OBJECTIVE:Despite sustained investment in research capacity building, embedding research within clinical practice remains challenging, particularly within regional, rural and remote healthcare settings where workforce shortages, geographic dispersion and limited research infrastructure constrain research engagement. This paper presents the Integrated Research Enablement Framework (IREF), explaining how clinician-led research is activated, supported and embedded within healthcare settings. METHODS:A theory-informed framework development approach integrated cumulative empirical evidence generated through 9 years of implementation and evaluation of a regional research capacity building program with an interpretive synthesis of relevant research capacity building and implementation science literature. Framework development iteratively integrated empirical observations and theoretical models to identify mechanisms underpinning research enablement. RESULTS:The IREF comprises three interdependent domains: capability development, relational expertise and enabling infrastructure. These operate through integrated mechanisms including facilitation, mentorship, organisational alignment and resourcing, to support the activation, sustainment and embedding of clinician-led research. The framework conceptualises research capability development as a relational, practice-integrated process responsive to the contextual realities of regional and rural healthcare delivery. CONCLUSION:The IREF complements existing research capacity building and implementation science frameworks by explicitly articulating the mechanisms through which clinician-led research becomes embedded within routine clinical practice. It provides an operational framework for developing research capability while strengthening the organisational conditions required to sustain research within healthcare systems.
AIM:This commentary explores the growing financial challenges associated with rural and remote clinical placements for nursing and allied health students and considers their implications for workforce development in regional Australia. Drawing on routinely collected survey data provided by the Western Australian Centre for Rural Health (WACRH) between 2017 and 2024, we use student-reported experiences as evidence of persistent concerns about financial burdens during rural clinical placements and discuss potential policy and practice responses. CONTEXT:Rural workforce shortages remain a persistent national challenge for University Departments of Rural Health which facilitate rural training experiences for health science students. Rising costs of living, housing shortages across Australia, and a policy shift towards longer rural placements have increased concerns about placement poverty, a term used to describe the financial burden students experience because of completing mandatory professional placements. WACRH includes support for students undertaking clinical placements in our regions through accommodation at no personal cost to the student, vehicle access for placement activities and limited travel subsidies to remote sites. APPROACH:Data from pre- and post-placement surveys (2017-2024) was analysed. Quantitative data from Likert-style questions on financial concerns were analysed in Stata, while qualitative open-ended responses describing financial challenges were manually coded. Analyses examined variation by year and location. CONCLUSION:Financial concerns have increased over time, with a notable rise in students reporting being "Concerned" or "Very concerned" since 2022. Many students reported significant cost-of-living pressures, dual accommodation expenses, additional food and travel costs, and limited financial support. Achieving national rural workforce policy outcomes requires greater support for rural placements, including funding that reflects the true costs of rural training.
THE CHALLENGE:Rural and remote clinicians frequently make treatment decisions under conditions of uncertainty, exacerbated by limited access to specialist services, fewer locally available treatment options, and evidence that may not fully inform care for an individual patient. THE OPPORTUNITY:N-of-1 trials and related single-case experimental designs (SCEDs) offer a structured method for generating individual-level evidence to support treatment decisions yet remain rarely used in routine clinical practice. Beyond informing care for individual patients, aggregated N-of-1 trials can also generate evidence that is directly relevant to rural populations and models of care. IMPLICATIONS:This editorial outlines the potential of N-of-1 trials and SCEDs in rural and remote health and argues that increasing awareness, training, and practical support could enable their wider adoption.
OBJECTIVE:There is a paucity of evidence exploring the experiences and care needs for First Nations Australians with head and neck cancer (HNC). The aim of the study was to explore the journey of HNC diagnosis, treatment, and early recovery for patients and carers to inform service improvement. SETTING, PARTICIPANTS AND DESIGN:First Nations HNC patient and carer (n = 19) experiences were explored qualitatively through Yarning. Data was analysed using reflexive thematic analysis, with First Nations researcher involvement embedded in all stages of data collection and analysis. RESULTS:Key themes identified included: Strengths and protective factors; Coordination of care; Quality and continuity of care; Cultural safety; Communication and information; Cultural connectedness in hospital; and Gaps in health system support. The Strengths and protective factors theme was noted to be interwoven throughout the other themes and supported participants as a safety net during their care. Practical recommendations to the HNC care pathway were also offered under each theme. CONCLUSIONS:The seven themes identified provided insights into the HNC care experiences for First Nations Australians. These findings and participant recommendations will inform a co-design process to create an optimised care pathway.
AIMS:This commentary examines how guardianship legislation interacts with the practical realities of providing care to older adults with cognitive decline in rural New South Wales. It aims to highlight systemic inequities arising from geographic isolation, workforce limitations and medico-legal uncertainty, and proposes reforms that align guardianship practice with the principles of autonomy, dignity and supported decision-making. CONTEXT:In Australia, substitute decision-making for adults lacking capacity is governed by state guardianship law and Commonwealth-aged care regulation. Although these frameworks are designed to protect vulnerable individuals, their implementation in rural hospitals is often constrained by access to Consultation-Liaison (CL) Psychiatry, restricted administrative support, and delayed access to tribunal processes. These pressures contribute to inconsistent interpretation of guardianship powers, prolonged hospitalisation, and uncertainty around restrictive practice. The Royal Commission into Aged Care Quality and Safety called for nationally consistent rights-based decision-making but did not fully address the unique barriers faced in rural settings. APPROACH:Drawing on three illustrative clinical vignettes from a rural CL Psychiatry service, this commentary explores how legislative ambiguity and resource scarcity shape substitute decision-making in everyday clinical practice. The discussion integrates medico-legal analysis, CL Psychiatry perspectives and rural health literature to identify critical gaps in knowledge, access and coordination. CONCLUSION:Improving guardianship practice in rural hospitals requires investments in clinical education, streamlined medico-legal and psychiatric support, and coherent legislative alignment between state and Commonwealth frameworks. Addressing these inequities is essential to ensuring that the protections embedded in guardianship law translate into timely, person-centred care for older adults living in rural Australia.
OBJECTIVE:To provide the first national analysis of the distribution and professional composition of PhD-qualified health professionals across metropolitan, regional, rural and remote Australia. DESIGN:Cross-sectional analysis of 2021 Australian Census data. SETTING:Australia, classified by Modified Monash Model (MM) remoteness categories. PARTICIPANTS:Health professionals reporting a doctoral-level qualification (PhD). MAIN OUTCOME MEASURES:Counts and proportions of PhD-qualified health professionals by MM category and occupation group; association between remoteness and PhD representation. METHODS:Occupations were grouped into medicine, allied health, and nursing. Residential locations were mapped to MM categories. Descriptive statistics and linear regression examined distribution patterns. RESULTS:Of 21 510 PhD-qualified health professionals, 85% lived in metropolitan areas (MM1), with 3027 (14%) in regional, rural and remote communities and only 12 (< 1%) in very remote areas (MM7). Medical practitioners comprised 61%, allied health 36% (predominantly psychology) and nursing 3%. Increasing remoteness was associated with reduced PhD representation (β = -0.0041, p = 0.011). CONCLUSIONS:Research capacity is concentrated in metropolitan areas, yet a substantial base of PhD-qualified professionals exists in RRR communities. Targeted investment in funding, infrastructure and support could leverage this workforce to build sustainable rural health research capacity.
OBJECTIVE:To test the utility and acceptability of a novel VR training tool for community health practitioners in assessing diabetes-related foot disease in Aboriginal and Torres Strait Islander people. METHODS:The VR program featured five virtual patient models and a range of interactive assessments covering essential clinical and triage skills. DESIGN:Pragmatic quasi-experimental case series. SETTING:The VR training program was completed in collaboration with three Aboriginal Community-Controlled Health Organisations in regional South Australia, with recruitment directed internally at each organisation. PARTICIPANTS:Forty-one primary healthcare staff participated, of which 34 were matched on pre- and post-VR surveys and 20 completed at least three training scenarios. MAIN OUTCOME MEASURES:Evaluation consisted of pre-test self-efficacy scores immediately prior to participants undergoing training, submission of post-test self-efficacy scores, the System Usability Scale, and Training Evaluation Inventory scores after completing all training modules. RESULTS:Following completion of VR training, participants reported increased self-efficacy scores (n = 20) for performing key assessment and triage skills. User feedback (n = 39) demonstrated that participants generally agreed that the training user experience was engaging, acceptable, and of value for clinical education. CONCLUSION:Community health practitioners generally found the VR training tool acceptable, useful, and increased their self-confidence in assessing and managing diabetes-related foot disease for Aboriginal and Torres Strait Islander people, highlighting the potential of VR to upskill community practitioners.
OBJECTIVE:To explore the risks and barriers to care of informal carers of farmers living on-farm with dementia and cognitive impairment. METHODS:Seven individual semi-structured telephone interviews were conducted between June and July 2025. Purposive sampling included carers to discuss their perceptions of caring for people with dementia living on farms. DESIGN:Qualitative study, grounded theory with iterative thematic analysis. SETTING:Rural Australia. PARTICIPANTS:Informal carers. MAIN OUTCOMES:Risks and barriers to care. RESULTS:Six themes were noted in the interviews: (1) Geographic isolation; (2) Physical hazards and farm responsibilities; (3) Interpersonal relationship conflict; (4) Inadequate government support; (5) Lack of local healthcare resourcing; and (6) Positive aspects of the farm environment. Participants discussed strategies for care, such as enlisting additional familial support. Some of these themes were unique to the farm context. CONCLUSION:Carers of farmers with dementia highlighted a combination of risks and barriers to care that often interact synergistically with each other, leading to unmet needs for care. Carers highlighted a need for tailored solutions to care in the unique farm context. Integrating the farm environment with accessible assistance off farm appeared to be a strong desire among carers.
BACKGROUND:The ratio of psychologists to the population is vastly lower in rural communities compared to urban areas, and more clinicians are critically needed in rural Australia. Other health disciplines have implemented generalist frameworks and training to encourage and prepare clinicians to remain in rural practice. Research often references rural psychology practice in conjunction with the broader allied health discipline. OBJECTIVE:Though prior research has identified skills needed for rural psychology practice, further research is needed to expand and update the current understanding of rural psychology competencies. Therefore, the current study explored the competencies and skills used by rural psychologists. METHODS:Qualitative interviews with 15 rural psychologists from across Australia were conducted and analysed using a reflexive thematic approach. RESULTS:Participants spoke of the unique skills required to manage the challenges of rural practice, identifying eight thematic competencies: clinical skills, networking, cultural responsiveness, practitioner wellbeing, ethics, risk, professional development and telehealth. CONCLUSION:Themes highlighted the need for a discipline-specific approach to supporting rural psychologists in practice. Applications of this research, particularly towards supporting and retaining psychologists in rural Australia, are discussed.
The National Health Reform Agreement 2026-2031 has now been published. As the primary framework governing health funding in Australia, the Agreement also sets the overarching policy direction and defines the roles, responsibilities and expectations of the Australian Government and all state and territory governments. The National Rural Health Alliance has long argued that the National Health Reform Agreement must explicitly prioritise rural health and clearly articulate the specific commitments required to address rural and remote health inequities. The Alliance welcomes the inclusion of a new schedule in the 2026-2031 Agreement-Schedule F: Better Health Equity for Rural and Remote Communities. This article contends that Schedule F creates an important opportunity for genuine and lasting reform to better support rural health in Australia.
OBJECTIVE:Japanese encephalitis (JE) is a mosquito-borne disease caused by JE virus (JEV) infection, detected for the first time in south-eastern Australia in 2022. In New South Wales (NSW), detections of JEV in mosquitoes and animal hosts, human JE cases, and climate and environmental considerations have informed which areas are considered high risk for JEV and which populations are eligible for vaccination (funded by Australian states and territories). However, early evidence indicates slower-than-expected uptake in these high-risk areas. We aimed to explore how community members and healthcare professionals (HCPs), including general practitioners (GPs), pharmacists, and nurses, perceive and have responded to JEV risk through vaccination and personal mosquito-bite prevention practices. SETTING:Tamworth is classified as high-risk for JEV by NSW Health. PARTICIPANTS:Semi-structured interviews with community participants (n = 15), GPs (n = 7), nurses (n = 3), and pharmacists (n = 3). DESIGN:An interpretative qualitative study. Data were analysed using an inductive thematic approach. RESULTS:Three themes were identified: (1) Risk awareness shaped by experience, not policy: "I didn't realise Tamworth was identified as an area as well, I just was totally unaware," (2) Vaccine eligibility does not translate into uptake: "There isn't really much promotion at the moment," and (3) Building community-level preparedness through communication: "Messaging that the whole community knows about." CONCLUSION:Despite early public health efforts, awareness of JE and uptake of preventive measures remained limited in a high-risk regional setting. Supporting trusted healthcare providers with clear, consistent communication is critical to optimising JE vaccine uptake.
OBJECTIVE:To evaluate the clinical effectiveness, operational efficiency, and stakeholder satisfaction of telepharmacy compared to face-to-face pharmacist reviews in regional hospital sites in South Australia. DESIGN:Quantitative observational cohort study using service activity data and structured survey feedback. SETTING:Two spoke hospitals and a central hub hospital within the Riverland Mallee Coorong Local Health Network in South Australia. PARTICIPANTS:Hospital inpatients reviewed by a clinical pharmacist during face-to-face visits (n = 39) and via telepharmacy (n = 21), along with nursing staff and patients who provided feedback. METHODS:Data were collected on cohort sizes, pharmacist travel time, review timing, number of clinical interventions, and patient risk stratification. Patient and staff feedback was gathered using structured surveys. MAIN OUTCOME MEASURES:The pilot assessed clinical activity, time efficiency, intervention rates, and patient risk profiles. Survey responses were analysed for satisfaction and perceived value. RESULTS:More patients were seen face-to-face than via telepharmacy (5.7% vs. 3.6%), and face-to-face reviews occurred sooner after admission (median 61 h (IQR 24.1-162) vs. 72.6 h (IQR 48.1-121.9)). A significant proportion of high-risk patients were seen via telepharmacy (42.9%), and more clinical interventions were made per patient with telepharmacy than face-to-face (median 6 (IQR 2-8) vs. 1 (IQR 0-2)). Patient feedback was positive, with 92.3% reporting no dislikes. Nursing staff were mostly satisfied, though some preferred face-to-face interactions. CONCLUSION:Telepharmacy is a feasible model for regional medication review, enabling prioritisation of high-risk patients and clinical pharmacist interventions. Further research into barriers and enablers is required to support its continued use and broader implementation.
OBJECTIVE:To describe an evidence-informed, experience-based co-design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service. METHODS:A scoping review of palliative care delivery and early referral models to inform evidence-informed, experience-based co-design workshops involving consumers, clinicians, and health service staff. DESIGN:Sequential mixed-methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context-appropriate outpatient early referral model. SETTING:A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer. PARTICIPANTS:Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops. MAIN OUTCOME MEASURES:Co-designed model structure and components, perceived feasibility in a resource-constrained regional context, and agreed service scope and patient eligibility. RESULTS:The process generated a regionally tailored early referral pathway incorporating needs-based screening, prioritisation to manage limited capacity, and staged roll-out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource-driven variation in care delivery. CONCLUSIONS:Evidence-informed co-design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.
OBJECTIVE:Disparities in colorectal cancer exist for incidence and survival in disadvantaged and rural areas. This study created a composite indicator of multiple modifiable risk factors for colorectal cancer to visualise relative prevalence across Australia at the small-area level and by socio-economic status. DESIGN:Cross-sectional ecological analysis. SETTING:The Australian 2020-2021 National Health Survey. PARTICIPANTS:9796 participants sampled from the Australian adult population (18 years +), living in 2350 small areas. METHODS:Data on the prevalence of smoking, alcohol consumption, body mass index, and physical activity were used to generate colorectal cancer risk index scores. Index scores were calculated for each person, and mean scores were created for each small area using Bayesian spatial modelling. Index scores were compared across area-level socio-economic quintiles and geographical remoteness subgroups. RESULTS:Although limited data was available in remote areas, observed patterns indicated that locations outside of major cities tended to have moderate-to-high index scores (mean 0.44, SD 0.25), while major cities showed higher proportions of areas with lower but more variable scores overall (mean 0.34 SD 0.21). Risk scores were higher in disadvantaged areas (0.39, SD 0.21) than advantaged areas (0.33. SD 0.21). This trend was consistent across education, occupation, and economic resources indices. CONCLUSION:People living further away from major cities and in socioeconomically disadvantaged areas may be more likely to have multiple modifiable health behaviours for colorectal cancer. When applied to a geographically representative dataset, the Index may be used to inform targeted health promotion interventions and localised community-based actions to reduce colorectal cancer risk and close the socio-economic and geographical gaps in incidence and mortality.
Introduction Australian rural and remote communities face challenges accessing allied health services due to a range of workforce, funding and service challenges. The Allied Health Rural Generalist Education and Training Scheme (TAHRGETS) was introduced to provide training, supervision and workplace project opportunities for early career allied health professionals across rural and remote private and non-government services in Australia. The purpose of this study was to explore the enablers and barriers to implementing rural generalist training positions in private and non-government settings and make recommendations for sustainable implementation.Methods A qualitative study utilising semi-structured interviews was undertaken utilising thematic analysis which was then mapped against the Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.Results Twenty-five allied health professionals, 21 managers and supervisors and five project team members were interviewed. Twenty-six characteristics were identified including 19 enablers and 11 barriers to implementation. Enablers included the structured nature of the training positions, study time at work, funding provided to organisations, facilitation of the programme and support provided by managers and supervisors. Barriers included recruiting participants while transitioning into the workforce, time constraints, workload pressures and limited incentive for completion.Conclusion Rural generalist training positions for private and non-government organisations across rural and remote Australia were enabled through tailored support mechanisms and robust facilitation; however, policy level recognition is required for ongoing sustainability.
INTRODUCTION:Partnerships with research users (e.g., communities, clinicians) are effective in supporting virtual health innovation (VHI) projects to co-develop, implement and evaluate sustainable, relevant innovations that improve care access in rural communities. However, building trusting relationships with underrepresented groups is challenging and time-intensive. OBJECTIVE:To synthesise partnership processes (principles, strategies) and effects (outcomes/impacts) from rural VHI projects. DESIGN:A scoping review of peer-reviewed articles on rural VHI partnership projects (2020-2024) identified through five databases. Partnership principles (norms/beliefs), strategies (observable actions) and outcomes/impacts (short- to long-term effects) were extracted and analysed using directed content analysis. Reporting followed the PRISMA-ScR checklist. FINDINGS:Of 7413 abstracts, 85 articles met inclusion criteria. VHI partnership projects were conducted in 15 countries, covering telehealth, digital education and health apps. Nearly half (45.9%) involved partnerships with Indigenous communities. We identified 149 principles and 80 strategies. Principles commonly related to relationship building (55.3%), shared decision-making (51.8%) and knowledge co-production (49.4%). From nine evaluation studies, 36 outcomes/impacts were extracted, of which 81% were positive. DISCUSSION:While a range of partnership processes and effects were identified, reporting was inconsistent, and few studies incorporated formal evaluations. Future research should adopt systematic approaches to report and evaluate their partnership engagement, thereby expanding the evidence base and facilitating shared learning for more effective and meaningful engagement with rural communities. CONCLUSION:This systematic overview of partnership processes and effects lays the groundwork for more effective, culturally safe engagement. Strengthening partnerships in these contexts can improve healthcare access and reduce rural health disparities.
PROBLEM:Accessing professional support such as professional development, clinical supervision and peer support can be difficult for rural and regional allied health (AH) clinicians and may have a negative impact on workforce recruitment and retention. SETTING:The Loddon Mallee Health Network, a Health Service Partnership of 19 health services in North-Western Victoria. Professions included were AH therapy professions. KEY MEASURES FOR IMPROVEMENT:Five professional support and workforce capacity building strategies were implemented, relating to clinical supervision, building capacity to provide student placements, professional development, graduate support and building AH clinical educator capacity. Program logic was used as the overarching methodology to evaluate the implementation of these strategies. STRATEGIES FOR CHANGE:The project engaged AH managers, clinical educators and clinicians from across the region to collaboratively develop and implement the identified professional support strategies. EFFECTS OF CHANGE:Access to professional support and building the capacity of the workforce improved through shared approaches including the following: clinical supervision, professional shadowing and peer support for educators and shared student placements. LESSONS LEARNT:Benefits to using a regional approach to plan, deliver and evaluate professional support for AH were identified. Recommendations are made to inform collaborative approaches to professional support in regional settings.
