Rural: Overview

Abstract
Purpose: To reduce risk of cardiovascular disease (CVD) in adults, as assessed by primary care doctors in rural NSW, Australia. Medical nutrition therapy (MNT) was delivered by Accredited Practicing Dietitians (APDs) using telehealth.

Methods: The study was a 12-month pragmatic cluster randomised controlled trial. All primary care practices (PCPs) within a large rural region were invited to participate, with enrolled practices stratified based on rurality and practice size. Patients at moderate to high CVD risk were recruited via practices. Usual care (UC) was provided by the patient's general practitioner (GP). In addition to UC, the intervention group received two hours of MNT telehealth (video calls) consultations from an APD during five sessions over 6 months. The primary outcome was total serum cholesterol. Secondary outcomes included LDL cholesterol, triglycerides, blood glucose control, blood pressure, weight and waist circumference. Changes were analysed using Bayesian linear mixed models and posterior probability.

Findings: Sixteen PCPs recruited 132 eligible participants (n = 91 intervention, n = 41 UC), with 79% (72/91) and 80% (33/41) respectively completing a primary or secondary outcome. No significant differences were found between groups for total cholesterol, LDL cholesterol or blood pressure at 12-months. However, the intervention group had significant improvements in blood glucose control (HbA1c: -0.16%, 95%CI: -0.32, -0.01) and decreased body weight (-2.46 kg, 95%CI: -4.54, -0.41) compared to UC at 12-months.

Conclusions: Results indicate that two hours of MNT delivered by an APD via telehealth is a synergistic adjunct therapy to support the usual care provided by GP, with benefits continuing to 12-months.

Keywords: Cardiovascular disease; Dietitian; Medical nutrition therapy; Primary health care; Rural health; Telehealth.

Abstract
Indigenous communities internationally have demonstrated remarkable strength despite significant challenges. Health disparities among Indigenous peoples persist due to historical injustices and ongoing racial discrimination, not inherent vulnerabilities. Disparities are rooted in a legacy of colonisation, systemic exclusion, and socio-economic inequities impacting access to healthcare, education, and employment. Preliminary searches show limited literature on models of care for remote living Indigenous children. This review aimed to identify internationally, effective models of care for Indigenous children in rural and remote areas. A scoping review was conducted, analysing literature on models of care for remote Indigenous children. This study followed the JBI's Scoping Review Guidance and PRISMA Scoping Review guideline. Inclusion criteria were aged ≤18, rural or remote areas, majority Indigenous, reported health outcomes, described a model of care, in English, and published since 1990. Data were systematically extracted, quality appraised using the 'Aboriginal and Torres Strait Islander Quality Appraisal Tool' then analysed using descriptive-analytical methodology. This review included 16 papers: 8 case series, 3 qualitative studies, and 5 trials. Of these, 7 studies were in Australia, 7 in the USA and 2 in Canada. All studies primary aim was to improve quality of care. Models of care described in the included papers varied, being delivered in traditional healthcare settings, homes, and elsewhere in the community. This review provides insights into the design and implementation of models of care in remote communities with primarily Indigenous populations. The authors recommend 1) that future reviews privilege 'realist evaluation' when examining models of care, 2) designers consider whether a model of care will run for a fixed-period versus ongoing as they have different requirements for success and 3) a toolkit approach to model of care development like the Qungasvik toolkit which provides evidenced modules adaptable to local conditions, easing workload on local people developing programs.

Abstract
Objective: To explore the values of Aboriginal people in the Northern Territory during their perioperative journey.

Design: A community-based participatory action research approach was used, integrating yarning, deep listening and reflection methods to gather qualitative data in culturally appropriate ways. Data collection involved two yarning circles followed by interpretation and triangulation sessions with co-researchers.

Setting: Conducted in non-health care settings in Garramilla (Darwin) between May 2023 and September 2024, the study included participants from urban, regional and remote NT Aboriginal communities.

Participants: Purposive and snowball sampling were used to engage 18 participants with lived experience of surgery, who share expertise in renal health journeys and have kinship ties spanning from Saltwater Country to Desert Country, with diverse age, language and gender representation.

Main outcome measures: Thematic insights into what First Nations peoples in the NT value during the perioperative journey, to inform culturally safe models of care.

Results: Respect emerged as the core principle in the perioperative journey, with family involvement, cultural practices and effective communication identified as key elements. Respect was evident in honouring cultural protocols, integrating traditional healing practices and recognising patient autonomy. Family involvement was highlighted as essential, with kinship ties influencing shared decision-making processes and support throughout the perioperative experience. Culturally competent communication, including the use of interpreters and clear explanations, played a critical role in bridging cultural differences and ensuring shared understanding. Together, these elements fostered a sense of safety, belonging and empowerment. Ultimately, trust was identified as an overarching outcome that unified these interconnected values, enhancing patient comfort, engagement and overall satisfaction in the perioperative journey.

Conclusion: Respect is integral to Aboriginal people in the perioperative journey, and they value family, culture and communication when navigating surgery. When these values coalesce, trust is generated. These findings highlight the need to integrate culturally informed, patient-centred care models that prioritise respect and trust building to improve accessibility, experience and surgical outcomes.