Advancing health promotion in rural and remote Australia: Strategies for change

Findings, progress, and lessons learned during the first 3 years of a student-led interprofessional health clinic in regional Australia

We describe the establishment and operation of a student-led interprofessional chronic disease prevention and management clinic in regional Australia. Our aim was twofold. First, to report on service delivery, student placement, and health outcome data; and second, to discuss key lessons learned during the first 3½ years of clinic operations. Between July 2019 and December 2022, 146 (79.3%) clinic participants completed the 4-month program and participated in an average of 48.4 occasions of service (total 7,060). The clinic supported 1,060 clinical placement weeks across 147 health students. There was a significant improvement across health measures reported at program completion, with the largest changes observed for the 6-min walk test and preference-adjusted quality of life. Nine key challenges and lessons were identified that affected operations and service delivery, which should be of interest to healthcare teams considering establishing an interprofessional student-led clinic.

Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians - analysis of cross-sectional data (Crossroads II)

BACKGROUND

Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems.

METHODS

The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016-18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders.

RESULTS

Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions.

CONCLUSIONS

The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.

Prevalence Rates of Depression and Anxiety among Young Rural and Urban Australians: A Systematic Review and Meta-Analysis

Globally, depression and anxiety are major public health concerns with onset during adolescence. While rural Australia experiences overall lower health outcomes, variation in mental health prevalence rates between rural and urban Australia is unclear. The aim of this paper was to estimate the pooled prevalence rates for depression and anxiety among young Australians aged between 10 and 24 years. Selected studies from a systematic literature search were assessed for risk of bias. Random effects model using DerSimonian and Laird method with Freeman-Tukey Double Arcsine Transformation was fitted. Sensitivity analyses were performed. Prevalence estimates were stratified by region and disorder. The overall pooled prevalence of depression and anxiety was 25.3% (95% CI, 19.9-31.0%). In subgroup analysis, anxiety prevalence was 29.9% (95% CI, 21.6-39.0%); depression: 21.3% (95% CI, 14.9-28.5%); and depression or anxiety: 27.2% (95% CI, 20.3-34.6%). Depression and anxiety prevalence were higher in urban 26.1% (95% CI, 17.3-35.9%) compared to rural areas 24.9% (95% CI, 17.5-33%), although the difference was not statistically significant. The heterogeneity was high with an I² score of 95.8%. There is need for further research on healthcare access, mental health literacy and help-seeking attitude in Australia.

Strengthening health promotion development with Aboriginal and Torres Strait Islander males in remote Australia: A Northern Territory perspective

Aims

To elucidate key considerations for effective health promotion with Aboriginal and Torres Strait Islander males in remote Northern Territory.

Context

Despite the significant disparities in health outcomes amongst Aboriginal and Torres Strait Islander males, particularly in remote Northern Territory, investment in health promotion policy and practice has been inadequate. Progressing towards self‐determination with Aboriginal and Torres Strait Islander males, and to meet the unique health and well‐being needs of this marginalised demographic, consideration for staff retention and training, strengths‐based approaches, and implications of divergent masculinities must be considered when devising and delivering culturally responsive and appropriate health promotion interventions. Health promotion needs to be conducted in a collaborative manner, and in less conventional settings, to better engage Aboriginal and Torres Strait Islander males.

Approach

This commentary draws on the author's reflections about working in remote Aboriginal and Torres Strait Islander health policy, practice and research contexts in Northern Australia. It brings together diffuse strands of scholarship about Aboriginal and Torres Strait Islander male health; Aboriginal and Torres Strait Islander health promotion; and health promotion in rural and remote contexts. In doing so, we identify and discuss strategies that have potential to strengthen Aboriginal and Torres Strait Islander male health promotion in rural and remote Australia.

Conclusion

Health services and professionals in remote Northern Territory must leverage the inherent strengths of Aboriginal and Torres Strait Islander males to imbue service delivery with both meaning and capacity for self‐determination. In doing so, this might ultimately help to alleviate the marginalisation of this demographic.