Barriers to, and enablers of, participation in the Allied Health Rural and Remote Training and Support (AHRRTS) program for rural and remote allied health workers: a qualitative descriptive study

Abstract

BackgroundAllied health professionals play a critical role in enhancing health outcomes in primary and tertiary settings. Issues affecting the recruitment and retention of allied health workers in rural and remote areas are multifactorial. Access to relevant and effective continuing professional development is argued to be a recruitment and retention strategy for health professionals in non-metropolitan areas, however trial of the effectiveness of professional development programs and identification of enablers and barriers to participation is needed. The Allied Health Rural and Remote Training and Support (AHRRTS) program aimed to provide an integrated program of education and professional support activities for allied health professionals working within Queensland Health in rural and remote locations. The aim of this study was to explore enablers and barriers to access to, and effective participation in, the AHRRTS program from various allied heath stakeholders’ perspectives.MethodsA qualitative descriptive study utilising semi-structured interviews with various allied heath stakeholders was undertaken. The interview questions focussed on a number of issues pertinent to AHRRTS program, with specific probing questions regarding barriers and enablers to participation in the AHRRTS program. The interviews were then transcribed verbatim and analysed using thematic analysis.ResultsUsing purposive sampling, a total of 55 stakeholders were interviewed for this study. Time, organisational factors and travel were identified as common barriers and organisational factors, travel and presentation modes were identified as common enablers. Interestingly, some of these factors act as barriers and/or enablers highlighting that these are essentially two sides of the same coin. The findings suggest that while it is important to have policies and procedures for ongoing support of allied health professionals, it should be complemented by enabling strategies to address persistent barriers.ConclusionThe study suggests that while a program such as AHRRTS is accessible and facilitates participation in a number of ways, significant barriers to participation continue to persist at the coal face. Addressing these barriers will require a targeted, multifaceted approach. Lessons from this study provide unique insights into factors which influence the successful implementation and sustainability of recruitment and retention initiatives for rural and remote allied health workers.

Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review

“…The strongest single predictor of satisfaction was program yearDennis et al 2010 [32] USALongitudinal cohortSelf-reported pre-and post-Likert scale and end-of-year reflections132 AHPsEvaluate learning from VC structured discussionsRuralNeeds based journal club - critical appraisalCritical appraisal skills; access to research and implementationAccess to research pre-to post 2006 to 2009 change of 3.10 to 3.88; critical appraisal skills change of 2.80 to 3.76; implementation change of 3.09 to 3.98DuBose et al 1997 [27]USACross sectional cohortExamination and satisfaction evaluation (5 point Likert scale)31 medical sonographersEvaluate education program comparing VC and FTFRural and metroSonographic anatomyKnowledge by rural versus classroom; overall; level of experience of participants & satisfactionStudents in remote sites did as well as those in classroom ( p  > 0.05), more years of experience had a small significant effect ( p  < 0.05, R 2  = 0.42); satisfaction evaluation was generally good (mean 3.7, range 4.9 to 2.7). However, significant difference in satisfaction between rural and classroom ( p  < 0.05) with rural indicating feelings of isolation from other students and instructor.Ducat et al2014 [20]AustraliaDescriptive QualitativeSemi-structured interviews42 AHPsEvaluate education program using blended delivery (TC, VC, FTF)Rural and remote8 domains in line with the Allied Health Capability frameworkEnablers and barriersBarriers: Competing time demands; clinical work takes precedence; difficulty accessing the equipment for VC participation.Enablers: Access to VC was cost effective; no need for travel; efficiencies with staff time.Evans & Sachs 2000 [28]USACross sectional cohortPre-and post-knowledge assessment with follow-up survey378 sonographersEvaluate a TC with an expert panelRural and urbanUltrasound equipment developmentsSatisfaction; relevance; knowledgeOverall satisfaction mean 4.5 (SD 0.60); relevance mean 4.55 (SD 0.61); between groups (managers and radiologic technologists) difference in satisfaction ( p  = 0.02) and relevance ( p  = 0.01); no gender differences in satisfaction p  = 0.72 or relevance p  = 0.94; satisfaction and relevance were correlated p  < 0.001; knowledge scores improved from 85% to 95%Fahey et al 2003 [38]AustraliaCross sectional cohortPost session evaluation, surveys and interviews38 AHPsEvaluate 12 session VC programRuralChild psychological developmentKnowledge; changes to practice; satisfaction with technologyQuestionnaires: 80% felt the sessions were informative and self-report practice change would occur; 86% comfortable with technology; 12% discomfort; several stated ‘nothing replaces person in the room’. 80% rated online medium as excellent or very good, 1% unsatisfactory / poor.…”

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

“…In Australia, these chronic rural health workforce shortages have been identified as significantly contributing to the substantial unaddressed health care needs found in rural and remote communities [1]. Of particular and growing concern are shortages of allied health professionals (AHPs), particularly given the greater reliance on collaborative, team-based care in rural places and the lead role that AHPs play in providing rehabilitation and chronic disease management services [2,3]. Shortages of AHPs are also likely to be a contributing factor in the lower hospitalisation rates for rehabilitation care among Australians living in rural areas, with 6.9 hospitalisations per 1000 population for outer regional areas and 6.2 for remote areas compared to 19 in major cities [1].…”

“You get exposed to a wider range of things and it can be challenging but very exciting at the same time”: enablers of and barriers to transition to rural practice by allied health professionals in Australia

“…For example only 0.8% of psychologists practice in rural areas, compared to 79.5% in metropolitan areas [12]. This shortage is particularly alarming considering the pivotal role AHPs play in the provision of health care services, such as chronic disease management, rehabilitation and acute care [13]. Addressing the mal-distribution and lack of AHPs in rural areas is of critical importance to help improve health inequalities experienced by Australians living in rural and remote locations [10].…”

“…To date, much of the focus on addressing health workforce shortages in rural and remote Australia has had a focus on medical and nursing professions [13]. In South Australia, while the Rural Health Professionals Program (RHPP) and the Transition to Professional Practice Program (TPPP) provide financial and professional supports to all health professionals including allied health, the uptake of these programs are mostly associated with the nursing professions.…”