A 2018 report analysed projections in population, health status and health workforce trends in rural and remote Australia, to determine the health status, health service needs and gaps in services over the next decade. Cancer, mental health and cardiovascular disease are predicted to be the most prevalent health concerns over this period, with those in rural and remote areas expected to be most impacted.

The report also found, over the next decade, there will be significant shortages of essential health services in rural and remote Australia. For example, in 2028, projections demonstrate there will be less than one-fifth of the number of general practitioners (GPs) in remote as compared to metropolitan areas (43 as compared to 255 per 100,000 population respectively); just one-twelfth of the number of physiotherapists (23 as compared to 276 per 100,000 population); and half the number of pharmacists (52 as compared to 113 per 100,000 population).

In addition, a follow-up report released in 2020 sought to specifically demonstrate the inequities in access to primary healthcare services currently experienced by those in rural and remote areas.

In the rural and remote context, where there are small populations spread across large geographical areas, it may not be realistic or practical for everyone to have access to permanent local services. However, the Australian Institute of Health and Welfare proposes that all Australians should have reasonable access to services, which it defines to be access within a 60-minute drive time.

It was found that 42,805 people had no access to any place-based primary healthcare services within this 60-minute drive time. Furthermore, when looking at the specific primary healthcare type, it was found that 65,050 Australians had no face-to-face access to a GP; 440,387 had no access to a nurse-led clinic; 142,269 had no access to dental services; and 106,848 had no access to mental health services within a 60-minute drive time.

These reports show that the greater the distance from city centres, the greater the disparity remote Australians face in access to health care, education and facilities. Acknowledging the tyranny of distance as a hurdle in healthcare provision to remote Australians, the presentation will explore the need for further research and collaborations to agree a definition of what is ‘reasonable’ access to health care for rural and remote Australians and how, through innovative service models, we can better ensure equity of access to services.

The past twenty years has seen a dramatic increase in research into the effects of arts and cultural engagement on the health and wellbeing of individuals and communities (Fancourt and Finn 2019: vii). The Creative Health Inquiry Report (APPGAHW 2017) and the ArtPlace America white paper Creating Healthy Communities (Sonke et al 2019) represent two significant recent efforts to assert the role of the arts in advancing health and wellbeing. Both reports advocate community-based and societal approaches to improving wellbeing through the arts, as opposed to individualised approaches.

In Australian communities, our research shows the value of arts and cultural engagement is in social bonding and bridging that allows individuals and communities to develop a ‘sense of connectedness, self-understanding and identity construction, as well as a sense of belonging with, or pride in, one’s community, defined by geography or people’ (Brown and Novak 2007 and 2013). Using outcomes from an Australian Council Research Project (2019–22) investigating the impact of arts and cultural engagement in regional Australian communities, this paper examines the connection between wellbeing and social inclusion through an arts lens.

Locating the examination of wellbeing and social inclusion in community-initiated projects in central-west Queensland, The Lost Art, and north-west Tasmania, Shorewell Presents … Dear Friend, the paper illustrates through these projects how creative and cultural activities maintain social connection and avoid potential social fragmentation. Additionally, the paper will discuss project responses to COVID-19 using both physical and virtual creative art-based engagement strategies in a crisis to entice continued participation and support wellbeing.

In April 2016, our local GP called a public meeting. Over one-third of the population came to hear of the difficulties she was facing as the only doctor in a town with a permanent population of roughly 1,000 people.

What we heard shocked us – the practice was facing closure as she was overworked and yet unable to make ends meet. To address these issues the Mallacoota Community Health Infrastructure and Resilience Fund Inc (CHIRF) was formed.

In 2018 CHIRF formed an alliance with the Remote Vocational Training Scheme (RVTS) and became the first town in a targeted-recruitment pilot strategy, to recruit, retain and train doctors to GP Fellowship in remote communities, via a supported model of remote supervision and distance education.

Adding the training program to the recruitment package enabled Mallacoota to find a new doctor who has been with us for three years now. Our doctor was the first of 14 who has been recruited to 18 of Australia’s hardest to fill locations, including six remote Aboriginal Medical Services.

The RVTS targeted-recruitment model has brought a more stable workforce and enhanced continuity of care to the participating communities, as well as providing career progression to specialist qualifications for the recruited doctors. There have also been numerous spin-off effects for the community which have enabled Mallacoota to expand both facilities and services.

Results from the pilot have revealed that the linking of high-quality vocational training to a specific remote location is an effective strategy to recruit and retain doctors to rural, remote and First Nations communities with high medical workforce need. The strategy has been most effective in locations such as Mallacoota where on-ground community-driven support fosters collaboration between partnering organisations.

Encouraged by these initial findings, the Australian Government is now providing additional salary support funding to enhance the market competitiveness and business viability of participating practices.

The story of what happened in Mallacoota, and how this led to our facilities and services playing an integral role in the survival of the community during the bushfires, is an example of how close community involvement with the medical system can lead to positive outcomes.

Lessons have been learned and challenges remain but, as a remote community, we have become more acutely aware of the substantial gaps that still exist within the health system and the further opportunities that exist for these to be resolved.

There are 1.3 million Australians affected by ear disease, resulting in preventable hearing loss and communicative ability. Ear disease is very common in rural communities where rural community pharmacists are well-placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP).

The Locally Integrated Screening and Testing Ear and Aural Program (LISTEN UP) has been developed to apply an ear health intervention to the rural community pharmacy setting in Queensland, Australia, to improve management of ear disease. The aims are to evaluate:

1. the feasibility, potential effectiveness and acceptability of a community-pharmacy-based intervention for ear health
2. the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy
3. the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities.

A study protocol has been designed and developed to conduct a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. The intervention will initially be piloted for six weeks, followed by a 12-month impact study. Patients aged >6 months presenting to the participating pharmacies with an ear complaint will be invited to participate. Pharmacists will be trained to conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a GP if required, according to the study protocol, with same-day or next-day appointments available. At completion of the examination, patients will complete a satisfaction survey and receive a follow-up phone call at seven days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data.

This presentation will describe the study protocol and demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed.

Introduction: Rural residents face high rates of skin cancers and barriers to skin cancer care, including geographical distance, extended waiting times for service access and higher financial burdens. These issues can contribute to late diagnosis and poorer outcomes among rural patients.

A convergence of high consumer demand for skin cancer screening, long-term health workforce shortages and a group of passionate individuals led to a place-based, nurse-led, skin cancer care initiative in rural western Victoria. This study was undertaken to describe the elements of the initiative and map changes over time, from start-up to implementation and service delivery over three years, using a program logic model.

Methods: A longitudinal descriptive study, grounded in thematic approaches, is being employed to document elements of the skin cancer care initiative over time. Health service executive management, and clinical and ancillary staff, were invited to participate in interviews during the start-up phase of the initiative. Transcripts were thematically analysed independently by two researchers before comparison and refinement of themes. A program logic model was developed to organise themes into contextual elements, inputs, activities and anticipated outcomes, and will be used as a visual tool during discussions with key stakeholders. This program logic model will be refined during the implementation phase and again after three years of service delivery.

Findings: The skin cancer screening and care initiative is currently at the start-up phase. Seven interviews have been completed. Themes were mapped to the program logic model according to contextual elements (rural locale, health workforce shortages, historical late skin cancer diagnosis), key inputs (flexible and stable funding, systems support including referral pathways and clinical equipment, and human resources including appropriate nurse training and leadership) and activities (health promotion, local service delivery, treatment pathways). The anticipated outcomes identified include skin cancer care delivered locally, timely access, career development for nurses and, ultimately, decreased skin cancer burden.

Background and aims: Women in rural and remote areas may present to a hospital without a designated maternity service when birth is imminent. The Queensland Health Imminent Birth program for non-midwifery health professionals provides online theoretical education and a face-to-face workshop with simulation scenarios. Virtual reality offers an innovative way to deliver simulated learning experiences, bridging the issues of distance and timely attendance at face-to-face workshops. This pilot randomised controlled trial (RCT) aimed to examine the feasibility and effectiveness of an immersive virtual reality (IVR) simulation as an alternative to the Imminent Birth program’s face-to-face simulation workshop.

Methods: Twenty-three undergraduate health students were recruited to participate in the pilot RCT. All students were first invited to review and complete the online theoretical modules from the Queensland Health Imminent Birth program, after which they were randomly allocated to participate in either the existing face-to-face simulation (N=12) or an IVR simulation of the same scenario (N=11). Measures of knowledge retention, clinical reasoning and self-reported confidence in clinical practice were completed at three time points: prior to provision of theoretical modules, after completion of simulations and at two-week follow-up. The System Usability Scale (SUS) was also administered to the intervention group immediately following the completion of the IVR simulation to evaluate the usability and acceptability of the IVR equipment.

Results: Knowledge and clinical reasoning increased significantly for both intervention and control groups immediately after simulations, and these improvements were retained at two-week follow-up. Confidence followed a similar pattern and, although a significant decrease was observed in confidence scores for both groups between post-test and two-week follow-up, scores continued to remain considerably higher than at pre-test. The mean SUS score of 70.7 (SD=10.1) indicated that the IVR simulation was rated as ‘good’ by participants.

Conclusions: Findings from this pilot RCT indicate that IVR simulation is equally effective to the established face-to-face simulation in the Queensland Health Imminent Birth program in producing improvements in knowledge, clinical reasoning and confidence in practice. As such, IVR technologies may present an innovative solution for bridging concerns of distance experienced by rural health professionals. Moreover, use of IVR simulations with the addition of augmented reality may be a viable means of improving access to other forms of continuing professional development for health professionals practicing in rural and remote communities.

Background and aims: Indigenous people experience mortality at younger age than non-Indigenous Australians, largely due to chronic disease. The National Agreement on Closing the Gap seeks to overcome the entrenched inequality faced by many Aboriginal and Torres Strait Islander people so that their life outcomes are equal to all Australians. One initiative is the Medical Outreach Indigenous Chronic Disease Program (MOICDP). This program seeks to improve access to health services for Aboriginal and Torres Strait Islander people living with chronic disease.

The Marathon Health Indigenous Chronic Disease (ICD) Clinic in Bathurst provides multidisciplinary clinical services focused on diabetes, cancer and cardiovascular disease. This clinic regularly engages with ~200 people, however no formal evaluation has been implemented. The aim of this study was to commence the co-designed development of an evaluation framework for this clinic, by consulting key stakeholders to identify the variables, measures and the methods for collecting that information, and collate this for use in future evaluations and service design activities.

Method: A qualitative design was utilised. Interviews were conducted with Bathurst ICD Clinic staff members, service managers and representatives from the funding body (NSW Rural Doctors Network). Research participants were made aware of the process of developing the evaluation framework for the ICD Clinic and completed a semi-structured interview with the researcher. Participants’ interviews were recorded and transcribed. A thematic analysis was undertaken following Braun and Clarke’s (2006) six steps.

Results: Themes that emerged from the data included an extensive range of information that participants believed should be considered in the development of an evaluation framework for this ICD Clinic. This information included an extensive number of variables that fitted well with the program logic model (inputs, activities, outputs, outcomes and impact) and with domains of key frameworks, including the Ngaa-bi-nya evaluation framework, the Chronic Care for Aboriginal People model of care and the value-based health care frameworks.

Conclusion: This study is an important first step towards the development and implementation of a co-designed evaluation framework for the Bathurst ICD Clinic. The results of this study provide a collation of the information that some of the key stakeholders in this service believe is important to be collected and informs the methods that will be used to do this in future evaluation activities. The results of this study will be combined with other similar research to understand the views of the clinic users, local community and Elders.

Background: Drug issues can no longer be understood as big city problems. Drug use and related consequences impact all communities across Australia, including rural areas, while much of the capacity to address the issue is placed in the major population centres. Furthermore, there is a notable lack of locally tailored responses.

Mansfield Restart is a unique community-led drug rehabilitation intervention. It differs from existing approaches due to a high level of community engagement, evidenced by the diverse membership of the Community Steering Committee. Restart aims to reduce drug use and the effects of drug use and addiction on individuals, their families, friends and the broader community. The program operates from Mansfield District Hospital. Restart is delivered by a Registered Nurse Program Coordinator, and guided by key community stakeholders including GPs, local government, lawyers and police. Restart tackles the problem of drug use through multiple strategies including case management, treatment, rehabilitation, as well as prevention, and offers wraparound care. Restart has been evaluated through the use of program and survey data, and interviews with clients and key informants. This presentation explains the unique nature of Restart and reports on the evaluation.

Method: Integrated referral pathways, both into and out of the program, offers clients wraparound, holistic and person-centred treatment. An important and notable component of the extensive referral system is the multidisciplinary approach offered to clients. A crucial aspect of Restart is interprofessional collaboration, whereby professionals from distinct disciplines communicate and work effectively for the best patient outcome. Local medical, psychosocial, legal and law enforcement systems have come together, reflecting the many domains of life affected by drug problems. Individuals are referred into the program primarily from the community and from various medical pathways. Legal and law enforcement referrals also occur.

Results: During the three-year trial a total of 159 people contacted Restart and 107 people engaged by attending appointments. Alcohol, methamphetamine and cannabis are the main drugs used by Restart clients. Most clients have been classified as high-risk and complex. Of the clients who engaged with Restart, 17 per cent have maintained abstinence and fully recovered, while 44 per cent have indicated all or some of their goals have been achieved.

Conclusion: Restart has made significant impacts to our community, which emphasises the importance of locally tailored responses to addressing drug use.

‘The support I received was monumental and life-changing. When I was at my lowest point, this service was introduced and provided so much help.’

Background: Multiple international experts have called for the application of systems approaches to the prevention of complex problems. One such current project is Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-Communicable Disease (RESPOND). RESPOND is an NHMRC-funded project across 10 local government areas in north-east Victoria. Mansfield is one of these areas.

The rural town of Mansfield has a population of 8,584, with 970 (aged 0–9 years) children. Data collected in 2019, from 190 children in Years 2, 4 and 6 showed 21 per cent of boys and 24.5 per cent of girls were overweight or obese, and only 11 per cent of boys and 12 per cent of girls met their daily vegetable intake requirements.

This data mobilised the local community to explore what was working well and to identify additional opportunities to improve children’s health. This abstract presents a case study of this systems-thinking approach to children’s health in Mansfield.

Methods: Local facilitators were trained in the use of community-based system dynamics and led community workshops in late 2019 to construct a causal loop diagram (CLD) that explored the question: ‘What helps and what discourages our children to eat healthily and be physically active?’. From this CLD, community stakeholders identified factors and connections impacting the issue, and prioritised feasible solutions. Three community working groups were established: Social Connection, Food and Nutrition, and Physical Activity.

Results: To champion a systems approach to prevention, resources were mobilised to appoint a local champion at 0.2FTE to facilitate community-led change. An overarching finding of this work demonstrated enhanced efficiencies within the health promotion team through the reinvention of work models that facilitate rather than operationalise change. One initiative from each of the three working groups is presented.

The Social Connection working group co-designed the ‘Mansfield Resilience Project’ which supports local parents across a multitude of topics (on request) via an online education platform. The Food and Nutrition working group assisted the poor access to fresh fruit and vegetables through the establishment of the ‘Mansfield Fresh Food Drive’. To increase incidental activity, the Physical Activity working group co-designed an innovative ‘Active Footpath Project’ that adds value to existing infrastructure.

Discussion: Working with community stakeholders in the design and implementation of change efforts enhances local buy-in and sustainability. Importantly the experience of Mansfield has seen efficiency gains in resourcing health promotion that led to unique community-driven prevention programs.

Background: Family and domestic violence (FDV) is a serious public health issue with insidious physical, mental health, behavioural and social consequences; sadly, FDV is more prevalent in rural areas. The rate of assault by a family member in the Mid West and Gascoyne region from July 2019 to June 2020 was 36 per cent higher than that for regional Western Australia (WA) and more than twice the state average.

The National Plan to Prevent Violence Against Women and their Children recommends primary prevention initiatives that increase gender equality, with locally relevant interventions across all levels of the social ecology: individual and relationships; organisation and community; system and institutional; and societal.

Intervention research by the WA Centre for Rural Health (WACRH) is supporting Community, Respect and Equality (CRE), a plan for primary prevention of FDV in the City of Greater Geraldton. Speaking Out Against Disrespect is online bystander training that aims to build individuals’ skills and confidence to intervene in situations that demean or dismiss women by challenging sexist language and behaviour.

Findings: Between December 2020 and August 2021, the training was accessed by 600 individuals, predominantly females (78%) aged 18–39 years (77%). Of these, 62 per cent cent were students on placement in rural areas who completed the training entirely of their own volition. The remainder reported working for an organisation in or outside of the CRE. Immediately following the online training, shifts in skills were reported in:

• understanding of the link between disrespect, sexism and family violence (shift from 62% prior to 96% reporting good/very good understanding after the training)
• knowledge of appropriate things to do and say to challenge sexism and disrespect (shift from 45% prior to 94% reporting good/very good knowledge after the training)
• knowing how to take action when witnessing inappropriate, disrespectful and discriminatory behaviour (shift from 44% prior to 92% reporting good/very good skills after the training).

The presentation will report on a six-month follow-up survey to investigate:

• actual bystander action taken following the training (if any)
• reasons for taking or not taking action when witness to disrespect
• participants’ perceptions of community attitudes to bystander action
• differences between members of participating CRE organisations who completed the training and others who completed the training.

There is a need to support the development of and build the biomedical workforce capacity in regional and remote Australia. The Ramaciotti Regional and Remote Health Sciences Training Centre (Menzies-Ramaciotti Centre) was established to develop a sustainable, local and Aboriginal and Torres Strait Islander biomedical and health sciences workforce in the Northern Territory. The Centre facilitates biomedical and health sciences career progression for regional and remote youth. It was launched in February 2021 and has and is currently delivering a range of training programs to 35 youth and students, 25 of whom identify as Aboriginal and/or Torres Strait Islander. The Centre is uniquely positioned and co-led by Indigenous and non-Indigenous staff within the research sector in order to build innovative approaches to the ways in which training in delivered. This has included the advancement of a range of partnerships with a number of schools and other workforce providers across the Top End. It has centred the voices of youth and students in the governance of the Centre to support innovation and to identify what is necessary for success. This has also included adaptive education and training models to ensure the delivery of training services for those school leavers and students that may ordinarily experience additional barriers to these services. Here the co-leads report on the Menzies-Ramaciotti Centre, its current governance processes and provide some insights to the enablers of the Centre’s success to date.