Volume twenty-one, Issue 3

The medical literature is replete with examples of studies about groups in which researchers from the ‘outside’ present and discuss their findings without any reflection of the views of those who have been researched. RRH has taken the decision that an article about people in any country or region without authors from that country or region will not be published and a recent RRH article provides an excellent example of how communities can be meaningfully engaged in research. This Editorial is a call to the international health science community to develop and adopt research and publication policies so that there is “nothing about us without us”.

Expanding community pharmacists’ scope of practice in rural and remote locations has the potential to improve access to health care and improve health outcomes. Internationally, a lack of support from other health professionals has presented a barrier to the uptake of expanded pharmacy models. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings.

This case-series study describes how a small rural healthcare system managed COVID-19 patients admitted between March and May, 2020. The authors describe their "hub and spoke" approach to best utilize scarce system resources, the assembly of a multidisciplinary clinical team to manage patients admitted and the challenges faced in adapting to the rapidly changing standards of care. The authors describe how a small team of generalist physicians and others can, in a crisis, provide a level of care comparable to that found in academic centers. They conclude that the development of strong clinical and research networks will help equip rural areas to respond not only to current and future pandemics, but more broadly to emerging care delivery challenges.

Remote area nurses often work in isolated and extreme geographical locations, alongside and with Aboriginal and Torres Strait Islander people. This study investigated what remote area nurses perceived were enablers and barriers to being involved in the delivery of care to an Aboriginal person with a terminal diagnosis passing away on their traditional lands.

This study examined whether social support, problem solving and family function predicted depressive symptoms, caregiving-related life changes, self-care and caregiver burden in rural heart failure caregivers. It also compared differences in these variables between rural and urban caregivers. Findings suggest important considerations for reducing burden and improving outcomes for rural heart failure caregivers.

The number of maternal deaths remains high in sub-Saharan Africa. Although improved antenatal care (ANC) service provision has been prioritized across the region, research is limited on the ANC experiences of Indigenous women. This study describes ANC attendance patterns at a hospital, and characterizes factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda.

Water is crucial for food security and health, but fewer than 40% of rural households in Brazil are connected to the water distribution network. Boardwalk Cisterns is a rainwater harvesting program that provides clean water for populations with precarious access to water in Brazil. This study reports on the perceptions of farmers about the impact of the Boardwalk Cisterns program in the northeast, semi-arid region of the country.

A água é crucial para a segurança alimentar e saúde, mas menos de 40% das famílias rurais no Brasil estão conectadas à rede de distribuição de água. O Cisternas Calçadão é um programa de captação de água da chuva que fornece água potável para populações com acesso precário à água no Brasil. Este estudo relata a percepção de produtores rurais sobre o impacto do programa Cisternas Calçadão na região semi-árida do Nordeste do país.

Facemasks are widely recommended as a COVID-19 prevention strategy, but decisions to wear a mask depend on multiple factors. While surges in cases within rural communities are likely an impetus for behavior change, rising case rates likely explain only part of mask-wearing decisions. This study examined the relationship between county-level indicators of rurality and mask wearing.

While cancer deaths have decreased nationally, declines have been much slower in rural areas compared with urban areas. This cross-sectional study explored the association between breast cancer service capacity, and breast cancer incidence and mortality, in Arizona’s low populous counties. Compared to urban counties, rural county status was associated with lower breast cancer incidence rates, although there were no statistically significant differences in breast cancer mortality. These findings may reflect the challenges of using county level data, particularly per capita data, in a state where counties average over 7500 square miles.

It is critical that those working with Aboriginal and Torres Strait Islander communities engage in culturally safe practice by acknowledging and understanding the impacts of trauma. In this Commentary, the authors examine the origins of cultural safety as a recommended practice for working with Indigenous peoples, demonstrating its flaws and shortcomings in practice and argue that without an understanding of the impacts of trauma, ‘ticking the box’ of cultural safety training simply is not enough to achieve equity in Indigenous health outcomes.

Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at the patients’ bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients’ lives.

Grey nomads are people over the age of 55 who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Although grey nomads are challenging the established view of ageing in Australia, some evidence suggests that they exert a significant burden on rural health services. This scoping literature review explored the characteristics and behaviours of grey nomads, many of whom live and travel with diabetes.

Unpaid carers play a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing is often impacted in this role. There are limited data on how carer strain, depression and empowerment may be improved for carers. This study investigates the effectiveness of a carer support program developed with a community-based participatory action research approach in four remote Aboriginal communities in Western Australia.

Research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just ticking the boxes on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice.

Safe drinking water and effective sanitation in remotely located Indigenous communities are essential services and their provision is a human right. Yet sustainable provision of these services can be challenging. This narrative review identifies five key enablers to effectively and sustainably provide essential water and sanitation services to remote Indigenous communities.