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Samina P, Chakraborty C, Grewal R, Kaura T. Public-engagement strategies of the South Asian COVID-19 Task Force: The role of racialized healthcare workers in COVID-19 mitigation in Ontario. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003729. [PMID: 39356662 PMCID: PMC11446452 DOI: 10.1371/journal.pgph.0003729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/27/2024] [Indexed: 10/04/2024]
Abstract
The COVID-19 pandemic began in late 2019 and its uneven impact across different communities globally was quickly evident. In Canada, South Asian communities were disproportionately affected. In response, the South Asian COVID-19 Task Force (SACTF) emerged, seeking to address the unique challenges faced by the South Asian community. The embedded single case study design was employed to explore the role of SACTF in COVID-19 mitigation in Ontario. Informed by critical race theory and a public engagement conceptual framework published by the Canadian Health Services Research Foundation (2010), we analyzed how contexts guided the goals, processes, and outcomes of SACTF activities. We conducted one-on-one semi-structured interviews and focus group discussions with SACTF's Board of Directors and analyzed SACTF-produced knowledge dissemination materials and media coverage of SACTF spanning March 2020 to February 2022. SACTF's success in educating and advocating for South Asians offers important insights into the gaps in public health communication and the inequities in healthcare delivery. It emphasizes the importance of tailoring emergency responses to community-specific needs and the role of racialized healthcare workers in facilitating trust-building within minority communities. By incorporating insights of racialized healthcare workers in health system decision-making, both public engagement and community health outcomes can be improved. This study contributes to a nuanced understanding of community-centric pandemic responses and demonstrates the need for diverse representation in decision-making processes for long-term health system resilience. Both healthcare knowledge and lived experiences made SACTF alert to how pandemics unfold differently and have differential effects on racialized populations. SACTF's responses offer practical recommendations for future pandemic preparedness and emergency responses, emphasizing the role of advocacy groups in addressing public health gaps and serving as crucial allies for communities and governments.
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Affiliation(s)
- Pushpita Samina
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Chandrima Chakraborty
- Department of English and Cultural Studies and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rajdeep Grewal
- Faculty of Health Sciences, Department of Family Medicine, Division of Emergency Medicine, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tajinder Kaura
- Faculty of Health Sciences, Department of Family Medicine, Division of Emergency Medicine, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Barbic S, Mallia E, Wuerth K, Ow N, Marchand K, Ben-David S, Ewert A, Turnbull H, Gao C, Ding X, Dhillon A, Hastings K, Langton J, Tee K, Mathias S. Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada. Early Interv Psychiatry 2024; 18:877-887. [PMID: 38736277 DOI: 10.1111/eip.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/08/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
AIM Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic. METHODS Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined. RESULTS A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic. CONCLUSIONS Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.
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Affiliation(s)
- Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | | | - Nikki Ow
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Shelly Ben-David
- School of Social Work, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | | | - Chloe Gao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- MD/PhD Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaoxu Ding
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Avneet Dhillon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Hastings
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Karen Tee
- Foundry, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Cooke M, Shields T. Anti-Indigenous racism in Canadian healthcare: a scoping review of the literature. Int J Qual Health Care 2024; 36:mzae089. [PMID: 39233448 PMCID: PMC11414646 DOI: 10.1093/intqhc/mzae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/12/2024] [Accepted: 09/04/2024] [Indexed: 09/06/2024] Open
Abstract
Health inequity between Indigenous (First Nations, Inuit, and Métis) peoples and other citizens is an important policy concern in Canada, as in other colonial countries. Racism in healthcare has been identified as contributing to poorer care and to worse outcomes. Despite a large literature regarding racism in other healthcare contexts, the dimensions of the existing literature on anti-Indigenous racism in Canadian healthcare are unclear. A scoping review examined the evidence of anti-Indigenous racist experiences in healthcare in the research literature, including the types of racist behaviours identified, settings studied, and Indigenous populations and geographic regions included. We identified English and French language journal articles on anti-Indigenous racism in Canadian healthcare settings in Scopus, PubMed, CINAHL, and the Bibliography of Indigenous Peoples in North America, and grey literature reports. A total of 2250 journal articles and 9 grey literature reports published since 2000 were included in screening, and 66 studies were included in the final review. Most used qualitative interviews with patients, but a large proportion included healthcare providers. Most were conducted in urban settings, a majority in Ontario or British Columbia, with mixed Indigenous populations. The largest proportion focussed on patient experiences with healthcare in general, rather than specific clinical contexts. Most racist experiences identified were 'covert' racism, including patients feeling treated differently from non-Indigenous patients, being ignored, treated more slowly, or not believed. Stereotyping of Indigenous peoples as substance users, poor patients, or poor parents was also commonly reported. 'Overt racism', including the use of racist slurs, was not widely found. Some quantitative studies did use standardized or validated instruments to capture racist experiences, but most did not result in generalizable estimates of their prevalence. The few studies linking racism to health outcomes found that experiencing racism was related to reluctance to seek healthcare, potentially leading to higher unmet healthcare needs. Gender was the intersecting dimension most identified as shaping healthcare experiences, with Indigenous women and girls at risk to specific stereotypes. Some papers suggested that socio-economically disadvantaged Indigenous people were at the highest risk to experiencing racism. Types of anti-Indigenous racism identified in Canadian healthcare appear similar to those reported in other jurisdictions. Indigenous peoples facing multiple dimensions of disadvantage, especially gender and social class, may be the most likely to experience racism. It is likely that the experience of racism in healthcare has implications for Indigenous peoples' health, mainly by reducing healthcare access.
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Affiliation(s)
- Martin Cooke
- Department of Sociology and Legal Studies and School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Tasha Shields
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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Rodney R, Hinds M, Bonilla-Damptey J, Boissoneau D, Khan A, Forde A. Anti-oppression as praxis in the research field: Implementing emancipatory approaches for researchers and community partners. QUALITATIVE RESEARCH : QR 2024; 24:872-893. [PMID: 39119444 PMCID: PMC11303120 DOI: 10.1177/14687941231196382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Equity, diversity, and inclusion (EDI) and anti-oppression (AO) policies are implemented in research to address intersecting systemic barriers for marginalized populations. Grant applications now include questions about EDI to ensure researchers have considered how research designs perpetuate discriminatory practices. However, complying with these measures may not mean that researchers have engaged with AO as praxis. Three central points emerged from our work as a women's research collective committed to embedding AO practices within the research methodology of our community-based study. First, research ideas must be connected to larger pursuits of AO in and across marginalized communities. Secondly, AO as praxis in the research design is an exercise in centering cultural knowledge and pragmatic research preparation and response that honours the collective. Lastly, AO approaches are not prescriptive. They must shift, adapt, and change based on the research project and team, creating space for transformative resistance and emancipation of racialized researchers and community workers.
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Devotta K, O’Campo P, Bender J, Lofters AK. Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers. Curr Oncol 2024; 31:4038-4051. [PMID: 39057173 PMCID: PMC11276223 DOI: 10.3390/curroncol31070301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.
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Affiliation(s)
- Kimberly Devotta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B1W8, Canada
| | - Jacqueline Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- University Health Network, Toronto, ON M5G2C4, Canada
| | - Aisha K. Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
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Moscou K, Bhagaloo A, Onilude Y, Zaman I, Said A. Broken Promises: Racism and Access to Medicines in Canada. J Racial Ethn Health Disparities 2024; 11:1182-1198. [PMID: 37285050 PMCID: PMC10246521 DOI: 10.1007/s40615-023-01598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Discriminatory policies, attitudes, and practices have had deleterious impacts on the health of Black, Indigenous, and other racialized groups. The aim of this study was to investigate racism as barrier to access to medicines in Canada. The study investigated the characteristics of structural racism and implicit biases that affect medicines access. METHODS A scoping review using the STARLITE literature retrieval approach and analysis of census tract data in Toronto, Ontario, Canada, were undertaken. Government documents, peer-reviewed articles from public policy, health, pharmacy, social sciences, and gray literature were reviewed. RESULTS Structural racism that created barriers to access to medicines and vaccines was identified in policy, law, resource allocation, and jurisdictional governance. Institutional barriers included health care providers' implicit biases about racialized groups, immigration status, and language. Pharmacy deserts in racialized communities represented a geographic barrier to access. CONCLUSION Racism corrupts and impedes equitable allocation and access to medicine in Canada. Redefining racism as a form of corruption would obligate societal institutions to investigate and address racism within the context of the law as opposed to normative policy. Public health policy, health systems, and governance reform would remove identified barriers to medicines, vaccines, and pharmaceutical services by racialized groups.
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Affiliation(s)
| | | | - Yemisi Onilude
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
| | - Ifsia Zaman
- Simon Fraser University, Burnaby, BC, Canada
| | - Ayah Said
- McMaster University, Hamilton, ON, Canada
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Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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Sultana T. Intersectional Effect of Gender, Race, and Socioeconomic Status in Mental Health Service Utilization: Evidence from the Canadian Community Health Survey 2015-2016. Community Ment Health J 2024; 60:589-599. [PMID: 38041771 DOI: 10.1007/s10597-023-01213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015-2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality.
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Affiliation(s)
- Toufica Sultana
- General Education Cell, Eastern University, Dhaka, Bangladesh.
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh.
- Department of Sociology, University of Saskatchewan, Saskatoon, Canada.
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Abstract
Little is understood about the unintended consequences of cannabis liberalization on children. Subsequently, this scoping review aimed to map and identify evidence related to acute cannabis intoxication in children. We searched three medical literature databases from inception until October 2019. We identified 4644 information sources and included 158 which were mapped by topic area relating to 1) public health implications and considerations; 2) clinical management; and 3) experiences and information needs of HCPs and families. Public health implications were addressed by 129 (82%) and often reported an increased incidence of acute pediatric cannabis intoxications. Clinical information was reported in 116 (73%) and included information on signs and symptoms (n = 106, 92%), clinical management processes (n = 60, 52%), and treatment recommendations (n = 42, 36%). Few sources addressed the experiences or information needs of either HCPs (n = 5, <1%) treating children for acute cannabis intoxication or families (n = 1, <1%) seeking care. Increasing incidence of acute cannabis intoxications concurrent with liberalization of cannabis legislation is clear, however, evidence around clinical management is limited. Additionally, further research exploring HCPs and families experiences and information needs around cannabis intoxication is warranted.
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Affiliation(s)
- Lindsay A Gaudet
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kaitlin Hogue
- Department of Pediatric Emergency Medicine, Max Rady College of Medicine, Winnipeg, University of Manitoba, MB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Elliott
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Cochrane Child Health, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Burns KE, Dubé È, Godinho Nascimento H, Meyer SB. Examining vaccine hesitancy among a diverse sample of Canadian adults. Vaccine 2024; 42:129-135. [PMID: 38103960 DOI: 10.1016/j.vaccine.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/26/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context.
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Affiliation(s)
- Kathleen E Burns
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Ève Dubé
- Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada.
| | | | - Samantha B Meyer
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
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Pantha S, Jones M, Gartoulla P, Gray R. A Systematic Review to Inform the Development of a Reporting Guideline for Concept Mapping Research. Methods Protoc 2023; 6:101. [PMID: 37888033 PMCID: PMC10609252 DOI: 10.3390/mps6050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Concept mapping is a phased, mixed-method approach that is increasingly used in health research to develop an understanding of complex phenomena. The six phases of concept mapping are preparation, idea generation, structuring (clustering and prioritization), data analysis, interpretation, and utilization of the map. The reporting of concept mapping research requires the development of a specific reporting guideline. We conducted a systematic review to identify candidate reporting items for inclusion in a reporting guideline. Three databases (MEDLINE, CINAHL, and PsycInfo) were searched to identify studies that used concept mapping methodology. We included 75 concept mapping studies published since 2019 from which we extracted information about the quality of reporting. A third of the studies focused on public health. We identified 71 candidate items that relate to the quality of reporting concept mapping research. The rationale for the study, the focus prompt, procedures for brainstorming, and structuring statements were consistently reported across the included studies. The process for developing the focus prompt, the rationale for the size of the stakeholder groups, and the process for determining the final concept map were generally not reported. The findings from the review will be used to inform the development of our reporting guideline for concept mapping research.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia;
| | - Pragya Gartoulla
- Australian Institute of Family Studies, Melbourne, VIC 3000, Australia;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
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Pinto AD, Eissa A, Kiran T, Mashford-Pringle A, Needham A, Dhalla I. Enjeux relatifs à la collecte des données sur la race et l’identité autochtone lors du renouvellement de la carte santé au Canada. CMAJ 2023; 195:E1062-E1064. [PMID: 37580079 PMCID: PMC10426351 DOI: 10.1503/cmaj.221587-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Andrew D Pinto
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont.
| | - Azza Eissa
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Tara Kiran
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Angela Mashford-Pringle
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Allison Needham
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Irfan Dhalla
- Laboratoire Upstream (Pinto, Eissa), Centre MAP pour des solutions de santé urbaine, Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut des politiques, de la gestion et de l'évaluation de la santé (Pinto, Eissa, Mashford-Pringle, Dhalla), École Dalla Lana de santé publique et Département de médecine familiale et communautaire (Pinto, Eissa, Kiran), Faculté de médecine, Université de Toronto; Département de médecine familiale et communautaire (Pinto, Kiran), Hôpital St Michael, Réseau universitaire de santé de Toronto, Toronto, Ont.; Équipe de santé familiale de Barrie (Eissa), Unité d'enseignement en médecine familiale de Barrie, Centre de santé régional Royal Victoria, Barrie, Ont.; ICES Central (Kiran, Dhalla); Centre MAP pour des solutions en santé urbaine (Kiran), Institut du savoir Li Ka Shing, Réseau universitaire de santé de Toronto; Institut Waakebiness-Bryce pour la santé autochtone (Mashford-Pringle), École Dalla Lana de santé publique, Université de Toronto; Direction de la lutte antiraciste, de l'équité et de la responsabilité sociale (Needham, Dhalla) et Département de médecine (Dhalla), Hôpital St Michael, Réseau universitaire de santé de Toronto; Département de médecine (Dhalla), Faculté de médecine, Université de Toronto, Toronto, Ont
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Montesanti S, MacKean G, Fitzpatrick KM, Fancott C. Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada. BMC Health Serv Res 2023; 23:320. [PMID: 37004050 PMCID: PMC10066017 DOI: 10.1186/s12913-023-09248-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. METHODS A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. RESULTS Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. CONCLUSIONS The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.
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Affiliation(s)
- Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Gail MacKean
- Imagine Citizens Network, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Douglas D, Ndumbe-Eyoh S, Osei-Tutu K, Hamilton-Hinch BA, Watson-Creed G, Nnorom O, Dryden OH. Le Black Health Education Collaborative: le rôle essentiel de la théorie critique de la race dans l’élimination du racisme envers les Noirs dans la formation et l’exercice de la profession médicale. CMAJ 2023; 195:E175-E177. [PMID: 36717125 PMCID: PMC9888540 DOI: 10.1503/cmaj.221503-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Delia Douglas
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - Sume Ndumbe-Eyoh
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - Kannin Osei-Tutu
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - Barbara-Ann Hamilton-Hinch
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - Gaynor Watson-Creed
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - Onye Nnorom
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É
| | - OmiSoore H Dryden
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Faculté Rady des sciences de la santé ( Douglas), Université du Manitoba, Winnipeg, Man.; Division de la santé publique clinique, École de santé publique Dalla Lana (Ndumbe-Eyoh, Nnorom), Université de Toronto, Toronto, Ont.; École de médecine Cumming (Osei-Tutu), Université de Calgary, Calgary, Alb.; Faculté de santé (Hamilton-Hinch), Université Dalhousie, Halifax, N.-É.; Études canadiennes sur les Noirs, Faculté de médecine (Watson-Creed, Dryden), Université Dalhousie, Halifax, N.-É.; Faculté de médecine Temerty (programme de doctorat en médecine) ( Nnorom), Université de Toronto, Toronto, Ont.; Département de médecine familiale et communautaire (Nnorom), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Black Studies Research Institute (sciences, technologie, ingénierie, mathématiques et médecine) (Dryden), Université Dalhousie, N.-É.
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Luhanga F, Maposa S, Puplampu V, Abudu E, Chigbogu I. "You have to strive very hard to prove yourself": experiences of Black nursing students in a Western Canadian province. Int J Nurs Educ Scholarsh 2023; 20:ijnes-2022-0094. [PMID: 37294866 DOI: 10.1515/ijnes-2022-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/20/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study explored the experiences of Black students in two western Canadian undergraduate nursing programs. METHODS Using a qualitative focused ethnography design grounded in critical race theory and intersectionality, participants were recruited using purposive and snowball sampling. Data were collected through individual interviews, and a follow-up focus group. Data were analyzed using collaborative-thematic analysis team approaches. RESULTS n=18 current and former students participated. Five themes emerged: systemic racism in nursing, precarious immigrant context, mental health/well-being concerns, coping mechanisms, and suggestions for improvement. CONCLUSIONS An improved understanding of Black student experiences can inform their recruitment and retention. Supporting Black students' success can potentially improve equity, diversity, and inclusivity in nursing education programs and/or their representation in the Canadian nursing workforce. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE The presence of a diverse nursing profession is imperative to meet the needs to provide more quality and culturally competent services to diverse population.
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Affiliation(s)
- Florence Luhanga
- School of Nursing, Saskatchewan Polytechnic, Regina campus, Regina, SK
| | - Sithokozile Maposa
- College of Nursing, University of Saskatchewan, Prince Albert Campus, Prince Albert, SK, Canada
| | - Vivian Puplampu
- School of Nursing, Saskatchewan Polytechnic, Regina campus, Regina, SK
| | - Eunice Abudu
- School of Nursing, Saskatchewan Polytechnic, Regina campus, Regina, SK
- University of Regina, Regina, SK
| | - Irene Chigbogu
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, Canada
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Fante-Coleman T, Wilson CL, Cameron R, Coleman T, Travers R. ‘Getting shut down and shut out’: Exploring ACB patient perceptions on healthcare access at the physician-patient level in Canada. Int J Qual Stud Health Well-being 2022; 17:2075531. [PMID: 35585792 PMCID: PMC9132487 DOI: 10.1080/17482631.2022.2075531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The experiences of African, Caribbean and Black (ACB) Canadians are seldom explored in the Canadian context. Family physicians act as a gateway to the rest of the healthcare system and are necessary to provide proper patient care. However, Canada’s history with colonialism may impact the socio-cultural context in which patients receive care. Method 41 participants from Waterloo Region, Ontario, were engaged in eight focus groups to discuss their experiences in the healthcare system. Data were analysed following thematic analysis. Results Style of care, racism and discrimination and a lack of cultural competence hindered access. oor Inadequate cultural competence was attributed to western and biomedical approaches, poor understanding of patients’ context, physicians failing to address specific health concerns, and racism and discrimination. Participants highlighted that the two facilitators to care were having an ACB family physician and fostering positive relationships with physicians. Conclusion Participants predominantly expressed dissatisfaction in physicians’ approaches to care, which were compounded by experiences of racism and discrimination. Findings demonstrate how ACB patients are marginalized and excluded from the healthcare syste Iimplications for better access to care included utilizing community healthcare centres, increasing physicians’ capacity around culturally inclusive care, and increasing access to ACB physicians.
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Affiliation(s)
- Tiyondah Fante-Coleman
- Access and Equity Research Lab1, Department of Psychology2, Department of Health Sciences4 Wilfrid Laurier University, Waterloo, Ontario, Canada
- Dalla Lana School of Public Health5 University of Toronto, Toronto, Ontario, Canada
- Black Health Alliance, Toronto, Ontario, Canada
| | - Ciann L. Wilson
- Access and Equity Research Lab1, Department of Psychology2, Department of Health Sciences4 Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Ruth Cameron
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
- AIDS Committee of Cambridge, Kitchener, Waterloo and Area, Kitchener, Ontario, Canada
| | - Todd Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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19
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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20
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Rishworth A, Cao T, Niraula A, Wilson K. Health Care Use and Barriers to Care for Chronic Inflammatory Diseases (CID) among First and Second Generation South Asian Immigrant Children and Parents in Ontario Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14608. [PMID: 36361486 PMCID: PMC9655293 DOI: 10.3390/ijerph192114608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Although immigrants are disproportionately impacted by growing chronic inflammatory disease (CIDs) rates, yet suffer barriers to access health care, little attention has been given to their primary healthcare or specialist healthcare access as it relates to complex, chronic diseases in Canada, a country with universal health care. This study aims to investigate CID health care use and barriers to care among first- and second-generation immigrant South Asian children and parents in the Greater Toronto Area, Ontario. Drawing on analysis of 24 in depth interviews with children and parents (14 children, 10 parents), the results reveal that although CIDs disproportionately affects South Asian immigrants, they encounter health system, geographic, interpersonal, and knowledge barriers to access requisite care. These barriers exist despite participants having a GP, and are compounded further by limited familial systems, culturally insensitive care, and structural inequities that in some instances make parents choose between health access or other basic needs. Although all participants recognized the importance of specialized care, only 11 participants regularly accessed specialized care, creating new schisms in CID management. The findings suggest that a multisectoral approach that address individual and structural level socio-structural drivers of health inequities are needed to create more equitable healthcare access.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Tiffany Cao
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Ashika Niraula
- CERC in Migration and Integration, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
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21
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Douglas D, Ndumbe-Eyoh S, Osei-Tutu K, Hamilton-Hinch BA, Watson-Creed G, Nnorom O, Dryden OH. Black Health Education Collaborative: the important role of Critical Race Theory in disrupting anti-Black racism in medical practice and education. CMAJ 2022; 194:E1422-E1424. [PMID: 36280240 PMCID: PMC9616137 DOI: 10.1503/cmaj.221503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Delia Douglas
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - Sume Ndumbe-Eyoh
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - Kannin Osei-Tutu
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - Barbara-Ann Hamilton-Hinch
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - Gaynor Watson-Creed
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - Onye Nnorom
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
| | - OmiSoore H Dryden
- Black Health Education Collaborative (Douglas, Ndumbe-Eyoh, Osei-Tutu, Hamilton-Hinch, Watson-Creed, Nnorom, Dryden), Toronto, Ont.; Rady Faculty of Health Sciences (Douglas), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health - Division of Clinical Public Health (Ndumbe-Eyoh, Nnorom), University of Toronto, Toronto, Ont.; Cumming School of Medicine (Osei-Tutu), University of Calgary, Calgary, Alta.; Faculty of Health (Hamilton-Hinch), Dalhousie University, Halifax, NS; Black Canadian Studies, Faculty of Medicine (Watson-Creed, Dryden), Dalhousie University, Halifax, NS; Temerty Faculty of Medicine (MD program) (Nnorom); Department of Family and Community Medicine (Nnorom), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Black Studies (in STEMM) Research Institute (Dryden), Dalhousie University, NS
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22
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Husbands W, Lawson DO, Etowa EB, Mbuagbaw L, Baidoobonso S, Tharao W, Yaya S, Nelson LE, Aden M, Etowa J. Black Canadians' Exposure to Everyday Racism: Implications for Health System Access and Health Promotion among Urban Black Communities. J Urban Health 2022; 99:829-841. [PMID: 36066788 PMCID: PMC9447939 DOI: 10.1007/s11524-022-00676-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
This study explores the social determinants of Black Canadians' exposure to everyday racism, its relationship to health system access, and implications for health promotion. We used data from the A/C Study survey on HIV transmission and prevention among Black Canadians. We implemented the survey (N = 1360) in 2018-2019 in Toronto and Ottawa-two large cities that together account for 42% of Canada's Black population-among self-identified Black residents aged 15-64 years, who were born in sub-Sahara Africa or the Caribbean or had a parent who was born in those regions. Participants reported racist encounters in the preceding 12 months using the Everyday Discrimination Scale. We assessed the socio-demographic correlates of racist experiences and the impact of racism on health system access using multivariable generalised linear models. Sixty percent of participants reported experiencing racism in the preceding 12 months. Based on the adjusted odds ratios, participants were more likely to experience racism if they were older, employed, Canadian-born, had higher levels of education, self-identified as LGBTQ + and reported generally moderate access to basic needs and adequate housing; and less likely to experience racism if they lived in Ottawa, self-identified as female or reported higher levels of social capital. Visiting a healthcare provider or facility, and difficulty accessing healthcare were associated with racist experiences. Racist experiences diminished the likelihood of being tested for HIV. Racist experiences were widespread, especially among those with higher levels of social wellbeing or greater exposure to Canadian institutions. Study participants also associated racist experiences with the healthcare system.
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Affiliation(s)
- Winston Husbands
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario HIV Treatment Network, Toronto, Canada
| | - Daeria O. Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Egbe B. Etowa
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Shamara Baidoobonso
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College, London, UK
| | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, USA
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Center for Interdisciplinary Research On AIDS (CIRA), School of Public Health, Yale University, New Haven, USA
- Yale Institute of Global Health, Yale University, New Haven, USA
| | - Muna Aden
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
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23
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Loer AKM, Koschollek C, Hövener C. Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states. BMC Health Serv Res 2022; 22:1050. [PMID: 35978356 PMCID: PMC9382615 DOI: 10.1186/s12913-022-08419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality. METHODS Analyses are based on data from a feasibility study of the project "Improving Health Monitoring in Migrant Populations" (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months. RESULTS Of the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization. CONCLUSIONS Our results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.
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Affiliation(s)
- Anne-Kathrin M. Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101 Berlin, Germany
| | - Carmen Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101 Berlin, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101 Berlin, Germany
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24
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Miao Q, Guo Y, Erwin E, Sharif F, Berhe M, Wen SW, Walker M. Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada. PLoS One 2022; 17:e0269158. [PMID: 35772371 PMCID: PMC9246499 DOI: 10.1371/journal.pone.0269158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Racial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates. Results Among 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people. Conclusion There are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.
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Affiliation(s)
- Qun Miao
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Yanfang Guo
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Erica Erwin
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Fayza Sharif
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Meron Berhe
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mark Walker
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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25
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Reproductive justice in patient care: tackling systemic racism and health inequities in sexual and reproductive health and rights in Canada. Reprod Health 2022; 19:44. [PMID: 35172842 PMCID: PMC8849010 DOI: 10.1186/s12978-022-01328-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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26
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Logan AC, Berman BM, Prescott SL. Earth Dreams: Reimagining ARPA for Health of People, Places and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12788. [PMID: 34886514 PMCID: PMC8657388 DOI: 10.3390/ijerph182312788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022]
Abstract
Bold new approaches are urgently needed to overcome global health challenges. The proposed Advanced Research Projects Agency for Health (ARPA-H) is intended to provide rapid health breakthroughs. While new technologies for earlier disease detection and more effective treatment are critical, we urge equal attention be given to the wider (physical, emotional, social, political, and economic) environmental ecosystems driving the non-communicable disease (NCD) crisis in the first place. This requires an integrated, cross-sectoral vision that spans the interwoven connections affecting health across the scales of people, places, and planet. This wider "exposome" perspective considers biopsychosocial factors that promote resilience and reduce vulnerabilities of individuals and communities over time-the many variables driving health disparities. Since life course health is strongly determined by early life environments, early interventions should be prioritized as a matter of effectiveness and social justice. Here, we explore the origins of the Advanced Research Project Agency and point to its potential to build integrated solutions, with wisdom and ethical value systems as a compass. Since the planned ARPA-H is anticipated to spawn international collaborations, the imagined concept is of relevance to a broad audience of researchers. With appropriate input, the quest for health equity through personalized, precision medicine while deconstructing unacceptable structural inequities may be accelerated.
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Affiliation(s)
- Alan C. Logan
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
| | - Brian M. Berman
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L. Prescott
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- inVIVO Planetary Health, Worldwide Universities Network (WUN), Baltimore, MD 21231, USA
- ORIGINS Project, Telethon Kids Institute, Perth Children’s Hospital, University of Western Australia, 15 Hospital Avenue, Nedlands, WE 6009, Australia
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27
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Bresee L. Addressing Racism in Hospital Pharmacy Practice Research. Can J Hosp Pharm 2021; 74:305-306. [PMID: 34602616 DOI: 10.4212/cjhp.v74i4.3184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lauren Bresee
- , BScPharm, ACPR, MSc, PhD, is a Special Projects Advisor with the Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario; an Adjunct Assistant Professor with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; and a member of the O'Brien Institute for Public Health, University of Calgary. She is also an Associate Editor with the Canadian Journal of Hospital Pharmacy
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28
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Bresee L. Aborder le racisme dans le domaine de la recherche pratique en pharmacie hospitalière. Can J Hosp Pharm 2021; 74:307-308. [PMID: 34602617 DOI: 10.4212/cjhp.v74i4.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lauren Bresee
- , B. Sc. Pharm., ACPR, M. Sc., Ph. D., est conseillère pour les projets spéciaux auprès de l'Agence canadienne des médicaments et des technologies de la santé (ACMTS) à Ottawa (Ontario); professeure agréée adjointe au Département des sciences de la santé communautaire, Faculté de médecine, Université de Calgary (Alberta); et membre de l'Institut O'Brien de la santé publique de l'Université de Calgary. Elle est également rédactrice adjointe du Journal canadien de la pharmacie hospitalière
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