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Groot G, Marques Santos JD, Witham S, Leeder E, Carr T. "Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care. Can J Nurs Res 2024; 56:178-188. [PMID: 38373404 PMCID: PMC11032001 DOI: 10.1177/08445621241230099] [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] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. OBJECTIVE The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. METHODS We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. RESULTS Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. CONCLUSION According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.
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Affiliation(s)
- Gary Groot
- Department of Community Health and Epidemiology and Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | | | - Stephanie Witham
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Erin Leeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Buchwald DS, Bassett DR, Van Dyke ER, Harris RM, Hanson JD, Tu SP. "Sorry for laughing, but it's scary": humor and silence in discussions of Colorectal Cancer with Urban American Indians. BMC Cancer 2023; 23:1036. [PMID: 37884866 PMCID: PMC10601143 DOI: 10.1186/s12885-023-11245-y] [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: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Given high rates of cancer mortality in Native communities, we examined how urban American Indian and Alaska Native elders talk about colorectal cancer (CRC) and CRC screening. METHODS We conducted seven focus groups with a total of 46 participants in two urban clinics in the Pacific Northwest to assess participant awareness, perceptions, and concerns about CRC and CRC screening. Using speech codes theory, we identified norms that govern when and how to talk about CRC in this population. RESULTS Our analyses revealed that male participants often avoided screening because they perceived it as emasculating, whereas women often avoided screening because of embarrassment and past trauma resulting from sexual abuse. Both men and women used humor to mitigate the threatening nature of discussions about CRC and CRC screening. CONCLUSIONS We offer our analytic results to assist others in developing culturally appropriate interventions to promote CRC screening among American Indians and Alaska Natives.
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Affiliation(s)
- Dedra S. Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Seattle, WA 98101 USA
| | - Deborah R. Bassett
- Department of Communication, University of West Florida, 11000 University Parkway, Pensacola, FL 32514 USA
| | | | - Raymond M. Harris
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Seattle, WA 98101 USA
| | - Jessica D. Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812 USA
| | - Shin-Ping Tu
- Division of General Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VG 23298 USA
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Pinero de Plaza MA, Gebremichael L, Brown S, Wu CJ, Clark RA, McBride K, Hines S, Pearson O, Morey K. Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease. Int J Integr Care 2023; 23:17. [PMID: 38107834 PMCID: PMC10723014 DOI: 10.5334/ijic.7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). Methods A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Results Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. Discussion The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Conclusions Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.
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Affiliation(s)
- Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Lemlem Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | | | - Chiung-Jung Wu
- School of Health, University of the Sunshine Coast, Petrie, QLD, 4502, AU
- Royal Brisbane & Women’s Hospital, QLD, 4029, AU
| | - Robyn A. Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Katharine McBride
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Telethon Kids Institute, Adelaide, SA, 5000, AU
- The John Curtin School of Medical Research, The Australian National University, Acton, ACT 2601, AU
| | - Sonia Hines
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
- Flinders University, Rural and Remote Health, Alice Springs, Northern Territory, 0871, AU
| | - Odette Pearson
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Adelaide Medical School, The University of Adelaide, SA, 5000, AU
| | - Kim Morey
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
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de Vries M, Stewart T, Ireton T, Keelan K, Jordan J, Robinson BA, Dachs GU. Patients' and carers' priorities for cancer research in Aotearoa/New Zealand. PLoS One 2023; 18:e0290321. [PMID: 37607163 PMCID: PMC10443847 DOI: 10.1371/journal.pone.0290321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Discrepancies have been reported between what is being researched, and what patients/families deem important to be investigated. Our aim was to understand research priorities for those who live with cancer in Aotearoa/New Zealand, with emphasis on Māori. METHODS Adult outpatients with cancer and their whānau/family completed a survey (demographics, selecting keywords, free-text comments) at Christchurch hospital. Quantitative and qualitative data were evaluated using standard statistical and thematic analyses, respectively. RESULTS We recruited 205 participants, including both tūroro/patients (n = 129) and their whānau/family/carer (n = 76). Partnership with Māori health workers enabled greater recruitment of Māori participants (19%), compared to the proportion of Māori in Canterbury (9%). Cancer research was seen as a priority by 96% of participants. Priorities were similar between Māori and non-Māori participants, with the keywords 'Cancer screening', 'Quality of Life' and 'Development of new drugs' chosen most often. Free-text analysis identified three themes; 'Genetics and Prevention', 'Early Detection and Treatment', and 'Service Delivery', with some differences by ethnicity. CONCLUSIONS Cancer research is a high priority for those living with cancer. In addition, participants want researchers to listen to their immediate and practical needs. These findings may inform future cancer research in Aotearoa. MāORI TERMS AND TRANSLATION Aotearoa (New Zealand) he aha ō whakaaro (what are your thoughts) hui (gathering) mate pukupuku (cancer) mokopuna (descendent) Ōtautahi (Christchurch) rongoā (traditional healing) tāne (male) te reo (Māori language) Te Whatu Ora (weaving of wellness, Health New Zealand) tikanga (methods, customary practices) tūroro (patients) (alternative terms used: whānau affected by cancer or tangata whaiora (person seeking health)) wahine (female) Waitaha (Canterbury) whakapapa (genealogy) whānau ((extended) family, based on whakapapa, here also carer).
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Affiliation(s)
- Millie de Vries
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
| | - Tiria Stewart
- Te Pūtahi Mātai Toto o Te Waipounamu, Christchurch Hospital, Christchurch, NZ (Nga Puhi, Ngāti Porou)
| | - Theona Ireton
- Māori Health Services, Christchurch Hospital, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ (Ngā Wairiki, Ngāti Porou)
| | - Karen Keelan
- Te Aho o Te Kahu–Cancer Control Agency, Ministry of Health, NZ (Ngāti Porou)
| | - Jennifer Jordan
- Psychological Medicine, University of Otago, Christchurch, NZ
- Specialist Mental Health Service Clinical Research Unit, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ
| | - Bridget A. Robinson
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
- Canterbury Regional Cancer and Haematology Service, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ
| | - Gabi U. Dachs
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
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Waanders A, Brown A, Caron NR, Plisiewicz A, McHugh ST, Nguyen TQ, Lehmann K, Stevens J, Storm PJ, Resnick A, Davidson TB, Mueller S, Kline C. Indigenous peoples and inclusion in clinical and genomic research: Understanding the history and navigating contemporary engagement. Neoplasia 2023; 37:100879. [PMID: 36738585 PMCID: PMC9918407 DOI: 10.1016/j.neo.2023.100879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
Despite significant improvements in pediatric cancer survival outcomes, there remain glaring disparities in under-represented racial and ethnic groups that warrant mitigation by the scientific and clinical community. To address and work towards eliminating such disparities, the Pacific Pediatric Neuro-Oncology Consortium (PNOC) and Children's Brain Tumor Network (CBTN) established a Diversity, Equity, and Inclusion (DEI) working group in 2020. The DEI working group is dedicated to improving access to care for all pediatric patients with central nervous system (CNS) tumors, broadening diversity within the research community, and providing sustainable data-driven solutions. To this end, the DEI working group aims to coordinate regular educational sessions centered on critical DEI topics in pediatric research and clinical care of pediatric patients, with a focus on pediatric neuro-oncology. In April 2022, the group led a moderated panel of experts on Indigenous Peoples' rights and participation in clinical research activities. The following paper serves to provide the scientific community a perspective on how to prioritize the inclusion of Indigenous Peoples in research with cultural sensitivity and with the intent of improving not only representation, but patient outcomes regardless of patient race, ethnicity, or socioeconomic background.
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Affiliation(s)
- Angela Waanders
- Department of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA,Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alex Brown
- Australian National University and Telethon Kids Institute, Adelaide, SA, Australia
| | - Nadine R. Caron
- University of Northern British Columbia, Prince George, BC, Canada
| | - Alexa Plisiewicz
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sean T. McHugh
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Thinh Q. Nguyen
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kaitlin Lehmann
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jeffrey Stevens
- Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, WA, USA
| | - Phillip J. Storm
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Adam Resnick
- Center for Data-Driven Discovery in Biomedicine, Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Tom Belle Davidson
- Division of Hematology-Oncology, Cancer and Blood Disease Institute and Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA,University Children's Hospital Zurich, Zurich, Switzerland
| | - Cassie Kline
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Pituskin E. Cancer as a new chronic disease: Oncology nursing in the 21st Century. Can Oncol Nurs J 2022; 32:87-92. [PMID: 35280062 PMCID: PMC8849169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Edith Pituskin
- Associate Professor, Faculty of Nursing, Associate Clinical Professor, Dept of Oncology, Tier 2 Canada Research Chair, University of Alberta, P: 780-432-8221 | F: 780-492-2551
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Pituskin E. [Not Available]. Can Oncol Nurs J 2022; 32:93-99. [PMID: 35280060 PMCID: PMC8849167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Edith Pituskin
- Professeure agrégée, Faculté des sciences infirmières, Professeure agrégée d'enseignement clinique, Département d'oncologie, Chaire de recherche du Canada de niveau 2, Université de l'Alberta, Tél. : 780-432-8221 | Téléc. : 780-492-2551
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Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach. Curr Oncol 2021; 29:132-143. [PMID: 35049686 PMCID: PMC8775083 DOI: 10.3390/curroncol29010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.
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Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers' perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv Res 2021; 21:848. [PMID: 34419035 PMCID: PMC8380380 DOI: 10.1186/s12913-021-06821-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Saskatchewan, Canada, Indigenous cancer care services at the municipal, provincial, and federal levels are intended to improve quality care but can result in a complex, fragmented, and multi-jurisdictional health care system. A multi-phase needs assessment project was initiated to document Indigenous cancer care needs. Guided by Indigenous patient partners, clinicians, academics, and policy makers, the present study reflects a needs assessment of Indigenous cancer supports from the perspectives of cancer care service providers. METHODS Qualitative data were collected through three focus groups with 20 service providers for cancer patients and their families at three Saskatchewan cities. Participants included chemotherapy and radiation nurses, social workers, a patient navigator, dieticians, and practicum students. A semi-structured interview guide was used to conduct the sessions to allow for freedom of responses. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Service providers' perspectives were categorized into five themes: 1) addressing travel-related issues, 2) logistical challenges, 3) improvements to Indigenous-specific health care supports, 4) cultural sensitivity in health care, and 5) consistency in care. Supports provided differed for the two Indigenous groups, First Nations and Métis. Service providers made recommendations regarding how needs could be met. They saw language translation providers and Elder supports as important. Recommendations for improving travel were for medical taxis to include breaks so that passengers may alleviate any uncomfortable side effects of their cancer treatment. Further, Indigenous-specific accommodations were recommended for those requiring medical travel. These recommendations aligned with supports that are available in four other Canadian provinces. CONCLUSIONS These results identified gaps in supports and outlined recommendations to address barriers to cancer care from the perspectives of service providers. These recommendations may inform evidence-based health system interventions for Indigenous cancer patients and ultimately aim to improve cancer care services, quality of life, and health outcomes of Indigenous patients throughout their cancer journey.
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Affiliation(s)
- Jennifer R Sedgewick
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Anum Ali
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Andreea Badea
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Room 3242, Health Science Building 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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