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Rodrigues IB, Fahim C, Garad Y, Presseau J, Hoens AM, Braimoh J, Duncan D, Bruyn-Martin L, Straus SE. Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations. BMC Med Res Methodol 2023; 23:262. [PMID: 37946142 PMCID: PMC10636989 DOI: 10.1186/s12874-023-02083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The concept of intersectionality proposes that demographic and social constructs intersect with larger social structures of oppression and privilege to shape experiences. While intersectionality is a widely accepted concept in feminist and gender studies, there has been little attempt to use this lens in implementation science. We aimed to supplement the Consolidated Framework for Implementation Research (CFIR), a commonly used framework in implementation science, to support the incorporation of intersectionality in implementation science projects by (1) integrating an intersectional lens to the CFIR; and (2) developing a tool for researchers to be used alongside the updated framework. METHODS Using a nominal group technique, an interdisciplinary framework committee (n = 17) prioritized the CFIR as one of three implementation science models, theories, and frameworks to supplement with intersectionality considerations; the modification of the other two frameworks are described in other papers. The CFIR subgroup (n = 7) reviewed the five domains and 26 constructs in the CFIR and prioritized domains and constructs for supplementation with intersectional considerations. The subgroup then iteratively developed recommendations and prompts for incorporating an intersectional approach within the prioritized domains and constructs. We developed recommendations and prompts to help researchers consider how personal identities and power structures may affect the facilitators and inhibitors of behavior change and the implementation of subsequent interventions. RESULTS We achieved consensus on how to apply an intersectional lens to CFIR after six rounds of meetings. The final intersectionality supplemented CFIR includes the five original domains, and 28 constructs; the outer systems and structures and the outer cultures constructs were added to the outer setting domain. Intersectionality prompts were added to 13 of the 28 constructs. CONCLUSION Through an expert-consensus approach, we modified the CFIR to include intersectionality considerations and developed a tool with prompts to help implementation users apply an intersectional lens using the updated framework.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Yasmin Garad
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | - Diane Duncan
- Physician Learning Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lora Bruyn-Martin
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Many studies have used retrospective reports to assess the long-term consequences of early life stress. However, current individual characteristics and experiences may bias the recall of these reports. In particular, depressed mood may increase the likelihood of recall of negative experiences. The aim of the study was to assess whether specific factors are associated with consistency in the reporting of childhood adverse experiences. METHOD The sample comprised 7466 adults from Canada's National Population Health Survey who had reported on seven childhood adverse experiences in 1994/1995 and 2006/2007. Logistic regression was used to explore differences between those who consistently reported adverse experiences and those whose reports were inconsistent. RESULTS Among those retrospectively reporting on childhood traumatic experiences in 1994/1995 and 2006/2007, 39% were inconsistent in their reports of these experiences. The development of depression, increasing levels of psychological distress, as well as increasing work and chronic stress were associated with an increasing likelihood of reporting a childhood adverse experience in 2006/2007 that had not been previously reported. Increases in mastery were associated with reduced likelihood of new reporting of a childhood adverse experience in 2006/2007. The development of depression and increases in chronic stress and psychological distress were also associated with reduced likelihood of 'forgetting' a previously reported event. CONCLUSIONS Concurrent mental health factors may influence the reporting of traumatic childhood experiences. Studies that use retrospective reporting to estimate associations between childhood adversity and adult outcomes associated with mental health may be biased.
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Affiliation(s)
- I Colman
- School of Epidemiology, Public Health & Preventive Medicine,University of Ottawa,Ottawa,Canada
| | - M Kingsbury
- School of Epidemiology, Public Health & Preventive Medicine,University of Ottawa,Ottawa,Canada
| | - Y Garad
- School of Public Health,University of Alberta,Edmonton,Canada
| | - Y Zeng
- School of Public Health,University of Alberta,Edmonton,Canada
| | - K Naicker
- School of Epidemiology, Public Health & Preventive Medicine,University of Ottawa,Ottawa,Canada
| | - S Patten
- Departments of Psychiatry and Community Health Sciences,University of Calgary,Calgary,Canada
| | - P B Jones
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - T C Wild
- School of Public Health,University of Alberta,Edmonton,Canada
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Colman I, Garad Y, Zeng Y, Naicker K, Weeks M, Patten SB, Jones PB, Thompson AH, Wild TC. Stress and development of depression and heavy drinking in adulthood: moderating effects of childhood trauma. Soc Psychiatry Psychiatr Epidemiol 2013; 48:265-74. [PMID: 22684339 DOI: 10.1007/s00127-012-0531-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/23/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Studies suggest that childhood trauma is linked to both depression and heavy drinking in adulthood, and may create a lifelong vulnerability to stress. Few studies have explored the effects of stress sensitization on the development of depression or heavy drinking among those who have experienced traumatic childhood events. This study aimed to determine the effect of childhood trauma on the odds of experiencing depression or heavy drinking in the face of an adult life stressor, using a large population-based Canadian cohort. METHODS A total of 3,930 participants were included from the National Population Health Survey. The associations among childhood trauma, recent stress and depression/heavy drinking from 1994/1995 to 2008/2009 were explored using logistic regression, as were interactions between childhood trauma and recent stress. A generalized linear mixed model was used to determine the effects of childhood trauma and stressful events on depression/heavy drinking. Analyses were stratified by sex. RESULTS Childhood trauma significantly increased the odds of becoming depressed (following 1 event: OR = 1.66; 95%CI 1.01, 2.71; 2+ events, OR = 3.89; 95%CI 2.44, 6.22) and drinking heavily (2+ events: OR = 1.79; 95%CI 1.03, 3.13). Recent stressful events were associated with depression, but not heavy drinking. While most interaction terms were not significant, in 2004/2005 the association between recent stress and depression was stronger in those who reported childhood trauma compared to those with no childhood trauma. CONCLUSIONS Childhood trauma increases risk for both depression and heavy drinking. Trauma may moderate the effect of stress on depression; the relationship among trauma, stress and heavy drinking is less clear.
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Affiliation(s)
- Ian Colman
- School of Public Health, University of Alberta, Edmonton, Canada.
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