AIM:This systematic review aims to investigate, identify, and compare evidence related to the barriers, enablers, and strategies to embedding translational research within a public hospital system focussed on nursing and allied health disciplines.METHODS:A systematic review looking at the international literature on the barriers, enablers and strategies in embedding translational research within a public health system addressing nursing and allied health professions. The study channelled the PRISMA reporting guidelines for systematic reviews and meta-analyses. Databases searched were Medline, Embase, Scopus and Pubmed from January 2011 to December 2021 (inclusive). A quality assessment was conducted of literature using the mixed methods appraisal tool 2011 version.RESULTS:Thirteen papers met the inclusion criteria. The studies included were from Australia, Saudi Arabia, China, Denmark and Canada. Occupational therapy and physiotherapy were the only two allied health disciplines identified in the search process. The review found considerable inter-relationships between the enablers, barriers, and strategies to embedding research translation in a public hospital setting. Three over-arching themes 'leadership, organisational culture and capabilities' were developed to capture the complexity of factors in embedding translational research. Key subthemes identified were education, knowledge, management, time, workplace culture and resources. All thirteen articles identified that a multifactorial approach is required to embed a research culture and translate research findings into clinical practice.CONCLUSIONS:The themes of leadership, organisational culture and capabilities are inherently intertwined and therefore successful strategies require a whole of health approach with organisational leadership driving the strategy, as changing organisational culture takes time and considerable investment. We recommend that public health organisations, senior executives and policy makers consider the findings of this review to provide evidence to initiate organisational changes to support and help create a research environment to drive research translation within the public sector.

BACKGROUND:Complex trauma is a significant public health issue with detrimental health, interpersonal and psychological impacts, which can impede client recovery and result in multiple representations. 'Trauma Informed Practice' (TIP) is an evidence-based model which ensures safe and effective services for clients and staff. This study examines health professional's use of TIP, and the motivators, enablers and barriers to implementation in a multidisciplinary setting. METHODS:A mixed methods study with 24 front-line clinicians and managers within a community health setting in Australia. A purpose designed, expert validated TIP checklist was completed, followed by semi-structured focus groups. Survey data was reported using descriptive statistics. Focus group data was digitally recorded, transcribed and thematically analysed. RESULTS:Ten key factors were identified motivating, restricting or enabling TIP implementation. Seven were organisational factors including supportive and informed management, flexibility of service models, levels of service demands, resource availability, education opportunities, good client outcomes, and reporting requirements. Philosophical approach, team orientation, and vicarious trauma/stress management were three individual professional factors. Critically, alignment in two ways was necessary for successful implementation, that is: in knowledge and understanding across organisational role levels - clinician, manager and executive; and, in professional philosophy and team orientation of individual clinicians. CONCLUSION:Providing TIP is essential for ensuring optimum client outcomes for trauma survivors and for maintaining workforce wellbeing. Although the increasing uptake to TIP is evident within the health setting, further attention is required to address the tension between service models focused on efficiently servicing whole populations and those attuned to effectively meeting the needs of high risk groups. A complex strategy to unite therapeutic and managerial goals is necessary if client, professional and organisational needs are to be effectively met.

INTRODUCTIONThe early closure of the Voluntary Dental Graduate Year Program and the Oral Health Therapy Graduate Year Program by the Australian Government adversely impacted New South Wales (NSW) Aboriginal Community Controlled Health Services (ACCHSs). This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation.METHODSAll graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity.RESULTSPrior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity.CONCLUSIONThe Dalang Project is an example of a successful co-designed project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.

Introduction There is a maldistribution of dental professionals working in rural and remote regions of Australia. This study investigates dental graduates from a newly established rural clinical school (RCS) at Charles Sturt University (CSU), New South Wales, Australia, and records graduates' workforce locations and views on working in both metropolitan and rural practice. Materials and Methods In late 2015 to early 2016, CSU graduates of 2013 and 2014 were asked to complete a telephone interview related to their employment choices. Thirty-nine interviews (68% of contactable graduates) were completed. Qualitative framework analysis was applied to identify trends and themes. Results More than half of the graduates were working rurally, with 67% working full-time and 77% in private practice. Key influencing factors on graduates related to rural employment were as follows: family and personal relationships, developing clinical skills, rural community, lifestyle, professional support, mentorship, job availability, full-time employment and financial incentives. Key barriers to working rurally included leaving family and friends, small patient base, low salary, partner factors, and professional and personal isolation. Conclusion More than half of the CSU graduates were working in rural communities, demonstrating initially positive rural workforce outcomes. Reasons for choosing to work rurally were complex and spanned a broad spectrum of social, personal, professional development and support, community, economic, environmental and lifestyle factors. Future workforce strategies should apply a broad multifactorial approach to consider the complex interrelated employment factors. Furthermore, increased evaluation is required of the CSU programme, with increased workforce outcomes and exploration of employment retention factors.

INTRODUCTION:This study compares the workplace decisions from University of Sydney (USYD) dental graduates who participated in a 1-month voluntary Rural Clinical Placement Program (RCPP), USYD graduates who did not participate in the RCPP (non-RCPP), and with graduates who qualified from a dental Rural Clinical School (RCS) at Charles Sturt University (CSU).METHODOLOGY:From mid-2015, USYD students who graduated between 2009 and 2013, and CSU graduates from 2013 to 2014, were requested to complete a telephone interview related to employment choices. For USYD, 135 interviews were completed (63% of contactable graduates) and for CSU, 39 interviews (68%). Mixed methods were applied to analyse the data.RESULTS:For USYD, 33% of RCPP participants were working rurally compared with 18% of the non-RCPP, whilst 54% of CSU graduates were working rurally. For USYD, the self-reported influence of the RCPP on the graduates' employment decisions was a significant predictor of rural employment. For CSU, country of birth and employment status were weakly associated with rural employment. Across the three cohorts, key employment factors were as follows: job availability, family, personal relationships, good mentorship, clinical training, partner factor and lifestyle. In addition, both the RCPP and CSU graduates showed greater interest and awareness of rural employment than the non-RCPP.CONCLUSION:The CSU RCS and USYD RCPP are leading to positive rural employment outcomes, and it is clear that the provision of a rural experience is influencing graduates to work rurally. Further investigation of the CSU program is required to fully assess its impact and to provide longitudinal workforce information.

BACKGROUND There is little longitudinal evaluation of rural dental education outreach programs. This longitudinal research investigates the influence of a Rural Clinical Placement Program (RCPP) on workforce outcomes in terms of practice locations for five graduate years from the University of Sydney. METHODS Work locations for the graduates from 2009-2013 were identified in 2015 and 2017 by rurality, using faculty contact lists, phone calls and online methods. A total of 397 graduate locations were identified out of 404 (98.2%) (267 RCPP participants and 137 non-RCPP participants). Semi-structured questionnaires were used to report on demographic and characteristic data. Univariate and multivariate statistical analyses were utilised to explore associations. RESULTS Rural Clinical Placement Program participation in 2015 was significantly associated with an increased likelihood of working rurally (PR = 2.16), and almost two times the likelihood of rural retention in the period from 2015 to 2017 (PR = 1.93). In the multivariate analyses, both rural experience prior to the RCPP and pre-placement rural intentions were significant independent predictors of an increased likelihood for rural employment and rural retention. CONCLUSIONS Participation in the RCPP was associated with increased rural employment and retention. Prior rural experience and pre-placement rural intentions were identified as significant independent predictors of rural employment.

INTRODUCTION:The challenges in the recruitment and retention of dentists in rural Australia have contributed to a lack of dental service provision to rural communities. This paper explores the workforce factors involved in the employment location decisions of dentists' post-graduation.MATERIALS AND METHODS:Graduates between 2009 and 2013 from the University of Sydney, Dental School, were asked to complete a telephone interview related to their employment history. A total of 135 interviews were conducted, with 63% (135/214) of contactable graduates, or 33.4% (135/404) of all the graduates (2009-2013). Interviews followed a semi-structured script.RESULTS:Key factors which positively impacted on rural employment included the following: job competition in metropolitan areas, good rural salaries, financial incentives, clinical experience, rural lifestyle and professional mentorship. Barriers were as follows: proximity to friends and family, building a social and professional network, isolation, less professional support and reduced access to education.CONCLUSION:Recommendations to increase rural employment include: competitive rural salaries, financial incentives and formal mentorship during both recruitment and integration into a rural community. Dental schools should consider advertising identified drivers of rural employment, namely good salaries, full-time employment, clinical experience and rural lifestyle. This study provides important information related to rural employment and rural retention.

Introduction: Australia has a lack of dental practitioners in rural and remote regions. This study evaluates the impact of a Rural Clinical Placement Program (RCPP) offered to final year students at the University of Sydney (USYD) Dental School on the graduates working locations. Materials and Methods: University of Sydney students who graduated between 2009 and 2013 (n = 404) were invited to complete a telephone interview. One hundred and thirty-five graduates were interviewed, 90 RCPP participants and 45 non-participants. Results: The majority of graduates interviewed were from a metropolitan background (87%), 47% were female, 77% worked full time, and 70% were employed in private practice. A higher proportion (33%) of the RCPP participants were working in rural Australia compared with 18% of the non-participants. The graduates reported that the RCPP was a high-quality program with excellent rural clinical supervisors, provided broad clinical dentistry; they met appreciative patients and enjoyed the rural lifestyle. Conclusions: The RCPP was a valuable and positive experience with many considering it as a highlight of their dental education. A large proportion reported the program positively influenced their employment location choices, and a higher proportion of the RCPP participants were identified as working rurally, compared to the non-participants.

BACKGROUND:Significant investment has been undertaken by many countries into 'Rural Clinical Training Placement Schemes' for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context.METHODS:A systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework.RESULTS:Sixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa. Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment.CONCLUSIONS:Future research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.

CONTEXT/INTRODUCTIONThe availability of clinical dental services in rural locations is a major concern for many countries as dental care professionals gravitate to work in metropolitan areas. This systematic review examines the literature on Rural Placement Programs within dentistry and their impact on workforce intentions and employment outcomes. The review provides a detailed analysis of the methodological characteristics of the literature, considers the quality of the evidence and compares the outcomes within an international context.MATERIALS AND METHODSThe systematic review identified published literature between 2005 and 2016 from databases including EMBASE, MEDLINE, PubMed, NursingOVID and Cochrane. The PRISMA protocol was adopted for the development of the study, and the Health Gains Notation Framework was implemented to assess the quality of the selected research papers.RESULTSEleven studies considering Rural Clinical Placement Programs met the inclusion criteria. The studies were from Australia, South Africa, United States, Thailand and India. The evidence in this review indicates that well-designed, financially supported programmes that provide a perceived valuable clinical experience, good supervision and professional support in a rural environment can lead to dental students stating increased intentions to working in a rural location. However, there was a lack of evidence and research into whether these rural intentions result in positive action to take up employment in a rural location.CONCLUSIONThe evidence suggests that well-prepared rural clinical placements, which have experienced clinical supervisors, good professional student support from the dental school, provide a valuable clinical experience and are sufficiently funded, can increase intentions to work in a rural location upon graduation. However, there is a lack of evidence in dentistry into whether intentions translate into practitioners taking clinical positions in a rural location. Future research should be planned, which will undertake longitudinal cohort studies to identify factors that have an important influence on rural job choice.

Background The consumption of water, milk and various sugary drinks and their relationship with the caries experience of a random sample of teenagers aged 14 to 15 years living in New South Wales, Australia was investigated. Methods Data were obtained from both clinical and questionnaire components of the NSW Teen Dental Survey, 2010. The analyses allowed for various demographic and behavioural risk factors using caries experience ( DMFT >0) and mean DMFT as the key outcome variables. Results Males were more likely than females to consume large volumes of sugary drinks. Consuming two or more glasses of sugary drinks per day led to significantly increased caries experience amongst this sample of 14 and 15 year olds. Factors found to be associated with elevated sugary drink consumption included family income, gender, and mother's education level. Conclusions There is a strong correlation between increased caries experience of NSW teenagers and high levels of consumption of sugary drinks.

The Local Government Area of Gosford implemented a water fluoridation scheme in 2008. Therefore the opportunity was taken to record the dental health of primary school children aged 5–7 years prior to the fluoridation and compare the results with other communities in NSW with different access to fluoridated water. The aim was to compare the oral health of New South Wales (Australia)s 5–7 year olds living in fluoridated, and non- fluoridated communities. One of the areas was due to implement water fluoridation and is termed the pre-fluoridation site.

OBJECTIVE:To investigate the potential social and behavioural risk factors influencing the oral health of teenagers aged 14 and 15 years living in New South Wales Australia.METHODS:Quantitative and qualitative methodologies were used in this research project. Data were obtained from both the clinical and questionnaire components of the NSW Teen Dental Survey 2010 and were analysed in SAS 9.2. The analyses allowed for various demographic and behavioural risk factors to be assessed using caries experience, severe caries and DMFT (decayed, missing or filled teeth) counts as the key outcome variables.RESULTS:Of the 1,256 14- and 15-year-olds who had a dental examination, 1,199 (95.5%) provided questionnaire data. The clinical examinations found that 44.4% of teenagers overall had caries experience in at least one tooth, while 10.6% of the sample had experienced severe caries. Severe dental caries was found to be significantly related to a variety of factors, including family income, fluoridation status, tooth brushing behaviour and sugary drink consumption.CONCLUSIONS:The oral health of 14- and 15-year-olds in NSW is influenced by social and dietary factors as well as access to fluoridated water supplies. There was also a strong relationship between self-rated oral health status with DMFT and with caries experience.IMPLICATIONS:The findings of this study will assist policy makers by highlighting the current caries risk factors that should be part of future health promotion programs.

Introduction Staff views on a rural clinical placement involving 4th year dental undergraduates from the University of Sydney (Australia) were collected in order to monitor whether the programme was feasible and acceptable to the academic Faculty Staff and the rural clinical supervisors. Materials and methods An evaluation of the rural placement programme was undertaken in 2009 at three rural sites in New South Wales (Australia). Semi-structured pre- and post-placement in person interviews recorded the views of three University Faculty Staff whilst similar data were collected by telephone interviews for three supervising clinicians at the rural clinical sites. Interviews gathered opinions on the organisation, implementation and outcomes of the rural placement programme. Results Eight qualitative analysis identified themes were specified and included communication, programme duration, effect on students and staff, benefits of the programme, rural intentions, programme sustainability and the success of the programme. Positive pre-placement aspects were potentially good clinical experience, new environment, sharing of knowledge and interaction with a rural community. Negative issues were anxieties about students' clinical ability to offer a service, missing lectures and maintaining clinical training quotas. The post-placement themes were generally positive; staff reported that the students enjoyed the rural community experience, their communication and clinical skills improved. Conclusion According to the staff, the placement programme was feasible and provided acceptable positive clinical and personal development for the students. This research will help educators planning to incorporate a rural clinical programme into a University curriculum.

BACKGROUND:Dental caries remains one of the most common chronic diseases of adolescents. In Australia there have been few epidemiological studies of the caries experience of adolescents with most surveys focusing on children. The New South Wales (NSW) Teen Dental Survey 2010 is the second major survey undertaken by the Centre for Oral Health Strategy. The survey is part of a more systematic and efficient approach to support State and Local Health District dental service planning and will also be used for National reporting purposes.METHODS:Data for the NSW Teen Dental Survey were collected in 2010 from a random sample of Year 9 secondary school students aged 14 to 15 years from metropolitan and non-metropolitan schools under the jurisdiction of the NSW Department of Education and Training, the Catholic Education Commission and Independent Schools in New South Wales. Nineteen calibrated examiners performed 1269 clinical examinations at a total of 84 secondary schools across NSW. The survey was accompanied by a questionnaire looking at oral health related behaviours, risk factors and the usage of the Medicare Teen Dental Plan.RESULTS:175 schools were contacted, with 84 (48%) accepting the invitation to participate in the study. A total of 5,357 student consent forms and parent information packages were sent out and 1,256 students were examined; leading to a student participation rate of 23%. The survey reported a mean DMFT for 14 and 15 year olds of 1.2 and it was identified that 45.4% of students had an experience of dental caries. Major variations in caries experience reported occurred by remoteness, water fluoridation status, socio-economic status and household income levels.CONCLUSIONS:The NSW Teen Dental Survey provided state-wide data that will contribute to the national picture on adolescent oral health. The mean DMFT score of 1.2 is similar to the national caries experience data for this age group from the Australian Child Dental Health Survey in 2009.

IntroductionIn Australia, as in many other countries there is a disparity in the number of dentists working in rural locations compared with metropolitan areas, and this is a growing problem. The aim of the research was to monitor the location of recent graduates who undertook a rural clinical placement whilst in the final year of Sydney Dental School, to determine whether it influenced their choice of job location.Materials and MethodsStudents who graduated in 2008 and 2009 were followed up to ascertain their working location. Forty per cent of the 2009 graduates participated in a rural placement during their undergraduate degree and 60% did not. In 2008, none of the students went on a rural placement as the scheme had not been implemented. The Australian Health Practitioner Regulation Agency (AHPRA) internet website was used to find the working location of the graduates. The rural, remote and metropolitan areas (RRMA) classification system was used to classify which areas of Australia were metropolitan, regional, rural and remote zones.ResultsThe graduates of 2008 and 2009 were followed up in 2011 and 2012 to ascertain their working location. In 2011, 12.7% of the 2008 graduates were employed in a rural location compared to 27.6% of the entire 2009 graduating class. In 2011, of those 2009 graduates who participated in the rural placement programme, 44.8% were working in a rural or remote region compared to 17% of the graduates who did not participate. In 2012, the second follow-up found that 18.6% of the 2008 graduates were working in a rural location compared to 25.9% of all the 2009 graduates. In 2012, 43.3% of the 2009 rural placement participants were found to be working in a rural location compared to 14.9% of the non-participants.ConclusionsThe study followed up recent dental graduates' working locations to provide longitudinal evidence of the influence of an undergraduate rural placement programme on their work choices. It was found that a higher proportion of graduates who participated in the rural placement programme were working in a rural location when compared with those who had not been offered a placement.

OBJECTIVE:To evaluate the effectiveness of a rural clinical placement on students' self-perceived clinical skills and work location choice post-graduation.METHODS:A one month rural placement program was introduced in 2008-2009 for 4(th) year dental undergraduates. Student's views on the rural exercise were collected by pre and post self-completion questionnaires, which were distributed to rural placement students and to the students who did not participate in the placement. Information was collected on self-reported skill levels in various clinical techniques using Likert scales and future rural work intentions. Clinical supervisors and University Faculty Members opinions on the students clinical work were also collected via interviews.RESULTS:The mean age of the respondents was 27 years and the majority were female (57%). All the placement students (volunteers) completed pre and post placement questionnaires and (67%) of the non-placement students completed the pre questionnaire and (65%) a post questionnaire. When the two groups were compared in terms of their Likert scores, there was a significantly (P<.02) larger increase in skill level in the rural group. Clinical supervisors confirmed volunteers increased in confidence and ability in clinical skills post placement. The majority (96%) of students who completed a placement reported that they were more likely to work in a rural environment after graduation.CONCLUSIONS:The rural placement improved the self-perceived clinical skills of the volunteers and enhanced positive attitudes towards working in a rural location.

INTRODUCTION:Australia's dental workforce is largely metropolitan, with a corresponding lack of dentists in rural areas. Some evidence from the discipline of medicine suggests that providing a rural placement program for undergraduates may encourage them work in a rural area post-graduation. Therefore, the University of Sydney Faculty of Dentistry implemented a rural placement program for final year dental undergraduates with funding provided by the Australian Government Department of Health and Ageing.METHODS:In 2009, a one-month Rural Placement Program was introduced for 4th (final) year dental undergraduates. Of the 80 fourth year students, 40% volunteered to participate in the program. Their views on the program were collected in pre- and post-questionnaires which were self-completed. Framework analysis was used to identify common themes in the student responses. This article focuses on the placement experience of the participants with particular emphasis on the factors and barriers which influenced their intention to work in a rural location post-graduation.RESULTS:Participants' characteristics included a mean age of 27 years, 59% female and 77% had been raised in a city environment. All the participants completed the pre- and post-placement questionnaires. The most common pre-placement hopes were to increase their clinical skills and to experience a rural environment. Pre-placement concerns related to missing lecture time at the university and having less time there to complete their clinical quota requirements. Over half of the students (57%) were considering employment in a rural location prior to the placement. Post-placement the students reported being pleased with the clinical experience provided, with increased time management skills and clinical confidence emphasised. The rural clinical supervisors and staff were highly rated by students for their support, helpfulness and teaching ability. After the placement the majority of students (97%) were considering working in a rural environment once qualified. Positive factors identified as influencing their decision were the broad clinical range of procedures available, good clinical mentors, reduced commuting and a quieter lifestyle. Barriers to working in a rural location were identified as missing friends, partners and the number of available job opportunities. All participants would recommend the placement to future students.CONCLUSIONS:In this successful undergraduate Rural Placement Program the students valued both personal and educational components. They became more aware of the potential advantages of working in a rural location and almost all would consider working in a rural area after graduation.