Daniel Terry

The Socio-Economic and Physical Contributors to Food Insecurity in a Rural Community

Australia is considered a highly food-secure nation; however, this is not always the case for every individual, household, and community. This article examines the physical and financial access to food of the population of Dorset, a rural municipality in North East Tasmania (Australia); the impact that socio-economic factors have on their food security; and the coping strategies they use when food shortages occur. A mixed-methods approach was used: Quantitative data were collected through the Tasmanian Household Food Security Survey and qualitative data through nine community focus groups conducted throughout the Dorset municipality. A total of 364 respondents (response rate 63%) completed the survey. Two main themes were identified within the data: food availability and food access. Food availability considered food origin, sustainability, and food production, whereas food access considered physical access, financial access, and other access issues such as awareness, skills, cultural preferences, and social support. The data revealed the wide-ranging effects of the importation of cheaper food alternatives, which had long-term implications not only on individuals’ health but also on the economic health of the community. A number of respondents indicated they were at times unable to buy nutritious foods due to limited finances, which led some to go without food or use other strategies to feed themselves. This study highlights the inappropriateness of the continuation of individual behavior change as a policy focus, as many of the problems facing communities are beyond individual abilities. Thus, the implications for policy from this study are centered on providing further support for strategies that focus on ensuring equity and food security for all, particularly the rural inhabitants of many food-secure nations.

Women's access needs in maternity care in rural Tasmania, Australia: A mixed methods study

OBJECTIVES This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural womens challenges in accessing maternity services and (iii) rural womens access needs in maternity services. METHODS A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored womens views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. FINDINGS The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural womens access needs. CONCLUSION The study suggested that womens access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families.

Factors influencing community nursing roles and health service provision in rural areas: a review of literature

Aims: This review sought to better understand the issues and challenges experienced by community nurses working in rural areas and how these factors shape their role. Methods: Databases were searched to identify relevant studies, published between 1990 and 2015, that focussed on issues and challenges experienced by rural community nurses. Generic and grey literature relating to the subject was also searched. The search was systematically conducted multiple times to assure accuracy. Results: A total of 14 articles met the inclusion criteria. This critical review identified common issues impacting community nursing and included role definition, organisational change, human resource, workplace and geographic challenges. Conclusion: Community nurses are flexible, autonomous, able to adapt care to the service delivery setting, and have a diversity of knowledge and skills. Considerably more research is essential to identify factors that impact rural community nursing practice. In addition, greater advocacy is required to develop the role.

Workplace health and safety issues among community nurses: a study regarding the impact on providing care to rural consumers

Objectives The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers. Methods The study undertook a narrative inquiry underpinned by a phenomenological approach. Community nursing staff who worked exclusively in rural areas and employed in a permanent capacity were contacted among 13 of the 16 consenting healthcare services. All community nurses who expressed a desire to participate were interviewed. Data were collected using semistructured interviews with 15 community nurses in rural and remote communities. Thematic analysis was used to analyse interview data. Results The role, function and structures of community nursing services varied greatly from site to site and were developed and centred on meeting the needs of individual communities. In addition, a number of workplace health and safety challenges were identified and were centred on the geographical, physical and organisational environment that community nurses work across. The workplace health and safety challenges within these environments included driving large distances between client’s homes and their office which lead to working in isolation for long periods and without adequate communication. In addition, other issues included encountering, managing and developing strategies to deal with poor client and carer behaviour; working within and negotiating working environments such as the poor condition of patient homes and clients smoking; navigating animals in the workplace; vertical and horizontal violence; and issues around workload, burnout and work-related stress. Conclusions Many nurses achieved good outcomes to meet the needs of rural community health consumers. Managers were vital to ensure that service objectives were met. Despite the positive outcomes, many processes were considered unsafe by community nurses. It was identified that greater training and capacity building are required to meet the needs among all staff.

Moving forward with dignity: Exploring health awareness in an isolated Deaf community of Australia

BACKGROUND Those within the Deaf community are disadvantaged in a number of aspects of day-to-day life including their access to health care. At times, they may encounter barriers to health care even before they reach the consultation room. As a consequence, they may receive insufficient and inappropriate health care which may lead to poorer health outcomes. OBJECTIVE A study was conducted to explore health awareness and access to health information and services of Deaf people living in Tasmania, Australia and identify ways of enhancing the interaction between the Deaf and the wider community. METHODS A questionnaire was administered, including a number of demographic, health awareness and health service usage questions. In addition, semi-structured interviews and focus groups were conducted with service providers and the Deaf community between March and August 2014. An interpreter was present to translate the questions into Auslan and who then translated the Deaf participants discussion into English for the researcher. Data were then analyzed using research software SPSS v20.0 and NVivo 10.0. RESULTS Health as a concept was poorly understood, including mental health, sexual health and health concerning alcohol and drug abuse. Regarding health care resources, due to a sense of security, trust and confidence, the family physician or general practitioner was the single most important health care provider among the Deaf. CONCLUSIONS The Deaf remain underserved by the current health care system; however, through resourcefulness and life experiences, the Deaf have developed coping and management strategies to move forward with dignity in education, meaningful employment and health access.

Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health

Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.

Satisfaction amid professional challenges: International medical graduates in rural Tasmania.

BACKGROUND At the time of recruitment, migration, and placement, international medical graduates (IMGs) encounter professional challenges. These challenges may include a loss of status and professional identity, professional isolation in rural practice, restrictions on medical practice, and social isolation. Understanding the nature of these challenges may facilitate the recruitment, placement, and success of international medical graduates within rural Tasmania. AIMS The aim of this study was to investigate the experiences, challenges, and barriers that IMGs encounter as they work and live in rural Tasmania. METHODS The study used a mixed-methods design where data were collected using a questionnaire and semi-structured interviews across the south, north, and northwest of Tasmania. IMGs were recruited through purposive snowball and convenience sampling. RESULTS A total of 105 questionnaires were returned (response rate 30.0 per cent) and 23 semi-structured interviews were conducted with IMGs across Tasmania. Questionnaire participants indicated that the majority of IMGs are satisfied in their current employment; however, interview participants indicated there were a number of barriers to practising medicine in Tasmania as well as factors that would influence ongoing employment in the state. Despite these challenges, professional support was recognised as a key contributor to professional satisfaction, particularly among IMGs who had just arrived. CONCLUSION The study contributes to the current knowledge and understanding of IMGs who live and work in rural areas. The study shows that there are high levels of satisfaction among IMGs with their current position; however, the research also provides insight into the complexities and factors that impact IMGs as they work and live within rural areas such as Tasmania. This study offers an understanding for policy to improve greater retention of IMGs across rural areas.

Do Not "Let Them Eat Cake": Correlation of Food-Consumption Patterns among Rural Primary School Children from Welfare and Non-Welfare Households.

Physical and financial access impacts food choice and consumption, while educational attainment, employment, income, gender, and socioeconomic status are also influential. Within this context, the aim of the paper is to examine the association between various foods consumed and eating patterns of children between low and higher income households. A paper-based survey was completed by parents/carers of children in 41 primary schools in rural and regional areas of Victoria. Data collected included demographics and the consumption of fruit, vegetable, and other foods including drinks. Ordinal data were analysed using Spearman’s rank-order correlation. The main findings were that children who consumed more fruit and vegetables tended to have a higher intake of healthy drinks (plain milk and water) as well as a lower intake of unhealthy snacks and drinks (sugar sweetened drinks). Those who perceived that fruit and vegetables cost too much reported greater consumption of unhealthy snacks and sugar-sweetened beverages, which was more prominent in low-income households. Changing food consumption behaviours requires a complex systems-based approach that addresses more than just individual issues variables. A participatory approach that works with local communities and seeks to build an understanding of unique challenges within sub-groups has potential for embedding long-lasting and meaningful change in eating behaviours.

Challenges of working and living in a new cultural environment: A snapshot of international medical graduates in rural Tasmania

OBJECTIVES To highlight the experiences and challenges of international medical graduates (IMGs) living and working in rural and remote Tasmania, and how this informs their acculturation and retention in the state. DESIGN This paper reports the findings from the Tasmanian IMG questionnaire, which was administered both in hardcopy and online format to all known IMGs within the state. A total of 105 questionnaires were returned, representing a response rate of 30.0%. RESULTS IMGs were from the 30 countries and the majority were under 49 years of age, had migrated in the past 10 years, with over half having worked in the state for less than 2 years. Many IMGs indicated that they were satisfied with their current employment, the medical facilities, the friendliness of their patients and the friendliness of the community where they lived, and would like to stay much longer in Tasmania. CONCLUSIONS Many IMGs have previously lived and worked in rural areas and are reasonably satisfied with their current employment and lifestyle in Tasmania. However, the following factors play an important part in their views and attitudes: employment satisfaction, access to schools, employment for spouse or partner and access to cultural or religious foods and goods. Nevertheless, beyond employment satisfaction, employment itself, coupled with career pathway and training opportunities, were highlighted as contributory factors for leaving Tasmania.

The urban-rural divide: Hypertensive disease hospitalisations in Victoria 2010–2015

Background Hypertension is present in 23–32 per cent of Australians, making it one of the most prevalent diseases in the country. It is the greatest risk factor for cardiovascular disease, the leading cause of death in Australia and it affects rural populations at a higher rate than urban residents. Aims The aims of this study were to investigate the differences in hypertensive disease hospitalisations across rural and urban Victoria, and to determine predicting variables.