"You get exposed to a wider range of things and it can be challenging but very exciting at the same time": enablers of and barriers to transition to rural practice by allied health professionals in Australia.

BACKGROUND: There is consistent evidence highlighting the mal-distribution of the health workforce between urban and rural and remote regions. To date, addressing this mal-distribution has focused on medicine and nursing with limited initiatives targeted at allied health. Therefore, the aim of this research was to explore the enablers of and barriers to transition to rural practice by allied health professionals across South Australia in Australia. METHOD: Qualitative descriptive methodology was used to underpin this research. Individual, in-depth semi-structured interviews were conducted with employers, managers and allied health professionals from rural regions of South Australia who were identified using purposive maximum variation sampling strategy. RESULTS: A total 22 participants shared their perspectives on the enablers of and barriers to transition to rural practice by allied health professionals across South Australia. Thematic analysis of the interview data resulted in a number of key issues impacting transition to rural-based practice. These findings could be broadly categorised into three stages during the transition: 'before'; 'during' and 'after'. DISCUSSION: This study identified a range of enablers of and barriers to transition to rural practice by allied health professionals. Five overarching themes - nature of rural practice, exposure to rural 'taster', social/lifestyle, job availability/characteristics, and mentor and support were identified. In particular, exposure to rural 'taster', social/lifestyle, and mentor and support were the key themes reported by the stakeholders. The multifactorial nature of the barriers and enablers highlight the complexity underpinning how AHPs transition to rural-based practice. These barriers/ enablers are often inter-linked and continually evolving which pose significant challenges for health care stakeholders to successfully addressing these. CONCLUSION: This research sheds light on the complexities that confront and successful strategies that are required for health care stakeholders when considering how best to support allied health professional transition to rural practice.

A systematic review of the effectiveness of primary health education or intervention programs in improving rural women's knowledge of heart disease risk factors and changing lifestyle behaviours.

BACKGROUND: Cardiovascular disease is the leading cause of death and disability for women in Australia. Women living in rural areas are at greater risk of heart disease, because of limited access and availability of healthcare in rural areas. Lifestyle is a major determinant to the risk of heart disease. Risk factors such as smoking, hypertension, diet, physical activity and alcohol intake can be controlled or modified by lifestyle changes. As heart disease develops over many years, women need to be following healthy lifestyle practices and reduce their chance of a first or recurrent heart attack. AIM: To determine the effectiveness of primary health education or intervention programs for cardiac risk reduction in healthy women living in rural areas. INCLUSION CRITERIA: Types of participants. Women aged 16-65 years, living in rural areas, who participated in primary healthcare education programs. Types of interventions. Primary health education or intervention programs aimed at improving rural women's knowledge of their risk of heart disease, for example group work, videos, telephone, workshops, educational material and counselling. Types of outcomes. Primary outcomes included: • Knowledge level of heart disease risk factors. • Lifestyle modification, for example dietary improvements such as reduced daily salt intake, increased intake of fruit and vegetables and decreased intake of fat, increased frequency of exercise, decreased levels of smoking, alcohol intake within national guidelines. • Health assessment measures, for example blood pressure, body weight, cholesterol levels. Types of studies. Any randomised controlled trials, other experimental studies, as well as cohort, case-control and cross-sectional studies were considered for inclusion. Search strategy. A search for published and unpublished studies in the English language was undertaken. METHODOLOGICAL QUALITY: Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments. DATA COLLECTION AND ANALYSIS: Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Although similar outcomes are explored in many of the studies, the variable outcome measures precluded the use of meta-analysis. Data are therefore summarised in tables or by using narrative analysis. RESULTS: Nine trials were included in the review. Three trials compared the effects of interventions on physical activity, one on smoking and five on multiple risk factors. Studies following interventions targeting physical activity reported that women's physical activity can be increased and that these increases can be sustained at 12 months. While there were decreases in blood pressure at 6 months, studies with a 5-year follow up found no decreases for both systolic and diastolic blood pressure. Overall results of studies into dietary modification programs also did not sustain an effect over a longer period of time. CONCLUSION: The results of this review suggest that in rural areas, lifestyle interventions delivered by primary care providers in primary care settings to patients at low risk appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with diabetes or existing heart disease.

An exploration of rural women's knowledge of heart disease and the association with lifestyle behaviours.

Heart disease is the leading cause of morbidity and mortality in Australian women. The purpose of the study was to investigate Australian rural women's knowledge of heart disease and the association with lifestyle behaviours. A questionnaire was developed to collect data on rural women's knowledge and risk of heart disease. Despite having an overall good knowledge of heart disease, there was an identified lack of health promoting behaviours by the women to reflect their knowledge. Over half of the women participants of this study reported two or more lifestyle risk factors for heart disease. This study shows that women might know about heart disease risk factors, nevertheless they might be unaware of their susceptibility to heart disease in relation to the risk factors. Without an awareness of personal susceptibility, women might be less likely to take action to reduce the risk of heart disease.

Are Australian rural women aware of coronary heart disease?

Heart disease is the leading cause of morbidity and mortality in Australian women. In 2005, 109 000 women died of heart disease and 27 000 women died of breast cancer. The reported study sought to assess rural women's level of awareness of heart disease as the leading cause of death. A self-enumerated questionnaire designed to collect information on rural women's perception and awareness of heart disease was distributed to women attending a women's health clinic in a regional hospital. Of 65 participants, 13% (n = 8) identified heart disease as the most significant health problem. Sixty-four per cent of women participating in the study reported that breast cancer claims more lives than heart disease. The authors concluded that women do not perceive heart disease as a substantial health concern. Programmes directed at young women to improve their perception of risk for heart disease and to encourage them to make healthy lifestyle choices are required to reduce overall heart disease morbidity and mortality.