Research Publications and Outputs

Developing the rural health workforce to improve Australian Aboriginal health outcomes: a systematic review

Fri, 01 Jan 2016 00:00:00 GMT

Developing the rural health workforce to improve Australian Aboriginal health outcomes: a systematic review Gwynne, Kylie; Lincoln, Michelle Objective: The aim of this study was to identify evidence based strategies in the literature for developing and maintaining a skilled and qualified rural and remote health workforce in Australia to better meet the health care needs of Australian Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) people. Methods: A systematic search strategy was implemented using the PRISMA statement and checklist. Exclusion and inclusion criteria were applied, and 26 papers were included in the study. These 26 papers were critically evaluated and analysed for common findings about the rural health workforce providing services for Aboriginal people. Results: There were four key findings of the study: the experience of Aboriginal people in the health workforce affects their engagement with education, training, and employment; particular factors affect the effectiveness and longevity of the non-Aboriginal workforce working in Aboriginal health; attitudes and behaviours of the workforce have a direct effect on service delivery design and models in Aboriginal health; and student placements affect the likelihood of applying for rural and remote health jobs in Aboriginal communities after graduation. Each finding has associated evidence-based strategies including those to promote the engagement and retention of Aboriginal staff; training and support for non-Aboriginal health workers; effective service design; and support strategies for effective student placement. Conclusions: Strategies are evidenced in the peer-reviewed literature to improve the rural and remote workforce for health delivery for Australian Aboriginal people and should be considered by policy makers, funders and program managers. This is the peer reviewed version of the following article: Gwynne, K., & Lincoln, M. (2016). Developing the rural health workforce to improve Australian Aboriginal health outcomes: a systematic review. Australian Health Review. Advance online publication. doi: 10.1071/AH15241, which has been published in final form at: http://www.publish.csiro.au/ah/Fulltext/AH15241

Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales

Thu, 01 Jan 2015 00:00:00 GMT

Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales Gallego, Gisselle; Chedid, Rebecca Jean; Dew, Angela; Lincoln, Michelle; Bundy, Anita; Veitch, Craig; Bulkeley, Kim; Brentnall, Jennie Objective: To explore the characteristics of allied health professionals (AHPs) working with people with disabilities in western New South Wales. Design: A cross-sectional survey was conducted using an online questionnaire. Setting: Rural western NSW. Participants: AHPs including physiotherapists, speech pathologists, occupational therapists and psychologists (“therapists”) working with people with disabilities. Main outcome measure: Questionnaire Results: The majority of respondents were female (94%), with a mean age of 39 years; average time since qualification was 14 years; mean years in current position was 6. Most worked with people with a lifelong disability. Two-thirds reported family ties kept them in rural areas; 71% grew up in a rural/remote area. Most participants (94%) enjoyed the rural lifestyle and 84% reported opportunities for social interaction as good or very good. Participants with dependent children were less likely to cease working in western NSW within 5 years than those without dependent children (p<0.05). Conclusions: The characteristics of therapists working with people with disabilities in rural NSW were identified. Overall working, but also social, conditions and community attachment were important for this group. Understanding the workforce will contribute to policy development to meet increasing demands for therapy services. This is the peer reviewed version of the following article: Gallego, G., Chedid, R. J., Dew, A., Lincoln, M., Bundy, A., Veitch, C., Bulkeley, K., & Brentnall, J. (2015). Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales. Australian Journal of Rural Health, 23(4), 227-234. doi:10.1111/ajr.12163, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/ajr.12163/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

Thu, 01 Jan 2015 00:00:00 GMT

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia Gallego, Gisselle; Dew, Angela; Lincoln, Michelle; Bundy, Anita; Chedid, Rebecca Jean; Bulkeley, Kim; Brentnall, Jennie; Veitch, Craig Introduction: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. Objective: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists – “therapists”) living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. Methods: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs’ current job, and their workforce preferences were explored using a best–worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs’ relative preferences for six different job attributes. Results: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, “high autonomy of practice” is the most valued attribute level, followed by “travel BWSDCE arrangements: one or less nights away per month”, “travel arrangements: two or three nights away per month” and “adequate access to professional development”. On the other hand, the least valued attribute levels were “travel arrangements: four or more nights per month”, “limited autonomy of practice” and “minimal access to professional development”. Except for “some job flexibility”, all other attributes had a statistical influence on AHPs’ job preference. Preferences differed according to age, marital status and having dependent children. Conclusions: This study allowed the identification of factors that contribute to AHPs’ employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention.

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development

Thu, 01 Jan 2015 00:00:00 GMT

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Veitch, Craig; Lincoln, Michelle; Bundy, Anita; Brentnall, Jennie Objective: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas. Methods: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison. Results: Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes. Conclusion: The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs).

Multiple stakeholder perspectives on teletherapy delivery of speech pathology services in rural schools: a preliminary qualitative investigation

Wed, 01 Jan 2014 00:00:00 GMT

Multiple stakeholder perspectives on teletherapy delivery of speech pathology services in rural schools: a preliminary qualitative investigation Lincoln, Michelle; Hines, Monique; Fairweather, Craig; Ramsden, Robyn; Martinovich, Julia The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs.

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia

Tue, 01 Jan 2013 00:00:00 GMT

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia Chedid, Rebecca; Dew, Angela; Veitch, Craig Background/aim: This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study’s purpose was to identify the impact of information and Communication Technology on the workforce practices of occupational therapists’ working in a rural area of New South Wales. Methods: Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison,was used to analyse the interview transcripts. Results: This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients’ acceptance.Conclusion: The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently.

Addressing the barriers to accessing therapy services in rural and remote areas

Wed, 01 Aug 2012 00:00:00 GMT

Addressing the barriers to accessing therapy services in rural and remote areas Dew, Angela; Bulkeley, Kim; Veitch, Craig; Bundy, Anita; Gallego, Gisselle; Lincoln, Michelle; Brentnall, Jennie; Griffiths, Scott Purpose: Throughout the world, people with a disability who live in rural and remote areas experience difficulty accessing a range of community-based services including speech-, physioand occupational therapy. This paper draws on information gathered from carers and adults with a disability living in a rural area in New South Wales (NSW), Australia to determine the extent to which people living in rural areas may receive a person-centred therapy service. Methods: As part of a larger study in rural NSW into the delivery of therapy services, focus groups and individual interviews were conducted with 78 carers and 10 adults with a disability. Data were analysed using constant comparison and thematic analysis. Results: Three related themes emerged: (i) travelling to access therapy; (ii) waiting a long time to get therapy; and (iii) limited access to therapy past early childhood. The themes overlaid the problems of recruiting and retaining sufficient therapists to work in rural areas. Conclusions: Community-based rehabilitation principles offer possibilities for increasing person-centred therapy services. We propose a person-centred and place-based approach that builds on existing service delivery models in the region and involves four inter-related strategies aimed at reducing travel and waiting times and with applicability across the life course.

Strengthening Supports for Children 0-8 years and their Families: A Literature Review

Thu, 01 May 2014 00:00:00 GMT

Strengthening Supports for Children 0-8 years and their Families: A Literature Review Dew, Angela; De Bortoli, Tanya; Brentnall, Jennie; Bundy, Anita The Strengthening Supports for Children and Families 0-8 Years Strategy is to improve the way that the New South Wales (NSW) Department of Family and Community Services: Ageing, Disability and Home Care (ADHC) provide services to young children and their families (NSW Government, 2013b). Consistent with the international, national and state policy context and discourse, ADHC’s strategy encourages the inclusion of young children with disabilities and their families in mainstream settings. This report presents the findings of a systematic review of the literature on interventions provided in mainstream settings for children with disabilities aged 0 to 8 years and their families. Further, the focus of the review is on inclusion-based approaches to delivering services in mainstream settings. The review examines the literature describing: - best practice for promoting the inclusion of young children and their families - benefits and outcomes of inclusion-based approaches - key factors in the effective provision of inclusion-based approaches - barriers and challenges to inclusion-based approaches.

Recruitment and retention of allied health professionals in the disability sector in rural and remote New South Wales, Australia

Tue, 26 Nov 2013 00:00:00 GMT

Recruitment and retention of allied health professionals in the disability sector in rural and remote New South Wales, Australia Lincoln, Michelle; Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Veitch, Craig; Bundy, Anita; Brentnall, Jennie; Chedid, Rebecca; Griffiths, Scott Background: People with disability living in rural areas are vulnerable to the loss of access to allied health services due to a critical shortage of allied health professionals (AHPs). This study aimed to investigate recruitment and retention issues of importance to AHPs providing services to people with disability in rural New South Wales, Australia. Method: Focus groups and semi-structured interviews were conducted with 97 purposively sampled service providers in the disability sector. Interviews and focus groups were digitally recorded and transcribed. A modified grounded theory approach using thematic analysis and constant comparison was used to analyse the data. Results: Three major themes relating to recruitment and retention were identified: (a) flexible recruitment, (b) retention strategies that work, and (c) challenges to retention. Conclusions: AHPs in the disability sector identified some of the same issues influencing recruitment and retention as AHPs in the health, education, and private sectors. Several unique issues were also identified that will assist policymakers to improve recruitment and retention of AHPs employed in the disability sector in rural areas.

Carer and service providers’ experiences of individual funding models for children with a disability in rural and remote areas

Tue, 01 Jan 2013 00:00:00 GMT

Carer and service providers’ experiences of individual funding models for children with a disability in rural and remote areas Dew, Angela; Bulkeley, Kim; Veitch, Craig; Bundy, Anita; Lincoln, Michelle; Brentnall, Jennie; Gallego, Gisselle; Griffiths, Scott There is a global movement for people with a disability towards personcentred practices with opportunities for self-determination and choice. Person-centred approaches may involve individual funding (IF) for the purchase of required support. A shift to a person-centred model and IF should allow people with a disability and their carers greater choice in therapy access. However, individuals who live in rural and remote areas have less choice and access to therapy services than their metropolitan counterparts. Drawing on data from a larger study into therapy service delivery in a rural and remote area of New South Wales, Australia, this study describes some benefits and barriers to using IF to access therapy services in rural areas. Ten carers and 60 service providers participated in audio-recorded focus groups and individual interviews during which IF was discussed. Transcribed data were analysed using thematic analysis and constant comparison. Greater access to and choice of therapy providers were identified as benefits of IF. Four barriers were identified: (i) lack of information and advice; (ii) limited local service options and capacity; (iii) higher costs and fewer services and (iv) complexity of self-managing packages. A range of strategies is required to address the barriers to using IF in rural and remote areas. Carers indicated a need for: accessible information; a local contact person for support and guidance; adequate financial compensation to offset additional travel expenses and coordinated eligibility and accountability systems. Service providers required: coordinated cross-sector approaches; local workforce planning to address therapist shortages; certainty around service viability and growth; clear policies and procedures around implementation of IF. This study highlights the need for further discussion and research about how to overcome the barriers to the optimal use of an IF model for those living in rural and remote areas. The definitive version is available at www3.interscience.wiley.com

Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the ‘wobbly hub and double spokes’ project

Fri, 01 Jun 2012 00:00:00 GMT

Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the ‘wobbly hub and double spokes’ project Veitch, Craig; Lincoln, Michelle; Bundy, Anita; Gallego, Gisselle; Dew, Angela; Bulkeley, Kim; Jennie, Brentnall; Griffiths, Scott Background: Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia. Methods/Design: The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and evaluate the implementation and impact of new or adapted policies that arise from the preceding stages. Discussion: The project will provide policy makers with research evidence to support consideration of the complex balance between: (i) the equitable allocation of scarce resources; (ii) the intent of current eligibility and prioritisation policies; (iii) workforce constraints (and strengths); and (iv) the most effective, evidence-based clinical practice.

The need for new models for delivery of therapy intervention to people with a disability in rural and remote areas of Australia

Thu, 01 Mar 2012 00:00:00 GMT

The need for new models for delivery of therapy intervention to people with a disability in rural and remote areas of Australia Dew, Angela; Veitch, Craig; Lincoln, Michelle; Brentnall, Jennie; Bulkeley, Kim; Gallego, Gisselle; Bundy, Anita; Griffiths, Scott Early therapy intervention by occupational therapists, physiotherapists, and speech pathologists (therapists) is recognised to yield benefits across the lifecourse (Carpenter, 2007; Law, 2002; Thomaidis, Kaderoglou, Stefou, Damianou, & Bakoula, 2000; Ziviani, Feeney, Rodger, & Watter, 2010). As a result,there have recently been increases in funding for therapy positions in disability services in New South Wales(NSW), Australia (New South Wales Government, 2006). However, research by Keane, Smith, Lincoln,and Fisher (2011), Chisholm, Russell, and Humphreys (2011), and Denham and Shaddock (2004) indicated that there is a shortage of therapists living and working in rural and remote areas of Australia.

Issues affecting therapist workforce and service delivery in the disability sector in rural and remote New South Wales, Australia: perspectives of policymakers, managers and senior therapists

Mon, 11 Jun 2012 00:00:00 GMT

Issues affecting therapist workforce and service delivery in the disability sector in rural and remote New South Wales, Australia: perspectives of policymakers, managers and senior therapists Veitch, Craig; Dew, Angela; Bulkeley, Kim; Lincoln, Michelle; Bundy, Anita; Gallego, Gisselle; Griffiths, Scott Introduction: The disability sector encompasses a broad range of conditions and needs, including children and adults with intellectual and developmental disabilities, people with acquired disabilities, and irreversible physical injuries. Allied health professionals (therapists), in the disability sector, work within government and funded or charitable non-government agencies, schools, communities, and private practice. This article reports the findings of a qualitative study of therapist workforce and service delivery in the disability sector in rural and remote New South Wales (NSW), Australia. The aim was to investigate issues of importance to policy-makers, managers and therapists providing services to people with disabilities in rural and remote areas. Methods: The project gathered information via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGOs) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues.Results: Five broad themes resonated across participants’ roles, locations and service settings: (1) challenges to implementing policy in rural and remote NSW; (2) the impact of geographic distribution of workforce and clients; (3) workforce issues - recruitment, support, workloads, retention; (4) equity and access issues for rural clients; and (5) the important role of the NGO sector in rural service delivery and support. Conclusions: Although commitment to providing best practice services was universal, policy-related information transfer between organisations and employees was inconsistent. Participants raised some workforce and service delivery issues that are similar to those reported in the rural health literature but rarely in the context of allied health and disability services. Relatively recent innovations such as therapy assistants, information technology, and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations were expected to extend the coverage provided by therapists. Nongovernment organisations played a significant role in service delivery and support in the region. Participants recognised the need for therapists working for different organisations, in rural areas, to collaborate both in terms of peer support and service delivery to clients. First published in the journal Rural and Remote Health www.rrh.org.au