Public Health Commons^™

The Together Study: Exploring The Relationship Between Ontario Undergraduate University Students’ Levels Of Resilience And Their Experiences Of Diversity And Inclusion, Manvir Ahluwalia

Electronic Thesis and Dissertation Repository

This study’s primary purpose was to assess, quantitatively, the relationship between Ontario undergraduates’ levels of resilience and experiences of diversity and inclusion, and to identify demographic factors most associated with these outcomes. The secondary purpose was to explore, qualitatively, students’ experiences of diversity and inclusion and their perspectives on how these experiences influenced their resilience. Demographic questions, three scales, and (focus group and individual) interviews were used. Undergraduates (n = 276) from 19 Ontario universities completed the survey. Pearson’s correlation revealed a positive relationship between resilience and experiences of diversity and feelings of inclusion. Demographics indicative of equity-deserving group …

Voice: Exploring The Experiences Of University Students Who Have Experienced Gender-Based Violence, Rabani Nagra

Electronic Thesis and Dissertation Repository

Introduction: The occurrence and severity of gender-based violence (GBV) on Canadian higher education campuses has been a concern for decades. In September 2021, there were multiple reports of GBV at several Canadian universities with Western University being an exceptional case. The goal of this study was to explore: (1) the experiences of students who have experienced GBV during their enrollment at Western University; (2) the impact of GBV on students’ academics; and (3) student knowledge and experience with GBV resources.

Methods: This cross-sectional, qualitative study used an interpretive description framework and dialogue maps, underpinned by intersectionality. Seventeen undergraduate students were …

Sociodemographic Determinants Of Potentially Avoidable Hospitalizations Due To Ambulatory Care Sensitive Conditions Among Hospitalized Patients In The United States, Munira Kashem

Electronic Thesis and Dissertation Repository

Social determinants of health play a crucial role in explaining the variation of potentially avoidable hospitalizations (PAH) due to Ambulatory Care Sensitive Conditions (ACSCs). Utilizing data from the National Inpatient Sample from 2018 to 2020 in the United States, this study conducted retrospective cohort analyses to explore the relationships between sociodemographic factors, specifically income, race, geography, age, and sex and PAH. Our approach used multilevel logistic regression models to adjust for potential confounders and account for clustering of admissions within hospitals. Of the 17,629,891 hospital admissions examined in this study, 1,868,609 (10.6%) were attributable to ACSCs. Our results indicate that …

Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan

Electronic Thesis and Dissertation Repository

Patient-centered care (PCC) is a growing standard for healthcare delivery due to the benefits to patient autonomy. Lacking a cohesive definition in the physiotherapy literature, it is also lacking in implementation. Employing interpretive description with semi-structured interviews, the goal was to understand how physiotherapists drawn from private for-profit clinics in Canada describe PCC, and barriers and facilitators to providing it. Results included requiring person-centered communication in PCC, seeing Health holistically, centering the patient in care, and being a skill that becomes clearer with practice experience. Barriers included: lack of practitioner reflexivity, patient not desiring self-directed care, and limited access to …

Models Of Shared Care For The Management Of Psychotic Disorder After First Diagnosis In Ontario., Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: To describe the provision of care for young people following first diagnosis of psychotic disorder.

DESIGN: Retrospective cohort study using health administrative data.

SETTING: Ontario.

PARTICIPANTS: People aged 14 to 35 years with a first diagnosis of nonaffective psychotic disorder in Ontario between 2005 and 2015 (N=39,449).

MAIN OUTCOME MEASURES: Models of care, defined by psychosis-related service contacts with primary care physicians and psychiatrists during the 2 years after first diagnosis of psychotic disorder.

RESULTS: During the 2-year follow-up period, 29% of the cohort received only primary care, 30% received only psychiatric care, and 32% received both primary and …

Access To A Regular Primary Care Physician Among Young People With Early Psychosis In Ontario, Canada, Rebecca Rodrigues, Jennifer N S Reid, Joshua C. Wiener, Suzanne Archie, Richard G Booth, Chiachen Cheng, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Aristotle Voineskos, Paul Kurdyak, Saadia Hameed Jan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access.

METHODS: Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence …

Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi

Electronic Thesis and Dissertation Repository

Arthritis is a common disorder that may result in pain and inflammation, making it challenging to move or continue being active. Arthritis comes in a variety of forms. The two studies of this thesis aimed to identify the influence of intersectionality, especially sex and gender, in arthritis. The first study, a structured review, evaluated the inclusion of sex/gender and intersectional identities in patient resources of three arthritis societies: the Canadian Arthritis Society, the American Arthritis Foundation, and the National Rheumatoid Arthritis Society. The appraisal tool, the Sex/Gender and Intersectional Considerations in Patient/Consumer Health Information Appraisal Tool was used to evaluate …

Data-Driven Decision Support Tool Co-Development With A Primary Health Care Practice Based Learning Network, Jacqueline K. Kueper, Jennifer Rayner, Sara Bhatti, Kelly Angevaare, Sandra Fitzpatrick, Paulino Lucamba, Eric Sutherland, Daniel J. Lizotte

Epidemiology and Biostatistics Publications

Background: The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities’ Practice Based Learning Network (PBLN) data-driven decision support tool co-development project.

Methods: We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data. We summarize our work to date in …

The Predictors Of Multimorbidity (Defined As Diabetes + Hypertension) Amongst Males Aged 15-54 In India: An Analysis Of The Nfhs-5, Vikramjit Brar

Electronic Thesis and Dissertation Repository

Research Question: “What are the predictors of multimorbidity (defined as having diabetes + hypertension) amongst males aged 15-54 in India?”

Methods: Using mixed-effect multi-level binary logistic regression models, data from the 2019-2021 India NFHS-5 were analyzed. Separate multivariable analyses were conducted for males from urban and rural areas so the association between common predictors of interest (sociodemographic & lifestyle), and multimorbidity could be determined.

Results: Various predictors (listed below) were found to have a statistically significant association to multimorbidity with some variation across urban and rural areas:

Urban areas: Age, region of residence, wealth, religion, occupation, and …

The Role Of Patient And Rehabilitation Factors In The Recovery Of Home And Family Work Roles Following Distal Radius Fracture, Sheena Saju Philip Ms.

Electronic Thesis and Dissertation Repository

Background: Distal radius fracture (DRF) is a common upper extremity fracture that causes significant impairment and leads to difficulties in fulfilling important life roles such as indoor and outdoor cleaning, meal preparation, grocery shopping, caring for others, and earning and managing family income. However, clinicians do not routinely address home and family life roles after a DRF. Patient and rehabilitation factors are crucial in addressing home and family work roles (HFWRs). The HFWR questionnaire consists of tasks that are typically performed at home.

Objective: The overarching objective of this thesis is to explore the role of patient and rehabilitation …

"We Are The Living Dead": The Gendered Impacts Of Open-Pit Mining In The Dominican Republic, Klaire Gain

Electronic Thesis and Dissertation Repository

Despite a rhetorical commitment to enhancing community well-being, Canadian mining corporations have a history marked by ecological degradation and human rights violations, with women experience disproportionately negative impacts. While Latin America and the Caribbean (LAC) is a desired topography for open-pit mining, the geographical area of the Dominican Republic has been largely absent from the literature. As such, this dissertation, rooted in decolonial ecofeminism, enacted a critical narrative inquiry with 7 women from the Dominican Republic to explore the gendered impacts of open-pit mining on their health and well-being.

This thesis is composed of six chapters, with chapter one introducing …

Intimate Partner Violence, Mental Health Services And The Covid-19 Pandemic In Ontario: What Are The Differences, If Any, In Mental Health Service Accessibility And Service Satisfaction During Covid-19 Between Women In Abusive Relationships And Women In Non-Abusive Relationships?, Nokuzola Ncube

Electronic Thesis and Dissertation Repository

Introduction: Intimate partner violence (IPV) increased during the COVID-19 pandemic in Canada as a result of increased economic pressures and social isolation brought on by stay-at home orders. During the COVID-19 pandemic, women experiencing IPV experienced declines in mental health conditions and unique difficulties in accessing mental health services amid closures, shifts in service delivery, and inconsistent availabilities.

Methods: An online survey was administered to 44 women living in Ontario (23 who had not experienced IPV and 16 who had not) to explore their satisfaction and access to mental health services during the COVID-19 pandemic. Descriptive statistics were used to …

Developing An Online Questionnaire To Investigate The Covid-19 Pandemic’S Impacts On Social Isolation And Health In Older Adults Living With Multimorbidity: A Pilot Study, Patricia Nistor

Electronic Thesis and Dissertation Repository

Introduction. Social restrictions preventing the spread of COVID-19 possibly increased social isolation and loneliness. The validity and reliability of a questionnaire assessing the COVID-19 pandemic’s impact on social isolation and loneliness in community dwelling older adults with multimorbidity was investigated.

Methods. A conceptual framework was developed to guide questionnaire construction. Participants were recruited through professional networks, comprising a convenience sample. Feedback interviews assessed usability and face validity. Content validity was assessed using a Content Validity Matrix, and construct validity through tests of association. Reliability of validated scales was assessed using Cronbach’s ⍺. Descriptive statistics and logistic regression were computed. …

Social Supports For Adolescent And Young Adult Polycystic Ovary Syndrome Patients: A Scoping Review, Caitlin E. Mungall

Western Libraries Undergraduate Research Awards (WLURAs)

Polycystic ovary syndrome (PCOS) is a chronic disorder with negative health consequences for millions of women. The paucity of research regarding interventions targeting the psychosocial symptoms of PCOS for adolescents and young adults (AYAs), susceptible to low self-esteem and depression, warranted this review. This paper provides an overview of research on the social supports currently available for AYAs and identifies areas where further research is required to elucidate their support needs. A scoping review methodology identified 15 studies that met inclusion criteria. Findings revealed that this is an emerging field of research and most included studies originated in North America. …

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

Electronic Thesis and Dissertation Repository

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. …

The Impact Of Access To Oral Health Care On Inadequate Oral Health And Multimorbidity, Luis Limo

Electronic Thesis and Dissertation Repository

The connection between oral health and other non-communicable chronic conditions—commonly referred in the dental literature as the oral-systemic health connection—emphasizes the role of oral health care on both oral diseases and chronic conditions, particularly in vulnerable populations like the elderly. This thesis comprises 2 studies: the first is a systematic review on the impact of oral health care interventions, as an indicator of access to oral health care, on chronic conditions of which their co-existence would result in multimorbidity; the second study is a cross-sectional investigation of the associations between oral health, access to oral health care, and multimorbidity among …

Exploring The Experience Of Sexuality And Gender During The Healthcare Transition Of The Youth With Cerebral Palsy, Umma Salma

Electronic Thesis and Dissertation Repository

Background: Transition from the pediatric to adult health care system is an important phase of healthcare for youth with cerebral palsy (CP). Sexuality and gender are two very important components of health that are mostly ignored in the healthcare transition process. It is possible that health care providers only see a client’s disability, and therefore, key aspects of sexuality and gender diversity may be ignored, or deemed irrelevant as a result of their disability status. Therefore, the purpose of our study is to explore how gender and sexuality may influence the experience of health care transition for youth with cerebral …

(In)Dependence, Socio-Sexual Relationships, And Sexual Health Among Adults With Mild Intellectual Disability (Mid): A Critical, Qualitative Exploration, Vanessa L.E. Cox Ms

Electronic Thesis and Dissertation Repository

The purpose of this critical, qualitative study was to explore how adults with mild intellectual disability navigate independent socio-sexual relationships in settings where they are highly dependent upon caregivers and family members who exert significant control over most aspects of their lives. Data were gathered during one-on-one interviews conducted with adults with MID (n=15), and parental caregivers (n=6). Theoretical insights from critical disability studies and sexual citizenship were used to analyze the findings, which are presented thematically by study population. Participants with MID faced challenges to establishing and maintaining meaningful relationships, including a lack of choice about where and how …

The Changing Landscape Of Orthopaedic Surgery In Ontario: Where We Are, Where We Have Been, And Where We Are Going., Silvio Ndoja

Electronic Thesis and Dissertation Repository

Orthopedic surgery is a field which has often been talked about with regards to surgeon underemployment. This is particularly important given the paradoxical increasing demand for orthopedic care. There has not been well studied literature understanding the state of orthopedic surgery training in Ontario, Canada. Using a combination of various databases and surveying surgeons trained in Ontario we sought to provide some insight.

We demonstrated multiple important findings. More recent graduates are feeling less ready to enter practice and almost all graduates do at least 1 fellowship, with equal amount of 1 versus 2 fellowships. We showed an effect of …

Examining Individualized Participatory Approaches To Care For Individuals With Intellectual And Developmental Disabilities, Megann Yen Dong

Electronic Thesis and Dissertation Repository

Person-centred plans have been identified as an upstream approach to addressing the inequities experienced by individuals with intellectual and developmental disabilities. However, little evidence on implemented approaches exists. This integrated thesis consists of two studies exploring individualized participatory approaches to care within community-care services, guided by an integrated knowledge translation approach. The first study is a scoping review aimed to identify individualized participatory approaches to care in the literature. The second study is a qualitative descriptive study utilizing semi-structured interviews with community-care staff (n=11) to understand an operationalized person-centred planning approach. The scoping review provides insight into the variability of …

Sleep And Multimorbidity In The Canadian Longitudinal Study On Aging, Shreni Patel

Electronic Thesis and Dissertation Repository

Sleep health is a latent construct comprising various sleep measures such as duration, quality, initiation, maintenance, and daytime sleepiness. This thesis compared the association of two measures of sleep health, a conventional summary score and a pooled index, with incident multimorbidity over a 3-year follow-up in 30,097 middle- to older-aged adults from the Canadian Longitudinal Study on Aging. At baseline, approximately 26% and 29% of participants with multimorbidity displayed poor sleep patterns according to additive and pooled indexing methods. Longitudinal analysis indicated that those with additive scores of 4 to 5 at baseline had a 1.54 (95% CI: 1.18, 2.03) …

Primary Care Physician Engagement In Health System Transformation: A Case Study, Atharv Joshi

Electronic Thesis and Dissertation Repository

Primary care physician engagement is essential in enhancing organizational performance, system efficacy, and provider collaboration; yet limited literature exists within health systems research. This thesis explored physician engagement throughout the development of an organization known as the London Middlesex Primary Care Alliance (LMPCA). This thesis used a qualitative case study approach guided by a constructivist paradigm. The findings revealed six themes which contributed to the development of the LMPCA and provided insight into how physicians were engaged within health systems work. Unique to this study were two facilitators for engagement: the role of a transformation lead and the use of …

Ontario Adults' Mental Health, Wellbeing, And Prosocial Behaviour During The First 16 Months Of The Covid-19 Pandemic: A Longitudinal Study, Katie J. Shillington

Electronic Thesis and Dissertation Repository

The overall purpose of this dissertation was to provide a detailed assessment of the mental health, wellbeing, and prosocial behaviour of Ontario adults aged 30–59 (those at highest risk for losing years of healthy life due to chronic disease) during the first 16 months of the COVID-19 pandemic (April 2020–August 2021). To address this dissertation’s purpose specifically, four distinct yet thematically connected articles were written. Article 1 provides the starting point of this program of research via an overview of Ontario adults’ inter-related health behaviours (i.e., physical activity, sedentary behaviours, and dietary intake) and outcomes including, mental health, and wellbeing …

The Influences Of The Mindfulness Ambassador Program On Graduate Students, Varsha Vasudevan

Electronic Thesis and Dissertation Repository

The two-fold primary purpose of this pilot study was to: (1) explore, qualitatively, the influence of the Mindfulness Ambassador Program (MAP) on graduate students’ experiences of stress and their relationship with themselves and meaningful others; and (2) investigate, quantitatively, if participation in the MAP elicited changes in graduate students’ levels of stress, self-awareness, interpersonal skills, and/or social connectedness. The secondary purpose of this study was to gain an understanding of graduate students’ satisfaction with the MAP. This one-group mixed-method study utilized a brief demographic questionnaire, open-ended questions, semi-structured interviews, two MAP-specific program questionnaires, the Perceived Stress Scale, the Situational Self-Awareness …

Sociodemographic Factors And The Risk Of Paediatric Out-Of-Hospital Cardiac Arrest, Samina Idrees

Electronic Thesis and Dissertation Repository

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. This thesis aims to explore the relationship between sociodemographic factors and POHCA. The findings from our systematic review indicate that there are racial disparities in POHCA risk and in the provision of bystander cardiopulmonary resuscitation. There was little evidence of sociodemographic disparities in bystander defibrillation, survival and neurological outcome, particularly across adjusted analyses. The findings from our case-control study in Ontario, Canada, indicate that children living in marginalized areas have an elevated risk of experiencing POHCA. We also found that children living in northern urban or …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

Electronic Thesis and Dissertation Repository

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 …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

Electronic Thesis and Dissertation Repository

The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

Inaugural Artificial Intelligence For Public Health Practice (Ai4php) Retreat: Ontario, Canada, Jacqueline K. Kueper, Laura C. Rosella, Richard G. Booth, Brent D. Davis, Sarah Nayani, Maxwell J. Smith, Dan Lizotte

Computer Science Publications

The Artificial Intelligence (AI) for Public Health Practice Retreat was a hybrid event held in October 2022 in London, Ontario to achieve three main goals: 1) Identify both the goals of public health practitioners and the tasks that they undertake as part of their practice to achieve those goals that could be supported by AI, 2) Learn from existing examples and the experience of others about facilitators and barriers to AI for public health, and 3) Support new and strengthen existing connections between public health practitioners and AI researchers. The retreat included a keynote presentation, group brainstorming exercises, breakout group …

The Resilience And Socioeconomic Status Of Caregivers And School-Aged Children In The Context Of The Covid-19 Pandemic, Julia Yates

Electronic Thesis and Dissertation Repository

Introduction: The COVID-19 pandemic has challenged caregivers’ and school-aged children’s ability to adapt. Their adaptability may be due to their resilience, which socioeconomic status (SES) may impact.

Methods: Surveys were administered to 22 caregivers and 27 school-aged children (7-10 years) living in Ontario to measure their resilience and SES in the context of COVID-19. Correlations were employed to explore relationships between: (1) caregiver and child resilience; and (2) resilience and SES.

Results: Analyses found no significant relationship between caregiver and child resilience, nor resilience and SES in the context of COVID-19. Trends revealed caregivers with normal resilience had a higher …