The rural allied health workforce study (RAHWS): background, rationale and questionnaire development

The allied health professions form approximately 18% of the health workforce in Australia and are well placed to contribute to future multidisciplinary models of health care. There are many reports describing the health workforce in Australia for the medical and nursing professions but there is very little information available about the nature of the allied health workforce. Recent studies have highlighted the need for more current and detailed information about the rural allied health workforce to inform future workforce planning. National health policy reform requires that new healthcare models take into account future workforce requirements, the distribution and work contexts of existing practitioners, training needs, workforce roles and scope of practice. The absence of accurate data profiling the existing rural allied health workforce makes this impossible. The Rural Allied Health Workforce Study (RAHWS) aims to use a cross-sectional survey instrument with high validity to provide a large scale but detailed profile of the allied health workforce in regional, rural and remote Australia. The RAHWS survey instrument used in this study is


Introduction
Allied health professionals comprise a substantial proportion of the health workforce and make a significant contribution to the health and wellbeing of the Australian population.
According to the Australian Institute of Health and Welfare (AIHW) 1 the allied health professions form approximately 18% of Australia's health workforce, while medical practitioners comprise approximately 12% and nurses 63%.
Despite the acknowledged importance of allied health services, there is remarkably little information detailing the existing allied health workforce, particularly in rural areas.
Available studies are dated, based on a small sample size, geographically limited or report important inconsistencies 2 .
For example, the conclusions of Victorian 3 and Tasmanian 4 studies about the value of student placements for rural recruitment are not in agreement.Peer reviewed publications exploring Australian rural allied health workforce issues are also sparse 5,6 .The need for data collection regarding the current allied health workforce has been repeatedly mentioned in the literature 2,7,8 .However, workforce data are robust for nurses and medical practitioners, including many peer-reviewed publications and major governmental reports [9][10] .The AIHW 2006 report provides a small amount of detail about the national allied health workforce based on 2001 Australian Bureau of Statistics census data 1 .More recent reports have concluded that there is a lack of data about the Australian allied health workforce, particularly for rural and remote areas 11 .
The Rural Allied Health Workforce Study (RAHWS) is ongoing in Tasmania and New South Wales (NSW).This report describes the development of a method to obtain workforce information using a cross-sectional survey instrument of high validity which has the capacity to provide a large scale but detailed profile of the allied health workforce in regional, rural and remote Australia.The data produced may inform future public health and primary care policy development, as well as generating a deeper understanding about the recruitment and retention of rural allied health professionals.The work is the product of a collaboration of three Australian Government funded University Departments of Rural Health (UDRHs) 12 .

Background and rationale
Allied health professionals provide a broad range of diagnostic and therapeutic services in both the public and private healthcare systems.For example in aged care, Because of the diversity of roles, defining 'allied health' is difficult.In 2007, Lowe, Adams and O'Kane examined the manner in which different jurisdictions, organisations, purchasers of allied health services and professional groups used the term 'allied health' 13 .The following criteria were derived from their analysis: • are tertiary qualified, having completed an accredited entry level qualification permitting them to obtain either state or territory registration, a license or accreditation to practice, and/or to join the relevant professional body • apply their skills and knowledge to restore and maintain optimal physical, sensory, psychological, cognitive and social function It is well known that there is a national shortage of allied health professionals and that this problem is worse in rural areas 14 .An analysis of 2001 ABS census data undertaken by Services for Australian Rural and Remote Allied Health (SARRAH) in 2004 demonstrated that people living in outer regional centres have access to only about half as many allied health professionals as people living in metropolitan centres.This figure decreases to less than a quarter in some remote locations(Fig1).The per capita reduction of allied health services associated with increasing rurality has implications for the healthcare needs of rural and regional residents.In particular, the ageing population could stretch the already sparse allied health workforce beyond the ability to cope with the expected increased demand for services.
In a climate of health workforce shortages, the Productivity Commission has recently suggested service innovations, such as the use of supervised therapy assistants and extending the scope of health professional practice on a competency basis 15 .The need for innovative service delivery models is particularly acute in rural areas where practitioners' ingenuity is frequently tested in meeting the healthcare needs of the population.
In 2006, the Australian Health Workforce Official Committee (AHWOC) developed a checklist to assess the impact of new initiatives on the health workforce 16  including that of the nursing and medical workforce 9,10,[17][18][19] .

Conclusions
Accurate and current information about the rural health workforce is essential to future policy development, and yet there is remarkably little known about allied health professionals in regional, rural and remote Australia.Section One: Some Background Information physiotherapists, occupational therapists and social workers contribute to both speedy discharge from hospital and the prevention of readmission.Podiatrists, exercise physiologists and dietitians are key team members in managing chronic conditions such as diabetes.Audiologists and speech therapists provide screening of and therapy for children with developmental disabilities.Medical laboratory scientists and radiographers provide essential diagnostic services, and psychologists help to address the rising prevalence of mental © S Keane, TN Smith, M Lincoln, SR Wagner, SE Lowe, 2008.A licence to publish this material has been given to ARHEN http://www.rrh.org.au 3 illness.Allied health professionals often work in multidisciplinary models of care, with an emphasis on preventive services and are well placed to provide interprofessional health education and health promotion services.
. The Committee advises that new projects must take into account future workforce requirements, the distribution and work contexts of existing workforce, training arrangements and workforce roles and scope of practice.The absence of data profiling the existing allied health workforce renders such analysis impossible.The questionnaire The RAHWS survey instrument (Appendix I) is the result of a comprehensive consultation with clinicians in the public and private healthcare system, allied health academics from three Australian universities, and public healthcare administrators.A pilot survey was performed in the Hunter-New England region of northern NSW in 2005 2 .The questionnaire was well accepted by allied health professionals in that region and opportunities for a larger scale study soon eventuated.The RAHWS questionnaire was expanded from the pilot version to include further questions in three broad categories: background information; current employment; and education and professional development.The added questions target issues related to recruitment and retention and were constructed with reference to the literature,

Figure 1 :
Figure 1: The allied health workforce by degree of rurality and remoteness.
Developing a meaningful national data-set requires a uniform sampling process across the allied health population, in spite of the challenges involved.The RAHWS survey instrument has been specifically developed to meet the need for detailed, large-scale and uniform data collection.Good concurrent and face validity of this instrument have been demonstrated and its design allows for flexible methods of data collection, using either online or of delivery.The data collected can be easily analysed for a wide range of variables with crosscorrelation of responses.The results can be used to answer a large number of research questions about recruitment and retention, professional education and service delivery.The RAHWS survey has been performed in Tasmania and non-metropolitan parts of NSW.Other states have also expressed strong interest in using the same survey instrument and methodology.It is hoped that data collection will take place across the whole of Australia on a state-bystate basis over a sampling period of approximately 12 to 18 months.If this can be achieved it will create the largest repository of data about the allied health workforce ever available in this country.

Frequency
a) Approximately how long does it take for you to travel between home and work?: =____________ (b) Estimate the hours per week spent in work-related travel (excluding home-work-home)?: =________ (c) How far is the most distant site that you service from where you usually work?: = _________ km (d) What form of transport do you use for this work-related travel?

Section
Four: Some More Important Questions Please indicate your preferred response to the following statements by ticking the boxes, where: SA = Strongly agree; A = Agree; N = Neutral; D = Disagree; SD = Strongly disagree; NA = Not applicable are flexible You are always able to schedule annual leave when you want it Locum backfill is always available when you are away on leave Your department / practice is chronically short-staffed There is a high level of staff turnover where you work You have good facilities and equipment to work with You have good admin.support for enquiries, appointments, etc.You have good clinical support (colleagues or therapy assistants) You work as a member of a multidisciplinary team SA positions always occurs in a timely way Temporary and / or part time positions are often hard to fill Locums are always available for unfilled positions Personnel are allocated according to areas of clinical need You are working in your area of clinical expertise You participate in clinical rotations / rosters across practice areas You use a wide range of clinical skills in your work Your are satisfied with your access to CPD opportunities You have regular face-to-face contact with colleagues in your field You have good access to more experienced staff in your field You feel professionally isolated SA have had to become multi-skilled to meet clinical demands There are service gaps because of limited human resources You sometimes work beyond the boundaries of your profession Your workload is reasonable You are autonomous and can decide your own work priorities You feel 'burned out' Your grading and salary are appropriate for the job you do You believe your manager understands your professional role You believe your manager values the work you do You get along well with your work colleagues You feel that your work makes a difference to patients / clients You enjoy living in your local community You feel that your work is valued by the local community

1 .
Which Allied Health Profession do you belong to?
Section Two: Your Current Employment 17. Do you have more than one paid position with different employers?Yes No If 'Yes', how many positions?______________ 18.In what sector do you work?(Tick more than one box if appropriate) (b) How many of those hours would be (a) paid overtime = ________ : (b) unpaid overtime ________ (c) About how many hours in total would you prefer to work in all your positions?