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 …

An Introduction To The Sustainable Developmental Goals Through The Lens Of Dewroze, Obidimma Ezezika, Kishif Fatima, Umayangga Yogalingam, Mona Jarrah, Suzanne Sicchia

Health Studies Publications

The following interactive discussion questions are based on a fictional animated storyline by Chapter 1 of the third edition of An Introduction to Global Health. The animated storyline and questions are intended to provide students with the opportunity to understand global health, the Sustainable Development Goals (SDGs), and barriers related to the social determinants of health, in the context of a developing country.

Students will be introduced to the fictional village of Dewroze where they will learn how poverty shapes vulnerabilities that lead to health inequities. In this village, students will meet Ada, Ada’s father, Ada’s mother who is pregnant, …

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 …

Exploring Quality Improvement For Diabetes Care In First Nations Communities In Canada: A Multiple Case Study., Meghan Fournie, Shannon L. Sibbald, Stewart B. Harris

Health Studies Publications

BACKGROUND: Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada.

METHODS: This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform …

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 …

Ethics And Epidemiology Workshop Report: Towards Ethics-Informed Epidemiology And Epidemiology-Informed Ethics, Zoe Ritchie, Brendan T. Smith Phd, Maxwell J. Smith Phd

Health Studies Publications

Two key groups of researchers have worked in parallel to advance health equity—one on the descriptive component (those in public health sciences, e.g., epidemiologists) and one on the normative component (those in the humanities and social sciences, e.g., philosophers and ethicists). Yet a significant gulf exists between their respective research. Consequently, advances in thinking regarding the philosophical underpinnings and normative requirements of health equity have been largely divorced from the design of public health interventions that seek to reduce health inequities. As a consequence, public health interventions aiming to advance health equity may fail to target the most appropriate populations …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda Lee Terry, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B. Brown, Erin Christian, Thomas R. Freeman, Paul S. Gill, Shannon L. Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda L. Terry Dr., Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B Brown, Erin Christian, Thomas R Freeman, Paul S Gill, Shannon L Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

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 …

History Of International Aid, Obidimma Ezezika, Kishif Fatima, Umayangga Yogalingam, Mona Jarrah, Suzanne Sicchia

Health Studies Publications

The following interactive discussion questions are based on a fictional animated storyline developed from Chapter 2 of the third edition of An Introduction to Global Health by Michael Seear and Obidimma Ezezika. The storyline and questions are intended to provide students with the opportunity to understand trends that shaped the modern aid industry, the origins of foreign aid institutions and organizations, and the history that led to current large-scale foreign aid initiatives.

There are questions for each of the five modules of the storyline as well as general reflection questions at the end. To answer the questions associated with the …

An Introduction To The Sustainable Developmental Goals Through The Lens Of Dewroze, Obidimma Ezezika, Kishif Fatima, Umayangga Yogalingam, Mona Jarrah, Suzanne Sicchia

Health Studies Publications

The following interactive discussion questions are based on a fictional animated storyline by Chapter 1 of the third edition of An Introduction to Global Health. The animated storyline and questions are intended to provide students with the opportunity to understand global health, the Sustainable Development Goals (SDGs), and barriers related to the social determinants of health, in the context of a developing country.

Students will be introduced to the fictional village of Dewroze where they will learn how poverty shapes vulnerabilities that lead to health inequities. In this village, students will meet Ada, Ada’s father, Ada’s mother who is pregnant, …

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 Impact Of Funding Models On The Integration Of Registered Nurses In Primary Health Care Teams: Protocol For A Multi-Phase Mixed-Methods Study In Canada., Maria Mathews, Sarah Spencer, Lindsay Hedden, Julia Lukewich, Marie-Eve Poitras, Emily Gard Marshall, Judith Belle Brown, Shannon Sibbald, Alison A Norful

Health Studies Publications

BACKGROUND: Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.

METHODS: This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) …

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 …

A Framework To Support The Progressive Implementation Of Integrated Team-Based Care For The Management Of Copd: A Collective Case Study., Shannon L. Sibbald, Vaidehi Misra, Madelyn Dasilva, Christopher Licskai

Health Studies Publications

BACKGROUND: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care.

METHODS: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for …

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 …

A Case Analysis Of Partnered Research On Palliative Care For Refugees In Jordan And Rwanda, Sonya De Laat, Olive Wahoush, Rania Jaber, Wejdan Khater, Emmanuel Musoni, Ibraheem Abu Siam, Lisa Schwartz, Matthew Hunt, Lynda Redwood-Campbell, Laurie Elit, Elysée Nouvet, Rachel Yantzi, Kevin Bezanson, Carrie Bernard, Takhliq Amir, Ani Chénier, Gautham Krishnaraj, Corinne Schusterwallace

Health Studies Publications

© 2021, The Author(s). Background: This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational …

Confronting Complexity And Supporting Transformation Through Health Systems Mapping: A Case Study., Anna J Hussey, Shannon L Sibbald, Madonna Ferrone, Alyson Hergott, Robert Mckelvie, Cathy Faulds, Zofe Roberts, Andrew D Scarffe, Matthew J Meyer, Susan Vollbrecht, Christopher Licskai

Health Studies Publications

INTRODUCTION: Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat.

STUDY DESCRIPTION: This case study documents the first phase of system transformation at a regional level …

Do Women Empowerment Indicators Predict Receipt Of Quality Antenatal Care In Cameroon? Evidence From A Nationwide Survey, Edward Kwabena Ameyaw, Kwamena Sekyi Dickson, Kenneth Setorwu Adde, Obidimma Ezezika

Health Studies Publications

Background

World Health Organisation (WHO) recommends quality antenatal care (ANC) for all pregnant women, as one of the strategies for achieving targets 3.1 and 3.2 of the sustainable development goals. Maternal mortality ratio remains high in Cameroon (782 maternal deaths per 100,000 live births). Extant literature suggest a positive association between women empowerment indicators and maternal healthcare utilisation in general. In Cameroon, this association has not received scholarly attention. To fill this knowledge gap, we investigated the association between women empowerment indicators and quality ANC in Cameroon.

Methods

Data of 4615 women of reproductive age were analysed from the women’s …

Evaluating The Implementation Of A Chronic Obstructive Pulmonary Disease Management Program Using The Consolidated Framework For Implementation Research: A Case Study., Stefan Paciocco, Anita Kothari, Christopher J Licskai, Madonna Ferrone, Shannon L Sibbald

Health Studies Publications

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used.

METHODS: A qualitative case study was …

Barriers And Facilitators To The Implementation Of Large‑Scale Nutrition Interventions In Africa: A Scoping Review, Obidimma Ezezika, Jenny Gong, Hajara Abdirahman, Daniel Sellen

Health Studies Publications

The efective implementation of large-scale nutrition interventions in Africa is an ongoing challenge. This scoping review identifes and explores the barriers and facilitators to the implementation of large-scale nutrition interventions in the African region. We searched PubMed, EMBASE, Scopus, ERIC, and Web of Science using search terms focused specifcally on barriers and facilitators to the implementation of nutrition interventions in Africa. To supplement the database search, reference lists in publications included for full-text review were also examined to identify eligible articles for inclusion. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and …