The Sustainable Farm Families Project : changing attittudes to health

Introduction: Farm health and safety has historically focussed on strategies such as injury prevention, safety audits and fulfilling legislative responsibilities. However, farmer injuries mask deeper health issues including higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farm family health has not been fully investigated. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address premature death, morbidity and injury on Australian farms. The SFF project illustrates how increasing health literacy through education and physical assessment can lead to improved health and knowledge outcomes for farm families.

Methods: The SFF project focuses on the human resource in the triple bottom line and is working with farmers, families, industry and universities to collaboratively assess and promote improvement in the health and wellbeing of farm families. Based on a model of extension that engages farm families as active learners where they commit to healthy living and safe working practices, the SFF project is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farm men and women aged 18 to 75 years using a workshop format. Pre- and post-knowledge surveys, annual physical assessments and focus group discussions form the methodological context for the research over a three-year intervention.

Results: This article discusses the progress of the research outlining the design of the SFF project, the delivery and extension processes used to engage 321 farm families from within a broadacre and dairy-farming family sample. The article presents key learnings on intersectoral collaboration, engaging farmers and families in health, and the future for this project extending into agricultural industries across the nation. Key results reveal that health issues do exist in farming families and are often underreported by family members. Health indicators were at a level where referral and intervention was required in over 60% of men and 70% of women in both broad acre and dairy industries. Farm men and women verbalised health concerns relating to access, support and control mechanisms of the health system. Participants also revealed how they put into practice their new knowledge and how this has influenced their health.

Conclusions: The key learning is that farm men and women who are at high risk of premature morbidity and mortality will participate in health education and assessment programs based on industry collaboration with high levels of individual participation. This program provides evidence that farmers will engage with health professionals if programs are presented to them in personally engaging and relevant ways. The SFF program is a definite tool for interventional health promotion that supports attitudinal change to health and farming practices.

The lived experience of place for marginalised young people

This study explored the relationship between place and health for homeless, rural young people. Places that supported young people's health had the following attributes: feelings of physical safety and security, psychological fulfilment, sense of control, and identity. Places that appeared harmful to their health were described as alienating and threatening.

Contact with nature and children's mental, emotional, and social health

This research investigated the benefits of children's contact with nature as perceived by adult educators. It was found that contact with nature is perceived to: increase self-confidence and self-esteem; provide opportunities to experience mystery, privacy, and sensory engagement; connect children with school; and accommodate different learning styles and abilities.

Health-related beliefs, explanations and actions of older Anglo-Celtic-Australians

This thesis was an exploration of the health-related understandings and experiences of older Anglo-Celtic-Australians from a disadvantaged metropolitan locality. New insights were gained about the relationship between disadvantage and poor health outcomes; particularly the impact of limited self-care practices in combination with difficulties relating to the health care professionals.

Study of small rural schools in a climate of rapid change

An investigation of interactive factors affecting educational outcomes in small rural primary schools in a climate of rapid change. Demonstrates that the school-community relationship in small rural communities is a complex symbiosis. Teachers' understandings of how the small rural community context, the curriculum and pre-service experiences interact and work in these settings are crucial to maximising educational outcomes.

'no through road'? Disadvantage in rural education

Investigates educational disadvantage for students completing their secondary education in rural schools. For these students rural location has contributed reduced exposure to a broad range of literacy practices, and involvement in student cohorts with lower levels of socio-economic status, less extensive cultural knowledge and lower post-school aspirations.

Improving the quality of diabetes care in general practice

Objective: The evidence treatment gap for patients with type 2 diabetes.
Design: A summary of convenience sample of seven general practices.
Setting: Metropolitan and rural Victoria, Australia.
Participants: 561 patients of general practices (75% from rural general practices).
Main outcome measures: Demographic data, duration of diabetes, diabetes complications, HbA1c and lipid levels, blood pressure and score on PHQ-9.
Results: Patients with depression show more severe, progressive and intensively treated diabetes. The prevalence of depression in diabetes is about twice that of the general population.
Conclusion: Australian guidelines for diabetes should recommend screening for depression.

Diabetes risk reduction behaviours of rural postpartum women with a recent history of gestational diabetes

Introduction: For most women, gestational diabetes is temporary; however, an episode of gestational diabetes mellitus (GDM) confers an approximately seven-fold increased risk of developing type 2 diabetes mellitus. Objective: To examine readiness to adopt diabetes risk reduction behaviours and the prevalence of these behaviours among rural women with GDM during their last pregnancy.
Methods: The study design was a self-administered mailed questionnaire seeking information about demographics, stage of change, physical activity level and dietary fat intake. Setting: Regional outpatient context. Participants: Women with a single episode of GDM between 1 July 2001 and 31 December 2005 (n = 210). Main outcome measures: Stage of change for physical activity, weight loss and reducing dietary fat behaviour; meeting activity targets, body mass index (BMI) and dietary fat score.
Results: Eighty-four women returned completed questionnaires (40% response rate). Of the 77 women eligible (mean age 35 ± 3.8 years), 58% met recommended activity targets. Sixty-three percent of women were overweight or obese: mean BMI 29.6 kg/m2 (± 7.30). Women reported a high level of preparedness to engage in physical activity, weight loss and reduction of fat intake. Thirty-nine percent of women had not had any postpartum follow-up glucose screening. Women who remembered receiving diabetes prevention information were significantly more likely to meet physical activity targets (p<0.05).
Conclusions: Readiness to engage in behaviour change was high among this group of rural women for all three diabetes risk reduction behaviours measured. However, despite a high proportion of women meeting activity targets and reducing fat intake, the majority of women remained overweight or obese. Postpartum follow-up glucose testing needs to be improved and the impact of diabetes prevention information provided during pregnancy warrants further study.

Greater Green Triangle Risk Factor Study

Very limited data exist for chronic diseases and their risk factors and behaviours in the Greater Green Triangle (GGT) region, or anywhere in rural Australia. To identify health problems and to target interventions and monitor their impact it is necessary to have objective data on chronic disease risk factors. Three cross-sectional surveys were carried out in 2004, 2005 and 2006 in the GGT region in the south east of Australia. In 2004 the survey area was the Limestone Coast in South Australia, 2005 the Corangamite Shire in the south west of Victoria, and in 2006 the Wimmera district in central western Victoria. The data comprises physical measurements and results of blood samples that were taken from patients by specially trained survey nurses. It also comprises data extracted from follow up survey questionnaires that were sent to each patient who returned them through the mail.

A comparative study of factors influencing participation in sport and physical activity for metropolitan and rural female adolescents

The aim of this research was to provide a comparative analysis of the influence of behavioural alternatives, autonomy, competence and relatedness on participation in sport and physical activity for female adolescents within metropolitan and rural settings. Eighteen focus groups were conducted with a cross section of schools within metropolitan Melbourne and rural Victoria, Australia, involving 12–13-year olds and 15–16-year olds, using a semi-structured format. Content and thematic analyses were conducted on the data. Findings supported the sport commitment model by demonstrating that, in both rural and metropolitan settings, participation was influenced by the strength of commitment to a range of behavioural alternatives. Our findings also extended self-determination theory by suggesting that autonomy, competence, and relatedness were interrelated and their strength and influence on participation varied between settings. This study also has practical implications, including the promotion of more inclusive and supportive sports environments for female adolescents and promoting sport and physical activities as activity that promotes wellness, complements academic endeavours and reduces the stress of academic study.

Understanding determinants of nutrition, physical activity and quality of life among older adults : the Wellbeing, Eating and Exercise for a Long Life (WELL) study

Background : Nutrition and physical activity are major determinants of health and quality of life; however, there exists little research focusing on determinants of these behaviours in older adults. This is important, since just as these behaviours vary according to subpopulation, it is likely that the determinants also vary. An understanding of the modifiable determinants of nutrition and physical activity behaviours among older adults to take into account the specific life-stage context is required in order to develop effective interventions to promote health and well-being and prevent chronic disease and improve quality of life.

Methods : The aim of this work is to identify how intrapersonal, social and environmental factors influence nutrition and physical activity behaviours among older adults living in urban and rural areas. This study is a cohort study of adults aged 55-65 years across urban and rural Victoria, Australia. Participants completed questionnaires at baseline in 2010 and will complete follow-up questionnaires in 2012 and 2014. Self-report questionnaires will be used to assess outcomes such as food intake, physical activity and sedentary behaviours, anthropometry and quality of life. Explanatory variables include socioeconomic position, and measures of the three levels of influence on older adults' nutrition and physical activity behaviours (intrapersonal, social and perceived environmental influences).

Discussion : Obesity and its determinant behaviours, physical inactivity and poor diet are major public health concerns and are significant determinants of the quality of life among the ageing population. There is a critical need for a better understanding of the determinants of nutrition and physical activity in this important target group. This research will provide evidence for the development of effective policies and programs to promote and support increased physical activity and healthy eating behaviours among older adults.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Rural and regional Australian public accounting firm services : service provision, concerns and tensions

Public accounting firms provide a necessary and important service for rural and regional areas. However, the provision of high-quality services is hindered by a number of factors. This paper reports the findings from a large-scale survey of professional accounting firm practitioners located in rural and regional Australia, identifying factors causing concerns and tensions and quantifying their scope and importance. Prominent concerns and tensions identified include adverse effects arising from the employment market, communications technology developments and legislation such as the Corporate Law Economic Reform Program (Audit Reform and Corporate Disclosure) Act 2004 and the Financial Services Reform Act 2001.