A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community.

BACKGROUND: Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health. METHODS: The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively. RESULTS: Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign. CONCLUSIONS: The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals.

INTRODUCTION: Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management. OBJECTIVE: This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting. DESIGN: Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis. FINDINGS: Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1-Patient, carer and family's understanding about medication management is improved, 4.2-Patient, carer and family travel is decreased, 4.3-Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1-Enhanced communication between the patient and health care team, 5.2-Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1-Understanding about medications and their management is improved, 7.2-Workload is reduced, 7.3-Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1-A need for greater pharmacist capacity to meet demand, 10.2-A need for increased and sustained funding for the pharmacist role, 10.3-Large amount of travel to get to patients. CONCLUSION: Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.

A qualitative exploration of the experiences of Aboriginal and Torres Strait Islander people using a real-time video-based telehealth service for diabetes-related foot disease.

INTRODUCTION: Diabetes-related foot disease (DFD) is one of the most prevalent causes of global hospitalisation and morbidity, and it accounts for up to 75% of lower-extremity amputations globally. The 5-year mortality rate following any amputation ranges from 53% to 100%. Early identification of wounds and multidisciplinary management can reduce amputation rates by 39-56%. Rural and remote communities and Indigenous populations are disproportionately affected by DFD. This is reflected in amputation rates, which are much higher for Indigenous than for non-Indigenous Australians and for those in very remote areas than for those in major cities or inner regional areas. The large geographical spread of the population in Australia is a substantial barrier for those providing or accessing health services, particularly multidisciplinary and specialist services, which undoubtedly contributes to poorer DFD outcomes in rural and remote communities. METHODS: A real-time, video-based telehealth service for DFD management was established at the Royal Adelaide Hospital Vascular Services clinic to improve access to specialist services for rural and remote Aboriginal and Torres Strait Islander communities. An exploratory qualitative study that utilised one-on-one, semi-structured interviews was conducted with 11 participants who identified as Aboriginal and who had participated in the telehealth foot service. Interviews were transcribed, de-identified and analysed using thematic analysis, using an inductive approach. RESULTS: Four interrelated themes emerged. 'Practical benefits of staying home' describes the reduced burden of travel and advantages of having local healthcare providers and support people at consultations. 'Access to specialists and facilities' highlights how some participants felt that there was a lack of appropriate facilities in their area and appreciated the improved access telehealth provided. 'Feeling reassured that a specialist has seen their feet' reflects the positive impact on wellbeing that participants experienced when their feet were seen by specialist health staff. 'Facilitates communication' describes how participants felt included in consultations and how seeing a person on screen assisted conversation. CONCLUSION: The advantages of real-time, video-based telehealth go beyond reduced travel burden and improved access to specialist care. This model of care may facilitate relationship-building, patient wellbeing, and feelings of trust and safety for Aboriginal and Torres Strait Islander DFD patients.

'It sort of broke me': A thematic analysis of the psychological experiences and coping strategies employed by Australian fire-affected farmers.

INTRODUCTION: People exposed to bushfires are known to be at heightened risk of experiencing mental health challenges. When farms are impacted, farmers often risk losing not only their homes but also their businesses, containing their livestock, infrastructure and identities. OBJECTIVE: To understand the psychological experiences of farmers who have been exposed to fires on their farms and identify the coping strategies they already employ to recover and prepare psychologically for future bushfires. DESIGN: In-depth, semi-structured interviews were conducted face-to-face or via Zoom. Thematic analysis was used to analyse the data, using a descriptive, essentialist approach. Sixteen farmers and/or their spouses (50% female; median age of 50.8 years), who owned and/or played an active role in the operation of a farming or pastoral enterprise and had been affected by a farm fire within the last 20 years, participated. Participants resided in inner regional, outer regional and remote South Australia and New South Wales. FINDINGS: Seven overarching themes and 22 subthemes resulted: (1) intense emotions in the aftermath, (2) long-term psychological challenges, (3) deliberate focus on organising, prioritising and completing recovery-focused tasks, (4) importance of seeking and/or accessing support to rebuild, (5) adopting a positive attitude and outlook, (6) (dis)engaging from/with community and social connection and (7) various strategies employed to self-regulate emotions. DISCUSSION/CONCLUSION: This study demonstrates the unique set of psychological challenges Australian farmers experience in the wake of a farm fire and the coping strategies they report using to help them manage. Findings will inform the development of contextually and culturally appropriate bushfire recovery and preparedness initiatives that are tailored to meet the unique needs of farmers and build upon their existing strengths.

Models of palliative care for under-served populations in high-income countries: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas. INTRODUCTION: Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care, but what is not known is how these models can vary to meet the needs of under-served populations. INCLUSION CRITERIA: This scoping review will consider articles that focus on models of palliative care for under-served populations, irrespective of sex, age, or primary diagnosis. METHODS: MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), and Scopus will be searched for articles, irrespective of language, published from 2014. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Two independent reviewers will extract data from included articles using a data extraction tool developed for this review. Results will be tabulated and/or presented diagrammatically, as well as summarized to explicitly address the objective of the review. REVIEW REGISTRATION: Open Science Framework osf.io/x4ky3.

'If you want something to happen, you have to do it yourself': Understanding rural Australian's perspectives of health volunteering.

ISSUE ADDRESSED: Rurality is associated with poorer health outcomes and access to health services, yet a strength of rural living includes community cohesion indicated by high rates of volunteering. While volunteerism is an effective means to target health needs in resource-restricted contexts, research on volunteerism to address rural Australian health needs is limited. This research aimed to explore rural adults' perspectives of volunteerism in local activities and programs that had a direct health related benefit (health volunteering). METHODS: Eight people from the Murray Mallee region of South Australia participated during April 2021, ranging in age from 32 to 75 years. Participants were invited to one-on-one interviews that occurred via a phone call or teleconference meeting, which were audio-recorded and transcribed verbatim to facilitate thematic analysis. RESULTS: Seven main themes emerged. Participants identified that (1) health volunteering takes many forms, (2) health volunteering affords local ownership and accessibility, (3) health volunteers have particular skills and values, but also (4) gain social benefits and learn new skills. Rural health volunteering was also associated with (5) a variety of personal costs, and (6) there are several environmental barriers and (7) facilitators to rural health volunteering that should be considered when designing health programs. CONCLUSION: Results provide insight into how rural communities can enhance the development and application of volunteering roles to support health volunteering. SO WHAT?: Including local champions, reducing the financial burden and developing support networks for volunteers are practical suggestions to enhance levels of volunteering for health in rural settings.

Understanding farmers' barriers to health and mental health-related help-seeking: The development, factor structure, and reliability of the Farmer Help-Seeking Scale.

PURPOSE: The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers' barriers to health-related help-seeking. METHODS: An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database. FINDINGS: Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; "Health Issues are a Low Priority," "Concerns about Stigma," "Structural Health System Barriers," "Minimization and Normalization," "Communication Barriers," and "Continuity of Care.". Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability. CONCLUSIONS: The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers' help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group.

What consumers, general practitioners and mental health professionals want: the co-design and prototype testing of a transdiagnostic, acceptance and commitment therapy-based online intervention to reduce distress and promote wellbeing among Australian adults.

BACKGROUND: Many Australians experience mental health challenges, but only a third access face-to-face psychological services, due to multiple barriers including long waitlists. Additional strategies to prevent or help people de-escalate distress at an early stage are needed. Web-based mental health interventions are becoming increasingly acceptable to consumers and referring General Practitioners (GPs), but most are designed for specific disorders/populations. This study explores consumers' and health professionals' preferences and recommendations for the design of a transdiagnostic, Acceptance and Commitment Therapy (ACT)-based, online intervention for Australian adults. METHODS: Thirty-five people (consumers, carers, GPs, mental health professionals) participated in one or more co-design stages. Stage 1: semi-structured interviews to establish what is wanted from such websites (n = 22). Stage 2: feedback emailed on branding options (n = 20). Stage 3: feedback provided via Zoom or an online survey after testing a website prototype (n = 19). Data were analysed using Thematic Framework Analysis and descriptive statistics. RESULTS: Stage 1 highlighted nine key design principles (plus 25 subthemes) that participants emphasised as important to ensure the website would have broad appeal and meet their needs: (1) user choice is valued highly; (2) ACT-based content is acceptable as it is focused on helping people be proactive and 'get unstuck'; (3) non-pathologising, direct, empowering, lay language is endorsed; (4) a positive look and feel is appreciated; (5) images and videos are important to break up text and maintain engagement; (6) short text messages to aid engagement are valued; (7) provision of tailored psychoeducation for highly distressed and suicidal users is endorsed; (8) personal and proactive brand name is preferred (icanactnow); (9) diverse marketing and training activities are recommended. In Stage 2, icanactnow branding preferences were elicited (simplicity, colours to represent growth and a call to action). Stage 3 resulted in the inclusion of a safety plan template and a tailored entry portal for people referred to icanactnow by health professionals. High levels of satisfaction with the prototype were reported. CONCLUSIONS: These findings informed icanactnow and provide insights for the development of other online mental health interventions, in ways that appeal to both consumers and professionals recommending them.

'Being a farmer, I mostly always think there is something more important to do': A mixed methods analysis of the skin cancer detection practices of Australian farmers.

ISSUE ADDRESSED: Farmers experience skin cancer and die from melanoma at significantly higher rates than the general Australian population. This study examined Australian farmers' engagement with self-skin examinations (SSE), participation in clinical skin examinations (CSE) by a health professional, and self-reported barriers to engagement with these important skin cancer detection practices. METHODS: A cross-sectional, mixed-methods design was used. Australian farmers were recruited through an industry-based organisation representing livestock farmers. Farmers (N = 498; 22-89 years; 83.1% male) responded to a paper-based survey that included closed- and open-ended questions. RESULTS: Farmers reported engagement with self-conducted SSE and routine CSE that was comparable to findings in the general population, but 29.4% of farmers reported that they had not sought a CSE as soon as possible after noticing changes to their skin. Farmers reported a range of barriers to SSE, including physical difficulties examining their skin, difficulties identifying changes in their skin, forgetfulness, and lack of motivation. Barriers to CSE included accessibility, cost, difficulties finding the right doctor, and avoidance and complacency. CONCLUSIONS: There is a need to make clinical skin cancer detection more accessible to farmers, in addition to promoting self-skin examination and help-seeking behaviours within this at risk population. SO WHAT?: Novel approaches are needed to address systemic barriers faced by Australian farmers. These may include the use of teledermatology or artificial intelligence to assist with CSE. Remote training delivery methods may be also utilised to teach SSE skills to farmers who may be otherwise unable to access such opportunities.

The experiences of health workers using telehealth services for diabetes-related foot complications: a qualitative exploration.

BACKGROUND: Diabetes-related foot disease (DFD) accounts for up to 75% of lower-extremity amputations globally. Rural and remote communities are disproportionately affected by DFD. Telehealth has been advocated as a strategy to improve equity of access to health care in rural and remote communities. Current literature suggests that successful implementation of telehealth requires access to adequate reliable equipment, staff training, and support. A real-time video-based telehealth foot service (TFS) for delivering DFD management has recently been established in a Vascular Surgery and Podiatry clinic within a large South Australian metropolitan hospital. The purpose of this study was to gain insights into the experiences of rural and remote health professionals utilising the TFS, as this could be invaluable in optimising the uptake of telehealth use in DFD. METHODS: This exploratory, descriptive qualitative study employed one-on-one, semi-structured interviews with health professionals who utilised the service. Thematic analysis using an essentialist inductive approach was employed. RESULTS: Participants included 14 rural and remote health professionals; 2 general practitioners, 2 nurses, 1 Aboriginal Health Practitioner, and 9 podiatrists. In addition, 2 metropolitan-based TFS staff were interviewed. Five key themes were identified. 'Patients have reduced travel burden' included that telehealth enabled Indigenous patients to stay on country. 'Patients had increased psychosocial support' covered the benefits of having health professionals who knew the patient present in consults. 'Improved access' incorporated how telehealth improved interprofessional relationship building and communication. 'Technological and equipment challenges' highlighted that poor network connectivity and poor access to equipment to conduct telehealth consults in rural areas were barriers. The last theme,'Lack of service communication to rural health professionals', highlighted the need for communication around service details. CONCLUSION: Telehealth is a valuable tool that can improve access to treatment for rural and remote Indigenous DFD patients. While this has the potential to improve DFD outcomes, empirical data is required to confirm outcomes. Considering the advantages of telehealth and rural staff shortages, there is an urgent need for investment in improved equipment and processes and an understanding of the training needs of the health care workforce to support the use of telehealth in DFD management.

'It is a life changing experience': The experiences of living kidney donors who live in rural Australia.

INTRODUCTION: A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. OBJECTIVE: To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. DESIGN/SETTING/PARTICIPANTS: Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. FINDINGS: Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. CONCLUSION: Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.

Feasibility and preliminary effectiveness of virtual reality as a patient education tool for people with cancer undergoing immunotherapy: a protocol for a randomised controlled pilot study in a regional setting.

INTRODUCTION: Patient education is a critical component of healthcare delivery. However, medical information and knowledge are complex and can be difficult for patients and families to comprehend when delivered verbally. The use of virtual reality (VR) to convey medical information to patients may bridge this communication gap and lead to more effective patient education. It may be of increased value to those with low health literacy and levels of patient activation, in rural and regional settings. The objective of this randomised, single-centre pilot study is to examine the feasibility and preliminary effectiveness of VR as an education tool for people with cancer. The results will provide data to inform the feasibility of a future randomised controlled trial, including sample size calculations. METHODS AND ANALYSIS: Patients with cancer undergoing immunotherapy will be recruited. A total of 36 patients will be recruited and randomised to one of three trial arms. Participants will be randomised 1:1:1 to receive VR, a two-dimensional video or standard care (ie, verbal communication and information leaflets). Feasibility will be assessed by recruitment rate, practicality, acceptability, usability and related adverse events. The potential impact of VR on patient-reported outcomes (ie, perceived information provision quality, knowledge about immunotherapy and patient activation) will be assessed and stratified by information coping style (ie, monitors vs blunters) whenever statistical analyses are significant. The patient-reported outcomes will be measured at baseline, post-intervention and 2 weeks post-intervention. In addition, semistructured interviews will be conducted with health professionals and participants randomised to the VR trial arm, to further explore acceptability and feasibility. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Greater Western Human Research Ethics Committee, New South Wales Local Health District (2022/ETH01760). Informed consent will be obtained from all participants. Findings will be disseminated via relevant conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12622001473752.

"And you feel like you're suffocating how the fuck am I going to get out of all this?" Drivers and experiences of suicidal ideation in the Australian construction industry.

Introduction: This research was designed to generate understandings of drivers and experiences of suicidal ideation and distress among Australian Construction Industry (ACI) workers, as well as what helped during these experiences. Methods: Fifteen participants, from a variety of ACI or closely associated roles, with an average age of 45 years (29-66), engaged in individual, semi-structured interviews. Interviews were audio-recorded with consent and analyzed using descriptive thematic analysis. Results: Eight themes relating to what may drive the presence of suicidal ideation and distress were identified; 1) challenges of working within the ACI, 2) relationship and family issues, 3) social disconnection, 4) personal financial hardship, 5) perceived lack of support, 6) alcohol and drug use, 7) child custody/access and legal issues, and 8) experience of mental health challenges, trauma, or a significant adverse life event. Four themes relating to experience and expression of suicidal ideation and distress were identified: 1) suicidal thoughts, 2) impaired thinking, 3) observable expressions of suicidal distress, and 4) lack of observable expressions of suicidal distress. Six themes relating to what helped during experiences and well as what can be done by the ACI to help mitigate experiences, were identified: 1) presence of colleague and managerial support, 2) MATES in Construction, 3) engagement with non-work activities and social support, 4) personal skills and knowledge relating to suicide and mental health, 5) high level industry integration and engagement with support programs, and 6) work hours and expectations changes. Discussion: Findings highlight several industry and personal related challenges that may drive experiences, with many potentially mitigatable by ACI changes and focused prevention strategies. Participant suicidal thought descriptions align with previously identified constructs deemed central in suicidal trajectories. While findings highlight several observable expressions of suicidal ideation and distress, challenges associated with identifying and assisting individuals in the ACI who may be struggling were also reported. Several factors that helped ACI workers during their experiences, as well as what the ACI can do to mitigate future experiences, were identified. Recommendations are made based on these findings, encouraging a more supportive work environment, as well as continued development and increased awareness of support and education systems.

Development and initial psychometric evaluation of the Perceptions of Parental Illness Questionnaire for Cancer.

OBJECTIVE: To evaluate the psychometric properties of the Perceptions of Parental Illness Questionnaire for Cancer (PPIQ-C) among adolescents and young adults (AYAs). METHODS: A sample of 372 AYAs (aged 12-24 years) who had a parent diagnosed with cancer completed the PPIQ-C and the Kessler Psychological Distress Scale (K10). Exploratory factor analyses were conducted to examine the dimensional structure of the PPIQ-C. Scale reliability was evaluated using Cronbach's alpha (α) and McDonald's omega (ω). Pearson correlation analyses were conducted to assess construct validity by examining correlations between PPIQ-C subscale scores and K10 total scores. RESULTS: The PPIQ-C is organised into three sections, each with a separate factor structure for items representing identity, core (emotional representations, coherence, timeline, consequences, and controllability), and cause dimensions of the Common-Sense Model of Self-Regulation. Exploratory factor analyses determined the structure of each section: identity items comprised two subscales (12 items), core items comprised 10 subscales (38 items), and cause items comprised three subscales (11 items). Scale reliability was acceptable for all subscales, except the cause subscale chance or luck attributions (α = 0.665). Correlations between PPIQ-C subscale scores and K10 total scores provided support for construct validity. CONCLUSIONS: Preliminary evidence suggests that the PPIQ-C is a reliable, valid, and useful tool for assessing illness perceptions among AYAs with a parent with cancer. The PPIQ-C may be a useful addition to both clinical practice and future research, however further evaluation work is needed to confirm its structure and robustness prior to use.

Co-designing a peer-led model of delivering behavioural activation for people living with depression or low mood in Australian farming communities.

INTRODUCTION: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence-based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well-established barriers to mental health help-seeking and improve outcomes for this at-risk group. OBJECTIVE: This paper describes the findings of a co-design phase informing the development of a peer (farmer)-led approach for delivering BA for farmers living with depression or low mood. DESIGN: This qualitative study used a co-design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. FINDINGS: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context-tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. DISCUSSION: Findings suggest BA could be a contextually appropriate model of support for the farming community-given its practical and solution-focused approach-and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. CONCLUSION: Insights gained through co-design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood.

Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help.

AIMS: To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention. DESIGN: Qualitative descriptive design. METHODS: Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi-structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018-2020. Data were analyzed using thematic analysis and an essentialist, bottom-up approach. RESULTS: Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering. CONCLUSIONS: This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce. IMPACT: Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Stressors, Barriers and Facilitators Faced by Australian Farmers When Transitioning to Retirement: A Scoping Review.

Farms in Australia are largely family owned and managed. Complex interactions between farming history, traditions, family, business, succession, identity and place can lead to difficulties in planning for retirement for farmers. Due to the significant implications of this for farmers' health and wellbeing, there is a clear need to determine how farmers may be best supported through the work-to-retirement transition. This scoping review summarises the literature on Australian farmers' retirement experiences and the stressors they face during this transition. Barriers and facilitators that may hinder or help farmers were also explored. The relevant peer-reviewed literature was identified through database searching and the grey literature was collected via a web-based search. Seven studies were included in the review. Poor health and diminishing capacity to work was identified as a key stressor related to retirement. Other drivers of stress (i.e., pressure to live up to farming ideals, perceiving retirement as a threat to self-identity and financial concerns) overlapped with barriers to retirement. Farmers identified gradual transition, strong social networks, variety in interests and activities and early financial and succession planning as key facilitators of retirement. Findings will help inform the development of interventions to assist Australian farmers through this challenging stage of their lives.

The Australian and New Zealand nephrology nursing workforce: clinical pressure and organisational culture.

There has been increasing prevalence in the community of chronic kidney disease and an increased demand for nephrology trained nursing staff.We explored how nephrology trained nurses are impacted by daily caseload pressure, organisational support and workplace education.A co-designed 57-item questionnaire developed by the research team and clinical nephrology nurses hosted on Qualtrics™ was distributed to nephrology nurses in Australia and New Zealand.The 370 respondents described a strong professional identity as a nephrology nurse. 70% described pressure to work overtime and only 2% were adequately staffed. 40% felt at times that their patients clinical care was 'unsafe' and one-third described the erosion of work-based educational opportunities. However, team collegiality was high, a strength of the nursing profession.The nephrology nursing workforce will face important challenges over the next decade and there must be an organisational response to prevent continued staff shortages.

Suicide in the Construction Industry: A Targeted Meta-analysis.

OBJECTIVE: With research suggesting an increased risk of suicide for those employed in the construction industry the present review aimed to provide an updated, targeted, and rigorous estimate of the relative risk of suicide for this population. METHOD: Comprehensive searches of Medline, Psycinfo, Embase, Emcare, Web of Science, and Scopus databases, as well as grey literature and reference lists, were undertaken to identify studies which reported the rate or risk of construction industry workers' suicide. Only samples that did not incorporate other industries and utilized reference groups deemed representative of the general or employed populations, were included. RESULTS: Eleven studies were included in the review. Primary analysis was undertaken on seven studies deemed to have wholly samples wholly representative of the construction industry. Despite a high level of heterogeneity (I2 = 98%), results suggest increased risk of construction worker suicide compared to the wider population. Random effect meta-analysis indicated a pooled relative suicide risk = 1.25 (95% CI 1.03-1.52), reported. A sensitivity analysis using less stringent inclusion criteria, demonstrated the robustness of these findings. CONCLUSION: Despite limitations, this paper suggests that construction industry employees may have an elevated risk of suicide. Additionally, this review highlights the need for further research, using standardized methodologies, to generate more robust understandings. Future research will benefit by accounting for locale-specific cultural and socio-political factors and attempting to quantify more specific drivers of suicide risk for this population.

A Self-Help Online Intervention Is Associated with Reduced Distress and Improved Mental Wellbeing in Australian Farmers: The Evaluation and Key Mechanisms of www.ifarmwell.com.au.

OBJECTIVES: Farmers are faced with many stressors, along with numerous barriers to accessing traditional forms of mental health support. The ifarmwell online intervention was co-designed with farmers and is informed by Acceptance and Commitment Therapy to equip farmers with transferable coping strategies, particularly to help them cope with circumstances beyond their control. We aimed to evaluate the effect of ifarmwell on farmers' short- and long-term distress and mental wellbeing. METHODS: Australian farmers (21-73 years) who registered on www.ifarmwell.com.au completed measures at the commencement of module 1 (N = 228), the end of the intervention (N = 77) and 6-months post-intervention (N = 61). Primary outcomes included distress (Kessler Psychological Distress Scale) and mental wellbeing (Mental Health Continuum - Short Form). We also examined the relationship between distress, mental wellbeing, neuroticism (Quickscales-R) and ACT-based psychological mechanisms; psychological inflexibility (Acceptance and Action Questionnaire-II), cognitive fusion (Cognitive Fusion Questionnaire), believability of automatic thoughts (Automatic Thoughts Questionnaire-B), coping via acceptance (4 items from the situational COPE) and mindfulness (Five Facet Mindfulness Questionnaire-Short Form). Secondary outcomes of acceptability (Client Satisfaction Questionnaire-8) and usability (System Usability Scale) were also explored. RESULTS: Pre- to post-intervention, farmers' distress decreased and mental wellbeing increased. These effects were maintained at 6-month follow-up. Changes in these outcomes were greatest for participants who entered the intervention with high baseline distress (߈= -0.59, 95%CI =[-0.70, -0.47]) and low mental wellbeing (߈= -0.33, 95%CI = [-0.47, -0.19]). Decreases in distress and increases in mental wellbeing were associated with decreases in psychological inflexibility, cognitive fusion, and believability of thoughts, and increases in coping via acceptance and mindfulness. Levels of satisfaction (M = 26.92/32) and usability (M = 84.70/100) were high, and 94.6% of participants said they would recommend ifarmwell to a friend in need of similar advice and tools. CONCLUSIONS: ifarmwell is an effective and usable intervention that is likely to help farmers reduce their levels of distress and improve their mental wellbeing, by improving their psychological flexibility, ability to focus on the present and accept things beyond their control, as well as by reducing the extent to which they believe unhelpful thoughts.