UOW Rural Health Research Conference 2024

Friday, 15 March, 2024

Clinical Courage: Rural & Remote Clinicians are Courageous: Educating students on Placement

Associate Professor Robert Brooks

Clinical Courage is the lived experience of Rural & Remote Clinicians and is defined as working at the edge of or outside your comfort zone to provide access to care to patients. As such it is the life that those considering rural and/or remote practice need to be comfortable. Discussed initially in two conference papers [1 2] and explored in a number of qualitative papers [3-6], and through the ongoing process of questionnaire development (two papers [7 8]) there has been a growth in clinical courage knowledge. A second questionnaire development study is being analysed and will further contribute to the understanding of clinical courage. Clinical courage provides a language to explain the clinical experience of rural and remote clinicians.

It is hypothesised that training students during rural and remote placements on the lived experience of existing rural and remote clinicians will contribute to the recruitment and retention of students to rural practice.

The workshop aims to increase knowledge, explore a proposed educational model, and develop potential uses of the Clinical Courage Questionnaire (CCQ).

Workshop aims:

1. To introduce and explain Clinical Courage with the latest knowledge in particular the clinical and community aspects of clinical courage.
2. To test an educational model for students.
3. To explore uses of Clinical Courage and the CCQ. 

Implementation Research 101

Professor Andrew Bonney, Professor Judy Mullan, Dr Colin Cortie and Dr Christine Metusela 

To provide participants with an introductory understanding of Implementation Research, differentiating it from intervention research in health services research, and equipping them with the knowledge and skills to develop and evaluate implementation research projects.

Saturday, 16 March, 2024

Compliance with Surgical Antimicrobial Prophylaxis (SAP) Guidelines in a Regional Hospital

Rebecca Castor

Surgical Antimicrobial Prophylaxis (SAP) guidelines specify the most appropriate choice, dosage and timing of antimicrobials to reduce surgical site infections. Despite extensive evidence justifying the value and implementation of SAP guidelines, clinical practice continues to differ from optimal care.

Most existing research focuses on SAP guideline adherence in metropolitan settings. However, it has been suggested that adherence with SAP guidelines is lower in regional hospitals compared to metropolitan hospitals.

The purpose of this study was to determine compliance with SAP guidelines at a regional NSW hospital. The study also aimed to identify any barriers which may influence adherence to SAP guidelines in this setting.

Bringing research learning to the bush: the RR-CLaN education and training calendar

Dr Kimberley Davis & David Schmidt

Research education and training opportunities are known to attract and retain healthcare staff and build crucial skills in the workforce, generating and implement evidence to improve the safety, quality and effectiveness of care delivered. It also represents a key opportunity for organisations to position themselves as a place to live and work as a healthcare professional. The Rural Research Collaborative Learning Network (RR-CLaN) is a rural-led initiative aiming to provide high-quality research education and training to healthcare staff working in rural, regional and remote (R3) areas.

Patient perspectives on the role of interprofessional collaborative practice in Rural Australia

Associate Professor Kylie Mansfield 

Nearly half of the Australian population have at least one chronic health condition requiring care from multiple healthcare professionals in a process of interprofessional collaborative practice. Being located rurally is a major barrier to obtaining appropriate collaborative care. Through the use of interviews we aimed to explore the experience of patients in Forbes, a town in rural NSW to better understand their perspective of how their care is managed.

Rural healthcare providers’ perspectives on the usefulness of the Routine Opioid Outcome Monitoring tool

Dr Margaret Jordan

The Routine Opioid Outcome Monitoring (ROOM) tool has been validated in pharmacies as feasible in screening individuals prescribed opioids for chronic, noncancer pain (CNCP), and found to be acceptable by patients.[1] This study aimed to investigate the potential usefulness of the ROOM tool in the management of patients with CNCP prescribed long-term opioids, from the perspectives of rural multidisciplinary healthcare providers (HCPs) and to explore how it could be incorporated into clinical practice. 

Learning to Think Like a Doctor: How Long is Long Enough to Develop Good Clinical Reasoning within a Longitudinal Placement?

Associate Professor David Garne  

Longitudinal integrated placements are becoming an accepted approach to medical undergraduate training worldwide, but there is no agreed length of time needed for learning to be effective, especially the learning of clinical reasoning. The UOW twelve-month longitudinal program is a non-optional part of the curriculum, and the majority of students undertake this in rural settings across NSW.

"I went without food...": Food Insecurity and the Impact of Rurality during University Student Placements

Dr Katherine Kent, Associate Professor Kelly Lambert & Dr Anne McMahon

Food insecurity, characterised by inadequate access to safe and nutritious food, is a pressing concern among university students. However, the extent of food insecurity student’s experience during their professional placements and the impact of placement rurality on this issue remain understudied.

Rural generalism - case studies of what this means

Associate Professor Rowena Ivers

A Rural Generalist medical practitioner is a General Practitioner who has specific expertise in providing medical care for rural and remote or isolated communities. Rural generalists  provide safe primary, secondary and emergency care, culturally engaged Aboriginal and Torres Strait Islander peoples’ health and also provide a community or public health approach. Rural Generalist GPs also provide specialised medical care in one or more disciplines. Non GP specialists can also provide Generalist care, particularly in rural areas.

The UOW Graduate School of Medicine aims to support development of rural workforce, including via rural generalism, and as such, curriculum should reflect this.

Friday, 15 March, 2024

Unveiling Indigenous Health Insights: Master Students' Major Projects

Monica Bridge, Gary Field, Bronte Haynes, Claudia Marshall & Anita Penny

The Masters of Indigenous Health (MIH) is a relatively new course, with 2023 being the first year of graduates. Five students completed the program and completed a 24 credit point research project as their final assessable task. Students' experiences indicate that the collective nature of Indigenous research and methodologies has contributed to a more collaborative learning environment. Participants will gain invaluable insights into diverse projects and the melding of Indigenous and Western knowledge. There is a strong rural theme and learnings in each of the MIH research projects. Each project has been developed with Community and focused on addressing contemporary Indigenous health challenges.

The workshop will be an interactive forum for participants to gain knowledge in regard to Indigenous methodologies and contemporary Indigenous Health issues.

1. Student Presentations: Engage with the students as they showcase their MIH research projects, sharing how they have applied their Indigenous approaches to methodology, findings, and implications for healthcare policy developments and further research.
2. Panel Discussions: Participate in an enlightening discussions with MIH students, where you will be able to explore the projects, methodologies, and potential future directions. Students will also share their insights into the learning they have experienced in an innovative MIH program and how this has impacted their knowing, doing and being.
3. Networking Opportunities: Connect with like-minded individuals, fostering collaboration and idea sharing to support future studies and research in the area of Indigenous health.

Workshop aims: The aims of the workshop "Unveiling Indigenous Health Insights: Master Students' Major Projects" is to create a forum for Master of Indigenous Health students to share and disseminate their research findings and outcomes, and to fostering a deeper understanding of Indigenous health issues. Through this workshop, seek to promote collaboration, knowledge exchange, and awareness of the the impact of undertaking a Master of Research program on their way of knowing, doing as being as a person. Ultimately, the workshop aims to encourage participants to consider how they undertake research with and for Community.

Saturday, 16 March, 2024

Rural Healthcare providers’ perspectives on opioid management in people with chronic, noncancer pain

Dr Margaret Jordan

Higher rates of long-term opioid prescribing for people with chronic noncancer pain (CNCP) have been observed in Australian rural areas compared to metropolitan.[1] The aim of this study was to explore the barriers and enablers of opioid review and deprescribing by investigating how rural GPs currently manage patients prescribed long-term opioids for CNCP and how pharmacists and practice nurses (PNs) assist GPs in that management.   

Rural/urban inequity in prescribing and laboratory tests for patients with type 2 diabetes in New Zealand

Associate Professor Lynne Chepulis

Type 2 diabetes (T2D) affects ~300,000 people in Aotearoa including a disproportionate number of Maori and Pacific. However, whilst inequity in T2D has been previously evaluated by ethnicity the impact of rurality has been largely ignored.

What are the preferences of people with chronic kidney disease regarding digital lifestyle interventions?

Thai Binh Tran

Rural communities have higher incidence of kidney failure and rates of chronic kidney disease (CKD) related mortality. A healthy lifestyle is key to attenuate disease progression and optimise health outcomes. However, access to lifestyle services is limited due to shortage of allied health providers and consumers' geographic distance from health facilities. Digital interventions may be useful to increase access to services. Currently, consumers' perspectives regarding digital lifestyle interventions are unknown which may limit the capacity to develop interventions that align with consumers' needs and goals. Therefore, the following study aimed to synthesise the perspectives of people with CKD regarding digital interventions that promote a healthy lifestyle.

Time is Brain, so we must BEFAST: Improving stroke identification and triage in a rural ED

Donna Jay

Treatment for stroke is time critical. Upon patient presentation at an Emergency Department (ED), missed identification and appropriate categorisation of stroke patients results in longer waiting times, delays in treatment, and in some cases potentially irreversible damage. Traditionally, patients have been assessed for stroke using the FAST tool (Face, Arm, Speech, Time/Test). However, research showed that many FAST applications were negative for true strokes or gave a false positive. Consequently, there has been emerging use of a modified tool known as BEFAST, which adds Balance and Eyes into assessment.

Shoalhaven District Memorial Hospital is a rural (MM3) secondary hospital which is over an hour’s drive from the nearest tertiary centre. This study aimed to pilot BEFAST at this rural ED, and determine whether usage improved timely stroke detection and patient outcomes.

Survivorship needs of patients with head and neck cancer in regional/remote areas

Dr Poorva Pradhan

Survivors of head and neck cancer (HNC) have unique and complex needs compared to other cancer types. This is due to the anatomical complexity of the head and neck region, and the effect of treatment on essential functions such as swallowing and speech. Little is known about survivorship experiences of HNC survivors residing in regional/remote areas. The current study aims to explore the survivorship needs of patients residing in regional/remote areas with HNC.

Implementation and Prospective Evaluation of the Country Heart Attack Prevention Model of Care to Improve Attendance and Completion of Cardiac Rehabilitation for Patients with Cardiovascular Diseases Living in Rural Australia

Professor Robyn Clark

Cardiac rehabilitation (CR) utilisation remains low despite high-level evidence of mortality and morbidity reduction. We aimed to evaluate the clinical, economic and implementation outcomes of the CHAP model of care in rural Australia. 

Using geospatial telehealth utilisation data to guide service planning for rural consumers

Dr Kimberley Davis (on behalf of Sue-Ellen Hogg)

Telehealth benefits such as improved access to health care, reduced travel and wait times, improved patient experience and positive health outcomes are well documented.  Telehealth uptake grew rapidly due to the COVID-19 pandemic, with speech pathology an early adopter. As the service looked to cement telehealth into future service planning, the need to understand who was and wasn’t taking up this mode of care, as well as identifying potential barriers to equitable access, became apparent.

This study aimed to investigate the utilisation of telehealth as a mode of service delivery in speech pathology services across a regional-rural district of NSW.

The effect of a text message program on reducing overweight and obesity in Cardiac Rehabilitation

Rachael Turner

In Australia, coronary heart disease (CHD) is the leading chronic disease in males and females. Cardiac rehabilitation programs (CRPs) have been shown to reduce morbidity, mortality and recurrent cardiac events, plus improve cardiac risk factors and enhance quality of life.

Increasing trends for overweight and obesity had been observed in the Shoalhaven CRP. This study aimed to evaluate the acceptability and feasibility of a text message program (TEXT4HealthyHeart) on reducing overweight and obesity for SCRP consumers, and assessed its preliminary effect on a range of health measures.

Enhancing Engagement with Steering Straight: Text-Based Mental Health Care Among Australian Farmers

Brittany Doolan

Australian farmers experience higher rates of mental ill-health compared to the general population, yet their access to face-to-face mental health care is limited. Steering Straight: My Plan to Keep on Track (Steering Straight) was designed as a

preventative resource that encourages farmers to prioritise their mental wellbeing. However, sustained engagement during pilot testing was relatively low, potentially limiting its longterm effectiveness. This study explored whether text-based reminders improved engagement with Steering Straight and examined potential facilitators and barriers to long-term use.

The Neutactic Stereotactic System: A Novel Solution for Image-guided Stereotactic Surgery

Dr Elette Engels

Stereotactic systems are used in many intracranial surgical procedures such as laser ablation, neurostimulation, deep brain stimulation for Parkinson's disease treatment, brain biopsy, and brain cyst aspiration. Traditionally, the intracranial stereotactic procedure involves fixing a large metal frame directly to the patient's skull with screws or pins. The Neutactic device is palm-sized, CT and MRI compatible, light-weight, simpler to use, and far less invasive. This device is attached via suture to the skin surface and remains in place following imaging for immediate surgical intervention.

This work evaluates the accuracy of the Neutactic system with CT and MRI, and assesses the compatibility of the device for preclinical and clinical use. 

Saturday, 16 March, 2024

Perceptions of rural doctors in south-eastern NSW on the impacts of extreme weather on rural health

Mirella Carr

Extreme weather events have a well-known burden to health in Australia’s rural regions. Impacts can be direct, such as heat-related illness, or indirect, such as overwhelmed healthcare services. Less is known about the impact on healthcare provision, or healthcare provider attitudes to these events. This study explores the key observations and concerns of rural general practitioners in south-eastern NSW regarding the local healthcare-related impacts of extreme weather. This report is underscored by recent recurrent extreme weather in south-eastern NSW and projections that these events will worsen in the future.

Lifestyle and job satisfaction, mutually exclusive in rural and remote settings?

Rebecca Bosworth

The recruitment and retention of nurses and midwives (NM) in regional, rural and remote (RRR) settings are ongoing challenges that adversely impact optimal healthcare delivery. Using Bourdieu's theory of capital as a framework, this review explores the sources of motivation and challenges influencing the work and life experiences of NMs in these settings. The goal is to enhance integration, resilience and quality of life of NMs in RRR settings to enable them to continue their vital role.

Using an Under-utilised Rural Hospital to Reduce Surgical Waiting Lists

Associate Professor Steve Craig

The COVID-19 pandemic exacerbated existing surgical backlogs in public hospitals throughout Australia. It is more pronounced in rural areas, where centralisation of surgical services has led to a gradual decline of surgical departments and a reduced capacity to address waitlist problems.

One strategy to alleviate this has been to maximise use of same-day surgery. This study aimed to pilot a programme introducing specialist, day-surgery services at a rural (MM4) hospital with a single, unutilised operating theatre.

'A country practice' - what can rural towns do to recruit and retain rural medical workforce?

Associate Professor Rowena Ivers, Diane Harland & Katrina De Marco

Australia has unmet workforce needs for health care in rural areas. The literature describes factors that increase retention of rural medical workforce, including rural original, rural education and having a partner who has rural origin. Many programs focus on incentives to support doctors in working in rural and remote environments, however few resources are available to support rural towns wishing to recruit and retain medical workforce.

The Australian health workforce: disproportionate shortfalls in small rural towns

Dr Colin Cortie

The shortfall in the health workforce of rural and remote Australia may be due differences in demographic and workplace factors. The aim of this work was to examine these factors for doctors, nurses and midwives, and allied health professionals across Modified Monash (MM) regions and identify which factors are associated with shortfalls in the healthcare workforce.

The Rural Gap: Undergraduate nursing student-led career events for high school students

Kelly Lewer, Katherine Riley & Rebecca Bosworth

Developing a sustainable rural nursing workforce demands innovative recruitment tactics such as career days that showcase the dynamic aspects of rural healthcare. These initiatives effectively engage aspiring nurses, highlighting the significance and rewards of rural nursing careers. By fostering interest early on, undergraduate nursing students could play a pivotal role in inspiring high school students to consider nursing as a career. This poster presentation will report on a scoping review that explored the role of nursing undergraduates as leaders in the promotion of nursing as a career pathway and the rural gap that requires further attention.

Exploration of Older South Australians' Perspectives on Shared Decision Making in rural GPs

Dr Mohammad Hamiduzzaman  

SDM (Shared Decision-Making) implementation is a priority for Australian health systems, including General Practices (GPs). SDM implementation in GPs is often complex, especially for groups like older adults, due to clinical and socio-behavioural risk factors associated with it. Living in rural and remote areas can further complicate these factors. However, knowledge is limited about this dynamic from the perspectives of older rural Australians. Our study explores the quality of older rural South Australians' involvement in SDM and identifies barriers to SDM implementation in rural GPs.

Proximity to Services: The Implications for Chronic Pain Outcomes

Dr Brigitte Phillips

This presentation outlines the work undertaken by ePPOC in relation to measuring outcomes of chronic pain patients, and the impact of their distance to the treating pain service. ePPOC has been collecting chronic pain outcomes data since 2014, across Australia and New Zealand.

Mental Health, trauma and First responders in rural Australia: A scoping Review

Dr Rikki Jones

Exposure to traumatic and/or violent events is an inherent part of the role which can have a profound effect on the mental health of first responders. For first responders, attending to life and death situations is a daily reality, and exposure to traumatic events considered a significant part of their role. Frequent exposure to such traumatic and stressful situations can result in an accumulative impact putting first responders at risk of developing mental health problems such as increased anxiety and depression, post-traumatic stress disorders (PTSD), panic disorders, substance use, and suicide. Mental health issues for first responders are significant, complex, and multifaceted. 

Saturday, 16 March, 2024 

What can Aboriginal Community Controlled Health Services do to reduce re-incarceration?

Associate Professor Rowena Ivers & Josie Atkinson

Aboriginal Community Controlled Health Services - as organisation that are managed by community - in preventing the high rates of incarceration that occur as a flow-on effect from history of colonisation and dispossession.

Addressing food insecurity: Mapping and survey of community and commercial urban agriculture initiatives across the Illawarra Shoalhaven region of New South Wales

Suzy Pickles

As the global population continues to expand and urbanise, growing food in and around our cities brings a range of health, sustainability, and equity benefits to people and the planet. Despite favourable conditions for growing food and a network of growers in the Illawarra Shoalhaven region operating successfully within a largely fragmented landscape, there is no research that maps and understands the nature of urban agriculture initiatives. This research provides a situational analysis of commercial and community urban agriculture initiatives in Wollongong, Shellharbour, Kiama, and Shoalhaven Local Government Areas (LGAs). 

Assessment of healthiness of food outlets in Shellharbour and Shoalhaven Local Government Areas

Alemayehu Gebremariam

A modifiable factor contributing to unfavourable health outcomes is poor diet, which is highly influenced by the availability and accessibility of food outlets. Comparing rural and urban regions can identify and address disparities in food outlet density and healthiness to inform effective policy-making and improved public health outcomes. Therefore, the purpose this study was to assess the ratio of healthy to unhealthy food outlets in Shellharbour and Shoalhaven Local Government Areas (LGAs).

Donor-site morbidity following radial free flap reconstruction for head and neck surgical patients: An observational study

Dr Kimberley Davis (on behalf of Dr Brendon Tan)

Head and neck cancer (HNC) is the seventh most commonly-diagnosed cancer in Australia, with over 90% being squamous cell carcinoma (SCC). Surgical reconstruction for HNC using a radial forearm free flap (RFFF) allows surgeons to autotransplant vascularised tissue to repair large and complex defects.

This study aimed to investigate inpatient postoperative donor-site morbidity, cosmesis, and functional outcomes following RFFF reconstruction for HNC, evaluating differences according to patient remoteness.

Understanding the issues related to housing for Aboriginal people living on the far south coast

Associate Professor Maria Mackay

The research outlined in this presentation is a collaboration between UOW and Katungul Aboriginal Corporation Regional Health and Community Services that aimed to identify with local Community the strengths and limitations of the current housing status for Aboriginal people on the far south coast of Australia. Adequate housing is defined as: “Houses of an acceptable standard have four working facilities (for washing people, clothes or bedding, for storing/ preparing food, and a working sewerage system) and no more than two major structural problems.” Within National Closing the Gap (GTG), Target 9 espouses that 88 per cent of Aboriginal and Torres Strait Islander people will live in appropriate housing that is not overcrowded by 2031 and will contribute to closing the inequitable health gap. Current issues identified for Aboriginal peoples include homelessness, overcrowding, and a lack of suitability and availability.

Community consultation regarding health and wellbeing needs and services in the Shoalhaven area

Associate Professor Sue Thomas

The Shoalhaven has higher mental health, social and chronic health needs compared to NSW overall, with some problems continuing to rise annually. Further identified issues include a lack of mental health services, affordability, transport, lack of culturally welcoming spaces for marginalised groups and low coordination between services. Missing from the literature are strategies to address these gaps, particularly what the Shoalhaven community would like to see in their health services.

Suicide prevention 'gatekeeper' training in rural and regional communities

Dr Nicole Reilly

In the suicide prevention context, the term ‘gatekeeper’ is used to describe individuals who may incidentally encounter people at risk of suicide. Gatekeeper training programs aim to equip these individuals with knowledge, skills and strategies required to better recognise suicide risk and to respond in appropriate ways.  In this study, we examined immediate and longer-term effectiveness of ‘gatekeeper’ training for trainees from rural and regional communities across the Illawarra and Shoalhaven regions.

Using Arts-Based Methods to Understand Aboriginal Connection to Water

Bronte Haynes

Drowning rates among Australian Aboriginal people are alarmingly high (Pidgeon & Nimmo, 2019). This study, conducted by an Indigenous health master’s student at the University of Wollongong in collaboration with the Royal Life Saving Society Australia (RLSSA), delves into the intricate relationship between Indigenous communities and water. Its goal is to inform RLSSA’s efforts in water safety promotion. Employing arts-based methods, community mapping and yarning as a research approach this study specifically explores this connection in a remote community in Far West NSW.

The primary objective of the project is to comprehend the significance of water to the health, safety, and wellbeing of Aboriginal communities, particularly in relation to water-related behaviours. The research aids RLSSA in developing culturally sensitive water safety campaigns that consider social and cultural determinants, such as land connection and Indigenous knowledge, for innovative injury prevention strategies.