Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario., Shannon L. Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B. Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Interdisciplinary Pedagogy Through Problem-Based Learning: A Case Study In Global Health Education, Mona Jarrah, Bethlehem Girmay, Obidimma Ezezika

Health Studies Publications

This case study piloted an interdisciplinary Problem-Based Learning course, utilizing Hung’s (2006) 3C3R model. We explain the course design, curriculum, and implementation. We collected qualitative written questionnaires from students who participated in the course to investigate their learning experiences. As a result, students shed light on lessons they learned throughout the course, which led to the creation of a lessons learned guide for future instructors. This guide encompasses 8 lessons that were gleaned by both qualitative student feedback and instructor reflections from the course. These lessons include allocating in-class time to work on projects, using a modular approach in the …

Comparing Individual Versus Team Decision-Making Using Simulated Exercises In A Master Of Public Health Program, Shannon L. Sibbald, Nicole Campbell, Cecilia Flores-Sandoval, Mark Speechley

Health Studies Publications

In line with the complex modern health care system and the increasing importance of interprofessional teams, a powerful strategy to facilitate the acquisition of essential teamwork skills and expose students to complex decision-making processes is learning in teams. The purpose of our study was to obtain empirical evidence of superior decision-making by teams versus individuals in two simulated decision-making exercises conducted 4 months apart. We collected quantitative data from three cohorts of Master of Public Health students to determine if teams make better decisions than individuals (“team effect”) between September and January. Students completed simulated emergency survival exercises requiring them …

Are Sub-Saharan African National Food And Agriculture Policies Nutrition-Sensitive? A Case Study Of Ethiopia, Ghana, Malawi, Nigeria, And South Africa, Roshaany Asirvatham

Health Studies Publications

Background

In sub-Saharan Africa (SSA), malnutrition coupled with rising rates of undernutrition and the burden of overweight/obesity remains one of the most significant public health challenges facing the region. Nutrition-sensitive agriculture can play an important role in reducing malnutrition by addressing the underlying causes of nutrition outcomes. Therefore, we aim to assess the nutrition-sensitivity of food and agriculture policies in SSA and to provide recommendations for identified policy challenges in implementing nutrition-sensitive agriculture initiatives.

Methods

We assessed past and current national policies relevant to agriculture and nutrition from Ethiopia, Ghana, Malawi, Nigeria, and South Africa. Thirty policies and strategies were …

What Are The Barriers And Facilitators To Community Handwashing With Water And Soap? A Systematic Review., Obidimma Ezezika, Jennifer Heng, Kishif Fatima, Ayman Mohamed, Kathryn Barrett

Health Studies Publications

Handwashing with water and soap (HWWS) is an effective method of cleaning and disinfecting the surface of the hands. HWWS is effective in infection control and prevention transmission, such as in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). However, rates of handwashing compliance vary globally. This systematic review aimed to identify the barriers and facilitators to community HWWS globally. We conducted a comprehensive search strategy in OVID Medline, OVID Embase, Web of Science Core Collection, and Scopus using keywords and subject headings related to handwashing. Studies were excluded if they reported hand hygiene among healthcare or food service workers, considered …

The Roles Of Family Physicians During A Pandemic., Maria Mathews, Leslie Meredith, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily G Marshall, Richard Buote, Lauren Moritz, Sarah Spencer, Shabnam Asghari, Judith B Brown, Thomas R Freeman, Paul S Gill, Rita K Mccracken, Madeleine Mckay, Bridget Ryan, Shannon L Sibbald, Stephen Wetmore, Eric Wong

Health Studies Publications

Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate …

Evaluating Public Participation In A Deliberative Dialogue: A Single Case Study., Tiffany Scurr, Rebecca Ganann, Shannon L Sibbald, Ruta Valaitis, Anita Kothari

Health Studies Publications

BACKGROUND: Deliberative dialogues (DDs) are used in policy-making and healthcare research to enhance knowledge exchange and research implementation strategies. They allow organized dissemination and integration of relevant research, contextual considerations, and input from diverse stakeholder perspectives. Despite recent interest in involving patient and public perspectives in the design and development of healthcare services, DDs typically involve only professional stakeholders. A DD took place in May 2019 that aimed to improve the social environment (eg, safety, social inclusion) and decrease social isolation in a rent-geared-to-income housing complex in a large urban community. Tenants of the housing complex, public health, primary care, …

Examining The Barriers, Facilitators And Attitudes Towards Covid-19 Vaccine And Public Health Measures For Black Communities In Canada: A Qualitative Study Protocol., Obidimma Ezezika, Bethelehem Girmay, Toluwalope Adedugbe, Isaac Jonas, Yanaminah Thullah, Chris Thompson

Health Studies Publications

INTRODUCTION: Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will …

The Experiences And Challenges Of Community Health Volunteers As Agents For Behaviour Change Programming In Africa: A Scoping Review, Mary Ndu, Ellena Andoniou, Sorcha Mcnally, Francisco Olea Popelka, Marisa Tippet, Elysee Nouvet

Health Studies Publications

ommunity health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a …

Examining Bourdieu’S Concepts Of Capital, Habitus, And Field In Women’S Health Research In Nigeria: A Feminist Perspective, Mary Ndu

Health Studies Publications

Global health’s persistent focus on women’s health-seeking behaviour necessitates a philosophical understanding of the meaning behind women’s health decision-making. In studying health-seeking behaviour, researchers use philosophical paradigms to explicate and understand complex social concepts that continue to maintain health inequities and injustices. A commonly used theory is Bourdieu’s Theory of Practice. This paper examines the scholastic application of Bourdieu’s theory of practice to theorize women’s health-seeking behaviour in qualitative research to understand the rationale behind using health services. The theory of practice consists of four concepts: practice, habitus, field, and capital. Each concept conceptualizes the theory to find a logical …

Interdisciplinary Health Care Evaluation Instruments: A Review Of Psychometric Evidence., Hosung Joel Kang, Cecilia Flores-Sandoval, Benson Law, Shannon Sibbald

Health Studies Publications

Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After …

Implementation Of Insecticide-Treated Malaria Bed Nets In Tanzania: A Systematic Review., Obidimma Ezezika, Yasmine El-Bakri, Abitha Nadarajah, Kathryn Barrett

Health Studies Publications

Background

Malaria is a significant cause of morbidity, mortality, and economic burden among the Tanzanian population. An effective form of personal protection against malaria is the insecticide-treated bed net (ITN). Although Tanzania has made great efforts to implement ITNs in the general population, gaps in use, access, coverage, and ownership remain. We conducted a systematic review of the available data on the barriers and facilitators to the implementation of ITNs in Tanzania.

Methods

A comprehensive search was conducted in four databases: OVID Medline, OVID Embase, EBSCO CINAHL, and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses …

Family Physician Leadership During The Covid-19 Pandemic: Roles, Functions And Key Supports., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Judith Belle Brown, Paul S Gill, Madeleine Mckay, Eric Wong, Stephen J Wetmore, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Maria Alexiadis, Thomas R Freeman, Aimee Letto, Bridget L Ryan, Shannon L Sibbald, Amanda Lee Terry

Health Studies Publications

PURPOSE: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

DESIGN/METHODOLOGY/APPROACH: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers …

Factors Impacting Primary Care Engagement In A New Approach To Integrating Care In Ontario, Canada., Amanda C Everall, Kristina M Kokorelias, Shannon L Sibbald, Walter P Wodchis, Gayathri Embuldeniya

Health Studies Publications

INTRODUCTION: In 2019, Ontario's Ministry of Health (the Ministry) introduced Ontario Health Teams (OHTs) to provide population-based integrated healthcare. Primary care was foundational to this approach. We sought to identify factors that impacted primary care engagement during OHT formation from different perspectives.

METHODS: Interviews with 111 participants (administrators n = 80; primary care providers n = 17; patient family advisors = 14) from 11 OHTs were conducted following a semi-structured guide. Interviews were transcribed, coded, and thematically analyzed.

RESULTS: Participants felt that primary care engagement was an ongoing, continuous cycle. Four themes were identified: 1) 'A low rules environment': limited …

Development And Implementation Of A Reflective Writing Assignment For Undergraduate Students In A Large Public Health Biology Course, Obidimma Ezezika, Nancy Johnston

Health Studies Publications

Reflective writing may be undervalued as purely expressive rather than a critical or an academic tool in undergraduate public health biology courses. When grounded in course concepts and academic learning, a reflective essay can be a learning tool for students that helps them use discipline knowledge and apply it to real-world issues. Studies on teaching reflection have identified its value for training students in critical thinking and improving self-regulated learning. Considering Gibbs’ Reflective Cycle framework, in this article, we detail the design, implementation, and evaluation of a reflective writing assignment integrated into a lower-year undergraduate public health biology course. Through …

What Are The Barriers And Facilitators To Polio Vaccination And Eradication Programs? A Systematic Review., Obidimma Ezezika, Meron Mengistu, Eric Opoku, Aiman Farheen, Anuradha Chauhan, Kathryn Barrett

Health Studies Publications

Global efforts to eradicate polio by the Global Polio Eradication Initiative agency partners and country-level stakeholders have led to the implementation of global polio vaccination programs. This study presents the findings of existing studies regarding the barriers and facilitators that countries face when implementing polio interventions. A comprehensive search was conducted in OVID Medline, OVID Embase, EBSCO CINAHL Plus, and Web of Science. Eligible studies underwent quality assessment. A qualitative evidence synthesis approach was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR). The search identified 4147 citations, and following the removal of duplicates and screening according to …

Barriers And Facilitators To Implementation Of Oral Rehydration Therapy In Low- And Middle-Income Countries: A Systematic Review., Obidimma Ezezika, Apira Ragunathan, Yasmine El-Bakri, Kathryn Barrett

Health Studies Publications

BACKGROUND: Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries.

METHODS: A comprehensive search strategy comprised of relevant subject headings and keywords …

Implementation Of The Meningitis Vaccine Project In Africa: Lessons For Vaccine Implementation Programs., Obidimma Ezezika, Meron Mengistu, Thomas Lear

Health Studies Publications

Background The Meningitis Vaccine Project (MVP) was an international partnership that began in 2010 and focused on the development, testing, licensure, and widespread introduction of a conjugate vaccine with the promise of protecting millions of lives from group A meningococcal meningitis. To bridge gaps upstream of vaccine administration and in understanding the project’s planning, delivery and outcomes, the primary objective of this study was to delineate the barriers to and facilitators of sustainable implementation in an upstream context of the delivery of the MenAfriVac vaccine and to draw critical lessons for other vaccination programs. Methods We conducted a qualitative study …

Barriers And Facilitators To Implementation Of Oral Rehydration Therapy In Low- And Middle-Income Countries: A Systematic Review., Obidimma Ezezika, Apira Ragunathan, Yasmine El-Bakri, Kathryn Barrett

Health Studies Publications

BACKGROUND: Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries.

METHODS: A comprehensive search strategy comprised of relevant subject headings and keywords …

Covid-19 In Sub-Saharan Africa: Impacts On Vulnerable Populations And Sustaining Home-Grown Solutions, Lauren J. Wallace, Elysée Nouvet, Robert Bortolussi, Joshua A. Arthur, Eugenia Amporfu, Eric Arthur, Kofi Bobi Barimah, Bernard Aristide Bitouga, Harriet Chemusto, Joseph Ikechebelu, Ngozi Joe-Ikechebelu, Mandy Kader Kondé, Jean Damascene Kabakambira, Gabriel Kyomba Kalombe, Diana M.S. Karanja, Eveline Thobias Konje, Sekou Kouyate, Gojjam Limeneh, Felicien Munday Mulopo, Mary Ndu, Eric Ochomo, Oriokot Francis, Oumy Thiongane, Jeremiah Seni, S. Mohammed Sheriff, Douglas Singini

Health Studies Publications

© 2020, The Canadian Public Health Association. This commentary draws on sub-Saharan African health researchers’ accounts of their countries’ responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, …

The Application Of Drones In Healthcare And Health-Related Services In North America: A Scoping Review, Bradley Hiebert, Elysée Nouvet, Vyshnave Jeyabalan, Lorie Donelle

Health Studies Publications

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Using drone aircraft to deliver healthcare and other health-related services is a relatively new application of this technology in North America. For health service providers, drones represent a feasible means to increase their efficiency and ability to provide services to individuals, especially those in difficult to reach locations. This paper presents the results of a scoping review of the research literature to determine how drones are used for healthcare and health-related services in North America, and how such applications account for human operating and machine design factors. Data were collected from …

Context-Specific Challenges, Opportunities, And Ethics Of Drones For Healthcare Delivery In The Eyes Of Program Managers And Field Staff: A Multi-Site Qualitative Study, Vyshnave Jeyabalan, Elysée Nouvet, Patrick Meier, Lorie Donelle

Health Studies Publications

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Unmanned aerial vehicles (UAVs), also known as drones, have significant potential in the healthcare field. Ethical and practical concerns, challenges, and complexities of using drones for specific and diverse healthcare purposes have been minimally explored to date. This paper aims to document and advance awareness of diverse context-specific concerns, challenges, and complexities encountered by individuals working on the front lines of drones for health. It draws on original qualitative research and data from semi-structured interviews (N = 16) with drones for health program managers and field staff in nine countries. Directed …

The Attitudes And Behaviors Of Students, Staff And Faculty Towards Smoke-Free And Tobacco-Free Campus Policies In North American Universities: A Narrative Review., Daniel Dilliott, Sajjad Fazel, Nazia Ehsan, Shannon L Sibbald

Health Studies Publications

INTRODUCTION: In Canada, a series of recent public health policies and interventions have successfully led to a decline in national tobacco use rates. However, tobacco use among young adults remains high and the tobacco industry continues to place a strong marketing emphasis towards young adults on university campuses. In response, many universities across Canada are beginning to adopt smoke-free or tobacco-free campus policies. While the effectiveness of smoke-free and tobaccofree campus policies has been demonstrated in several countries, little is known about the attitudinal responses of university students, faculty and staff towards these policies. As such, we conducted a review …

Demographic And Socioeconomic Characteristics Of Canadian Medical Students: A Cross-Sectional Study., Rishad Khan, Tavis Apramian, Joel Hosung Kang, Jeffrey Gustafson, Shannon Sibbald

Health Studies Publications

BACKGROUND: While the importance of medical students' demographic characteristics in influencing the scope and location of their future practice is recognized, these data are not systematically collected in Canada. This study aimed to characterize and compare the demographics of Canadian medical students with the Canadian population.

METHODS: Through an online survey, delivered in 2018, medical students at 14 English-speaking Canadian medical schools provided their age, sex, gender identity, ethnicity, educational background, and rurality of the area they grew up in. Respondents also provided information on parental income, occupation, and education as markers of socioeconomic status. Data were compared to the …

Women's Freedom Of Movement And Participation In Psychosocial Support Groups: Qualitative Study In Northern India, Nicola Gailits, Kaaren Mathias, Elysée Nouvet, Pooja Pillai, Lisa Schwartz

Health Studies Publications

© 2019 The Author(s). Background: Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. Methods: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were …

Perceptions Of Drones, Digital Adherence Monitoring Technologies And Educational Videos For Tuberculosis Control In Remote Madagascar: A Mixed-Method Study Protocol, Elysée Nouvet, Astrid M. Knoblauch, Ian Passe, Andry Andriamiadanarivo, Manualdo Ravelona, Faniry Ainanomena Ramtariharisoa, Kimmerling Razafimdriana, Patricia C. Wright, Jesse Mckinney, Peter M. Small, Niaina Rakotosamimanana, Simon Grandjean Lapierre

Health Studies Publications

© 2019 Author(s). Introduction Poor road and communication infrastructure pose major challenges to tuberculosis (TB) control in many regions of the world. TB surveillance and patient support often fall to community health workers (CHWs) who may lack the time or knowledge needed for this work. To meet the End TB Strategy goal of reducing TB incidence by 90% by 2035, the WHO calls for intensified research and innovation including the rapid uptake of new tools, interventions and strategies. Technologies that â € leapfrog' infrastructure challenges and support CHWs in TB control responsibilities have the potential to dramatically change TB outcomes …

Priorities, Barriers, And Facilitators Towards International Guidelines For The Delivery Of Supportive Clinical Care During An Ebola Outbreak: A Cross-Sectional Survey, Marie Claude Battista, Christine Loignon, Lynda Benhadj, Elysee Nouvet, Srinivas Murthy, Robert Fowler, Neill K.J. Adhikari, Adnan Haj-Moustafa, Alex P. Salam, Adrienne K. Chan, Sharmistha Mishra, Francois Couturier, Catherine Hudon, Peter Horby, Richard Bedell, Michael Rekart, Jan Hajek, Francois Lamontagne

Health Studies Publications

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. During the Ebola outbreak, mortality reduction was attributed to multiple improvements in supportive care delivered in Ebola treatment units (ETUs). We aimed to identify high-priority supportive care measures, as well as perceived barriers and facilitators to their implementation, for patients with Ebola Virus Disease (EVD). We conducted a cross-sectional survey of key stakeholders involved in the response to the 2014–2016 West African EVD outbreak. Out of 57 email invitations, 44 responses were received, and 29 respondents completed the survey. The respondents listed insufficient numbers of health workers (23/29, 79%), improper tools …

Staying Current In Your Field Of Interest: Tips For Aspiring Students As Researchers, Dor D. Abelman

Health Studies Publications

Undergraduate students are becoming increasingly involved in research. They already posses the skills required to make meaningful contributions to their field of interest. Some important components of their success relates to a student's ability to stay up to date in the research of their field, and to learn practical skills pertaining to the publishing process. This article hopes to help with this through presenting easy-to-follow summary tables and short paragraphs on tips for success. Topics include staying up to date in a practical way, getting involved, reaching out for help, and publication. For students, by students, this report is relatable …

Factors Influencing Communication And Decision-Making About Life-Sustaining Technology During Serious Illness: A Qualitative Study, Jennifer Kryworuchko, P. H. Strachan, E. Nouvet, J. Downar, J. J. You

Health Studies Publications

© 2016, BMJ Publishing Group. All rights reserved. Objectives: We aimed to identify factors influencing communication and decision-making, and to learn how physicians and nurses view their roles in deciding about the use of life-sustaining technology for seriously ill hospitalised patients and their families. Design: The qualitative study used Flanagan's critical incident technique to guide interpretive description of open-ended in-depth individual interviews. Setting: Participants were recruited from the medical wards at 3 Canadian hospitals. Participants: Interviews were completed with 30 healthcare professionals (9 staff physicians, 9 residents and 12 nurses; aged 25-63 years; 73% female) involved in decisions about the …

Improving Communication In Agbiotech Projects: Moving Toward A Trust- Centered Paradigm., Obidimma Ezezika, Justin Mabeya

Health Studies Publications

Communication with end users about agricultural biotechnology does not necessarily lead to commensurate adoption of biotech crops. Agbiotech communication implies challenges like disagreement between proponents and opponents of genetically modified (GM) technology and media influence on public opinion, both of which can negatively impact public trust in, and thus adoption of, biotech crops. We argue that communication strategies for introducing biotech crops should focus on building and fostering trust between project partners developing biotech crops and the community they intend to serve to facilitate effective adoption of the crops. Strategies should include a combination of knowledge dissemination; early and continuous …