Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

Choroidal thickness in myopic and non-myopic children assessed with enhanced depth imaging optical coherence tomography

Purpose To examine choroidal thickness (ChT) and its topographical variation across the posterior pole in myopic and non-myopic children. Methods One hundred and four children aged 10-15 years of age (mean age 13.1 ± 1.4 years) had ChT measured using enhanced depth imaging optical coherence tomography (OCT). Forty one children were myopic (mean spherical equivalent -2.4 ± 1.5 D) and 63 non-myopic (mean +0.3 ± 0.3 D). Two series of 6 radial OCT line scans centred on the fovea were assessed for each child. Subfoveal ChT and ChT across a series of parafoveal zones over the central 6mm of the posterior pole were determined through manual image segmentation. Results Subfoveal ChT was significantly thinner in myopes (mean 303 ± 79 µm) compared to non-myopes (mean 359 ± 77 µm) (p<0.0001). Multiple regression analysis revealed both refractive error (r = 0.39, p<0.001) and age (r = 0.21, p = 0.02) were positively associated with subfoveal ChT. ChT also exhibited significant topographical variations, with the choroid being thicker in more central regions. The thinnest choroid was typically observed in nasal (mean 286 ± 77 µm) and inferior-nasal (306 ± 79 µm) locations, and the thickest in superior (346 ± 79 µm) and superior-temporal (341 ± 74 µm) locations. The difference in ChT between myopic and non-myopic children was significantly greater in central foveal regions compared to more peripheral regions (>3 mm diameter) (p<0.001). Conclusions Myopic children have significantly thinner choroids compared to non-myopic children of similar age, particularly in central foveal regions. The magnitude of difference in choroidal thickness associated with myopia appears greater than would be predicted by a simple passive choroidal thinning with axial elongation.

Light exposure and physical activity in myopic and emmetropic children

Purpose: To objectively assess daily light exposure and physical activity levels in myopic and emmetropic children. Methods: One hundred and two children (41 myopes and 61 emmetropes) aged 10 to 15 years old had simultaneous objective measures of ambient light exposure and physical activity collected over a 2 week period during school term, using a wrist worn actigraphy device (Actiwatch-2). Measures of visible light illuminance and physical activity were captured every 30 seconds, 24 hours a day over this period. Mean hourly light exposure and physical activity for weekdays and weekends were examined. To ensure that seasonal variations didn’t confound comparisons, the light and activity data of the 41 myopes, was compared with 41 age and gender matched emmetropes who wore the Actiwatch over the same two week period. Results: Mean light exposure and physical activity for all 101 children with valid data exhibited significant changes with time of day and day of the week (p<0.0001). On average greater daily light exposure occurred on weekends compared to weekdays (p<0.05), and greater physical activity occurred on weekdays compared to weekends (p<0.01). Myopic children (n = 41, mean daily light exposure 915 ± 519 lux) exhibited significantly lower average light exposure compared to 41 age and gender matched emmetropic children (1272 ± 625 lux, p<0.01). The amount of daily time spent in bright light conditions (>1000 lux) was also significantly greater in emmetropes (127 ± 51 minutes) compared to myopes (91 ± 44 minutes, p<0.001). No significant differences were found between the average daily physical activity levels of myopes and emmetropes (p>0.05). Conclusions: Myopic children exhibit significantly lower daily light exposure, but no significant difference in physical activity compared to emmetropic children. This suggests the important factor involved in documented associations between myopia and outdoor activity is likely exposure to bright outdoor light rather than greater physical activity.

Bonding and bridging : transition to school and social capital formation among a community of Indigenous Australian children

This study reports on an intervention program designed to facilitate transition to school of a whole community of Indigenous Australian children who had previously not been attending. The children were from families displaced from their traditional lands and experienced on-going social marginalisation and transience. A social capital framework was employed to track change in the children’s social inclusion and family-school engagement for two years, from school entry. Sociometric measurement and interview techniques were applied to assess the children’s social connectedness and peer relationship quality. Using these data, analyses examined whether bonding within the group supported or inhibited formation of new social relationships. Although transience disrupted attendance, there was a group trend towards increased social inclusion with some evidence that group bonds supported bridging to new social relationships. Change in family-school engagement was tracked using multi-informant interviews. Limited engagement between school and families presented an on-going challenge to sustained educational engagement.

‘Our’ community : corporate social responsibility, neoliberalisation, and mining industry community engagement in rural Australia

This paper addresses contemporary neoliberal mobilisations of community undertaken by private corporations. It does so by examining the ways in which the mining industry, empowered through the legitimising framework of corporate social responsibility, is increasingly and profoundly involved in shaping the meaning, practice, and experience of ‘local community’. We draw on a substantial Australian case study, consisting of interviews and document analysis, as a means to examine ‘community-engagement’ practices undertaken by BHP Billiton’s Ravensthorpe Nickel Operation in the Shire of Ravensthorpe in rural Australia. This engagement, we argue, as a process of deepening neoliberalisation simultaneously defines and transforms local community according to the logic of global capital. As such, this study has implications for critical understandings of the intersections among corporate social responsibility, neoliberalisation, community, and capital.

How rural criminology informs critical thinking in criminology

Over the past quarter century, a growing volume of rural-focused criminological work has emerged. In this article, the literature related to three rural criminological issues are examined and discussed in terms of their lessons for critical criminology. Research on rural communities and crime is examined as a way to criticize and challenge mainstream criminological theories and concepts like social disorganisation and collective efficacy, and to remind critical criminologists of the importance for developing critical perspectives for place-based or ecological theories of crime. Agricultural crime studies are discussed in terms of the need to develop a critical criminology of agriculture and food. Finally, criminological studies of rural ‘others’ is used to show the need for critical criminologists to give greater analytic attention to divisions and marginalities of peoples living in smaller and more isolated places based on gender, race, and lifestyles, among other factors.

Maternal report of young children's eating styles. Validation of the Children's Eating Behaviour Questionnaire in three ethnically diverse Australian samples

The aim of this study was to validate the Children’s Eating Behaviour Questionnaire (CEBQ) in three ethnically and culturally diverse samples of mothers in Australia. Confirmatory factor analysis utilising structural equation modelling examined whether the established 8-factor model of the CEBQ was supported in our three populations: (i) a community sample of first-time mothers allocated to the control group of the NOURISH trial (mean child age = 24 months [SD = 1]; N = 244); (ii) a sample of immigrant Indian mothers of children aged 1–5 years (mean age = 34 months [SD = 14]; N = 203), and (iii) a sample of immigrant Chinese mothers of children aged 1–4 years (mean age = 36 months [SD = 14]; N = 216). The original 8-factor model provided an acceptable fit to the data in the NOURISH sample with minor post hoc re-specifications (two error covariances on Satiety Responsiveness and an item-factor covariance to account for a cross-loading of an item (Fussiness) on Satiety Responsiveness). The re-specified model showed reasonable fit in both the Indian and Chinese samples. Cronbach’s α estimates ranged from .73 to .91 in the Australian sample and .61–.88 in the immigrant samples. This study supports the appropriateness of the CEBQ in the multicultural Australian context.

Validity of maternal-reported weight and height of children 2-5 year olds

To the Editor: In affluent-urban areas of India, overweight (6 %) and obesity (8 %) are prevalent in children as young as 2–5 y [1]. A potential risk factor for childhood obesity could be parent’s under-reporting their child’s anthropometry. In Indian culture, a larger body size is typically acceptable, and mothers may consider a chubby baby as healthy [2]. Therefore, it was proposed that Indian mothers may under-report their child’s weight status. The present study examined the validity of maternal reported height and weight of young, urban-affluent Indian children aged 2–5 y. After receiving approval from the QUT Human Research Ethics Committee, Australia 111 mothers with children aged 2–5 y attending private medical clinics (n = 5) in the affluent areas of Mumbai were recruited. Child’s height and weight were measured by the researcher using standard equipment/protocols. Mothers also reported their child’s height and weight.

How relevant are science curricula for rural and remote students?

This paper reports findings from the Choosing Science study (Lyons & Quinn, 2010) indicating that Australian Year 10 students in small rural or remote areas tend to regard their science lessons as less relevant than do students in larger towns and cities. Specifically, those in small rural or remote schools were significantly more inclined than their city peers to disagree that what they learned in science classes 'helped them make sense of the world'. They were also significantly more likely to strongly agree that they found science lessons boring, and to strongly disagree that science was one of the most interesting subjects. Potential explanations discussed include a mismatch between science curriculum content and the everyday experiences of students in these regions, the relative shortage of experienced specialist science teachers in rural or remote areas and a lack of opportunities to demonstrate the relevance of school science, among others. The paper considers the implications of these findings in relation to the Australian Science Curriculum and whether it is likely to better address the needs of rural and remote students.

Rural high school students' attitudes towards school science

This paper reports findings from an Australian survey of Year 10 students (N=3759) indicating that those in small rural and remote areas tend to enjoy school science significantly less than their peers in larger towns and cities (Lyons & Quinn, 2010). The study also found that rural and remote students were less inclined than those in other locations to enjoy science relative to other subjects. Such a result has not previously been recorded in the science education literature and raises a number of questions about the relevance and quality of the science education experienced by rural and remote students. It also raises timely questions about the applicability to rural and remote students of an Australian Science Curriculum. The paper explores these issues and their implications for policy and research.

Innovation for Equity in Rural Education : Proceedings of the International Symposium for Innovation in Rural Education

PREFACE The concept of an international symposium on rural education arose from a meeting between members of the SiMERR National Centre, Australia and the NURI Teacher Education Innovation Centre (NURI-TEIC) at Kongju National University, Korea in 2007. Despite the very different national contexts, the teams were struck by the similarities of the challenges facing rural schools in the two countries, and curious about the degree to which these challenges were shared by other countries. At a subsequent meeting in Australia in December 2007, the two centre Directors - Professor John Pegg (SiMERR) and Professor Youn-Kee Im (NURI-TEIC) - agreed on a framework for the first International Symposium for Innovation in Rural Education (ISFIRE). This volume consists of the keynotes and refereed papers presented at ISFIRE 2009. The papers provide insights into rural education in Australia, Bhutan, Canada, Korea, Norway, South Africa and the United States along the following themes: 1. Promoting rural policy initiatives; 2. Nurturing the rural teacher experience; 3. Enhancing rural student experience and growth; 4. Optimising the curriculum; 5. Improving resources in rural schools; and 6. Addressing special issues in rural education. The authors and titles of a further 23 presentations based on refereed abstracts only are listed at the end of this volume. The abstracts for these presentations can be found in the symposium Program. The academics and practitioners who came together for this symposium are passionate about rural education and have dedicated their time and capacities to working for the benefit of rural teachers, students and communities. The papers in this volume offer direction not only for Australia and South Korea, who jointly hosted this symposium, but for all countries in which rural education is contested ground. The keynotes in particular contribute rich perspectives on rural education trends, policies and practices. We hope that this volume generates a greater appreciation of the advantages of rural education and the many innovative approaches being implemented to meet its challenges.

Teachers' motivations for working in rural schools

This paper reports on the analysis of qualitative and quantitative data concerning Australian teachers’ motivations for taking up, remaining in, or leaving teaching positions in rural and regional schools. The data were collected from teachers (n = 2940) as part of the SiMERR National Survey, though the results of the qualitative data analysis were not published with the survey report in 2006. The teachers’ comments provide additional insight into their career decisions, complementing the quantitative findings. Content and frequency analyses of the teachers’ comments reveal individual and collective priorities which together with the statistical evidence can be used to inform policies aimed at addressing the staffing needs of rural schools.

Rural people and the land

There is a long and fundamental connection between rural place and the land. Whereas land is simply the foundation for the construction of towns and cities, whose urban culture and economy thrives on human ingenuity and industry that may have little direct attachment to the physical ground over which it occurs, historical discourses of rurality place the land at the heart of the rural economy and society. Rural people, such discourses hold, live on the land, work the land, tend the land and know the land. The land formed not only the base of the rural economy (as ‘a physical, tangible resource which can be ploughed, sown, grazed, built upon’ (Macnaghten and Urry 1998, 200)), but also shaped rural culture and the rural calendar, and contributed to the constitution of the rural character (see Bell 1994). As such, the land is central to rural sense of place.

Teachers and academics researching together : children's views on play

An international early years project led by QUT and University of Iceland researchers has investigated children’s accounts of play and the teacher’s role in play in kindergarten settings. While most commonly associated with young children’s activities and the work of childhood, play is recognised also as an activity that extends over the life span, from early childhood to adulthood, and across cultures, worldwide. As shown in national and state policy and curriculum documents, play is being subjected increasingly to specific guidelines that address the physical environment and educator involvement in early years settings. Parents and educators have strong opinions regarding the value and place of play. Children also have strong views about play, although little is known about their views and what they think play encompasses, and the value of play in their everyday lives.