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Review

The Perceptions of Rural Australians Concerning the Health Impacts of Extreme Weather Events: A Scoping Review

by
Emily Vohralik
1,
Jonathan Mond
1,2,3,
I. Nyoman Sutarsa
1,
Sally Hall Dykgraaf
1,*,
Breanna Humber
1 and
Sari Dewi
1,4
1
Rural Clinical School, School of Medicine and Psychology, College of Science and Medicine, Australian National University, Acton 2601, Australia
2
Centre for Rural Health, University of Tasmania, Hobart 7001, Australia
3
School of Medicine, Western Sydney University, Penrith 2751, Australia
4
Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jatinangor 45363, Indonesia
*
Author to whom correspondence should be addressed.
Climate 2025, 13(9), 180; https://doi.org/10.3390/cli13090180
Submission received: 31 July 2025 / Revised: 26 August 2025 / Accepted: 27 August 2025 / Published: 28 August 2025
(This article belongs to the Special Issue Confronting the Climate Change and Health Nexus: Interactions, Impacts, and Adaptation Strategies)
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Abstract

Understanding rural communities’ perceptions of the health impacts of extreme weather is vital for strengthening community resilience and adaptation strategies. This paper aimed to collate existing evidence on the perceptions of rural Australians regarding the health impacts of extreme weather events. A scoping review following PRISMA-ScR guidelines was conducted. Peer-reviewed empirical articles published up to 7 May 2025 were identified from Scopus, PubMed, and Web of Science. One author undertook two-step screening and data extraction, which was checked by another author, and data were analysed using a thematic approach. Of 242 non-duplicate articles screened, 34 were included, which discussed drought (n = 14), bushfire (n = 8), flood (n = 6), extreme heat (n = 4) or a combination of events (n = 2). Two main themes arose: (1) perceived severity, frequency and duration of extreme weather events; and (2) perceptions of health impacts. The second theme comprised six subthemes: mental health risks, social disconnectedness, disrupted connection to land, distress due to uncertainties, community resilience, and disproportionate effects on vulnerable groups. Evidence gaps included a lack of perspectives separated by gender and age and a shortage of voices of socio-economically disadvantaged groups. Future research should investigate how to understand rural communities’ resilience to develop targeted adaptation and mitigation strategies.

1. Introduction

Climate change is increasing the frequency, intensity and/or duration of extreme weather events including extreme heat, drought, desertification, dust storms, floods and extreme precipitation [1]. Additionally, evidence that human influence has increased the occurrence of compound extreme events such as bushfires has strengthened [2]. Researchers have found that anthropogenic climate change, particularly its impact on temperature extremes, has increased the probability of an extreme fire season like the 2019–2020 Australian bushfires by at least 30% [2].
The health impacts of extreme weather events are inequitably distributed towards those experiencing existing disadvantage [1,3], particularly rural and remote communities. They include directly increased morbidity and mortality which are compounded by indirect socioeconomic impacts such as disruption to infrastructure, health systems and community social supports [1].
People living in rural areas are often adversely impacted by extreme weather events to a greater extent than those in urban areas because of numerous factors which increase their vulnerability [4,5]. Around 43% of the global population lives in rural areas [6], and in Australia, 28% people live outside major cities, while inequity in health outcomes and social determinants of health for people in outer regional, rural and remote areas is increasing [7,8,9]. Rural populations typically have a lower socioeconomic status than people living in cities, a higher burden of disease and poorer access to healthcare services [8,9,10,11]. Furthermore, economic dependence on agricultural and food production industries and the associated water sources make these populations prone to disruption by extreme weather events [4,12]. In addition, the physical proximity to bush and farmland increases risk of harm from bushfires and drought [13]. The geographical isolation of many rural towns further impairs access to essential services and the ability to cope with the impacts of extreme weather events [7,11,12,14].
Rural communities often rely on primary healthcare services for healthcare delivery particularly during natural disasters and to mitigate the health effects of climate change [15,16]. Climate-related risks and extreme weather events are negatively impacting primary care utilisation and health outcomes in rural and remote areas [11]. The increasing frequency, intensity and/or duration of climate change-related extreme weather events is likely to exacerbate healthcare inequities between rural and urban communities [7].
While Australia shares some commonalities with global trends in extreme weather events, particularly those linked to climate change, its unique geographical and climatic characteristics lead to specific challenges. Australia is experiencing more frequent and intense heatwaves, heavy rainfall events, and longer and more severe fire seasons [17]. Given that rural Australians are more dependent on natural resources likely to be impacted by extreme weather events than those in urban areas, it is important to understand how their health outcomes may be protected and improved. With increased extreme weather events in Australia, lessons learnt can be potentially applied in other similar rural areas outside Australia.
There is some existing research into the health impacts of drought [18,19,20,21], particularly on farmers [22], as well as extreme heat [23,24,25], floods [5,26,27] and bushfires [28,29,30] on rural Australian communities. Over a decade ago, researchers reviewed the effects of drought, heatwaves and bushfires on the health of older rural Australians, emphasising the need for collaborative community programmes to support the ageing, particularly targeted mental health interventions [19]. Recently, others have updated the review of the health impacts of extreme heat on older rural Australians, with only ten included articles demonstrated limited research in this area [23]. A meta-analysis has assessed the prevalence of psychological distress after bushfires [31]; however, it did not focus on rural Australians or community perceptions related to mental health or disaster recovery.
Research investigating the perceptions of rural populations can highlight the perceived severity of and susceptibility to climate change and will also identify their perceived benefits of change and barriers to action [32]. Perceptions, knowledge and beliefs as components of health literacy have been known to be associated with health outcomes, including help-seeking behaviour [33]. Furthermore, while rural populations depend more directly on their local environment, their perceived threat of climate change is lower than that of their urban counterpart [34]. Additionally, a focus on community capacity-building to promote resilience has been shown to be effective at increasing coping within the context of specific communities [29,35,36,37]. Considering rural communities’ perceptions offers critical insight into how adaptation and mitigation strategies for future health impacts can be strengthened, as individuals’ beliefs and experiences shape their risk perceptions of natural hazards and, in turn, their engagement with adaptive and mitigating behaviours [38,39].
There is limited existing research related to rural Australians’ perceptions at the intersection of health and climate change. Researchers in Australia have begun exploring perceptions about factors comprising rural community resilience [35], including after flooding [36], emphasising the importance of social capital as well as environmental and economic factors. Others have investigated the role of the media in influencing perceptions about climate change health risks amongst Australians, finding that exposure to and interest in climate news was important [40]. The impacts of climate change on rural health services have been assessed from the perspective of rural general practitioners in Australia [16,41] and more broadly in a globally focused scoping review [11]. Another global review synthesised perceptions of both the public and health professionals about the health implications of climate change, without a rural focus, finding low awareness of specific health harms and mixed desire to learn more [42]. Within Australia, youth mental health and climate change concerns have been explored but either not focused on rural settings [43] or not related to extreme weather events [44].
Overall, the perceptions of rural Australians concerning the health impacts of extreme weather events are less well-studied than the impacts per se, with the evidence remaining scattered and not well synthesised or mapped. A comprehensive understanding about these rural perceptions will facilitate strengthening of community resilience and development of targeted adaptive strategies by clarifying motivators for behavioural change and local health system needs [32,38]. Community-based health promotion programmes that take into account these perceptions are more likely to reach vulnerable groups and they may have more information and motivation to take part in the process of adaptation to extreme weather events [37].
This scoping review aimed to compile published literature on the perceptions of rural Australians regarding the health impacts of extreme weather events and to identify gaps in the current literature. The review highlights possible avenues for targeted adaptation and mitigation strategies that engage local communities and services to address the health impacts of future events.

2. Methods

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [45]. The key concepts in this review were rural settings, extreme weather events, perceptions and health impacts. The Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW) classify rurality in Australia into categories like Inner Regional, Outer Regional, Remote, and Very Remote [46]. Given the various definitions of rurality in different studies [47], an inclusive definition of ‘not urban’ was used for this review to capture Australians living in regional, rural or remote areas.
Extreme weather events, listed in Table 1, were those related to climate change with evidence for increasing frequency, intensity and duration due to global warming [1,2]. Perceptions were defined as subjective opinions expressed by individuals and communities in relation to awareness, knowledge, attitudes, and beliefs of how extreme weather events impacted their health, environment, and livelihood [48]. Health impacts were either general (including social), physical, mental or indirect socioeconomic impacts.

2.1. Search Strategy

The population, phenomena of interest, context (PICo) [49] approach was used to develop a search strategy. Search terms were identified using PICo by preliminary searches in PubMed and Scopus databases and noting the keywords of seminal articles. Relevant Medical Subject Headings (MeSH) terms were also included. Search terms were grouped into five themes: rural, extreme weather event, health impact, perceptions, location (Table 1). Search strings were formed by separating keywords with Boolean operators (see Supplementary Material S1). The initial search strategy was developed in Scopus and then adapted for PubMed and Web of Science databases. Additionally, a hand-search of cited articles within eligible studies was conducted to identify further relevant studies.

2.2. Selection Process

Search results were exported into EndNote 21 [50] where duplicates were removed and then imported into Covidence [51] for screening. Titles and abstracts were screened by EV and BH against inclusion and exclusion criteria and any queries were checked by SD or JM and resolved by discussion. Full text screening of eligible articles was performed by EV, and eight queries were resolved by discussion against inclusion and exclusion criteria between EV, BH and SD.
The review included English-language articles published in peer-reviewed journals up to 7 May 2025, with no date limit. Inclusion criteria were primary studies including quantitative, qualitative and mixed methods designs, non-urban location in Australia, extreme weather event and perceptions towards health impacts. Exclusion criteria were non-primary articles including reviews, study protocols, commentaries, letters and editorials, grey literature, rurality not specified, if the study could not differentiate urban and rural data, if the study was about climate change without mention of an extreme weather event, or the study did not mention perceptions about health.

2.3. Data Extraction and Synthesis

Data was extracted from included studies using a modified extraction form that aligned with review objectives and piloted on five studies to ensure all relevant results were extracted (see Supplementary Material S2). Data was extracted by EV and BH, and re-checked by SD, with discussion and revisiting the full text to clarify any differences. The following information was extracted: authors’ names, publication year, study design and aims, extreme weather event, location, participant characteristics (such as age, gender, occupation, rurality) and key findings (perceptions of health impacts: general (including social) health, mental health, physical health, and indirect (socioeconomic) impacts).
Data were classified according to type of extreme weather event, perceptions of health impacts, gender, age and occupation. Given the inclusion of heterogenous study designs with both quantitative and qualitative findings, a thematic analysis of the articles was conducted [52]. This process provides a flexible yet systematic approach to integrating diverse data sources, allowing both numerical trends and narrative accounts to be examined together and distilled into comprehensive findings.
A hybrid deductive and inductive coding approach was employed. Extracted data were deductively coded using the predefined categories in the extraction form for key findings: ‘perceptions of health impacts’, described in the previous paragraph. Data were then further stratified by gender, age, occupation and vulnerability by tabulation in Microsoft Excel. An inductive approach was then used to identify more detailed codes that emerged from the data by grouping similar topics or keywords together. Draft descriptive themes were proposed by EV by identifying common or pertinent codes and grouping them into categories with similar meaning. Regular discussions between EV, SD and INS were conducted to check whether the themes were coherent, distinct, and well-supported by the data. Overall, final themes and subthemes were refined and presented narratively.

3. Results

A total of 373 articles were identified in the initial search. After duplicate removal and screening, a total of 34 articles were included in the analysis (Figure 1).

3.1. Overview of Included Studies

Included articles were published between 2007 and 2025 and comprised a mix of qualitative (n = 19), quantitative (n = 10) and mixed methods (n = 5) studies. Almost half the studies originated from New South Wales (NSW) (n = 15), and others were from South Australia (SA) (n = 7), Victoria (Vic) (n = 6), Queensland (Qld) (n = 4), or included several states (n = 2). Specific extreme weather events reported in the included studies were drought (n = 14), bushfire (n = 8), flood (n = 6), extreme heat (n = 4), or a combination of events (n = 2) (see Table 2). The demographics of the study populations varied (Table 2). The number of participants ranged from two to 2004, with the study of two participants consisting of a series of interviews with two rural women’s health workers to explore lived experiences of drought [53].
Findings were presented under two main themes: (1) perceived severity, frequency and duration of extreme weather events; and (2) perceptions of health impacts (Figure 2). The second theme comprised six subthemes: (2.1) direct health risks and impacts (both physical and mental), (2.2) social disconnectedness and the effects on health, (2.3) reduced connection to land and the impacts on personal wellbeing, (2.4) increased health risks due to uncertainties, (2.5) increased community resilience before, during and after extreme weather events, and (2.6) disproportionate health impacts affecting vulnerable groups.

3.2. Perceived Severity, Frequency and Duration of Extreme Weather Events

Overall, as summed up in a 2020 survey of rural Australians [70], majority of participants were concerned that climate change impacts such as drought and flood will worsen in the future. Young people [76] and medical students [79] expressed surprise at the severity of flooding in the Northern Rivers’ region of NSW, with greater concern for future flooding and climate change. They believed there were inadequate warnings for the severity of the situation which increased stress and reduced effective responses. Similarly, in a region of SA where drought was uncommon, farmers were surprised by the severity of drought [55].
An increase in heat exposure compared to the past was reported by almost half of the residents surveyed in both rural SA and Vic, with concern that heatwaves and health consequences would continue to increase into the future [78]. Other South Australians highlighted that increased intensity or duration of extreme heat made the experience more challenging and elevated the bushfire risk, but did not comment on heatwave trends over time [69]. In contrast, older people in Victoria who were sceptical about climate change did not recognise heat as a health threat and were confident in their ability to cope with future heatwaves as they had in the past [83].
Similarly, in a small NSW Northern Tablelands community belief about the frequency of future bushfires were linked to beliefs about climate change [60]. Some participants noted that bushfires are occurring more frequently than they used to, but those who believed in natural ‘climate cycles’ thought that bushfires will occur infrequently into the future and thus preparation efforts were reduced. Bushfire was perceived as a major threat to communities in Victoria [80] and was described as having catastrophic effects by NSW mental health workers which could have been reduced by listening to Aboriginal cultural land management practices [65].
Many articles described drought as prolonged, progressing and severe, with increased duration associated with greater levels of community-wide distress [53,54,56,62,70,82]. During the prolonged millennium drought adolescents in rural NSW began to recognise that climate change might be having an effect [81,82]. In a survey of 2004 NSW residents, respondents living in remote or very remote areas were 3.22 times more likely to think that drought was very or extremely likely to continue than people living in more geographically accessible areas [77].

3.3. Perceptions of Health Impacts

3.3.1. Direct Health Risks and Impacts (Both Physical and Mental)

Awareness of the health risks of extreme weather events varied among population groups. Older adults in rural NSW identified health-related suffering from climate change, particularly due to drought and flood, as a primary concern [70]. Conversely, peri-urban Victorians, including Landcare conservation volunteers who participate in community-led activities to protect and restore local environments, and new parents, perceived bushfire as a major community threat rather than an individual one and did not prioritise health issues [80]. Amongst Victorian residents over 55 years, 36% had heat-health concerns yet almost half did not consider themselves or others vulnerable to heat due to a sense of self-reliance [83]. Similarly, low awareness of heat risks was found in older age groups in regional SA and Victoria, especially those over 75 years, whereas younger adults and females showed higher awareness of heat impacts [78].
Both elderly and adult rural residents commonly perceived extreme heat as an inconvenience causing discomfort [69,83] and physical health issues like lethargy and heat stress [69,78]. Drought and extreme heat impacted outdoor enjoyment, particularly in rural farming communities [62,69]. A study of Central West NSW adults reported a negative impact of drought on their lives [72]. Interestingly, for children and adolescents in rural NSW, drought did not negatively impact their rural lifestyle, which was viewed as safer and more fun than city living [81,82].
Regarding mental health impacts, drought as a stressor was emphasised in most articles [54,55,56,61,62,63,70,72,73,75,81,82]. Farmers and rural businesspeople described drought stress in relation to financial pressure [55,62,63] and farmers reported concerns about the adverse effects of drought on their workload and mental health [55,56,62,63,73,75]. The emotional distress associated with witnessing the death of or killing their own livestock contributed to negative mental health effects for children [81,82] and farmers [56,66,67,73]. Rural Aboriginal people, farmers and health workers feared that prolonged drought may induce community-wide mood and behaviour issues [61,62].
In response to acute events like bushfire and flood, rural residents noted that mental health effects either arose immediately or were delayed, and many were long-term [27,60,65,66,67,71,76,79,80]. Immediate impacts included stress, anxiety and overwhelm, often exacerbated by communication difficulties and dealing with authorities during the disaster response [60,66,71,80]. Young people and rural medical students expressed trauma associated with severe flooding in the NSW Northern Rivers region [76,79]. Delayed psychological effects noted by rural healthcare workers [65,67] and Country Fire Association volunteers [80] surfaced months after bushfires when recovery programmes had often ended. Farmers [66], mental health workers [65] and young people [76] emphasised concerns about long-term mental health impacts such as residual anxiety and being easily triggered by weather changes. Pre-existing mental health issues were perceived to be exacerbated by drought [53,55] and flood [71,76], particularly notable in people with a disability [71].
Only six included articles discussed gender differences in relation to mental health effects of extreme weather events [56,57,67,75,81,82]. Local health workers found it difficult to reach men for counselling as they often considered themselves too busy or denied needing help [67]. Female farmers noted that their male partners were unavailable for emotional support, being preoccupied by disaster responses [57] or overwhelmed by their own negative mindset [56]. Interestingly, another study found no difference in psychological distress between male and female farmers during drought, but highlighted that females seek emotional social support more than males, who preferred venting of emotions [75]. Amongst rural NSW school students, males and females showed no difference in drought-related emotional distress [81], but a follow-up study in the same region reported higher distress in females [82].
In six studies, beliefs in self-reliance and stoicism were found to prevent discussions about mental health or seeking support during extreme weather events [53,56,60,62,64,67]. This led to a downplaying of mental health concerns despite residual stress, anxiety and post-traumatic stress disorder (PTSD) years after bushfires, with farmers struggling to talk about their mental health [60]. Within families, this culture of stoicism prevented children and parents from discussing their mental state after bushfires, impairing the seeking of social support and grieving losses [64]. Parents also worried about the negative emotional effects of drought [54] or bushfire [64] on their children, just as the children worried about their parents’ mental health [54,64].

3.3.2. Social Disconnectedness and the Effects on Health

Participants of included studies perceived disruptions to social connectedness in personal relationships, families and communities due to extreme weather events. Drought strained family relationships and increased parental distress, which children and adolescents noticed [54,62,81,82]. Bushfires altered parent–child communication, with both parties becoming hypervigilant and withholding mental health concerns to avoid burdening each other [64]. Drought led women to seek off-farm work due to decreased farm income, potentially spending less time with family [53,55,62]. Some adolescents in rural NSW worked more on family farms during drought, reducing social interactions with friends and time at school [54].
Several studies reported shrinking rural communities due to drought [53,54,61,62,81,82] and reduced community activities [54,68,69,71,81], resulting in increased social isolation. Young people lost friends who moved away during drought, reducing their social networks [54,82]. Aboriginal communities in rural NSW worried about population skewing as working-age people left smaller towns, leaving behind the ill and elderly [61]. These socioeconomic effects contribute to rural demise, threatening the viability of smaller communities. Similar concerns were noted in SA regarding extreme heat [69].
Social connections within communities were often disrupted during or after extreme weather events. Perinatal women [57] and people with disabilities and their carers [71] experienced significant disruptions to social support networks post-flood. Some individuals in a remote Victorian community felt excluded post-bushfire due to perceived social divisiveness [67]. Mental health workers in rural NSW observed that bushfire disaster responses amplified both positive and negative human traits, increasing social tensions and vulnerabilities [65]. Farmers in SA found community work stressful, compounding farm-related stress during drought [73]. Aboriginal and financially disadvantaged participants reported lower community connectedness post-flood, compared to other residents in the NSW Northern Rivers region [27]. In other rural NSW Aboriginal communities, drought was perceived to promote antisocial behaviour, negatively affecting social and emotional wellbeing and increasing community mistrust [61].

3.3.3. Reduced Connection to Land and the Impacts on Personal Wellbeing

A salient subtheme was how environmental damage and degradation harmed peoples’ identity, sense of place and connection to the land. This was significant for Aboriginal communities in rural and remote NSW in the context of drought which harmed traditional family structure, culture and place [61]. For example, the drought-related loss of habitat and wildlife was reported to threaten traditional men’s roles [61]. More broadly, Aboriginal participants described feelings of grief, loss and guilt because continuing severe drought was causing cultural and geographic dislocation, loss of country and identity [61]. Mental healthcare workers in rural NSW observed particularly devastating effects of bushfires on local Aboriginal communities who lost access to culturally significant lands [65].
Distress due to environmental changes and loss of sense of place, termed solastalgia, was a primary concern in some studies [62,70,81]. In rural farming communities, women in two studies reported distress [62] and a spiritual impact [55] associated with losing their gardens during drought. Extreme heat raised concerns about gardens and local parks in the context of water restrictions, highlighting the importance of the natural environment [69]. Others in farming communities described how the parched, dry landscape had a negative effect on mood, particularly for farmers, and made people reluctant to spend time outdoors [62]. Livestock farmers in Qld experienced feelings of personal failing due to progressing drought, destruction of the land, livestock death and declining business [56]. These farmers described a shift in the farming role from guardian of the land to a sole focus on survival [56]. During drought, farm labour increased and more time was spent managing livestock, water and fencing [55,59,73]. Bushfire was reported to change some farmers’ identity and connection to the land, with the environmental changes a constant, unwanted reminder of the fire [66]. For young adults, bushfire altered their identities by making them more alienated from others [30].

3.3.4. Increased Health Risks Due to Uncertainties

Rural Australians raised concerns about uncertainties regarding potential climate change impacts, the future, a perceived lack of control, and finances. Worry about climate change was increased in medical students and young people who experienced flooding because it highlighted communities’ vulnerabilities to extreme weather [76,79]. Rural healthcare workers observed that farmers experiencing drought worry about the effects of climate change on their livelihood and families, yet this may manifest as scepticism or denial [53]. Worry about the future was a common theme across drought [55,62,73,82] and flood [76]. For NSW farming communities, the most significant effects of drought on lifestyle and business were uncertainty and the inability to plan ahead [62]. Many rural Australians described a perceived lack of control during drought linked to unpredictable weather, finances and government regulations [62], particularly children and adolescents [54,81] and citrus farmers [63].
For many farmers and farm families, financial strain and uncertainty was a key concern arising from drought [54,55,59,62,73] and bushfire [67]. Financial pressures meant farm owners often had to reduce employee numbers [73] and Aboriginal farm employees described a differentially severe effect particularly due to lack of government compensation schemes [61]. Children and adolescents in rural farming communities worried about their family’s financial situation at home [54,82]. Both adolescents and their parents worried about loss of future education and employment opportunities because of drought-related financial strain and increased need to work [54,62].
Young people reported financial strain from flooding caused by disruptions to housing, work, travel, food supplies and services which often negatively impacted mental health [76,79]. These would likely be amplified in people experiencing financial hardship; however, the article looking at this population only focused on the effects of flood on social capital [27]. In a large survey of rural NSW residents, other concerns about financial pressures included rising insurance, increased cost of living, difficulty growing crops, and lack of water security [70]. Some rural residents perceived that government policies to respond to extreme weather events, especially drought, exacerbated rural suffering through a lack of control and financial strain [54,62,70,73].

3.3.5. Increased Community Resilience Before, During and After Extreme Weather Events

Despite the frequently described harms to mental and physical health and disconnection from land and community, multiple studies emphasised community resilience in the context of extreme weather events. The belief that rural communities are resilient and able to cope well with adversity was emphasised across drought [56,81], extreme heat [68,69,78,83] and bushfire [30,58]. This belief was associated with a lack of concern about increasing extreme heat for some people [68], including farmers [69] and older Australians [83].
Young people described optimism and community resilience in the face of drought [81,82] or flood [76] due to increased community participation and volunteering. For example, adolescent school students perceived drought as a factor that brings people together and provides more resources for drought-affected schools [81,82]. Many students believed they were learning to cope with drought, with personal resilience enhanced by humour in the face of adversity and strong connections to community and school [81]. In another study of adolescents and young adults post-flood, most participants perceived strong community cohesion and connectedness due to involvement in the community-led clean-up and a new volunteer organisation established due to the flood [76].
Bushfires were reported to catalyse positive community change, promoting new community involvement for young adults such as bush regeneration [30]. These young adults perceived informal networks of friends and family as the most meaningful social supports post-bushfire and emphasised the importance of acknowledgement of their unique experience [30]. Parents noted positive relational changes in their children post-bushfire as they engaged in more prosocial behaviours [64]. Females in three studies particularly valued social connectedness to strengthen community resilience and helped promote it during and after disasters, such as organising social events to bring people together and temporarily alleviate stress [36,56,64]. Connecting with individuals with similar disaster experiences was another common facilitator of community optimism, allowing time to debrief about stressors and laugh together [30,58,76].
For healthcare workers, a positive effect of bushfires was the strengthening of supportive workplace relationships in hospitals supported by a formal ‘Wellness Warriors’ recovery programme in which ‘pausing to listen’ promoted meaningful interactions and a more positive atmosphere at work [58]. For these hospital staff [58] and other mental health staff [65], bushfires emphasised the importance of connecting with colleagues and renewed their sense of purpose and commitment to promoting health within their community.
Rural mental health staff noted more broadly that the bushfire disaster response amplified positive human traits, such as camaraderie and mutual support, whilst bringing out tensions and vulnerabilities as discussed in the previous section [65]. Some adults in rural and remote NSW mentioned increased community connectedness during drought, such as through church or farm family gatherings, but majority perceived that negative community impacts were more prevalent [54]. Other rural Victorians observed an increase in social cohesion post-bushfire with a sense of shared experience and co-operative clean-up, but pre-existing social divisions returned as people recovered [67].
Evidently, rural community resilience and positivity before, during and after extreme weather events is a nuanced topic which varies based on age, type of extreme event and an individual’s perceived community connections. It is especially important given that community social connection was the strongest factor enabling coping in almost half of the included studies [30,36,55,56,62,63,64,66,67,68,69,71,76,79,81,83].

3.3.6. Disproportionate Health Impacts Affecting Vulnerable Groups

In 15 studies, participants expressed concerns about individuals or groups who were more vulnerable to increased hazard exposure or health impacts during extreme weather events [27,53,56,57,61,62,67,68,69,70,71,74,78,79,83]. People were concerned about the elderly, those with a chronic medical condition or an outdoor occupation being more susceptible to the health risks of extreme heat [68,69,78,83]. Female healthcare workers noted that rates of domestic violence increased during disasters which largely increased the harm to women’s health [53,57]. Other groups of mothers identified as needing additional support during disasters included women with disabilities, pre-existing mental health challenges, First Nations families and young mothers [57]. During flooding, there were concerns for the safety of those who drive through floodwater [74] and volunteer for clean-up efforts [79].
Rural residents expressed concerns about the exacerbation of pre-existing socioeconomic disadvantage by extreme weather events, particularly drought and flood [61,70,71]. For rural Aboriginal communities this included reduced culturally appropriate housing, worsened overcrowding, and fewer local Aboriginal health services [61]. Loss of access to culturally significant lands was a major impact of drought [61] and bushfire [65] for Aboriginal communities, but local mental health workers perceived that its significance was not recognised in evacuation plans and service responses [65]. Six months after flooding in the NSW Northern Rivers, Aboriginal and financial hardship respondents experienced lower social capital and higher rates of distress and probable PTSD compared to other survey respondents [27].
People worried that those with the least resources, including people with a disability and carers, were more likely to live in flood-prone areas because they are generally more affordable [71]. People with a disability described how floods compounded physical and mental health symptoms, which further impeded access to essential services and the ability to navigate recovery systems [71]. People with a disability and carers experienced high levels of financial stress arising from lack of affordable accommodation post-flood, which caused some to live in unsafe housing, relocate and lose support networks, or become homeless [71]. Despite widespread concern about rural populations who are more vulnerable to the health impacts of extreme weather events, only a small number of included studies directly involved these groups.

4. Discussion

4.1. Overview of Findings

This is the first scoping review to summarise the perceptions of rural Australians towards the health impacts of extreme weather events. Included articles captured perceptions associated with drought, bushfire, flood, extreme heat and mixed events. Extreme weather events impact health directly and indirectly via socioeconomic factors and have been reviewed by others [1,11,23,84,85,86], with many focusing on mental health [3,18,21,26,31,87].
This review identified two central themes: first, perceptions on extreme weather in terms of severity, frequency, and duration; and second, perceptions on health impacts. The latter theme revealed six interrelated subthemes, drawing attention to the psychological toll of extreme events, including mental health risks and uncertainty-related distress; social disconnectedness and isolation; rural community resilience; disruptions to cultural and emotional connections to land; and the disproportionate vulnerability of specific groups, underscoring existing social and health inequities.
Rural Australians’ beliefs about climate change are likely to influence their perceptions of severity and susceptibility to the impacts, as suggested in models of health behaviour such as the health belief model [32]. The nuance of peoples’ beliefs should be considered in planning health-promotion programmes for adaptation and mitigation because beliefs about the human contribution to climate change influence pro-environmental behaviour relevant for adapting to increasing extreme weather events [88]. Our findings show that many rural Australians described the drought, flood and bushfire events they experienced as severe, with concern for worsening future events influenced by climate change [55,70,76,78,79]. However, in two included studies the majority of participants were sceptical about climate change, associated with lack of trust in government [70] and reliance of the elderly on personal experience to cope with heatwaves [83].
Similarly to this finding, a study on perceptions in rural United Kingdom shows that lower threats of climate change are perceived in the most rural locations [34]. Lower awareness of the impact of climate change and higher resilience within rural population is believed to explain this phenomenon. Grounded in social learning theory, adaptation and mitigation of extreme weather impacts can be strengthened through collaboration, knowledge sharing, and co-creation of practices among stakeholders [89]. By exchanging experiences and feedback, communities and systems can enhance collective adaptive capacity. In rural settings, for instance, integrating local strategies for managing drought or bushfire risks with scientific guidance can foster systemic resilience that extends beyond individual actions.

4.2. Wide-Ranging Mental Health Concerns

Notable across many subthemes was the perceived saliency of mental health impacts across varied rural Australian population groups and in response to different extreme weather events [27,53,54,55,56,57,60,61,62,63,64,65,66,67,70,71,72,73,75,76,78,79,80,81,82]. For example, drought was viewed as a stressor associated with uncertainty and as the origin of other stressors such as financial strain, occupational issues for farmers and social stress [54,55,56,61,62,63,70,72,73,75,81,82]. Researchers have noted the need to recognise the complexity of the socioeconomic impacts of drought when designing adaptive strategies, including economic impacts, social stress, water markets, a changing farming industry and rural demographic shifts [90].
Another subtheme highlighted the capacity for environmental destruction to negatively impact on connection to land, sense of identity, and mental wellbeing, an increasingly relevant harm of climate change termed solastalgia [91]. Other recent research has recognised the significance of the mental health impacts of drought on rural communities globally [92] and in Australia [20,21,90], particularly farmers [18,22], yet there are limited reviews on this topic as it can be challenging to study such a long-term exposure. Indigenous communities proposed that capturing the spirit of Aboriginal knowledge, traditions and arts to renew respect for the land during drought could be a valuable consideration for future policy [61].
For the more acute events of flood and bushfire, mental health impacts were seen to be divided into immediate and long-term or delayed effects. The exacerbation of pre-existing mental health conditions was common. Mental health symptoms could impair the ability to access support services and reciprocally, disrupted access to essential services and financial strain worsened mental wellbeing, especially for medical students [79] and people with disability [71]. A recent Australian review found that long-term psychological distress post-bushfire was experienced by 14% of the general population but was at least twice the rate in firefighters [31]. Similarly, a scoping review [85] and recent primary survey [5,26] have investigated factors associated with short- and long-term mental health impacts of flooding, such as rurality and socioeconomic disadvantage.
The emphasis on mental health highlights the need for more targeted, local supports for rural Australians before, during and after extreme weather events [93]. It is well known that rural communities are particularly vulnerable in terms of adverse mental health outcomes including suicide [94]. Participatory action research which involves participants with researchers throughout design, conduct and evaluation of research can aid the implementation of effective community-based prevention strategies, for example, suicide prevention, by empowering communities to promote action [95]. It is important that mental health support options offered are appropriate to the needs of the population groups within the specific community and relevant to the extreme weather event(s) being experienced [93,96,97,98]. For example, farming men’s mental health was best supported through informal social settings in a rural Victorian town post-bushfire [67].
In the NSW Snowy Valleys bushfire response, mental health clinicians noted that mental health support for Aboriginal communities occurred predominantly outside of mainstream services [65]. Other rural Aboriginal communities in NSW valued community-based Aboriginal health promotion programmes to support general social and emotional health during drought, such as annual ‘footie knockouts’ aimed at youth [61]. Education was suggested by adolescents and farming communities in relation to mental illness during drought [54,55,62]. A recent qualitative study found that farmers prefer online mental health interventions that seem relevant and authentic with a casual tone whilst reflecting the diversity of the farming population [96].

4.3. Social Disconnection and Resilience

Social disconnectedness as a subtheme encapsulates the perception that extreme weather events have negative effects on community social health, reducing participation, increasing social isolation and harming mental health. Yet despite this, it was common for rural Australians to view their community as resilient before, during and after extreme weather events. Other research has found that social networks influenced mental health outcomes after a bushfire [28,29] and that social participation and networks are central to effective bushfire preparedness [99]. Therefore, adaptation strategies for extreme weather events should prioritise community-led planning to enable rural communities to strengthen their connectedness as this may also benefit mental health [35,36,93,95].
Harnessing the notion of resilience and optimism may more effectively engage communities for future adaptation and mitigation in response to increasing extreme weather events in rural areas [37]. Factors that promoted resilience in one rural Australian community included social networks and support, positive outlook, learning, infrastructure and support services, innovative economy and leadership [35]. More recent Australian research shows that rural communities value community-led, collective and democratic action in approaches to mitigate the mental health effects of extreme weather events [93]. These approaches promoted belonging, informal social connectedness, hope and optimism. Examples included local climate change mitigation groups with a focus on caring for the land, community water usage monitoring during drought, and getting together to support firefighters in bushfire season [93]. Others have noted that more research is needed on existing adaptive capacity and knowledge of rural communities [7,90] as well as understanding how rural people define their ‘sense of community’ [99].

4.4. Evidence Gaps

This review comprised perceptions of rural populations from only four states of Australia (NSW, Vic, SA and Qld), and did not capture perceptions of people from Tasmania, Western Australia, the Northern Territory or the Australian Capital Territory. Valuable insights relating to specific population groups in these states and territories have therefore been missed. These may include how hazard risk perceptions vary with socioeconomic status in these areas of Australia, and issues unique to the numerous remote farming and remote Indigenous communities across Western Australia and the Northern Territory. Most of the included studies also did not differentiate their results based on rurality of their participants. Therefore, we could not map and analyse whether perceptions vary between outer regional, remote, and very remote areas. This information would support targeted specific policy recommendations for each setting. Another possible factor that might have skewed the findings of this review was the overrepresentation of drought compared to other extreme weather events. This likely reflects a bias in the literature due to the chronicity of drought in Australia, including the decade-long drought experienced from 2000 to 2010 [18], allowing for more time to produce studies on drought.
Although a small number of studies looked at perceptions of children, adolescents, older Australians and females, most did not separate the perceptions between gender and age, limiting this cross-analysis of health impacts of extreme weather events. This is an important gap to address because women, young children and the elderly are known to be more vulnerable to the impacts of climate change [1,20,23]. There is, however, an Australian review being conducted on climate change adaptations to protect maternal and child health [100]. Additionally, males can have different preferences for mental health support or be difficult to reach [56,67]. Therefore, separating study findings into gendered perspectives has implications for designing more targeted strategies to increase engagement and mitigate health impacts of future extreme weather events. This gap on age- and gender-specific perspectives may persist in the literature if studies do not collect or present individual data specifically linked to gender and age as this may not be feasible in large-scale quantitative or qualitative data analysis.
The review found limited evidence exploring perceptions of vulnerable rural groups such as the elderly [83], people with a disability [71] or chronic health condition [68,69,78,83], females at risk of domestic violence or young mothers [53,57], those in financial hardship [27], and Aboriginal people [27,61], highlighting under-researched areas. Participants in 15 included studies [27,53,56,57,61,62,67,68,69,70,71,74,78,79,83] expressed concerns that vulnerable groups are disproportionately affected by the health impacts of extreme weather events. This reveals a research gap and a need for more targeted local financial and social supports that are accessible to vulnerable populations. The limited representation of socioeconomically disadvantaged groups possibly stems from factors relating to study design, participant recruitment and lack of time for people to participate due to socioeconomic stresses. Future research should aim to involve rural socioeconomically disadvantaged populations, for example, through community-academic partnerships with researchers with lived experience, community involvement in study design and purposive participant recruitment [7,26,95].

4.5. Strengths and Limitations

This scoping review was the first to assess the wide-ranging, yet often similar, perceptions of rural Australians concerning the health impacts of extreme weather events, filling a research gap. A key strength was the use of a comprehensive strategy including different study designs, allowing multiple types of data to be evaluated. Instead of characterising health impacts, we focused on perceptions to understand attitudes and beliefs of rural populations which can warrant adaptation and mitigation strategies suitable for rural populations.
Despite this review being novel and comprehensive, there are a number of limitations. In this review, only one reviewer performed screening and data extraction; however, any queries were checked by a second reviewer and resolved by discussion. It is possible that more bias was introduced during the screening and data extraction process than if two authors had performed all steps. The heterogeneous data from included studies made it difficult to combine; however, synthesising the data using thematic analysis provided robust qualitative findings. The broad scope of the review may have sacrificed depth of cross-analysis of extracted data and missed identifying, comparing and contrasting more specific trends in the findings.

5. Conclusions

This scoping review summarises rural Australians’ perceptions of health impacts from extreme weather events. It highlights many concerns about the diverse impacts of drought, bushfire, flood, and extreme heat on mental health, connection to land and community, and on vulnerable populations. The review underscores the importance of tailoring future adaptation and mitigation strategies to the unique needs of each rural community including their knowledge and beliefs, considering the substantial diversity in demographics and occupations. Mental health impacts, particularly from prolonged drought, are a significant concern, with many studies noting stressors associated with social impacts and financial strain. The review emphasises the need for effective mental health support and community social connectedness to enhance coping.
Future research should aim to understand rural communities’ existing adaptive capacity, definitions of ‘sense of community’ and preferred adaptive strategies to guide community-led adaptation. Longitudinal studies of perception changes over time and how they influence health outcomes will help to support longer-term behavioural changes necessary for adaptation to more frequent extreme weather events. Participatory research methods should be utilised to engage rural socioeconomically disadvantaged populations, such as community-academic partnerships [7,26,95]. Future research should also aim to stratify findings by age and gender and consider rural populations across all of Australia to enable targeted adaptive and mitigation strategies that consider the diversity between population groups.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/cli13090180/s1, Supplementary Material S1: Final database searches performed; Supplementary Material S2: Data extraction form.

Author Contributions

Conceptualization, E.V., J.M. and S.D.; methodology, E.V., J.M., I.N.S. and S.D.; formal analysis, E.V., J.M., B.H., I.N.S. and S.D.; investigation, E.V. and S.D.; writing—original draft preparation, E.V.; writing—review and editing, E.V., J.M., B.H., I.N.S., S.H.D. and S.D.; supervision, J.M., S.H.D. and S.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
PRISMA-ScRPreferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews
PICoPopulation, phenomena of interest, context
MeSHMedical Subject Headings
NSWNew South Wales
VicVictoria
SASouth Australia
QldQueensland
PTSDPost-traumatic stress disorder

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Climate 13 00180 g001
Figure 1. PRISMA flow diagram of scoping review.
Figure 1. PRISMA flow diagram of scoping review.
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Figure 2. Concept map of scoping review themes and subthemes.
Figure 2. Concept map of scoping review themes and subthemes.
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Table 1. Search terms identified using PICo and grouped into five themes.
Table 1. Search terms identified using PICo and grouped into five themes.
RuralExtreme Weather EventHealth ImpactPerceptionsLocation
Rural population (MeSH)

Rural
Regional
Remote
Provincial
Peri-rural
Peri-urban		Extreme weather (MeSH)
Natural disasters (MeSH)

Extreme event
Adverse climate event
Extreme / severe heat / temperature
Extreme / severe storm
Heatwave
Bushfire
Extreme rain / rainfall / precipitation
Flood, flooding
Drought		HealthHealth knowledge
Health attitudes
Health perceptions
Risk perception
Patient perceptions
Community perceptions
Public attitudes
Perceptions
Perspectives
Concerns
Beliefs
Attitudes
Awareness		Australia
New South Wales, NSW
Victoria, Vic
Queensland, Qld
South Australia, SA
Tasmania, Tas
Northern Territory, NT
Australian Capital Territory, ACT
Western Australia, WA
Table 2. Summary of characteristics of included studies.
Table 2. Summary of characteristics of included studies.
Study CharacteristicPublication (n = 34)References
Study design
    Qualitative19[30,36,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69]
        Semi-structured interviews12[30,53,55,56,57,58,60,63,64,65,66,68]
        Interviews and focus groups3[36,62,69]
        Forums3[54,59,61]
        Interviews and informal discussions1[67]
    Quantitative10[27,70,71,72,73,74,75,76,77,78]
        Cross-sectional survey10[27,70,71,72,73,74,75,76,77,78]
    Mixed methods5[79,80,81,82,83]
        Survey and focus groups4[79,80,81,82]
        Focus groups, interviews and meteorological data survey1[83]
Location
    New South Wales (NSW)15[27,54,58,60,61,62,65,70,71,72,76,77,79,81,82]
    South Australia (SA)7[55,63,64,68,69,73,75]
    Victoria (Vic)6[30,53,57,67,80,83]
    Queensland (Qld)4[36,56,59,74]
    SA and Vic1[78]
    SA and NSW1[66]
Extreme weather event
    Drought14[53,54,55,56,59,61,62,63,72,73,75,77,81,82]
    Bushfire8[30,58,60,64,65,66,67,80]
    Flood6[27,36,71,74,76,79]
    Extreme heat4[68,69,78,83]
    Flood, bushfire and drought1[57]
    Flood and drought1[70]
Age
    Children and adolescents4[54,64,81,82]
    Young adults3[30,76,79]
    Adults26[27,36,53,55,56,57,58,59,60,61,62,63,65,66,67,68,69,70,71,72,73,74,75,77,78,80]
    Older adults1[83]
Occupation
    Farmers6[55,56,63,66,73,75]
    Health workers or service providers5[53,57,58,65,68]
    Both farmers and other5[36,59,62,67,69]
    School students4[54,64,81,82]
    Medical students1[79]
    Other3[61,72,80]
    Not specified10[27,30,60,70,71,74,76,77,78,83]
Gender
    Female4[36,53,57,59]
    Male0
    Mixed30[27,30,54,55,56,58,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83]
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MDPI and ACS Style

Vohralik, E.; Mond, J.; Sutarsa, I.N.; Hall Dykgraaf, S.; Humber, B.; Dewi, S. The Perceptions of Rural Australians Concerning the Health Impacts of Extreme Weather Events: A Scoping Review. Climate 2025, 13, 180. https://doi.org/10.3390/cli13090180

AMA Style

Vohralik E, Mond J, Sutarsa IN, Hall Dykgraaf S, Humber B, Dewi S. The Perceptions of Rural Australians Concerning the Health Impacts of Extreme Weather Events: A Scoping Review. Climate. 2025; 13(9):180. https://doi.org/10.3390/cli13090180

Chicago/Turabian Style

Vohralik, Emily, Jonathan Mond, I. Nyoman Sutarsa, Sally Hall Dykgraaf, Breanna Humber, and Sari Dewi. 2025. "The Perceptions of Rural Australians Concerning the Health Impacts of Extreme Weather Events: A Scoping Review" Climate 13, no. 9: 180. https://doi.org/10.3390/cli13090180

APA Style

Vohralik, E., Mond, J., Sutarsa, I. N., Hall Dykgraaf, S., Humber, B., & Dewi, S. (2025). The Perceptions of Rural Australians Concerning the Health Impacts of Extreme Weather Events: A Scoping Review. Climate, 13(9), 180. https://doi.org/10.3390/cli13090180

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