title: The sustainable farm families project: changing attitudes to health.
abstract: BACKGROUND
  Farm health and safety has historically focussed on strategies such as injury prevention, safety audits and fulfilling legislative responsibilities. However, farmer injuries mask deeper health issues including higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farm family health has not been fully investigated. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address premature death, morbidity and injury on Australian farms. The SFF project illustrates how increasing health literacy through education and physical assessment can lead to improved health and knowledge outcomes for farm families.
  
  
  METHODS
  The SFF project focuses on the human resource in the triple bottom line and is working with farmers, families, industry and universities to collaboratively assess and promote improvement in the health and wellbeing of farm families. Based on a model of extension that engages farm families as active learners where they commit to healthy living and safe working practices, the SFF project is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farm men and women aged 18 to 75 years using a workshop format. Pre- and post-knowledge surveys, annual physical assessments and focus group discussions form the methodological context for the research over a three-year intervention.
  
  
  RESULTS
  This article discusses the progress of the research outlining the design of the SFF project, the delivery and extension processes used to engage 321 farm families from within a broadacre and dairy-farming family sample. The article presents key learnings on intersectoral collaboration, engaging farmers and families in health, and the future for this project extending into agricultural industries across the nation. Key results reveal that health issues do exist in farming families and are often underreported by family members. Health indicators were at a level where referral and intervention was required in over 60% of men and 70% of women in bothbroad acre and dairy industries. Farm men and women verbalised health concerns relating to access, support and control mechanisms of the health system. Participants also revealed how they put into practice their new knowledge and how this has influenced their health.
  
  
  CONCLUSIONS
  The key learning is that farm men and women who are at high risk of premature morbidity and mortality will participate in health education and assessment programs based on industry collaboration with high levels of individual participation. This program provides evidence that farmers will engage with health professionals if programs are presented to them in personally engaging and relevant ways. The SFF program is a definite tool for interventional health promotion that supports attitudinal change to health and farming practices.
authors.affiliation: Western District Health Service, Hamilton, Victoria, Australia. susan.brumby@wdhs.net
authors.forename: Susan A
authors.initials: SA
authors.lastname: Brumby
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Willder
authors.forename: John
authors.initials: J
authors.lastname: Martin
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D001315:Australia; D002908:Chronic Disease; D003299:Cooperative Behavior; D005190:Family; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012017:Referral and Consultation; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D055815:Young Adult