[No Abstract]

Rural regions in Australia have been, and continue to be, distinguished by very different population and labour market characteristics than those of more urbanised areas. Since the 1980s, rural regions have been exposed to a range of economic events and policies which has impacted on the structure and composition of the population and the labour force. These changes include trade liberalisation and globalisation, deregulation, declining numbers of agricultural establishments, advances in technology, increases in productivity and changes in the levels of public and private provision of goods and services. In addition, in recent years, serious shortages of labour, particularly skilled labour, has emerged as a major issue facing rural regions. However, there has been little economic research into rural labour markets relative to other labour markets, particularly since the 1980s. While there has been significant public discussion and political debate in recent years on the apparent changes experienced by rural regions, evidence regarding the nature, causes and impacts of these changes has often been anecdotal. For example, there is the popular notion of the �tree change� which refers to the idea that people are leaving metropolitan areas and moving to rural areas. Concurrently, there is also the significant discussion on the �rural downturn�, which refers to the belief that rural regions are declining in term of population and employment growth. Further, the agricultural sector has continued to be cited as the likely cause for downturns in rural population and employment growth rates in rural areas. However, again, there is a lack of economic research to substantiate these claims. The aim of this thesis is to redress the lack of economic research and to provide a comprehensive analysis of rural labour markets and population in Australia since the 1980s. Analysis focuses on the changing structure and composition of rural labour markets and the impact of population shifts on rural localities. Evidence is provided on the extent to which two decades of significant structural, technological and regulatory change have impacted on rural labour markets in Australia. This then provides a sound basis for the policy discussion in this thesis on population and labour market changes in rural Australia and the causes and implications of these changes.

Alcohol is a complex good which is ingrained within the social fabric of Australian culture. This is even more apparent within rural communities which are considered to have higher levels of risky alcohol consumption. While alcohol provides pleasure to many, it has devastating effects for others. Not only are individuals themselves affected, but also their families and the community at large. This thesis considers a number of the economic aspects associated with alcohol consumption in rural Australia. This thesis was completed in conjunction with a larger ongoing project: Alcohol Action in Rural Communities (AARC), which is a cost-benefit analysis of community-wide interventions to reduce alcohol-related harm in rural Australia. Given the study involves 20 rural communities in New South Wales, Australia; much of the analysis is centred around data collected from these communities. This thesis examines the amount and patterns of alcohol consumption, some of the associated harms, the value of reducing these harms, plus professionals’ and the public’s opinions on interventions, viewed as an optimal solution to reduce alcohol-related harm for the communities within this study. First, those factors which affect individuals’ decisions regarding how much alcohol to consume are examined through econometric modelling of the demand for alcohol. Moreover, a theoretical model is derived whereby individuals choose both the intensity and frequency of alcohol consumption in order to maximise their utility. This is then used to examine those factors that affect the relationship between intensity and frequency of alcohol consumption for individuals within the 20 communities of the study. Secondly, the impact that this alcohol consumption has in terms of the effect on morbidity, crime and traffic accidents within these 20 communities is analysed. The relationship between selfreported quality of life using the EQ5D (a quality of life instrument) and self-reported risky alcohol use are examined using ordered Probit and Tobit models. Also, the relationship between community levels of risky drinking and crime and traffic accidents that occur in alcohol-related times is analysed, controlling for the underlying level of crime in the community by using the rate of incidents that occur in non-alcohol-related times. It is found that rural communities in Australia are experiencing a sizeable amount of potentially avoidable harm due to risky alcohol use. Thirdly, the value of reducing alcohol-related harm in these communities, in terms of the amount households are willing to pay for these reductions, is estimated using contingent valuation methods. Individuals’ willingness to pay for a percentage reduction in alcohol-related harm is estimated using both a postal questionnaire for the 20 communities, plus a face-to-face questionnaire conducted in two of these communities. The face-to-face questionnaire is also used to conduct a double-bounded dichotomous choice experiment, to investigate the willingness of households to pay for a reduction in a number of different types of alcohol-related harm. Finally, the views on the optimal policy options to reduce alcohol-related harm for rural communities in Australia are examined for both professionals and the general public. A sample of drug and alcohol (D&A) professionals were asked to allocate a budget of $100,000 to a number of interventions in order to reduce alcohol-related harm in a hypothetical rural community. The D&A professionals most commonly selected interventions include training general practitioners (GPs), targeting high-risk groups, developing a harm-reduction code of practice, expanding social work services and the training of emergency department staff. Additionally, individuals from the general public were asked via a postal questionnaire to allocate a percentage of total funds to eight intervention areas in order to reduce alcohol-related harm in their communities. The top three intervention areas given the most funding, on average, by the public were school-based interventions, educational messages in the media, and greater police enforcement. There is no doubt that alcohol consumption causes a substantial amount of harm for rural communities within Australia. This thesis has provided information to inform the development of interventions tailored to specific communities and has derived estimates which can be used to help evaluate the cost-benefit of these interventions. There is still additional research to be done in order to obtain more accurate estimates of the exact effect alcohol has on rural communities and thus comprehensively evaluate which interventions are likely to be the most cost-effective in reducing this harm.

Family centred care is a concept espoused to be fundamental to achieving excellence in paediatric nursing. Although it is recognised that family centred care includes the child's rights to self determination the focus of this study is parental participation in the decision making and care of their hospitalised child at a partnership level. This is based on negotiation and requires frequent, effective communication between parents and nurses and for each to respect the other's knowledge and appreciate the other has something to offer in the relationship which will benefit the child. The purpose of this study was to identify whether family centred care was occurring in paediatric settings in rural Western Australia and explored parents' and nurses' perceptions of the concept. A questionnaire was designed based on the literature and common themes identified from focus groups. Convenience sampling was used and 15 rural hospitals facilitated participation of 243 parents who had a child under ten years of age hospitalised and 108 nurses who cared for children. Exploratory factor analysis identified four subscales from the parents' questionnaire and three subscales from the nurses' questionnaire which measured separate concepts of family centred care. Descriptive statistics were generated for each subscale, and independent t-tests, ANOVA and correlations were examined between independent variables and subscales of family centred care. There was a statistically significant difference in scores for parents' perceptions of `child friendly environment' between regional and district hospitals. Those parents who did not have social support scored a statistically significantly lower mean score for `respect as parent'. Nurses in district hospitals generated statistically significantly higher mean scores for `family focussed hospital' than those who worked in regional hospitals. / Parents and nurses both perceived that parents wanted to continue parenting their hospitalised child, however parents wanted to provide more nursing care than was perceived by nurses. Nurses' perceptions of delivering family centred care were greater than the perceptions of parents receiving it, however they were consistent in items that were scored low. Nurses did ask parents about the amount of participation they wanted in their child's care on admission however, it was not done on a regular basis. Parents perceived that nurses were unaware of other things that parents needed to attend to while their child was hospitalised and therefore did not enable parents to attend to these needs. More frequent negotiation of roles between parents and nurses by communicating each shift, or at least daily, could narrow the gap between differing perceptions in care provision and also enable parents to attend to their other roles thereby reducing their levels of physical and emotional stress.

The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.