Effective systems and services to improve rural health

Our researchers are co-partnering with communities to translate healthcare findings into practice.

Our research aims to enhance service delivery to help build and evidence-base and translate findings into practice.

Systems and services to address mental health

Research team:

  • Dr Victoria Palmer (University of Melbourne)
  • Professor Jane Gunn (University of Melbourne)
  • Professor Carol Harvey (University of Melbourne)
  • Associate Professor John Furler (University of Melbourne)
  • Professor David Osborne (University College London)
  • Dr Sandra Davidson (University of Melbourne)
  • Dr Mahesh Jayaram (University of Melbourne)
  • Dr Patty Chondros (University of Melbourne)
  • Professor Amanda Kenny (VVMCRHR)

Cardiovascular disease accounts for 40% of the excess mortality identified in people with severe mental illness. Modifiable cardiovascular risk factors are higher in this group and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with severe mental illness frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health.

This is Australia’s first ever randomised controlled trial of an assertive care intervention to reduce cardiovascular risk for people with severe mental illness.

The Assertive Care Cardiac Healthy Hearts Trial (ACCT) will test a co-produced, nurse-led intervention delivered with general practitioners to reduce absolute cardiovascular disease risk at 12 months compared with an active control group. ACCT will deliver a co-produced and person-centred, guideline level cardiovascular primary care intervention to a high-need population with severe mental illness. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation.

This research is supported by the National Health and Medical Research Council.

Read the study’s protocol.

Research team:

The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence of mental ill health is highest for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders, and that over 50% experiencing FEP do not finish secondary school.

This study used survey methodology to examine the experiences of Victorian rural and regional secondary school principals, deputy principals, teachers and school counsellors working with students who experience mental illness in their school. It investigated whether mental illness had a negative impact on secondary school completion and if schools had access to effective early intervention mental health services for their students.

This study found that rural high schools experience high rates of student mental illness in their school, barriers to getting help for their students and high rates of students who die by suicide. It identified the need to implement mental health services within Victorian rural secondary schools. Researchers found that teachers can identify students at risk but accessing mental health services is an issue. Education and mental health services must work together to ensure young people receive services in a timely and accessible manner.

Research team:

  • Alisha Maree Johnson (University of Western Sydney)
  • Associate Professor Ajesh George (University of Western Sydney)
  • Associate Professor Bronwyn Everett (University of Western Sydney)
  • Dr Toby Raeburn (University of Western Sydney)
  • Professor Amanda Kenny (VVMCRHR)

This study is the first of its kind to explore the oral health experiences and practices of mental healthcare providers, and adolescents with mental health issues and their carers. The information gained will help to inform the development of tailored strategies to improve the oral health, and general health and wellbeing, of adolescents with mental illness. Providing early intervention may help to reduce the prevalence of oral health problems in adulthood and improve quality of life.

Research team:

This multidisciplinary study is evaluating headspace services in Western Victoria for the Western Primary Health Network, from service and stakeholder perspectives.

Systems and services to address complex needs

Research team:

This study involved an extensive review of the literature relating to occupational therapy services for returned military and veterans. An online survey collected data from Australian occupational therapists to further understand the services provided to the Department of Veteran Affairs’ (DVA) clients and the barriers and enablers in delivering those services.

The survey findings indicated that there were issues with the DVA funding schedule. Travel to the client’s home or community was not funded, which was a major issue for private practice occupational therapists – particularly in rural and remote areas while renumeration rates were inconsistent with other compensable systems. Clients have complex needs and specific continuing professional development was also identified as a need for therapists.

Research team:

  • Hannah Beks (Deakin University)
  • Associate Professor Kevin McNamara (Deakin University)
  • Associate Professor (Vince Versace)
  • Professor Amanda Kenny (VVMCRHR)
  • Associate Professor James Charles (Deakin University)

This study explores how Aboriginal Community Controlled Health Organisations, as Complex Adaptive Systems (CAS), respond to the healthcare needs of Aboriginal and Torres Strait Islander people in the primary healthcare setting.

Researchers will undertake a mixed-methods process and impact evaluation of an Aboriginal community-developed and governed model of primary healthcare (Tulku wan Wininn mobile clinic), and a telehealth model of care.

They will examine the complexities of implementing new models of healthcare in Aboriginal Community Controlled Health Organisations, including impacts of COVID-19. And, they will use complexity theory to develop a theoretical framework, through a meta-synthesis of evaluation findings and existing theories, to explain how Aboriginal Community Controlled Health Organisations as CAS respond to the healthcare needs of Aboriginal and Torres Strait Islander people in the primary care setting.

Research team:

This study explores the impact of rurality and socioeconomic status on people’s ability to self-manage common chronic health conditions, especially where there is multimorbidity. The project includes a systematic review examining the impact of socioeconomic status on participation, engagement and outcomes from self-management interventions, and qualitative interviews with patients and health providers working in regional community health settings.

Using Shippee’s Cumulative Complexity Model, the experiences and understanding of workload and capacity in chronic disease management from both the patient and provider viewpoint are also being investigated. Future research will include analysis of a patient survey assessing workload and capacity, leading to the development of an alternative model of care for chronic disease self-management in disadvantaged multimorbid populations.

Research team:

Ear, nose and throat (ENT) care in rural Australia is suboptimal. The ‘Perils of Place’ report by the Grattan Institute identified four ENT hotspots in rural Victoria, two of which are located in the Murray Primary Health Network (PHN) region.

This study aims to optimise ENT care in rural Australia by investigating current issues around diagnosis and care of ENT conditions in the Murray PHN region. The research team will develop and implement tailored ENT care training for primary healthcare professionals in the region, and educational material for a community health campaign. They will also evaluate the impact on ENT care delivery in the region as a result of these interventions.

Research team:

  • John Baker (La Trobe University PhD candidate)
  • Steve Begg (La Trobe University)
  • Dr Mohd Masood (VVMCRHR)
  • Lukar Thornton (Deakin University)
  • Aziz Rehman (Federation University)

Density and proximity of tobacco retailers have important implications for smoking and tobacco use. There is a relationship between tobacco retailer density and/or proximity, and smoking behaviour among residents in lower-socioeconomic status communities, and among students who attend schools with a retailer located nearby.

This study investigates the licencing of tobacco retailers in rural Victoria. It will also examine the relationship between the proximity of tobacco retailers in rural Victoria with smoking behaviour.

Research team:

Complete dentures are prosthetic devices used to restore speech, appearance and function to edentulous patients. Fabrication of complete dentures has financial implications at the individual and public level.

This project aims to quantify the longevity and failure of complete dentures, and of complete dentures as opposed to natural teeth, in a population of patients who have received care through the Victorian public dental service. Understanding the natural history of complete dentures, including their lifespan and failure rate, will help policymakers to develop a denture replacement plan.

Research team:

  • Dr Evelien Spelten (VVMCRHR)
  • Professor Leigh Kinsman (University of Newcastle)
  • Professor Gina Agarwal (McMaster University, Canada)
  • Professor Peter O’Meara (Monash University)
  • Professor Leeroy Williams (La Trobe University/Eastern Health)
  • Professor Alan Shiell (La Trobe University)
  • Dr Saskia Duijts (Netherland Comprehensive Cancer Organisation (IKNL), The Netherlands)
  • Ruth Hardman (Sunraysia Community Health Services/La Trobe University PhD candidate)
  • Andrea Grindrod (La Trobe Palliative Care Unit)
  • Julia van Vuuren (La Trobe University)
  • Susan Morgan (Loddon Mallee Regional Palliative Care Consortium, Bendigo Health)
  • Hannah Jackson (La Trobe University)

This study began as an evaluation of a community palliative care service, set up to support patients who wanted to die at home, and their carers. It resulted in the establishment of an integrated community palliative care service that was subsequently assessed and found to be sustainable, acceptable and affordable. There were, however, concerns about its adaptability, mainly due to rural workforce shortages.

As part of this project, a study with Indigenous Elders in the Mildura area and their experiences with the local palliative care service was also undertaken, focussing on ways to increase uptake.

Further research, in collaboration with Sunraysia Community Health Services, hopes to identify innovative ways to improve symptom management and access to pain medication, and a proof-of-concept study with community paramedicine to support palliative care services in residential aged care facilities.

This research was supported by the Murray Primary Health Network (first two evaluations) and the Loddon Mallee Regional Palliative Care Consortium (focus groups with Indigenous Elders).

Arts-based approaches to systems and services

Research team:

  • Dr Christina West (University of Manitoba, Canada)
  • Professor Pamela S. Hinds (George Washington University, USA)
  • Professor Amanda Kenny (VVMCRHR)
  • Debra Dusome (University of Brandon, Canada)
  • Joanne Winsor (University of Manitoba, Canada)
  • Vanessa Slobogian (Alberta Children’s Hospital, Canada)
  • Meaghen Johnston (Mount Royal University, Canada)
  • Wendy Pelletier (Alberta Children’s Hospital, Canada)
  • Jewel Loewen (Alberta Children’s Hospital, Canada)
  • Jennifer Crysdale (Alberta Children’s Hospital, Canada)
  • Dr Michelle Lobchuk (University of Manitoba, Canada)
  • Dr Donna Wall (University of Manitoba, Canada)
  • Dr Victor Lewis (University of Calgary, Canada)

Paediatric bone marrow transplant (BMT) can be lifesaving, but it also increases uncertainty, worry, and fear for family members. Despite the increasing focus on BMT as a treatment for serious illness in children, there remains limited research on the psychosocial impact of BMT on the entire family. Early findings indicate that families living in rural communities face unique challenges that impact the whole family.

This study uses a family systems-expressive arts framework to understand the transition of the entire family through paediatric BMT. Families have been recruited from two large children’s hospitals. Integrated knowledge translation will be used in the study, with family members, adolescent/young adult bone marrow transplant recipients, and interdisciplinary professionals guiding all phases of the research. A knowledge translation video will also be created by participating family members.

This research is supported by Research Manitoba, Canada.

Research team:

  • Dr Christina West (University of Manitoba, Canada)
  • Dr Kendra Rieger (Trinity Western University, Canada)
  • Professor Amanda Kenny (VVMCRHR)
  • Debra Dusome (Brandon University, Canada)
  • Dr Fiona Shulte (University of Calgary, Canada)
  • Dr Mandy Archibald (University of Manitoba, Canada)

This study will explore child and family experiences of blood and marrow transplant (BMT) using a family systems-expressive arts framework and constructivist grounded theory.

The need for the Expressive Healing Network – a unique, partnership-based knowledge translation network – emerged from the Research Manitoba study. Researchers will use the emerging findings from the Research Manitoba study to examine the processes of knowledge translation in the Expressive Healing Network (face-to-face meetings and an interactive website environment).

This study aims to understand more about knowledge translation by applying a partnership approach to rapid translation of knowledge, with diverse stakeholders.

This research is supported by the Children’s Hospital Research Institute of Manitoba, Canada.

Research team:

  • Dr Kendra Rieger (Trinity Western University, Canada)
  • Professor Tom Hack (University of Manitoba, Canada)
  • Professor Amanda Kenny (VVMCRHR)
  • Dr Mandy Archibald (University of Manitoba, Canada)
  • Miriam Duff (Cancer Care Manitoba, Canada)
  • Patrick Faucher (Centre for Healthcare Innovation, Canada)
  • Tim Dyck (Cancer Care Manitoba, Canada)
  • Christina West (University of Manitoba, Canada)

This study investigates the impact of an art exhibit as an innovative arts-based knowledge translation strategy in oncology. Researchers initially conducted a qualitative grounded theory study of how people process their cancer experiences through a mindfulness-based expressive arts group. During the ten-week program, participants engaged in mindfulness practices and completed various expressive art activities including an art journal, an emotional continuum sketchbook, a body outline, and a mandala.

This art exhibit will feature photographs of the participants’ artwork grouped by qualitative findings; life-size banners of the participants’ body outline; pictures of the participants’ mandalas displayed as works of art; and/or photo books displaying all of the types of art created in the class and describing the weekly group activities. An exhibit brochure and an audio-guide will also be created.

Researchers will evaluate the impact of the art exhibit on attendees, as there is nascent research investigating this knowledge translation strategy in oncology. The art exhibit will be the ‘real-life case,’ examining how arts-based initiatives can facilitate knowledge translation and understanding with diverse groups of people.

This research is supported by Manitoba Centre for Nursing and Health Research, Canada.

Research team:

  • Dr Christina West (University of Manitoba, Canada)
  • Dr Kendra Rieger (Trinity Western University, Canada)
  • Professor Amanda Kenny (VVMCRHR)
  • Rishma Chooniedass (University of Manitoba, Canada)
  • Lisa Demczuk (University of Manitoba, Canada)
  • Joanne Chateau (University of Manitoba, Canada)
  • Professor Shannon Scott (University of Alberta, Canada)

Digital storytelling is an arts-based research method that can elucidate complex narratives in a compelling manner, increase participant engagement and enhance the meaning of research findings.

This systematic review will examine the use, impact, and ethical considerations of digital storytelling in health research. It will explore what is known about the purpose, definition, use (processes), and contexts of digital storytelling as part of the health research process; the impact on the research process, knowledge development and healthcare practice; and the key ethical considerations when using digital storytelling within qualitative, quantitative and mixed-methods studies.

In collaboration with national and international experts in digital storytelling, researchers will synthesise evidence about digital storytelling that is critical to the development of methodological and ethical expertise about arts-based research methods. They will also develop recommendations for incorporating digital storytelling in a meaningful and ethical manner into the research process.

This research is supported by Manitoba Centre for Nursing and Health Research, Canada.

Read the study’s protocol.

Research team:

Family violence is a critical issue in Australian society. Women living outside capital cities are 1.4 times more likely to be victims. Regional and rural women are less likely than metropolitan women to disclose family violence because of the nature of small communities, fear of further abuse from perpetrators, and systemic gaps in service delivery. The long-term impact of domestic abuse on women and, by extension, their children and communities, is significant.

Rural proofing is needed by developing resources that challenge gendered stereotypes of people who experience family violence in rural communities. Women who have survived family violence want to contribute their knowledge and be advocates for change.

This study will support women who have survived family violence to share their stories, contribute to social change and build capacity in rural communities. Using the process of digital storytelling researchers, family violence workers, and women with lived experience of family violence will work together to develop stories designed to contribute to societal change.