Aboriginal Health Practitioners obtaining, possessing and administering fluoride varnish: self-determination driven regulation amendment for integrated oral health care for Aboriginal children.

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation - The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children.

Centralized Intake Models and Recommendations for Their Use in Non-Acute Mental Health Services: A Scoping Review.

Centralized intake [CI] or single-entry models are utilized in health systems to facilitate service access by reducing waiting times. This scoping review aims to consolidate the Literature on CI service models to identify their characteristics and rationales for their use, as well as contexts in which they are used and challenges and benefits in implementing them. The review also aims to offer some lessons learned from the Literature and to make recommendations for its implementation in non-acute mental health services. The findings show that CI is mostly considered when there is increased demand for services and clients are required to navigate multiple services that operate individually. Successful models have meaningfully engaged all stakeholders from the outset and the telephone is the most common mode of intake. Recommendations are made for planning and preparation, for elements of the model, and for setting up the service network. When successfully implemented, CI has been shown to improve access and increase demand for services. However, if CI is not supported by a network of service providers who offer care that is acceptable to clients, the purpose of its implementation could be lost.

The victims, villains and heroes of 'panic buying': News media attribution of responsibility for COVID-19 stockpiling.

Societies often respond to a crisis by attributing blame to some groups while constructing others as victims and heroes. While it has received scant sociological attention, 'panic buying' is a critical indicator of such public sentiment at the onset of a crisis, and thus a crucial site for analysis. This article traces dynamics of blame in news media representations of an extreme period of panic buying during COVID-19 in Australia. Analysis reveals that lower socio-economic and ethnically diverse consumers were blamed disproportionately. Unlike wealthier consumers who bulk-bought online, shoppers filling trollies in-store were depicted as selfish and shameful, described using dehumanising language, and portrayed as 'villains' who threatened social order. Supermarkets were cast simultaneously as 'victims' of consumer aggression and 'heroes' for their moral leadership, trustworthiness and problem-solving. This portrayal misunderstands the socio-emotional drivers of panic buying, exacerbates stigma towards already disadvantaged groups, and veils the corporate profiteering that encourages stockpiling.

The Power in Rural Place Stigma.

The phenomenon and implications of stigma have been recognized across many contexts and in relation to many discrete issues or conditions. The notion of spatial stigma has been developed within stigma literature, although the importance and relevance of spatial stigma for rural places and rural people have been largely neglected. This is the case even within fields of inquiry like public and rural health, which are expansively tasked with addressing the socio-structural drivers of health inequalities. In this paper, we argue that developing a better understanding of rural place stigma is critical for addressing contemporary patterns of spatial injustice and health inequalities affecting rural communities globally. Drawing on international literature and examples from the reported experiences of rurally living Australians and news and other media, we present an analysis highlighting the power in rural place stigma. In doing so, we build a case for the relevance and importance of interrogating rural place stigma, especially in the fields of public and rural health, for changing the conditions within-and the broader positioning of-the rural in the public and political landscapes.

Hype, evidence gaps and digital divides: Telehealth blind spots in rural Australia.

Despite high unmet demand for health services across rural Australia, uptake of telehealth has been slow, piecemeal and ad hoc. We argue that widespread failure to understand telehealth as a socio-technical practice is key to understanding this slow progress. To develop this argument, we explore how technocentric approaches to telehealth have contributed to critical blind spots. First, the 'hype' associated with the technological possibilities of telehealth discourages thoughtful consideration of the unanticipated consequences when technologies are rolled out into complex social fields. Second, it contributes to critical gaps in the telehealth evidence base, and particularly a paucity of analyses focussing on the experiences of service users and patients. A third blind spot concerns the limited attention paid to the social determinants of health and digital divides in rural areas. The final blind spot we consider is an apparent reluctance to engage community stakeholders in co-designing and coproducing telehealth services. We used an iterative approach to identify studies and commentary from a range of academic fields to explain the significance of the telehealth blind spots and how they might be addressed. Insights suggest how expanding understanding of the social dimensions of telehealth could enhance its accessibility, effectiveness and responsiveness to community needs and contexts.

Using Mobile Phone Apps to Deliver Rural General Practitioner Services: Critical Review Using the Walkthrough Method.

BACKGROUND: The widespread use of mobile phones represents new frontiers for improving access to health care. This includes using mobile apps to deliver general practitioner (GP) services in rural areas. However, the wider adoption of apps for increasing access to rural GP services relies on understanding how they might intersect with the rural health system context. OBJECTIVE: This research aims to critically review mobile apps for delivering GP services in a rural health service context using the walkthrough method. METHODS: The sample comprised 3 GP service apps under the top 100 list in the medical category in the Apple App Store (also available via the Google Play Store) in Australia as of June 2020. The walkthrough method was applied to extract data and critique the explicit factors, such as the app interface elements, and implicit factors, such as the embedded cultural features related to use for people in rural settings. Data analysis was undertaken between 3 researchers over 6 months applying the walkthrough method and using critical reflection. RESULTS: There were 3 main themes: improving rural access, addressing rural health care needs, and providing quality of care. App-based GP services may improve rural GP service availability. However, this may be at a relatively superficial level that does not encompass the scope and intensity of the services needed in rural areas (including relevant chronic and emergency care) at a cost that rural patients can afford. The apps showed signs of limited tailoring to the cultural dimensions of rural health care as a barrier to rural use. Patients generally self-selected to use GP service apps with limited support, potentially leading to inappropriate uptake especially by disadvantaged groups with lower health literacy. Although the apps claimed to avail most GP services (70%-80% in some cases), it emerged after enrollment that emergency, complex, and serious conditions might be excluded, potentially imposing more complex caseloads on in-person rural GPs. Apps provided limited information about continuity and coordination of care and sharing information with rural GPs, potentially leading to fragmented and low-quality care. There was commonly no assurance of rural skills and experience of physicians staffing apps despite the wider scope of skills needed to be effective in rural general practice. CONCLUSIONS: GP apps may increase the availability of GP services, but they may require clearer exclusions, appropriate use through decision-making tools, more rural-tailored interfaces, and capacity to align appointment times and costs with patients with complex needs to engage and be useful in a rural context. It is also important to consider how these app-based services could share information with local health care staff for safety and continuity of rural primary care. Finally, information about the physicians' rural training and experience is critical for quality.

The impact of telehealth on patient attendance and revenue within an Aboriginal Community Controlled Health Organisation during COVID-19.

BACKGROUND AND OBJECTIVES: Aboriginal Community Controlled Health Organisations (ACCHOs) provide culturally appropriate medical services to Aboriginal and/or Torres Strait Islander people. The aim of this study was to examine the impact of telehealth on patient attendance and revenue within an ACCHO during COVID-19. METHOD: This is a time-series study of general practitioner attendances at a regional Victorian ACCHO in two periods: March-June 2019 (pre-COVID-19) and March-June 2020 (during COVID-19). RESULTS: After adjusting for the number of available appointments, there was a 27% increased rate of attendances per appointment slot during the COVID-19 period when compared with the pre-COVID-19 period, and a 59% increase in Medicare Benefits Schedule items claimed during the COVID-19 period, compared with the pre-COVID-19 period. DISCUSSION: The findings indicate that the provision of services via telehealth increased the number of people able to access the medical clinic, and that this had a positive financial impact for the organisation.

How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation.

AIM: To develop theory about how contexts and mechanisms interact to contribute to openness to future rural practice by medical students undertaking immersive rural training. METHODS: A realist evaluation based on RAMESES II protocol. We interviewed 23 students exploring Contexts (C) which were external (place-based) and internal (the student's characteristics), Mechanisms (M) (that drive a response) and Outcomes (O) (openness to rural work). RESULTS: 'Openness to rural work' related to: a desire to live rurally, work in rural medicine, or consider this as a possibility. This was triggered by responses to experience in rural places of an aspirational, intellectual and emotional nature (mechanisms). Students most affected were those with a strong motivation to help others and who value teamwork. Students with clearly envisaged career paths suited to metropolitan areas, or those retaining/prioritising strong social and community ties in metropolitan areas were less likely to commit to future rural work. CONCLUSION: Our theory indicates multi-level stimuli activates openness. Implications are that rural immersion programs could select students with an orientation towards teamwork, without pre-set professional ideation, and with a strong commitment to helping others. Experiencing rural immersion will trigger aspirational, intellectual and emotional responses leading to rural work openness for such students.

Mobile Health Apps That Help With COVID-19 Management: Scoping Review.

BACKGROUND: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. OBJECTIVE: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country's name as keywords and "coronavirus," "COVID-19," "nCOV19," "contact tracing," "information providing apps," "symptom tracking," "mobile apps," "mobile applications," "smartphone," "mobile phone," and "mHealth." Countries most affected by COVID-19 and those that first rolled out COVID-19-related apps were included. RESULTS: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. CONCLUSIONS: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic.

An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study.

BACKGROUND: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. In particular rural over regional GP placements are important for developing future GPs with broader skills because the rural scope of practice is wider. Having enough GP supervisors in smaller rural communities is essential such training. We aimed to explore what makes rural GPs' based outside of major regional centres, participate in supervising or not, their experiences of supervising, and impact of their practice context. METHODS: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania (outside of major regions - Hobart and Launceston), in towns of < 25,000 population, to explore the GPs' professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. RESULTS: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors impacted the decision to participate in supervision and the experience of participating: including uncertainty and discontinuity of registrar supply (rotational training systems), registrar competence and generating income. CONCLUSIONS: Supervising is strongly positive for rural GPs and related to job satisfaction but increasing supervision capacity in rural areas may depend on better policies to assure continuity of rural registrars as well as policies and systems that enable viable supervision models tailored to the context.

Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare.

Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socio-economic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemic-related healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.

COVID-19-Extending Surveillance and the Panopticon.

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault's (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review.

BACKGROUND: The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. METHODS: The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders. DISCUSSION: This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

'It's so rich, you know, what they could be experiencing': rural places for general practitioner learning.

Globally there is an urban/rural divide in relation to health and healthcare access. A key strategy for addressing general practitioner shortages in rural areas is GP vocational training in rural places, as this may aid in developing practitioners' scope, values and community orientation, and increase propensity for rural practice. This creates a need for deeper understanding of the nature and quality of this training. Rural GPs are well-positioned to reflect on vocational learning in 'place'. We aimed to explore rural GPs' perceptions and experiences of GP vocational learning in relation to rural places. Semi-structured interviews were conducted with 25 GPs based in smaller rural communities in Tasmania. Inductive and theoretical thematic analysis was undertaken. Rural places provide learning opportunities for GP registrars, which shape the relationships between GPs and registrars and their communities. Rural GPs are committed to developing the next generation and improving access to primary care for their communities. Rural places provide unique learning environments for general practice, including rich learning, relationships and community commitment.

Factors related to rural general practitioners supervising general practice registrars in Australia: A national cross-sectional study.

BACKGROUND AND OBJECTIVES: General practice training in Australia is uniquely structured to allow half of all registrars to train in rural areas, in order to increase rural workforce development and access to rural primary care. There is, however, limited national-scale information about rural general practice supervisors who underpin the capacity for rural general practice training. The objective of this research was to explore the factors related to rural general practitioners (GPs) supervising general practice registrars. METHOD: Results were obtained using multivariate analysis of the 2016 Medicine in Australia: Balancing Employment and Life survey data. RESULTS: Overall, 57.8% of rural GPs were supervising registrars. Supervising was strongly related to being Australian-trained, working in a larger practice, and supervising medical students and interns. DISCUSSION: Rural supervising capacity could be increased through supporting GPs in smaller practices to engage in supervision and maintaining the strong involvement of GPs in larger practices. Other important factors may include a greater number of Australian-trained graduates working in rural general practice and increased support for international medical graduates to Fellow and feel confident to supervise.

Men's weight loss stories: How personal confession, responsibility and transformation work as social control.

Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men's weight loss stories in a popular men's magazine. Between January 2009 and December 2012, we collected 47 men's weight loss stories from the Australian edition of Men's Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men's self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.

Obese people's perceptions of the thin ideal.

The media play a key role in promoting the thin ideal. A qualitative study, in which we used in depth interviews and thematic analysis, was undertaken to explore the attitudes of 142 obese individuals toward media portrayals of the thin ideal. Participants discussed the thin ideal as a social norm that is also supported through the exclusion of positive media portrayals of obese people. They perceived the thin ideal as an 'unhealthy' mode of social control, reflecting on their personal experiences and their concerns for others. Participants' perceptions highlighted the intersections between the thin ideal and gender, grooming and consumerism. Participants' personal responses to the thin ideal were nuanced--some were in support of the thin ideal and some were able to critically reflect and reject the thin ideal. We consider how the thin ideal may act as a form of synoptical social control, working in tandem with wider public health panoptical surveillance of body weight.

"At 150†kg, you can't run" men's weight loss stories in a popular health magazine provide appropriate examples of good health practice.

We explore weight loss stories from 47 men collected from the Australian edition of Men's Health magazine between January 2009 and December 2012. Our analysis uses a mixed methods approach that combines thematic analysis and descriptive statistics to examine weight loss strategies against clinical practice guidelines for the management of overweight and obesity. All the stories reported the use of physical activity for weight loss and most stories detailed dietary changes for weight loss. Our findings indicate that most of the men reportedly used some form of behavioural strategies to assist them in their behaviour change efforts. The weight loss methods used were consistent with clinical practice guidelines, with the exception of some dietary practices. As narratives may assist with behaviour change, stories like those examined in this study could prove to be very useful in promoting weight loss to men.

Online dating and mating: the use of the internet to meet sexual partners.

Australia has experienced a large increase in Internet usage, and online dating is used for seeking romantic and sexual partners. Using a qualitative approach, 15 people who use online dating took part in in-depth, online chat interviews. Nearly all participants used multiple dating sites to seek partners and making use of email, chat and webcam to engage with, assess, validate and qualify their potential sexual partners. They would "filter" the identity of other online daters before taking further actions. They used an array of filters and filtering processes to determine when and how they might progress to face-to-face meetings with these other online daters, and if and how there might be sexual outcomes from these meetings. Participants filtered using the text, photographs, chat, and webcam opportunities available online, and followed progressive personalized steps in communication and engagement in the lead-up to meeting other online daters in person.