Governance at community level : small towns in rural Victoria

The 'blurring' of the boundaries between and within public and private sectors has led to new styles of governing that affect the way that rural communities organise themselves. Some have called this a shift from 'government' to 'governance' where there has been a convergence of neo-liberal and communitarian ideologies to form the basis of a new relationship between the state, the market and civil society. We analyse the impact of these converging ideologies using a survey of development groups in 35 towns in rural Victoria and explore the types of community governance that have emerged as a response to changes in those towns that lost their local government authorities in the last decade of the twentieth century.

Community governance in rural Victoria: Rethinking grassroots democracy?

The development of local community associations in small rural towns in Victoria has engendered a sense of local self-governing that can be described as a shift from government to governance. This ‘more flexible’ approach extends beyond government, and the place of its agencies, to a greater sharing of power between the state, the market and civil society via new network and partnership structures. The question arises whether  community networks and partnerships bring with them a new sense of  democracy as well. The paper begins with a discussion of governance, its  relationship to two democratic frameworks - liberal minimalism (or representative governance) and associationalism - and the implications for democracy in community governance. Focusing on three internal factors (accountability of the leadership, inclusiveness and the scope of  responsibility), and two external factors (relationships to the state and types of relationships with other groups), the paper then explores the ways that community governance has been adopted in rural Victoria using in-depth interviews and a survey of community groups in 35 small rural towns. The ensuing discussion argues that while these community associations may be involved in forms of associational democracy, there is still some doubt about the inclusiveness of their membership and the extent to which their advocacy represents all sections of their communities. The paper then  concludes by suggesting that representative and associational forms of democracy need not be seen as opposites but as a more enhanced form of local governance.

An evaluation framework for the qualitative investigation of a physical activity prescription program in rural Victoria

Physical activity (PA) has consistently been shown to improve ones' physical, social and mental health. Hence, the rationale for promoting regular physical activity is relatively straightforward. However, what is less clear from the literature is the mix of strategies, (i.e. 'what is working and why?'), to increase in physical activity levels within a population. Of particular interest to primary care is the concept of Physical Activity Prescription Programs (PAPPs) delivered by general practitioners (GPs).

Several examples of a PAPP exist within England, America, New Zealand and Australia. These all aim to encourage GPs to deliver physical activity advice to their patients effectively and in a timely manner. Notwithstanding, the authors of a recent review of published literature on PAPPs, reveal a deficit of evidence regarding the components for successful PA interventions.

This research through an ethnographic enquiry aims to build on the evidence formulated to date. Through a case study research design, the researcher has developed a methodology to define what is/is not working within this recent trend.

In two rural Divisions of GP, participants have been identified as key stakeholders in the implementation of a PAPPs. They are categorised according to three theoretical paradigms, namely, Policy Makers, Linkers and Adaptors. Following this the three paradigms will be studied on the contextual factors, the characteristics and behaviours of members within all three paradigms. The study has also further defined certain elements for investigation, these include the:
intention of the players
effort undertaken by players, and
effect of parties within.

Primarily qualitative data will be collected; through Desk Analysis (Policies, Strategic and Business plans), Site Visits (Participant Observation) and semi-structured interviews. This presentation defines a qualitative framework and methodology for investigating the outcome of programs that historically has been evaluated using quantitative measures. Hence, the author of this study aims to present a qualitative investigation and subsequent results, defining aspects of a PAPP that allow for successful and sustainable implementation.

Serving the community : a biography of two primary teachers in rural Victoria 1922-1970

This biographical history investigates the formative influences, motivations and professional lives of wife and husband Ellen Cahalane Jennings (nee Murray) and Joseph Kevin Jennings in the context of their career as employees of the Victorian Education Department.

Young mothers’ lived experiences prior to becoming pregnant in rural Victoria : a phenomenological study

Objective: To explore the lived experiences and social context prior to becoming pregnant, of women who became mothers during adolescence in rural Victoria.
Design: Qualitative interpretive phenomenological study using semistructured interviews.
Setting: Rural community in North East Victoria, Australia.
Participants: Four rural women who gave birth to a child between the ages of 15 and 19.
Results: Five themes emerged from the data as being essential to the participants’ experiences prior to pregnancy. These included feeling isolated; life change: transition into adulthood; support and understanding in sexual relationships; feeling dissatisfied; and overcoming adversity. Participants’ provided practical recommendations to improve life for young people in rural areas through reflecting on their own experiences.
Conclusion: These findings highlight the complex nature of rural young women’s experiences leading up to pregnancy and suggest that early motherhood might be largely reflective of the social environment in which one lives prior to pregnancy. Providing somewhere safe to go, organised and appropriate social activities and increasing access to health services were identified as being pertinent to improving experiences for rural young people prior to pregnancy. Health professionals should consider the importance of supporting young women through non-judgemental, approachable and accessible services.

The country’s not what it used to be : research participants’ understandings of space, place and identity in rural Victoria

This chapter explores the various ways in which research participants from rural areas located in country Victoria, Australia, construct and reconstruct their understandings of themselves and their rural spaces in terms of place and identity. This chapter draws upon the data of two separate research projects that bought together a variety of researchers and research participants either growing up in, working in, or studying in rural areas.

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.

E-learning opportunities and challenges for legal education in rural Victoria

Access to justice extends beyond consideration of the systems and institutions of justice; it includes infrastructure such as transport, health, education and communications. Rural, regional and remote (‘RRR’) communities are more likely to face difficulties in accessing advice and accurate information on laws and processes available for resolution of disputes. Perhaps more fundamentally, they rarely have a voice in effecting reforms in laws and related policies. For several decades, community legal centres, legal aid, courts, and a range of other institutions have used community legal education programs to improve knowledge and access to law and justice systems, services and organisations. The recent Productivity Commission Inquiry into Access to Justice Arrangements notes that, ‘Better coordination and greater quality control in the development and delivery of these [community legal education, legal information] services would improve their value and reach.’ At the same time, research into the professional needs of RRR legal practitioners has found that many of these practitioners face considerable difficulties accessing good quality continuing professional development (‘CPD’) and informal networking/support opportunities.6 Current and emerging internet-based technologies open up opportunities for legal organisations to better meet the educational needs of both rural communities and legal practitioners. Though limitations still exist at multiple levels, relatively low-cost, media-rich, synchronous and tailored education programs can now be delivered effectively in many rural and remote areas. However, complex layers of decisions are required to critically assess, harness and optimise technologies to best suit the needs of users, and to utilise teaching and learning techniques that best match the technologies and participant needs. Getting these elements — needs, technology and learning technique — right, nevertheless offers extraordinary opportunities. Sound decisions and good practices should enable state-wide and specialist law and justice-related services interested in improving their engagement with RRR communities to dramatically improve the reach and quality of outcomes, not only for distant participants but the spectrum of stakeholders.

Screening for diabetic retinopathy using a non-mydriatic retinal camera in rural Victoria

PURPOSE: To develop a screening programme for the early detection of diabetic retinopathy using non-mydriatic retinal photography. METHODS: A community based screening service was offered to all people with known diabetes mellitus in selected townships in the LaTrobe and Goulburn Valleys in Victoria. At the local examination centre, basic sociodemographic information was collected as well as details of previous use of eye care services for the early detection of diabetic retinopathy. The examination included visual acuity (VA), glycosylated haemoglobin level and Polaroid photographs of each fundus using a Canon CR5-45NM non-mydriatic retinal camera (Canon, Tochigiken, Japan). Dilating drops were not used. Photographs were subsequently reviewed and letters were sent to all participants (with copies to their general practitioners) with recommendations for appropriate follow up. RESULTS: A total of 1177 people with diabetes attended the screening service, which is estimated to be 40% of the total population with known diabetes in the study area. The mean age was 65 years (range 20-94 years); 559 (48%) people reported not having a dilated fundus examination within the past 2 years; 345 (29%) people had never had a dilated fundus examination. Of the 2354 eyes, 2126 (90%) of the photographs were gradable. A total of 704 people (60%) had normal VA and no evidence of diabetic retinopathy, 209 people (18%) had diabetic retinopathy, 101 people (9%) had evidence of other fundus pathology, 42 people (3%) had reduced acuity (< 6/18) in one or both eyes (with no fundus pathology evident) and 121 people (10%) had ungradable photographs in one or both eyes. CONCLUSIONS: The present study demonstrates the usefulness of a screening programme with non-mydriatic retinal photography as an adjunct to current eye care services for the early detection of diabetic retinopathy.

Linking law: practical guidelines for delivering law to rural Victoria using e-learning technologies

These guidelines provide information, analysis and practical tips for organisations seeking to use digital technologies to enhance general and professional legal education for people living in remote, rural and regional (RRR) Victoria. Given the difficulties people living in RRR areas still face in having to take time away from work and home and travel long distances to attend many legal educational events, it makes sense to explore these options. However, it can be particularly difficult for organisations seeking to engage with RRR people to choose between educational technologies and techniques, given the considerable hype and movement in the field at present. Options are plentiful and complex, with multiple practical and organisational considerations attached to each, and the situation changes frequently as technologies improve. The increasing reach of high-speed internet and mobile networks is creating opportunities for different and more engaging educational methods to be used in most regional and rural areas, but fast internet is not the be-all and end-all. There is much that can be achieved with intelligent use of a range of lower-tech options including low-speed internet, phone, DVD and regional site-based educational technologies.

The impact of extensive loss of telecommunications on general practice: a case study in rural Victoria

OBJECTIVE: To describe the impact of major loss of telecommunications on general practice in a rural region of Australia. DESIGN: A multi-stage qualitative study. Purposively selected participants were invited to contribute to initial data collection using an online survey, followed by interviews with selected participants. Thematic analysis of the data was performed by both research team members. SETTING: South-western Victoria, Australia. PARTICIPANTS: Individuals from organisations involved in Telstra recovery efforts, disaster management, health care and general practice staff. MAIN OUTCOME MEASURES: The survey collected freeform responses from participants. Semi-structured interviews further explored a variety of experiences from purposively selected participants. RESULTS: Organisations and practices in the region were prepared for major disasters, but not for the unusual and 'limited' disaster of losing telecommunications, including lack of Internet access and loss of telephone services. Although alternative measures were found for telecommunications, there was still a significant impact on many health-care-related activities and general practice functionality during the outage period. In particular, there was an increase in duties for administrative staff to compensate for loss of telecommunications. Patient traffic for many services decreased due to uncertainty about availability and continuation of business. CONCLUSIONS: The Warrnambool outage could be used as a case study illustrating the dramatic impact of communication loss. Major impacts include changes in patient traffic, increased administrative duties and slowing of patient care. When developing or assessing disaster management plans, general practices should consider the impact of telecommunication loss on functionality and prepare appropriate alternative, accessible and reliable measures.

Initial destination hospital of paediatric prehospital patients in rural Victoria.

OBJECTIVE: The objective of this present study was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital. METHODS: All Ambulance Victoria primary ambulance transports for paediatric patients aged 1 month to 14 years in the Barwon South West region between 1 April 2008 and 28 February 2011 were reviewed. Each case was examined to determine the destination hospital location relative to the case scene location, and the overall nature of each case was grouped into one of seven categories (medical respiratory, medical cardiac, medical neurological, medical other, trauma time critical, and trauma non-time critical). RESULTS: There were 1191 cases identified, with 978 (82%) being taken to the closest hospital and 213 (18%) to a more distant facility. The average distance travelled from the scene to the destination hospital was 15.2 km, and almost 90% of patients transported to the nearest hospital were within 15 km of that hospital. Time critical trauma cases and respiratory-related medical cases had higher rates of transport to more distant hospitals as their initial destination (26% to non-closest and 23% to non-closest, respectively). CONCLUSION: The patient's condition and their location relative to the larger medical facilities appear to influence the decision of destination hospital. Uncertainty regarding the availability of 24 h hospital services and staffing details may contribute to longer transfers.

Governance in rural communities: the case of Victoria

State and federal government policies for rural areas have encouraged local people and organizations to play a greater role in the provision of their local services. This emphasis on local participation has been described as a shift from ‘government’ to ‘governance’. However while there is an emerging research around small towns in Australia there is very little known about the processes of community governance. This paper focuses on local development groups in small towns in rural Victoria that have emerged or have been reconstituted with a broader community focus following municipal amalgamations. The basic aim of this paper is analyse to what degree these local community development groups can be regarded as constituting a form of community governance and the implications this has for democracy and accountability in small rural areas. The paper begins with a discussion of community governance as it represented in the literature. We then analyse ten case studies from across Victoria in the light of the changing political context.

Risky business: stories from the field of rural community nurses' work in domestic violence.

This paper reports on a descriptive study into family violence in rural Victoria. Focus groups were held in a number of areas across rural Victoria with a total of 24 community nurse participants. The focus groups were audio-taped and the tapes transcribed to enable the clustering of themes. The dominant themes were: picking up cues, helping and helplessness, holding secrets and quiet resistance. Underpinning all these themes however, was the notion of 'risky business'. All nurses in the study gave examples of situations that they encountered; their ways of helping; of working sensitively; of working around a system that is unhelpful; and the ways in which their work while skilled, thoughtful and wise, is also costly in terms of the emotional wounds they carry. Rural nurses work with considerable risk and courage as they engage in the care and support of women experiencing family violence.