Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

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This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

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An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

Examining The Impact Of Financial Incentive Removal On Physical Activity: A Quasi-Experimental Study Of 584,760 Mobile Health Application Users, Sean Kevin Spilsbury

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BACKGROUND: Government interest in using financial incentives (FIs) to stimulate physical activity (PA) is increasing. The cost of longer-term incentive interventions may be prohibitive, however. PURPOSE: To examine the impact of FI withdrawal on PA. METHODS: A 25-week retrospective pre-post quasi-experimental study was conducted with users of a FI-based mHealth app. Users from three Canadian provinces were included. Daily FI were removed in Ontario (ON; intervention) but not British Columbia (BC) and Newfoundland and Labrador (NL; control). Simple linear regression models were used to examine weekly mean daily step count after FI withdrawal. RESULTS: The total sample included 584,760 users …

Falls Screening In Community- Dwelling Older Adults, Hadi Kooshiar

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Falls screening can prevent falls and their consequences. The two studies of this thesis aimed to identify the accuracy of falls screening tools and explore patient preferences and empirical validity of the self-rated Falls Risk Questionnaire (FRQ). The first study, Systematic Literature Review, found the Toulouse-St. Louis University Mini Falls Assessment and the Activities-specific Balance Confidence scale Hindi version emerged as accurate tools for predicting falls in the target population. The second study determined most of respondents, 36%, had no preference between Activities Specific Balance Confidence 6 items (ABC-6) or FRQ. The Bland & Altman approach revealed a degree of …

The Impact Of Interruptions In Gender-Affirming Medical Care During Covid-19 On Anxiety And Depression Among Trans And Non-Binary People In Canada: A Longitudinal Study, Sara Todorovic

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Background. Transgender and non-binary (TGNB) populations experience disproportionally high levels of anxiety and depression; it is imperative we investigate how the COVID-19 pandemic may have impacted the mental health of TGNB communities. Methods. Among a Canadian sample of TGNB persons aged >=15 years, we used multiple linear regression to examine whether interruptions in gender-affirming care were associated with anxiety and depression, and whether that effect was modified by pre-pandemic mental health. Results. Anxiety and depression levels were high both pre-pandemic and during the pandemic. Approximately a quarter of TGNB persons experienced interruptions in hormonal care. After adjusting for confounders, there …

Exploring Experiences Of Parents Of A Child With Medical Complexity: A Case Study Approach, Vanessa Rocchese

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Parents of children with medical complexity (CMC) have the unique experience of also being their child’s health care provider (HCP). This cross-sectional, qualitative single-case study sought to 1) examine experiences of parental caregivers of CMC whilst navigating healthcare and social systems; and 2) examine influences of urban/rural settings on parental caregiver experiences. An online demographic survey and semi-structured telephone interviews were utilized with two families, one urban (n=1) and one rural (n=2). A thematic analysis was undertaken using both intersectionality and the Conceptual Model of Health-Related Quality of Life-(HRQoL) as frameworks to explore findings. This study revealed that challenges in …

Investigating Children's Experiences And Participation In A Free Community-Based Physical Activity Program: The Grade 5 Act-I-Pass, Emma E. Ostermeier

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Physical activity is an important component of children’s health and development; however, a majority of Canadian children are not meeting the physical activity recommendations. This thesis aimed to identify the factors that influenced children’s enrollment and participation in a free community-based physical activity program, the Grade 5 ACT-i-Pass (G5AP). This thesis consisted of two individual, but interrelated studies. First, focus groups with G5AP participants were used to explore the factors that influenced children’s perceived physical activity levels and participation in the program. Second, a spatially-targeted promotional campaign was developed and implemented to help evaluate the impact of promotions on program …

Investigating Elementary School Food Programs: Impacts On Child Knowledge And Dietary Behaviours, Paige Colley

Electronic Thesis and Dissertation Repository

Good nutrition is an important part of maintaining a healthy lifestyle. A balanced diet can promote positive health outcomes, protecting against health problems caused by nutritional deficiencies. Canada has reported poor diet quality and high rates of overweight and obesity among children. Obesity has been linked to several non-communicable diseases including type 2 diabetes, heart disease, and some forms of cancer. Efforts to improve lifelong, healthy eating behaviours must be implemented.

This dissertation investigated the impacts of school food programming on child nutrition. A Centrally Procured School Food Program (CPSFP) was implemented at 30 elementary schools in Southwestern Ontario, Canada. …

Implementation Adherence And Perspectives Of The Physical Activity (Play) Policy Study: A Process Evaluation, Monika B. Szpunar

Electronic Thesis and Dissertation Repository

This study entailed a process evaluation of the Childcare PhysicaL ActivitY (PLAY) Policy. Early childhood educators (ECEs) in childcare centres (n = 5) delivered the policy (which included 8 recommendations) and documented adherence (i.e., dose) in daily implementation logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed post-intervention to assess barriers/facilitators, feasibility, enjoyment, and likelihood of future implementation. Descriptive statistics and thematic analysis were conducted. Adherence was highest for delivery of child-directed play (85.9%) and lowest for delivery of frequent outdoor periods (16.5%). Participants reported they were likely to continue policy implementation, …

The Effects Of Exercise On Cognition, Mobility, And Neuroimaging Outcomes In Older Adults Without Dementia, Narlon Cassio Boa Sorte Silva

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Cognitive decline is increasing with the aging population and, at present, there is no effective pharmacologic treatment available. Exercise interventions may impart protection against cognitive decline. A novel exercise approach is multiple-modality exercise (MME; aerobic, resistance, and balance exercise) with mind-motor training. Mind-motor training is a promising intervention in the study of cognitive function. Combining MME with mind-motor training may improve or maintain cognition and provide prevention of dementia early in the course of cognitive decline. Individuals with subjective cognitive complaints (SCC) comprise an at-risk group early in the spectrum of cognitive decline that could be targeted for prevention. The …

Timely Access To Maternal, Neonatal And Child Healthcare For Rural Communities In Rwanda: The Role Of Community Health Workers, Jean Bosco Bigirimana

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Abstract

Introduction: In Rwanda, although there has been some progress in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. Improving equitable access to quality healthcare services for maternal, neonatal and child healthcare (MNCH), community-based maternal, neonatal and child healthcare (CBMNCH) depends upon using “community health workers” (CHWs). Yet CHWs program faces difficulties that upset delivery of the quality of the comprehensive package of services. Unfortunately, little is known about CHWs` performance and job satisfaction in the provision of CBMNCH.

Goal: The study aimed to provide insight into …

Using The Re-Aim Framework To Evaluate The Feasibility Of A Parent-Focused Pilot Intervention Targeting Childhood Obesity, Daniel Briatico

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Background: Childhood obesity is a major public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviours and outcomes, but require effective evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a parent-focused pilot intervention (“C.H.A.M.P. Families”) targeting childhood obesity using the RE-AIM framework, an evaluation tool for community-based health interventions.

Methods: A single-centre, single-group, non-randomized, repeated measure feasibility study was conducted over the course of 10 months. Participants (n = 16 parents/caregivers representing 11 children with obesity) completed a 13-week parent-focused education intervention. …

Uptake Of Colorectal Cancer Screening Tests By Ontario Physicians., Owen Litwin

Electronic Thesis and Dissertation Repository

This population-based study used administrative healthcare data to examine the uptake of tests recommended for colorectal cancer screening by eligible Ontario physicians and non-physicians, and to examine if testing of primary care physicians is associated with greater testing in their patients. Physicians (n=11,434) were matched 1:4 to non-physicians (n=45,736) on age, sex, and geographic location as of April 21, 2016. Uptake of colorectal tests was similar in physicians (67.9%, 95% CI, 67.0–68.7%) and non-physicians (66.6%, 95% CI, 66.2–67.1%). Physicians were more likely than non-physicians to undergo colonoscopy and less likely to undergo fecal occult blood testing. Uptake of colorectal tests …

Resedent Study- Reducing Sedentary Behaviour May Slow Cognitive Decline In Older Adults With Mild Cognitive Impairment: A Pilot Study, Kirsten B. Dillon

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Physical activity (PA) has been shown to slow down dementia. Unfortunately, older adults spend most of their day in sedentary behaviours (SB). Breaking up prolonged bouts of sitting with intermittent bouts of light intensity PA may reduce glycemic variability in the brain; potentially mitigating cognitive decline. This study investigated how interrupting SB with 10 min bouts of light intensity PA 3x a day would affect mild to moderate cognitive impairment progression (primary outcome) in older adults residing in an assisted living facility. Participants (n=25) were assigned in clusters into a two arm 10-week single site pilot randomized controlled trial. Secondary …

Optimizing The Carrot Rewards App: An Examination Of Team-Based Financial Incentives To Increase Walking, Emma Pearson

Electronic Thesis and Dissertation Repository

Mobile health applications (mHealth apps) targeting physical activity (PA) have increased in popularity, yet effectiveness is often limited by low engagement. This study examined the impact of adding a team-based feature, Step Together Challenges (STCs), to an existing incentive-based mHealth app (i.e., Carrot Rewards) on PA. A 24-week retrospective matched pairs study was conducted (n=61,170; pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used STCs (experimental group) were matched with those who did not (controls). STC users could earn team incentives for collaboratively reaching individual daily step goals 10 times in seven days. Controlling for pre-intervention mean daily step count, …

Cognitive Impairment And The Mediterranean Diet: A Canadian Perspective, Ivan Culum

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Global life expectancy has increased steadily over the past century and is projected to continue increasing. Life expectancy increases are co-occurring with a reduction of fertility rates in many economically developed countries, which is resulting in an aging population, meaning that the proportion of older adults within the total world population will continue to increase. This is of particular concern as there is a rise of chronic neurodegenerative diseases among older adults, such as dementia, where the number of global deaths more than doubled since the turn of the century, making dementia the fifth leading cause of death worldwide. Dementia …

Active And Safe Routes To School: Evaluating School Travel Planning To Support Children's Active Travel, Adrian Nicholas Buttazzoni

Electronic Thesis and Dissertation Repository

Most Canadian children are not achieving their daily recommended physical activity (PA) levels despite the many emotional, psychological, and physical benefits of PA. Walking or wheeling to/from school, or active school travel (AST), is a viable method for improving children’s daily participation in PA. In Canada, the Active and Safe Routes to School initiative promotes AST through its comprehensive School Travel Planning (STP) program. Utilizing a mixed-methods approach, broadly, this thesis investigates the i) implementation and ii) effectiveness of a regional, two-year STP program supporting AST. This thesis includes a systematic review of AST intervention models implemented in North America, …

Standing And Dynamic Sitting In The University Classroom, Siobhan Smith

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Students almost exclusively sit in class, which translates to large amounts of forced sedentary behaviour and this in turn may have negative health consequences. The effect alternative postures have on classroom performance of university students remains unknown.

Using a randomized counterbalanced design, pilot study 1 (N=40) and 2 (N=20) investigated the effect of alternative postures on 3-minute and 50-minute classroom performance, respectively. In study 3, university students’ (N=1005) and faculty (N=218) acceptability to alternative workstations in the university classroom was assessed using a mixed method approach.

This thesis provides preliminary evidence that there is no difference between classic sitting, dynamic …

Understanding The Processes That Shape Cross Sector Service Provision In The Towards Flourishing Mental Health Promotion Strategy: A Secondary Analysis Utilizing Constructivist Grounded Theory Methodology, Shannon E. Winters

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In Canada, many national, provincial, and regional policies indicate that working together within and across sectors in health and social care is necessary and expected but evidence to support this call is lacking. This dissertation study explored the concept of cross sector service provision (CSSP), defined as: independent, yet interconnected sectors working together to better meet the needs of service users and improve the quality and effectiveness of service provision. The intent was to advance our understanding of processes involved in shaping service provision offered by two or more sectors. The thesis contains three studies. A Scoping Review that explored …

Standing Up For Student Health: An Application Of The Health Action Process Approach For Reducing Student Sedentary Behavior., Wuyou -. Sui

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Sedentary behavior (SB) has been associated with chronic diseases, such as Hypertension and Obesity; the risk appears greater the longer one engages in SB. University Students are a high-risk population for excessive SB due to academic responsibilities. Increasing frequency/length of breaks from sitting is an effective way to attenuate effects of SB. The Health Action Process Approach (HAPA) is a proven health behavior change model for behaviors like nutrition, but has yet to show effectiveness for increasing non-sedentary behaviors. Forty-five university students (12 Males, Mean age 23.3) were randomized into HAPA-intervention (sedentary behavior) or HAPA-control (nutrition) groups. Occupational Student and …

The Association Between The Neighbourhood Food Environment And Prevalence Of Three Chronic Diseases In Urban Canada: A Cross-Sectional Analysis, Jagraj Singh Pandher

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Research on the association between the neighbourhood food environment and prevalence of chronic diseases is very limited in Canada. The objective of this thesis was to investigate: (i) the associations between the neighbourhood food environment and prevalence of type II diabetes, cardiovascular disease and hypertension among Canadian adults living in urban areas; and (ii) whether or not dietary patterns, obesity and physical activity mediate such associations. Self-reported diagnosis of three chronic diseases, and individual-level socio-demographic and lifestyle variables were taken from the 2009-2010 Canadian Community Health Survey; neighbourhood-level socio-economic data were taken from the 2011 National Household Survey; and the …

The Sixties Scoop Among Aboriginal Veterans: A Critical Narrative Study, Munira Abdulwasi

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This study explored the experience of Aboriginal Veterans adopted and/or fostered during the Sixties Scoop using critical narrative inquiry. The objectives were to: 1) understand the lived experience of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) explore any health needs expressed by Aboriginal veterans adopted and/or fostered during the Sixties Scoop, and 3) provide recommendations for the implementation of health services and programs to assist this group of Aboriginal veterans with their health needs. Eight individual interviews were conducted with participants in Kitchener-Waterloo, London, Ottawa, Winnipeg, and Vancouver. All interviews were audio-taped, transcribed verbatim, and analyzed using …

Exploring Mothers' Influence On Preschoolers' Physical Activity Levels And Sedentary Time, Alana M. Maltby

Electronic Thesis and Dissertation Repository

Physical activity (PA) patterns continue from childhood into adulthood; therefore, establishing healthy PA levels early is imperative. Mothers have been identified as influencing preschoolers’ activity behaviours; however, a holistic exploration of maternal influence is lacking. The purpose of this study was to explore maternal influence on preschoolers’ PA and sedentary time. Preschoolers (n = 30) and their mothers wore ActicalTM accelerometers, and mothers completed the adapted Environmental Determinants of Physical Activity in Preschool Children - Parent Survey. Direct entry regression analyses were conducted to explore maternal influence (e.g., support, enjoyment) on preschoolers’ activity levels. Maternal support was a significant predictor …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

The Utility Of A Protection Motivation Theory Framework For Understanding Sedentary Behaviour, Tiffany S. Wong

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This study aimed to 1) examine the factor structure and composition of sedentary-derived Protection Motivation Theory (PMT) constructs and 2) determine the utility of these constructs in predicting general and leisure sedentary goal intention (GI), implementation intention (II), and sedentary behaviour (SB). PMT, GI, II constructs, and a modified SB questionnaire were completed by undergraduate students. After completing socio-demographics and the PMT items (n = 787), participants were randomized to complete general or leisure intention and SB items. Irrespective of model, principal axis factor analysis revealed that the PMT items grouped into eight coherent and interpretable factors. Using linear …

University Students' Perceptions Of The Relationship Between Bus Pass Ownership And Physical Activity Levels, Hieu Ly

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The purpose of this study was to assess the relationship between university students’: (a) perceptions of having a discounted bus pass and transit-related physical activity; (b) perceptions of having a discounted bus pass and weekly physical activity levels; and (c) transit-related physical activity and weekly physical activity levels. A sample of 545 undergraduate students completed an online survey. The analysis of three correlations and three t-tests illustrated significant relationships between students’ perceptions of the discounted bus pass and their transit-related physical activity, and males’ and females’ weekly physical activity levels. Three major themes emerged from the open-ended responses, which …

Evidence-Informed Advocacy: Non-Profit Organizations Use Of Evidence For Policy Influence In Public Health - A Case Study Of Wash Org Uganda, Carolyne Esther Nabalema

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Nonprofit organizations play a crucial role in lobbying governments for policy changes besides engaging in direct service delivery. Improved utilization of research and other evidence in health policy and practice will help save lives and improve quality of life. This case study of WashOrg International in East Africa was informed by two major questions 1) how is evidence on water, sanitation and hygiene being used by non-profit organizations to shape policy advocacy activities 2) what kinds of internal capacity exist in WashOrg International to use water, sanitation and hygiene evidence to inform policy advocacy? Data were collected through semi-structured interviews, …

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

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Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …

The Experiences Of Black Men Living With Hypertension In Ontario, Canada: A Critical Narrative Study, Rob Haile

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To date, most Black hypertension literature centers on the risk factors predictive of hypertension, and the treatment of this condition within this population. The purpose of this critical narrative inquiry is to better understand how Black men make sense of their hypertension diagnosis, and how they negotiate this condition into their everyday lives. Eight individual in-depth interviews were utilized to elicit stories from four Black men living in Ontario, Canada. Additionally, a critical stance was used in this study to illuminate how racism and power dynamics embedded within social, historical, and political contexts affected participants’ experiences of living with hypertension. …