeness of specific regional and rural towns. Most studies examining alcohol consumption used self-report data collection, meaning that interpretation of results needs to be tentative. There is a consistent pattern of higher rates of alcohol consumption and consequent harm within regional and rural Australia than in urban areas. CONCLUSIONS: There is emerging research examining alcohol consumption and alcohol-related harms within regional and rural Australia. All studies show that these populations experience disproportionate harm because of alcohol consumption. The causes and mechanism for this have not been investigated, and a program of research is required to understand how and why rural populations experience disproportionate levels of alcohol-related harm and ultimately, what interventions will be most effective in reducing alcohol-related harms.

How parental and school responses to choice policies reconfigure a rural education market in Victoria, Australia

Market principles now dominate the education and social policies of many Anglophone countries, including Australia, but articulate differentially within specific contexts. Existing historical legacies, local economic and social conditions, and geographical settings interact with federal and state funding and transport policies to shape the nature of regional education markets and the choices families make in a rural school market in Australia. Through two school case studies, this article explores the effects of policy shifts on parental choice and student movement within a regional Victorian community. Informed by policy sociology, the article views the policy as a dynamic, often ad hoc process with contradictory effects. It indicates how an ensemble of federal and state funding and conveyancing policies enable some schools to develop marketing practices that reconstruct the local education market to their advantage through the introduction of transport and flexi-boarding policies. It demonstrates that education markets are not confined to urban settings and that while choice is not a new phenomenon in this rural area, federal and state funding and transport policies have reconfigured local markets and intensified the market work undertaken by schools and parents with, in this instance, unequal effects on the provision of schooling in a rural region.

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.

Barriers and enablers to clinical fieldwork education in rural public and private allied health practice

There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect quantitative and qualitative data about the barriers and enablers that AHPs encounter when supervising students in their clinical setting. A total of 113 public and private AHPs from Southwest Victoria, Australia, returned the questionnaire. The AHPs were trained in the disciplines of occupational therapy, physiotherapy, speech pathology, dietetics, podiatry or psychology. The majority of respondents (75%) had previously supervised students. Most respondents had only provided fieldwork education in the public sector. Allied health professionals working in public and private sectors had positive experiences with clinical fieldwork education and often had increased job satisfaction while supervising students. They experienced similar enablers to involvement in clinical fieldwork education programs, however the barriers they encountered were different. The findings highlight the differing issues between rural public and private settings that need to be addressed for successful clinical fieldwork education and work-integrated learning. Strategies to address the identified barriers need to be specific to the work conditions of each setting.

Adaptation to climate change in regional Australia : a decision-making framework for modelling policy for rural production

A decision-making framework was developed and applied in regional Australia to identify adaptation issues arising in agricultural systems and rural production as a consequence of climate change. Australian agriculture is very susceptible to the adverse impacts of climate change, with major shifts in temperature and rainfall projected. An advantage of the framework is that it provides a suite of tools to aid in the formulation of strategies for sustainable regional development and adaptation. The decision-making framework uses a participatory approach that integrates land suitability analysis with uncertainty analysis and spatial optimisation to determine optimal agricultural land use (at a regional scale) for current and possible future climatic conditions. It thus provides a robust analytic approach to (i) recognise regions under threat of productivity declines, (ii) identify alternative cropping systems better adapted to likely future climatic conditions and (iii) investigate policy actions to improve the sub-optimal situations created by climate change. The decision-making framework and its methods were applied in a case study of the South West Region of Victoria.

Application of GIS-based computer modelling to planning for adaption to climate change in rural areas

A GIS-based computer modelling methodology was developed and applied to identify climate change adaptation issues arising in regional agricultural production systems (including forestry). Agricultural production in Australia is very susceptible to the adverse impacts of climate change due to projected shifts in rainfall and temperature. The methodology integrates land suitability analysis with uncertainty analysis and spatial (regional) optimisation to determine optimal agricultural land use at a regional scale for current and possible future climatic conditions. The approach can be used to recognise regions under threat of productivity decline, identify alternative cropping systems that may be better adapted to likely future conditions, and investigate implementation actions to improve the sub-optimal situations created by climate change. An example of how the methodology may be used is outlined through a case study involving the South West Region of Victoria, Australia. The case study provides information on the tools available to support the formulation of a regional adaptation strategy.

Pedagogy of the rural: teaching and learning for rural futures?

Pedagogy of the Rural illustrates the complexities of rural space and considers some of the underlying assumptions, ‘truths’ and ‘realities’ about rural education and teaching in a complicated and dynamic policy context. Pedagogy of the Rural offers an alternative to current teacher education practice – it is responsive to policy demands as well as local conditions and traditions, and has a futures orientation, in that it provides a way forward for valuing rural contexts for what they bring to teacher identities beyond traditional deficit positionings dominant in current discourses on rural. The authors examine notions of size and how this impacts on the ways in which beginning teachers in rural locations are positioned in terms of identity at a macro, meso and micro level. They also examine what it means to ‘be rural’ and use Pedagogy of the Rural to conceptualise rural understandings as a pedagogy that is not a pedagogy ‘for’ or ‘about’ but rather ‘of’ the rural. Complexities of the Pedagogy of the Rural are understood through Harré’s (2004) positioning theory, Baudrillard’s (1983) notion of simulation and simulacra and Lefebvre’s (2009) arguments around space and economic geographies. The interrelationship of place, space and identity unify teachers’ understandings of who they (or we) are, and are becoming, in a specific time and geographical location, raising questions about: subjectivity - who we are; power - what we can do; and desire- who we might become (Harré, Moghaddam, Cairnie, Rothbart, & Sabat, 2009), and the influence of personal and professional histories and what rural brings to our pedagogy within this.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

Small-scale rural pilot programs in chronic illness management - what next?

In recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as: ? coordinated care trials (COAG) ? more allied health services (MAHS) ? Commonwealth regional health service initiatives (CRHS) ? quality use of medicines (QUM) ? community packages for aged care services ? Indigenous chronic disease self-management pilot programs (CDSM) ? chronic disease self-management (CDSM) programs - Sharing Health Care SA ? chronic disease self-management (CDSM) programs in Indigenous communities. In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.