Understanding Australian rural women's ways of achieving health and wellbeing - a metasynthesis of the literature.

INTRODUCTION: Although Australian rural women appear to be coping well despite a lack of services, harsh environmental conditions and overall rural health disadvantage, there is little research into the factors which promote good health among them. The aim of this article is to document and analyse current understandings about how rural Australian women maintain health and wellbeing, by conducting a metasynthesis of peer reviewed empirical qualitative research. METHODS: Searches were conducted of CINAHL, MEDLINE, Proquest, Blackwell Synergy, Informit, Infotrac, National Rural Health Alliance and Indigenous Health Infonet data bases. A definition of health and wellbeing as a positive concept emphasising social and personal resources as well as physical capacities, provided a framework for the review. Six studies published in rural health, nursing and sociology journals between 2001 and 2006 were selected. Common and recurring themes from the original studies were identified. Reciprocal translation was used to synthesise the findings among the studies, leading to interpretations beyond those identified in the original studies. RESULTS: Four themes emerged from the metasynthesis: isolation, belonging, coping with adversity, and rural identity. The findings of this study exhibit a tension between a sense of belonging and the experience of social and geographical isolation. The study findings also reveal tension between adherence to a strong gendered rural identity which fosters a culture of stoicism and self reliance and feelings of resistance to societal expectations of coping with adversity. CONCLUSIONS: Metasynthesis enabled a deeper understanding of the health and wellbeing of rural women in Australia. The social experiences of rural women influence the way they construe their health and wellbeing. Understanding how women maintain health and wellbeing is critical in ensuring that policies and services meet the needs of rural women and do not entrench existing inequalities.

A flying start to health promotion in remote north Queensland, Australia: the development of Royal Flying Doctor Service field days.

CONTEXT: The Royal Flying Doctor Service (Queensland Section), Australia, provides health services for remote populations across an area of approximately 600,000 km2. The challenge presented to the service was to provide effective health promotion as well as acute clinical services. ISSUE: This article describes the development of field days, an initiative based on a capacity building approach to health promotion. Field days have been conducted at station properties, national parks, remote tourist facilities, a roadhouse and country racecourse. They usually consist of a morning interactive workshop based on locally identified health topics followed by an afternoon clinic. A developmental approach has been adopted, with participant feedback from each field day and reflections by health staff informing future field day activities and adjustments in methods of delivery. Between November 2001 and August 2005, 726 adults and 248 children attended 53 field days conducted at 18 remote locations in north Queensland. EVALUATION: Participants were asked to rate the overall usefulness, content and quality of the presentations/workshops on a scale from 1 (not useful/poor) to 10 (very useful/very good). Overall, feedback from participants was positive. The average scores were 9.1 for overall usefulness of the day and content of the sessions, and 9.2 for quality of the presentations. Field days demonstrate a flexible health promotion initiative based on a capacity building approach which is rated as useful and appropriate by participants. LESSONS LEARNED: The implementation of field days has highlighted the importance of building on community and organisational strengths as a means of overcoming skepticism about new services and approaches to health. Methods of delivery that are fun, non-threatening, practical, locally relevant, culturally appropriate and interactive work best. The development of field day packages containing workshop plans and resources facilitates flexibility and enables the program to be tailored to meet the needs of participants. Workforce planning and development have played a key role in reorienting existing services towards health promotion. Field days can inform the development of locally relevant health promotion initiatives based on a capacity building approach in other remote areas of Australia and internationally.