Influence of a rural interprofessional education placement on the rural health workforce: working in primary care, rural settings, and with Māori

Thursday, June 1st, 2023 | claly44p | No Comments

Darlow Ben, Brown Melanie, McKinlay Eileen, Gray Lesley, Purdie Gordon, Pullon Sue (2023) Influence of a rural interprofessional education placement on the rural health workforce: working in primary care, rural settings, and with Māori. Journal of Primary Health Care 15, 78-83.


Rural workforce outcomes:

“Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers.”

Although a little disheartening, the authors’ findings are not that surprising given the design of their study. By only including data to 3 years after graduation we don’t really know what influence it has had on actual workforce outcomes. If we look at doctors, it’s essentially impossible to work in a rural area within the first 2 years of graduation. However the authors’ conclusion probably does align with overseas research that short rural placements have minimal impact on workforce outcomes.

Although probably not so important given the “negative” result, an issue with this study was it used self-reported geographic location. It will be great to see any future research like this to be linked to the Geographic Classification for Health (GCH)

Working with Māori outcomes:

There wasn’t anything “measurable” here. However, the free text thematic analysis showed participant’s attitudes towards working with Māori were really positive. Some “before” data might have been useful too though for comparison and to see what changes were linked to the programme.

A new research area to explore?:
The free text comments from this study show some positive attitude shifts towards rural health. It would be really interesting to see some more research into the benefits of the “rurally attuned” urban medical professional. It might not fix our rural health workforce crisis but there would hopefully still be some benefits to our communities!

(Katelyn Costello)



Introduction: Pre-registration interprofessional rural immersion programmes provide students with first-hand insight into challenges faced in rural clinical practice and can influence future practice intentions. The impact of short rural and hauora Māori interdisciplinary placements on early healthcare careers is unknown.

Aim: Explore whether a 5-week rural interprofessional education programme influenced graduates’ choices to work in primary care, rurally, and with Māori patients.

Methods: We conducted a survey-based, non-randomised trial of graduates from eight healthcare disciplines who did (n = 132) and did not (n = 479) attend the Tairāwhiti interprofessional education rural programme with hauora Māori placements. Participants were surveyed at 1-, 2-, and 3-years’ post-registration. Self-reported practice location and vocation were analysed with mixed-model logistic regression. Free-text comments were analysed with Template Analysis.

Results: We did not identify any measurable impact on rural or community workforce participation at 3-years’ post-registration. Free-text analysis indicated that a short rural interprofessional immersion placement had long-term self-perceived impacts on desire and skills to work in rural locations, and on desire and ability to work with Māori and embrace Māori models of health.

Discussion: Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers. Three-years’ post-graduation may be too early to determine whether rural placements help to address rural health workforce needs. Reports from rural placement participants of increased ability to care for people from rural backgrounds, even when encountered in a city, suggest that assessment of practice location may not adequately capture the benefits of rural placement programmes.

Congratulations Jane Taafaki on her Exceptional PhD Thesis!

Thursday, May 11th, 2023 | claly44p | No Comments

Exceptional PhD Theses are awarded when all three examiners of a candidate’s thesis agree that the thesis is among the top 10 per cent of theses examined, so it is with great pleasure to congratulate Jane Taafaki on receiving this accolade!

An exceptional person as well as an exceptional thesis, Jane’s PhD is titled The lived experiences of rural Tuvaluans navigating the Aotearoa New Zealand healthcare system” & her Primary Supervisor was Dr Jude Sligo.

Jane asked participants from Oamaru and Dunedin to record their interactions with the health care system through photovoice – a research method where participants use photographs to illustrate their experiences.  Her findings contribute to the increasing body of Tagata Pasifika health research in New Zealand and will make a positive contribution to improved health outcomes of not only Tuvaluans but by extension other Pasifika peoples in New Zealand.

For more information on Jane & her research see the Otago Bulletin here


Masters Research Opportunity

Wednesday, May 10th, 2023 | claly44p | No Comments

The GCH Rural Health Research Group has an opportunity for a Masters project. The project would suit someone with an interest in rural health, public health or hauora Māori.

Are rural patients disadvantaged in their access to radiation oncology?

Radiation oncology treatment is one of the main treatment options available to treat cancer along with surgery and chemotherapy. About 1/3rd of cancer patients will receive radiation therapy as part of their treatment plan. Radiation treatment can be used as part of a regime to slow cancer growth or the spread of metastases in patients who are being treated with palliative intent – or increasingly can be used as part of curative cancer plan. Previous research has suggested that distance from a palliative care centre influences the likelihood of receiving radiation treatment. There are also differences in the use of radiation treatment by ethnicity. There are currently seven radiation treatment centres in New Zealand located in major urban centres. The Geographic Classification for Health (GCH) provides a classification system where urban is categorised into U1 (most urban) and U2 and rurality is categorised into 3 groups R1, R2 and R3 (most remote). All patients treated with radiation therapy are recorded in a Radiation Oncology Collection (ROC) along with data on the number of treatments, the type of cancer being treated and whether the treatment is aimed as a curative or palliative treatment. This project involves mapping the GCH to the meshblock (small geographic area) containing the ROC patient’s usual address to ascertain whether there are disparities in palliative and curative radiation treatment for rural patients compared to urban patients and whether these disparities exist for Māori and for different cancers.

For more information, please contact:

Prof. Ross Lawrenson, School of Health, Uni Waikato.       

Assoc Prof Gabrielle Davie, Preventive and Social Medicine, Uni Otago.

Prof Sue Crengle, Ngāi Tahu Māori Health Research Unit, Uni Otago.  

Prof Garry Nixon, General Practice and Rural Health, Uni Otago.          

Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?

Friday, May 5th, 2023 | claly44p | No Comments

Mathew, S., Fitts, M.S., Liddle, Z. et al. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?. BMC Health Serv Res 23, 341 (2023).


Interesting paper in the context of COVID19 on telehealth in rural and remote areas in Australia.  There are opportunities in this space with the COVID19 experience normalising telehealth, yet we need to bear in mind it is not an approach that save’s time or one that suits every one.  It would be interesting to hear the perspective of patients.



Background: The COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia.

Methods: Between February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes.

Results: Reduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions.

Conclusion: Telehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote communities to make full use of telehealth consultations. Training and employment of local Aboriginal staff as digital navigators could ensure a culturally safe clinical environment for telehealth consultations and promote the effective use of telehealth services among community members.

The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study

Thursday, May 4th, 2023 | claly44p | No Comments

Blattner K, Clay L, Nixon G, Richard L, Miller R, Crengle S, Anton R, Stokes T.  The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study . Rural and Remote Health 2023; 23: 7583.


It’s great to hear non-medical perspectives on the place/role of our rural hospitals. With no clear definition of what a rural hospital is, this paper highlights the range of contexts our hospitals work across between primary and secondary care, and the strengths and challenges they face.  For local communities, rural hospitals are invaluable yet they can appear invisible to the wider health system.  We hope this work further informs the Rural Health Strategy due later this year.


Introduction:  In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Māori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system.
Methods:  A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants’ views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method.
Results:  Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, ‘Our place and our people’, reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital’s response. Local services were provided by small, adaptable teams across broad scopes and blurred primary–secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, ‘Our positioning in the wider health system’, related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being ‘at the end of the dripline’. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them.
Conclusion:  This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Māori.


Any views or opinion represented in this site belong solely to the authors and do not necessarily represent those of the University of Otago. Any view or opinion represented in the comments are personal and are those of the respective commentator/contributor to this site.


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