Policy priorities to reduce disparities in ischaemic heart disease mortality among regional and rural Australians

This PhD thesis investigated the role of modifiable risk factors in the inequalities in ischaemic heart disease burden in rural Australia. The research highlights a need for addressing other factors, such as access to health services and reducing the barriers for the development of evidence-based policy for the prevention of cardiovascular disease in rural areas

Characterizing dietary intakes in rural Australian adults : a systematic literature review

Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians. A systematic literature review aimed to synthesize the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention, and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes. Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available and a lack of consistency between dietary outcomes collected in research to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities

Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action

[Extract] The positive impact of evidence-based practice on health service performance and health outcomes is well described. Marita Titler, an expert in evidence-based practice from the United States, has observed that “only by putting into practice what is learned from research will care be made safer”. However, the consistent and widespread application of evidence-based health care is largely dependent on a health service's research culture and the research capacity of its staff

A scoping review of the impact of Food Policy Groups on local food systems in high-income countries

This scoping review aimed to explore international evidence on the impact of Food Policy Groups (FPGs) on local food systems, in urban and rural regions of high-income countries. Peer-reviewed and grey literature were searched to identify 31 documents published between 2002 and 2022 providing evidence on the impact of FPGs. Activities spanned domains including increasing food equity (e.g. strengthening school meals programs); increasing knowledge and/or demand for healthy food (e.g. food literacy programs with children and adults); increasing food access (e.g. enhancing local food procurement); environmental sustainability (e.g. promoting low-waste food items on café menus); economic development (e.g. ensuring local businesses are not outperformed by large food distributors), and increasing food system resiliency (e.g. establishment of local produce schemes). Most FPGs reported conducting activities that positively influenced multiple food system domains and reported activities in urban areas, and to a lesser extent in rural areas. Our study highlighted a range of qualitative and quantitative evaluation strategies used to measure FPGs\u27 impact on local food systems. Our recommendations focus on regular and systematic evaluation and research surrounding the impact of FPGs activities, to build the evidence base of their impact. Ideally, evaluation would utilise comprehensive, and established tools. We recommend exploring the establishment of FPGs across more regions of high-income countries, particularly rural areas; and forming partnerships between FPGs, local government and universities to maximise implementation and evaluation of activities

The impact of the COVID-19 pandemic on rural food security in high income countries : a systematic literature review

Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies (n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale

Rural nutrition and dietetics research—Future directions

Aim: The aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities. Context: Clear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade. Approach: A review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts. Conclusion: Establishing strong, collaborative place-based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition-related disease disparity between rural and metropolitan Australia

Community health programs delivered through information and communications technology in high-income countries : Scoping review

Background: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods: The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers

Quantifying the role of modifiable risk factors in the differences in cardiovascular disease mortality rates between metropolitan and rural populations in Australia: a macrosimulation modelling study

OBJECTIVES: The study aimed (1) to quantify differences in modifiable risk factors between urban and rural populations, and (2) to determine the number of rural cardiovascular disease (CVD) and ischaemic heart disease (IHD) deaths that could be averted or delayed if risk factor levels in rural areas were equivalent to metropolitan areas. SETTING: National population estimates, risk factor prevalence, CVD and IHD deaths data were analysed by rurality using a macrosimulation Preventable Risk Integrated Model for chronic disease risk. Uncertainty analysis was conducted using a Monte Carlo simulation of 10 000 iterations to calculate 95% credible intervals (CIs). PARTICIPANTS: National data sets of men and women over the age of 18 years living in urban and rural Australia. RESULTS: If people living in rural Australia had the same levels of risk factors as those in metropolitan areas, approximately 1461 (95% CI 1107 to 1791) deaths could be delayed from CVD annually. Of these CVD deaths, 793 (95% CI 506 to 1065) would be from IHD. The IHD mortality gap between metropolitan and rural populations would be reduced by 38.2% (95% CI 24.4% to 50.6%). CONCLUSIONS: A significant portion of deaths from CVD and IHD could be averted with improvements in risk factors; more than one-third of the excess IHD deaths in rural Australia were attributed to differences in risk factors. As much as two-thirds of the increased IHD mortality rate in rural areas could not be accounted for by modifiable risk factors, however, and this requires further investigation