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Aims and objectives: This review aimed to demonstrate the self‐care behaviours of first‐generation Chinese immigrants with cardiovascular disease in western countries and identify related cultural factors. Background: Self‐care is the cornerstone to mitigate disease symptoms and maintain health status. Chinese immigrants to western countries, operating within a cross‐cultural context, may find self‐care to manage their cardiovascular disease challenging. Design: An integrative review was conducted. Methods: Seven databases were searched Scopus, ProQuest Health & Medicine, Medline (Ovid), Embase (Ovid), AMED (Ovid), PsycINFO and CINAHL, with output limited to peer‐reviewed studies published from 2000 to 2020 in English or Chinese. Initially, 2037 papers were screened. Six papers were retained and critiqued using the Joanna Briggs Institute critical appraisal tools. Deductive and inductive approaches were utilised to analyse the findings. The PRISMA 2020 checklist informed review reportage. Result: In general, Chinese immigrants with cardiovascular disease took an active role in management of their cardiovascular disease, including through diet and activity adaptation and adherence to western medication. Families also played a significant role in disease decision‐making and management. However, language and cultural barriers impeded their access to health information and resources in host countries. Relevance to clinical practice: Understanding self‐care behaviours and associated cultural factors among Chinese immigrants with cardiovascular disease is important to improve nurses' culturally sensitive practices and provide tailored health education interventions to promote self‐care behaviours among immigrant populations. The scarcity of literature on self‐care behaviours among Chinese first‐generation immigrants with cardiovascular disease indicates the need for further research in this area. Development of culturally and linguistically sensitive health resources and education programs is urgently needed. [ABSTRACT FROM AUTHOR]

Nurses specialised in wound, ostomy and continence (NSWOCs) who are working during a pandemic require engagement in self-care. Nurses across all sectors -- clinical practice, education, leadership, policy, research and service -- are each deeply aware of the burden of COVID-19, and provide the best care when they engage in self-care activities. Recent COVID-19 studies evaluating the mental health and well-being of staff working in the pandemic are of concern as staff are burdened by pandemic demands. Mental health and well-being, as well as skin and eye care, are essential. This paper talks about the Canadian perspective. [ABSTRACT FROM AUTHOR]

This review uncovers the extent to which immigrant and minority women find HPV self-sampling an acceptable and feasible alternative to PAP testing for screening for cervical cancer. A focused literature review was conducted using CINAHL, Medline, Proquest and Pubmed databases to search for content relating to acceptability or feasibility of HPV self-testing for immigrant populations or minorities. 575 prospective relevant papers were included in the final analysis and 28 selected using the inclusion and exclusion criteria. HPV self-sampling was found to be acceptable and feasible among immigrant and minority women. Participants studied indicated the importance of providing in-depth educational documents, diagrams, illustrations and supplementary resources in future HPV self-sampling studies. HPV self-sampling has the potential to significantly increase cervical cancer screening participation rates amongst immigrant and minority women. Future research studies should incorporate methods to increase the efficacy and acceptability of HPV self-testing amongst immigrant and minority women. [ABSTRACT FROM AUTHOR]

Purpose Foreign-born families face challenges following migration to Canada that may impact their well-being and lead them to homelessness. Yet, there is limited research on the experience of homelessness in this population. The purpose of this paper is to examine the health of foreign-born families staying in the emergency shelter system in Ottawa, Ontario, Canada, and compare their experiences to Canadian-born homeless families who are also living in shelters.Design/methodology/approach Interviews were conducted with 75 adult heads of families who were residing in three family shelters. This study focused on mental and physical health functioning, chronic medical conditions, access to care and diagnoses of mental disorders.Findings Foreign-born heads of families reported better mental health than did Canadian-born heads of families with a significantly lower proportion of foreign-born participants reporting having been diagnosed with a mental disorder. Foreign-born heads of families also reported fewer chronic medical conditions than did Canadian-born heads of families.Research limitations/implications This study relied on self-reported health and access to healthcare services. Data were drawn from a small, non-random sample.Originality/value This study is one of the first studies to examine the health and well-being of homeless foreign-born heads of families. Moreover, this paper also focuses on disparities in health, diagnoses of mental disorders, and access to healthcare services between foreign-born and Canadian-born families – a comparison that has not been captured in the existing literature. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Communication between health professionals and patients is an intergroup phenomenon where the health professional has the most power and status. Over the past few decades, there has been a steady increase in the availability to patients of information about healthcare and specific diseases on the Internet. In this paper, we ask whether the use of Internet health information assists patients to manage their consultations with health professionals better and whether it alters the intergroup dynamic by providing a more equal status for patients. In this study 370 participants from Australia and Canada completed a survey that included a 'willingness to communicate with health professionals' scale. They also commented on their use and trust of Internet health information. Thematic analysis suggests that patients' use of Internet health information serves as a broker between patients and their health provider in health consultations. We discuss the implications of these findings for health practitioners as they address how easier Internet access influences patient interactions with health professionals. We consider future research directions these finding provide in explaining communication behaviour in this context. [ABSTRACT FROM AUTHOR]

A study regarding the role and uniqueness of psychiatric nursing was conducted with 94 participants from Manitoba, Canada. The primary theme of comprehensive knowledge of mental health, mental illness, and addictions was foundational for the application of the sub-themes of therapeutic relationship, holistic approach, recovery orientation, stigma reduction, and advocacy for change. Values, beliefs, and attitudes towards people with mental illness and addictions need to be instilled in psychiatric nursing students throughout their educational program to provide high quality, compassionate, and safe care. Implications for incorporation of the theme and sub-themes into psychiatric nursing curriculum are described in the paper. [ABSTRACT FROM AUTHOR]

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services. [ABSTRACT FROM AUTHOR]

A novel, complex chronic condition emerged from the COVID-19 pandemic: long COVID. The persistent long COVID symptoms can be multisystem and varied. Effective long COVID management requires multidisciplinary, collaborative models of care, which continue to be developed and refined. Alberta's provincial health system developed a novel long COVID pathway. We aimed to clarify the perspectives of multidisciplinary healthcare providers on the early implementation of the provincial long COVID pathway, particularly pathway acceptability, adoption, feasibility, and fidelity using Sandelowki's qualitative description. Provider participants were recruited from eight early-user sites from across the care continuum. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Participants participated in structured or semi-structured virtual interviews (both group and 1:1 were available). Structured interviews sought to clarify context, processes, and pathway use; semi-structured interviews targeted provider perceptions of pathway implementation, including barriers and facilitators. Analysis was guided by Hsieh and Shannon as well as Sandelowski. Across the eight sites that participated, five structured interviews (n = 13 participants) and seven semi-structured interviews (n = 15 participants) were completed. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Qualitative content analysis was used on transcripts and field notes. Provider perceptions of the early implementation outcomes of the provincial long COVID pathway revealed three key themes: process perceptions; awareness of patient educational resources; and challenges of evolving knowledge. [ABSTRACT FROM AUTHOR]

Engagement of community members to act as peer workers is a key feature of many community-centred health promotion programmes. However, little is known about their experiences beyond the commonly reported themes of fulfilment through helping people in need and improvement of personal confidence, self-esteem and self-care. This gap in the literature is of particular interest given increasing involvement of peer workers in community-centred programmes addressing health disparities, such as uptake of cancer screening. This paper aims to explore experiences of the peer leaders who worked for the Cancer Awareness: Ready for Education and Screening ( CARES) project to promote awareness, knowledge, and uptake of breast and cervical cancer screening among under-/never-screened women who belonged to ethnic minority, recent immigrant and low-income communities in Toronto, Canada. In 2013, three focus groups were conducted with 14 peer leaders to explore their experiences. All were immigrant women between 30 and 50 years of age. All discussions were audio recorded and transcribed verbatim. We used situational maps and analysis to create a visual representation of the data, and to investigate peer leaders experiences. Situational analysis was chosen to bring to light dominant and also silent underlying aspects which define the meaning of being a peer leader. The first level of analysis identified main themes that characterised peer leaders' experience: (i) Helping others (women, friends and family) and themselves by improved self-confidence, self-awareness and self-care and (ii) Redefining professional and social positions through their project activities leading to professional development and networking. The second level of analysis explored the redefining process and identified some peer leaders' negotiations in relation to knowledge (science vs. myth), beliefs (fear vs. assurance) and boundaries (private vs. work). Adding to the literature on the peer workers' experience, the findings are discussed in relation to empowerment of peer workers, training implications and theoretical contributions. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to review the contribution of mobile health applications (‘apps’) to consumers’ self-management of chronic health conditions, and the potential for this practice to inform health policy, procedures and guidelines. Methods. A search was performed on the MEDLINE, Cochrane Library, ProQuest and Global Health (Ovid) databases using the search terms ‘mobile app*’, ‘self-care’, ‘self-monitoring’, ‘trial’, ‘intervention*’ and various medical conditions. The search was supplemented with manual location of emerging literature and government reports. Mapping review methods identified relevant titles and abstracts, followed by review of content to determine extant research, reports addressing the key questions, and gaps suggesting areas for future research. Available studies were organised by disease state, and presented in a narrative analysis. Results. Four studies describing the results of clinical trials were identified from Canada, England, Taiwan and Australia; all but the Australian study used custom-made apps. The available studies examined the effect of apps in health monitoring, reporting positive but not robust findings. Australian public policy and government reports acknowledge and support self-management, but do not address the potential contribution of mobile interventions. Conclusions. There are limited controlled trials testing the contribution of health apps to consumers’ self-management. Further evidence in this field is required to inform health policy and practice relating to self-management. [ABSTRACT FROM AUTHOR]

Introduction: Creating safer care is a high priority across healthcare systems. Despite this, most systems tend to focus on mitigating past harm, not creating proactive solutions. Managers and staff identify safety threats often with little input from patients and their caregivers during their health encounters. Methods: This is a qualitative descriptive study utilizing focus groups and one‐to‐one interviews with patients and caregivers who were currently using (or had previously used) services in health systems across Canada. Data were analysed via inductive thematic analysis to understand existing and desired strategies to promote safer and better quality care from the perspectives of patients and caregivers. Findings: In our analysis, we identified three key themes (safety strategies) from patients' and caregivers' perspectives and experiences: Using Tools and Approaches for Engaging Patients and Caregivers in their Care; Having Accountability Processes and Mechanisms for Safe Care; and Enabling Patients and Caregivers Access to Information. Conclusions: Safety is more than the absence of harm. Our findings outline a number of suggestions from patients and caregivers on how to make care safer, ranging from being valued on teams, participating as members of quality improvement tables, having access to health information, having access to an advocate to help make sense of information and having processes in place for disclosure and closure. Future work can further refine, implement and evaluate these strategies in practice. Patient or Public Contributions: An advisory group guided the research and was co‐chaired by a patient partner. Members of the advisory group spanned patient and caregiver organizations and health sectors across Canada and included three patient partners and leaders who work closely with patients and caregivers in their day‐to‐day work. In the research itself, we engaged 28 patients and caregivers from across Canada to learn about their safety experiences and learn what safer care looks like from their perspectives. [ABSTRACT FROM AUTHOR]

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults' ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens. [ABSTRACT FROM AUTHOR]

Background: Stanford's Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010-2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process.Methods: Multiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants' experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G).Results: Two hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization.Conclusions: Our findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness. [ABSTRACT FROM AUTHOR]

Background: Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. Methods: We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. Results: We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. Conclusions: This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this qualitative research study is to explore health-care providers' perspectives and experiences with a specific focus on supports reported to be effective during the COVID-19 pandemic. The overarching goal of this study is to inform leaders and leadership regarding provision of supports that could be implemented during times of crisis and in the future beyond the pandemic. Design/methodology/approach: Data were collected by semi-structured, conversational interviews with a sample of 33 health-care professionals, including Registered Nurses, Nurse Practitioners, Registered Psychologists, Registered Dieticians and an Occupational Therapist. Findings: Three major themes emerged from the interview data: (1) professional and personal challenges for health-care providers, (2) physical and mental health impacts on health-care providers and (3) providing supports for health-care providers. The third theme was further delineated into three sub-theses: formal resources and supports, informal resources and supports and leadership strategies. Originality/value: Health-care leaders are advised to pay attention to the voices of the people they are leading. It is important to know what supports health-care providers need in times of crisis. Situating the needs of health-care providers in the Carter and Bogue Model of Leadership Influence for Health Professional Wellbeing (2022) can assist leaders to deliberately focus on aspects of providers' wellbeing and remain cognizant of the supports needed both during a crisis and when circumstances are unremarkable. [ABSTRACT FROM AUTHOR]

kwong e.w.-y., pang s.m.-c., choi p.-p. & wong t.k.-s. (2010) Influenza vaccine preference and uptake among older people in nine countries. Journal of Advanced Nursing 66(10), 2297–2308. Aim. This paper is a report of a study delineating factors that influence older people’s preferences and uptake of the influenza vaccine in nine countries. Background. Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. Method. A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. Findings. We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants’ vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. Conclusion. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access. [ABSTRACT FROM AUTHOR]

Objective This study had two objectives. First, to understand and then describe the experiences of persons who inject drugs (PWID) and who use self-care treatment(s) to deal with resulting skin and tissue abscesses. Next, to understand and describe their journeys to and experiences with formal healthcare service provision. Methods Semi-structured interviews were conducted with ten adults who have experience with abscesses, engage in self-care treatment(s), and utilise formal healthcare services in Nova Scotia, Canada. Results Participants lived with abscesses and utilised various self-treatment strategies, including support from friends. Participants engaged in progressive self-care treatment(s) as the abscesses worsened. They reluctantly made use of formal healthcare services. Finally, participants discussed the importance of education. Moreover, they shared their thoughts in terms of how service provision could be improved. Conclusions Participants described their lives, including their journeys to intravenous drug use. They also described the self-care treatments they used to heal resulting abscesses. They used these self-care treatments because of a reluctance to utilise formal healthcare services. From a quality improvement perspective, participants outlined suggestions for: 1) expanding hours of service at the community wound care clinic and the centre; 2) permitting pharmacists to include prescribing topical and oral antibiotics; 3) promoting abscess prevention education for clients and healthcare providers; and 4) promising practices for the provision of respectful care during emergency care visits. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic, and the Tokyo Olympic Games postponement, has created unprecedented challenges for Olympic level athletes. Given the adversity athletes have faced since the World Health Organization (WHO) declared COVID-19 a global pandemic, the construct of psychological resilience is a useful framework for understanding athlete experiences during this time, and is conceptualized by Fletcher and Sarkar as an individual's ability to protect against the negative effect of stressors. The purpose of this research was to explore the experiences of Canadian athletes preparing for the Tokyo summer Olympic Games during the COVID-19 global pandemic. Interviews were conducted with 20 Canadian athletes across individual and team sports. The participants spoke of the multiple ways they were taking care of themselves and developing resilience throughout the pandemic, highlighting the complexity involved with managing an adversity. Four narratives illuminate the athletes' experiences: the critical role of context, the essential nature of social support, the importance of being more than an athlete, and the relevance of learning to reflect on one's life. For these athletes, factors such as Olympic qualification, stage of their career, physical and mental health, and access to resources influenced their experience of the pandemic, demonstrating the importance of both individual and environmental factors when exploring resilience. Importantly, the athletes did not manage this adversity on their own, but received strong support. Therefore, sport psychology consultants can assist an athlete's development of resilience by providing expertise and taking into account an athlete's personal context. Lay summary: Twenty athletes preparing for the Tokyo Olympic Games during the COVID-19 pandemic were interviewed and four narratives are presented. All athletes were experiencing the pandemic differently based on their personal circumstances and were managing the adversity with social support, reflection, and pursuits beyond sport. Develop resources for coaches, athletes, and sport psychology practitioners to become competent in understanding and developing a high-performance sport environment that is both challenging and supportive Recognize the importance of social support in learning how to effectively reflect and develop pursuits outside of high-performance sport Understand and develop resilience, in a way that promotes, rather than diminishes, mental health [ABSTRACT FROM AUTHOR]

Objective This qualitative inquiry explored the meaning associated with diabetes for people with type 1 and type 2 diabetes who developed diabetic foot ulcer (DFU). Methodology This qualitative study used a social constructivism and symbolic interactionism (SI) framework to guide the study design. The participants for this study were 30 adults with type 1 or type 2 diabetes and a DFU who met the research criteria and attended a wound care clinic in Ontario, Canada, between April and August 2017. Results Qualitative content analysis revealed three major subcategories that represent the core category (the meaning of diabetes) along with participants' perception of having diabetes and its particular complication -- 1) diabetes is a lifelong disease that you need to live with, 2) diabetes can damage your body, and 3) diabetes can kill you slowly. Conclusions The complexity of self-care and the consequences of unregulated diabetes influenced participants' perception, meaning, motivation, actions and reactions to diabetes. Understanding that each person with diabetes is unique and may experience or are affected by the disease in different ways helps healthcare providers (HCPs) to better understand how to address each individual's unique and complex needs. [ABSTRACT FROM AUTHOR]

Objective: Interventions for knee osteoarthritis (OA) in adults with a large body size (defined as a body mass index [BMI] ≥ 35 kg/m2) often prioritise weight‐loss, which may overshadow specific benefits for physical function, metabolic health, and body composition. As part of the development of a future clinical study, we gathered perspectives from individuals living with knee OA and a large body size to inform the proposed intervention design and delivery. Methods: Purposive and voluntary sampling was used to engage individuals ≥40 years of age with self‐reported knee OA and a BMI ≥ 35 kg/m2. An anonymous electronic survey was distributed on social media between April 2020 and June 2020. Open‐ended questions addressed a proposed 12‐week multimodal intervention (involving targeted nutrition, resistance exercises, and self‐management support). An optional semi‐structured interview was offered upon completion, with interviews recorded and transcribed verbatim. Reflexive thematic analysis and interpretation guided by an acceptability framework was used to identify recommendations for the intervention design and delivery. Results: Twenty individuals living across Canada completed the survey (100% female; 18 aged <65 years and 2 ≥ 65 years). Ten individuals completed the interview. From aggregate survey and interview data, three recommendations were generated: (1) the effectiveness of the intervention for health improvement (specifically mobility and pain) must be emphasised to avoid perceived weight‐loss expectations; (2) extend support beyond 12‐weeks and consider terminology free from weight‐bias to enhance acceptance; (3) include optional customisation of intervention delivery to reduce acceptability‐related burden. Conclusion: These female patient‐derived recommendations may improve perceived intervention acceptability, and thereby may enhance participant enrolment and retention in clinical trials. [ABSTRACT FROM AUTHOR]

Use of online health information is positively associated with citizen knowledge, empowerment, self-care, health outcomes, and quality of life. However, little is known about how mothers with incomes below the poverty threshold and with education levels of high school or less use and interact with the Internet as a key source of lay knowledge and skills for infant care and childrearing. Our objective in this study was to understand mothers' perceptions of their experience in using online information for these purposes. To obtain a rich and nuanced understanding of their experience, we used a qualitative study approach based on 40 individual semi-structured interviews with mothers. Adopting Freidson's concept of "lay referral system" to grasp mothers' experience with online parenting information, we found that they relied on this information source extensively. Our findings showed that Internet-based information and online interactions were part of their lay referral system and modified to some extent how they interacted with their lay consultants (family and friends). Three major themes emerged in relation to how the Internet functioned as a component of the mothers' lay referral systems: (1) strategic use of the Internet for better parenting; (2) critical stance towards the Internet; and (3) strengthening of autonomy, skills, and self-confidence. Mothers with spouses and an active social network were more likely to use online information to complement information obtained from their entourage or from professionals than were mothers with a less active social network or who were more socially isolated. Highlights: Mothers with incomes below the poverty threshold and with low educational attainment made extensive use of Internet-based information for child care and parenting. Mothers applied critical judgment to use online information strategically. For some mothers, information obtained or shared on the Internet replace conversations with family members or professionals. [ABSTRACT FROM AUTHOR]

Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside – one of Canada's overdose epicenters – this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations. [ABSTRACT FROM AUTHOR]

Objectives: Health status (HS)/ health-related quality of life measures, completed by self or proxy, are important outcome indicators. Most HS literature on children born preterm includes adolescents and adults with limited data at preschool age. This study aimed to describe parent-reported HS in a large national cohort of extreme preterm children at preschool age and to identify clinical and sociodemographic variables associated with HS.Methods: Infants born before 29 weeks' gestation between 2009 and 2011 were enrolled in a prospective longitudinal national cohort study through the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-Up Network (CNFUN). HS, at 36 months' corrected age (CA), was measured with the Health Status Classification System for Pre-School Children tool completed by parents. Information about HS predictors was extracted from the CNN and CNFUN databases.Results: Of 811 children included, there were 79, 309 and 423 participants in 23-24, 25-26 and 27-28 weeks' gestational age groups, respectively. At 36 months' CA, 78% had a parent-reported health concern, mild in >50% and severe in 7%. Most affected HS attributes were speech (52.1%) and self-care (41.4%). Independent predictors of HS included substance use during pregnancy, infant male sex, Score for Neonatal Acute Physiology-II, bronchopulmonary dysplasia, severe retinopathy of prematurity, caregiver employment and single caregiver.Conclusion: Most parents expressed no or mild health concerns for their children at 36 months' CA. Factors associated with health concerns included initial severity of illness, complications of prematurity and social factors. [ABSTRACT FROM AUTHOR]

Only a fraction of problematic cannabis users ever seek treatment from specialty addiction services. This gap could be reduced via online brief interventions and self-help resources; however, it is not clear whether cannabis users would be interested in accessing those tools. We examined whether cannabis use, motives for using cannabis, and protective behavioral strategies predicted hypothetical interest in accessing online self-help resources. We hypothesized that greater interest in accessing self-help materials would be predicted by (1) problematic cannabis use, (2) using cannabis to cope with negative affect, and (3) fewer cannabis-related protective behaviors. These predictions were tested in a secondary analyses of data from 649 cannabis-using Canadian university students (42.5% male; M age = 22.5) participating in a population survey. Data were analyzed using set wise hierarchical multiple linear regression models to predict hypothetical interest in online self-help resources, from cannabis use, motives, and protective behaviors. Problematic cannabis users reported more interest in hypothetically accessing online supports than non-problematic users. Problematic cannabis use, coping, and expansion motives, and protective behaviors were positively associated with hypothetical interest in accessing online resources. Findings suggest that online self-help interventions might be an effective public health approach to reduce cannabis use among Canadian university students. [ABSTRACT FROM AUTHOR]

lobchuk m.m., mcpherson c.j., mcclement s.e. & cheang m. (2011) A comparison of patient and family caregiver prospective control over lung cancer. Journal of Advanced Nursing 68(5), 1122-1133. Abstract Aim. This paper is a report of our secondary analysis of patient and family caregiver prospective control in lung cancer. Background. Control beliefs underlie self-care in sickness and health. Self-care often involves 'shared' activities between the afflicted individual and caregiving family and friends. However, depending on how control is perceived, conflicts can occur in decision-making thus jeopardizing optimal self-care. We need to comprehend how control beliefs compare between patients and caregivers and how their control beliefs are linked with dealing with serious illness. Methods. Based on questionnaire data collected in our larger study between September 2005 and February 2009, we conducted exploratory comparative analyses of 304 patients' and caregivers' control beliefs in managing lung cancer. Eight 5-point response items captured prospective control. Exploratory factor analysis with promax rotation was conducted to compare dyadic perceptions on the dimensionality of prospective control. We also conducted exploratory correlations between control beliefs and smoking cessation, attributional reactions, caregiver helping and symptom reports. Results. Principal component analysis identified the same factors for patients and caregivers: factor 1, Fate control and factor 2, Team control. Patient and caregiver 'Fate' and 'Team' control sub-scales were respectively associated with hope, caregiver helping and patient smoking cessation. Conclusion. Clinicians need to support, adapt or develop a philosophy of cancer care that is inclusive of partnerships, drawing on beliefs of patients and caregivers that controlling lung cancer is a team effort which in turn is tentatively linked to patient smoking cessation, positive emotions and caregiver helping. [ABSTRACT FROM AUTHOR]

Peer volunteers provide valuable support to foster parents. However, there has been limited research on what they consider to be valuable preparation for the role. In the present study, they were asked: "What is essential training for peer support volunteers to receive before starting?". Fifteen participants grouped 41 different responses that were analyzed using multidimensional scaling and cluster analyses. The resulting concepts included: (a) self-care, (b) effective use of self, (c) policies and procedures, (d) finding information and (e) how to address common challenges. Highlights: Goals: The study's goal was to identify the training needs of foster parent peer support volunteers from the perspective of active peer support volunteers. Methods: Methods included multidimensional scaling and cluster analysis on 41 different responses to a focal question about "essential training for peer support volunteers." Results: Results of the cluster analysis yielded five themes related to self-care and use of self and policies, accessing information and problem-solving. [ABSTRACT FROM AUTHOR]

Given barriers of patient-centred care (PCC) among physicians and trainees, this study assessed how medical schools addressed PCC in curriculum. The authors used content analysis to describe PCC in publicly-available curriculum documents of Canadian medical schools guided by McCormack's PCC Framework, and reported results using summary statistics and text examples. The authors retrieved 1459 documents from 16 medical schools (median 49.5, range 16–301). Few mentioned PCC (301, 21.2%), and even fewer thoroughly or accurately described PCC. Significantly more clerkship versus pre-clerkship (24.0% vs 12.6%, p < 0.00001), and elective compared with core course descriptions (24.7% vs 14.9%, p < 0.00001) mentioned PCC. The domain of foster a healing relationship was common (79.0%) compared with other domains: address concerns (16.5%), exchange information (14.9%), enable self-care (10.4%), share decisions (4.5%), and manage uncertainty (1.3%). Overall, few documents mentioned or described PCC or related concepts. This varied by school, and was more frequent in clerkship and elective courses, suggesting that student exposure may be brief and variable. Thus, it remains unclear if medical students are fully exposed to what PCC means and how to implement it. Future research is needed to confirm if PCC content in medical curriculum is lacking. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Patients adapt to cancer through self‐management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient–provider collaboration during radiotherapy and examine associations among patient–provider collaboration, self‐management and well‐being. Methods: An observational, cross‐sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one‐time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self‐management and well‐being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient–nurse and patient–oncologist collaboration. Results: Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient–nurse and patient–oncologist collaboration models, where collaboration predicted one self‐management aspect, and both physical and mental well‐being. Conclusion: During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self‐management skills. Initiatives to strengthen patient–provider relationships and support self‐management should be developed and applied to interprofessional‐cancer‐care teams. Impact: This is the first known study to empirically support the links among patient–provider collaboration, self‐management and patient outcomes. The study results can enhance practice, research and education. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PURPOSE: Arthrogryposis multiplex congenita (AMC) refers to a large heterogeneous group of conditions involving joint contractures in two or more different areas of the body. Contractures can lead to decreased range of motion and strength, and affect ambulation and autonomy. The aim of this study was to describe the orthopedic interventions and functional outcomes of a large cohort of children with AMC followed in a pediatric orthopedic center. METHODS: A retrospective chart review of all children diagnosed with AMC followed at Shriners Hospital for Children – Canada (SHC) between January 1979 and July 2016 was conducted. One hundred twenty patients were identified, of whom six were excluded due to misdiagnosis or insufficient chart information. One hundred fourteen were retained. Patient demographics, AMC classification, comorbidities, operative and non-operative treatments received as well as community ambulation status, level of autonomy in self-care and transfers at latest follow-up were recorded. RESULTS: There were 54 males and 60 females with a mean age at last clinic visit of 10 years 3 months. Amyoplasia and distal arthrogryposis (DA) were equally represented in our sample, 47 (41.2%) and 49 (43.0%) participants respectively, with the category Other comprising the remaining 18 (15.8%) participants. Children with DA had less involvement of the proximal joints than those in the two other groups. Contractures and deformities of the foot and ankle were the most prevalent, affecting 91.5% with Amyoplasia, 85.7% with DA and 83.3% in the Other category. Contractures of the shoulder and elbow were more common among individuals with Amyoplasia and those categorized Other than those with DA. In terms of walking ability, 98% of participants with DA were independent ambulators. Walking ability varied among the Other participants. Similarly, most children with DA were independent in self-care and transfers at the most recent follow-up. CONCLUSION: The relatively large sample size of this study allowed for a better insight into the challenges associated with AMC management. These findings demonstrated the need for genetic testing to provide accurate diagnosis and classification, along with the use of standardized outcome tools to measure effectiveness of interventions. As AMC is rare, multi-site prospective studies are needed to improve research opportunities, develop functional measures specific to AMC and disseminate findings on a wider scale. [ABSTRACT FROM AUTHOR]

Objective: Older adults with cancer have unique information and supportive care needs. There is a growing body of literature regarding the use of Internet health information, but less is known about the use of the Internet for cancer information amongst older adults with cancer. Materials and methods: This is a secondary analysis of qualitative data from a mixed‐methods study of the use of cancer‐related Internet information amongst adults with cancer. In the present study, we include transcripts from two samples: 34 interviews with adults over age 55 (n = 17) with cancer, and interviews and focus groups with healthcare professionals (n = 21). Data were analysed using thematic analysis with an interest in age‐related themes. Results: Our findings are grouped into three main themes: (a) independently augmenting healthcare services and supports; (b) supporting and situating information; and (c) mobilising family and support networks. Patients and healthcare providers described cancer‐related Internet information as a beneficial resource to address gaps in information and supplement information from healthcare professionals from diagnosis and throughout treatment. Older adults reported using cancer‐related Internet information to manage their cancer experience, although sometimes feeling technologically hesitant. However, healthcare professionals felt older adults were less likely than younger patients to seek cancer information from the Internet. Conclusion: The use of cancer‐related Internet information is growing amongst older adults with cancer. Older adults mobilise technology uniquely. Healthcare professionals can support these efforts by being aware and through initiating dialogue about information preferences. [ABSTRACT FROM AUTHOR]

Aims: This retrospective, exploratory study aimed to examine the categories and frequency of occupational performance issues (OPIs) identified by children (or their caregivers), who participated in a two-week, group-based modified constraint induced movement therapy program, Helping Hand. The effect of participant age on the OPIs identified was also explored. Methods: OPIs were identified using the Canadian Occupational Performance Measure for 46 Helping Hand participants, prior to program participation. Descriptive statistics including the frequency of identified OPIs were used to categorize the 236 OPIs into occupational areas. Descriptive statistics were also used to determine how the categories of OPIs and relative frequencies differed based on participant age. Results: The identified OPIs were diverse, and differed in frequency of identification and level of specificity. The OPIs identified varied based on participant age, with age groups showing developmentally appropriate differences in OPIs. Conclusions: Identification of OPIs should balance client-centredness with probing for specificity, in order for OPIs to be understood by clinicians. This will guide future program development and interventions that target age-appropriate occupational priorities. [ABSTRACT FROM AUTHOR]

Introduction: An occupational repertoire is the array of occupations that an individual has the perceived capacity to perform at a specific point in time. The Occupational Repertoire Development Measure – Parent is a new tool that uses parent report to identify the occupations children can and do perform and their interests in and opportunities for doing them. This study aimed to test the face validity, comprehensiveness, and internal consistency of the Occupational Repertoire Development Measure – Parent as a tool to measure the occupational repertoire of children aged between 2 and 12 years. Method: Twenty-nine occupational therapists completed an online questionnaire about the Occupational Repertoire Development Measure – Parent, and 27 parents completed it and then provided feedback via a structured interview. Descriptive statistics, content analysis, and the content validity index guided data analysis. Results: Participants view the Occupational Repertoire Development Measure – Parent as practical, simple, and supportive of occupation-centred practice to optimize children's development of a meaningful repertoire. Overall, self-care occupations were rated highly relevant. Lower-scoring occupations were those perceived as performed only by older children, nonessential for children with disabilities, or culturally unimportant. Conclusion: Results indicate value in the further development of the Occupational Repertoire Development Measure – Parent and validate that it asks relevant questions to understand a child's performance, engagement, and opportunities, leading to optimal repertoire development. [ABSTRACT FROM AUTHOR]

Background: The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) is the Canadian–French adaptation of the Melbourne Low-Vision ADL Index. It measures performance, personal importance and handicap situation in 16 instrumental activities requiring near vision (standardized material, part A) and in 9 self-care and domestic activities (self-report questionnaire, part B). This study aimed at measuring the MIDVAQ reliability and its relationship with measures of visual functions and functional vision. Methods: The MIDVAQ was administered twice to 100 visually impaired participants, at home, with their personal visual and non-visual aid. A second rater was present at T1. Two different versions of part A were used alternately at T1 and T2. Results: The total Handicap scale demonstrates good internal reliability (Cronbach's alpha coefficient = 0.82) and very high inter-rater and test-retest reliability (ICCs = 1.00 and 0.86). Part A alternative versions are highly comparable. Vision function measures are significantly correlated with total Handicap score, for which 48% of the variance is explained by functional vision estimates, age, and education. Conclusions: The MIDVAQ is highly valid and reliable. It can be useful to measure the functional impact of the visual impairment, its progression, and the outcomes of low vision rehabilitation services. Even if administered at home in an ecological way, this measure of the impact of the visual impairment in daily activities is very reliable. Given its good metric properties, this tool can be confidently used to assess the functional impact of visual impairment, outcomes of the low vision rehabilitation services, etc. This measurement tool provides complementary information to those obtained from clinical measures of visual functions, by reflecting the interaction between the functional abilities with the requirements of the environment. [ABSTRACT FROM AUTHOR]

Within Canada, the homeless have four times the cancer rates of the general population, lower rates of screening, later stage diagnosis, and poorer outcomes. In the United States, disparities in cancer burden also exist between the homeless and the housed. For example, lung cancer deaths occur at double the rate for the homeless compared with the housed. Cancer care is complex and requires many high-order health literacy skills to obtain and understand the information needed to make informed decisions about cancer care. A scoping review was conducted to summarize what is known about, the homeless, cancer and health literacy. The literature search yielded 1,124 articles. Of these, 33 articles met eligibility criteria. Results suggest that low health literacy may have a significant effect on access to cancer screening and care among the homeless population. [ABSTRACT FROM AUTHOR]

With decreasing inpatient lengths of stay following spinal cord injury (SCI), newly injured patients may be discharged into the community without the self-management skills needed to prevent secondary conditions. A mobile app was developed to facilitate self-management skills following SCI in the inpatient rehabilitation and early community settings. The objective of this study was to explore patients' perspectives on the usability of this self-management app. A mixed-methods study design was implemented. The app was trialed at a local rehabilitation centre with 20 inpatient participants who experienced a SCI. They received mobile app training sessions throughout their inpatient rehabilitation. A thematic analysis was performed on qualitative data from post-discharge exit questionnaires and researchers' field notes. Quantitative data (in the form of participants' tool usage data and self-reported system usability scale scores) were collected at discharge and 3 months post-discharge. Three main themes emerged from the qualitative analysis: (1) being accessible to users (i.e., being easy to adopt and compatible with assistive technologies), (2) being intuitive to navigate (i.e., incorporating a simple app layout and a system of alert notifications), and (3) offering users flexibility (i.e., providing users with control over their data). The mobile app received above average mean system usability scale scores, both at discharge (78.1/100) and 3 months post-discharge (71.6/100). Given that participants found the app acceptable for use in inpatient rehabilitation and following discharge into the community, further testing is warranted to explore its efficacy in preventing secondary complications. [ABSTRACT FROM AUTHOR]

Developing culturally appropriate diabetes nutrition interventions for immigrants could be facilitated knowing what is successful in the home country and other relevant countries. The primary purpose of this scoping review was to identify the design and delivery methods of nutrition interventions for Chinese populations with type 2 diabetes, in their home countries and as immigrants to western countries. A total of 14 articles was retrieved and included. Overall, the approaches used in China often were modelled on intensive lifestyle programs although alternative strategies were also identified. Most interventions were not focussed solely on nutrition, and only a few were conducted in community settings. Most of the interventions were delivered in a group format, while those conducted in China also included individual counselling, particularly for nutrition. In addition, the diabetes and nutrition-related outcomes, cultural relevance and acceptability, and other factors that influenced protocol compliance were considered. Improvements in blood glucose control were observed in participants in all interventions where it was measured. Participants reported increased nutritional knowledge but nutritional behaviour was generally not well documented. Trials conducted in the United States emphasized the importance of cultural adaptation of intervention programs, particularly with respect to dietary patterns and specific foods. Practice-transferable characteristics are highlighted. Research gaps included trials conducted in community settings with pragmatic implementation and evaluation, comparative trials of interventions to gauge relative effectiveness, and measuring and reporting dietary outcomes for better understanding of the impact on dietary behaviours and their relationship to health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This article explores first-hand accounts of Canadian bariatric patients' experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While researchers have identified many of the challenges and associated health and safety risks imposed on patients by engaging in medical tourism generally, little is known about the specific challenges experienced by Canadians seeking bariatric surgery abroad.Method: To better understand these challenges, we conducted thematic analysis on interviews conducted with 20 former Canadian bariatric tourists.Results: Our analysis illuminated three key challenges Canadians face in obtaining bariatric care: (1) stigma and isolation from friends, family and medical professionals; (2) self-directed navigation of domestic and destination health care systems; and (3) challenges with obtaining adequate follow-up care in Canada.Conclusions: While these challenges identified by participants may occur in other forms of medical tourism, it appears that these challenges are occurring simultaneously in cases of bariatric tourism by Canadians. These challenges appear to work in conjunction to heighten the health and safety risks potential Canadian bariatric tourists may be exposed to. Unless structural changes occur to increase domestic availability of bariatric surgery, Canadians are likely to continue seeking this care abroad. [ABSTRACT FROM AUTHOR]

With decreasing inpatient rehabilitation lengths of stay, there may be a greater risk of spinal cord injury (SCI) populations being discharged into the community without the self-management skills needed to prevent secondary complications. Recent advancements in mobile health has made mobile apps a feasible method of delivering population-based, self-management interventions to address SCI-specific secondary complications. The objective of this study is to describe stakeholder perspectives on the development of a functional mobile app to facilitate self-management skills needed to prevent secondary complications following recent SCI during inpatient rehabilitation. A user-centered design approach was used that involved an evolving mobile app and the collection of prospective qualitative data. Stakeholders from three groups were enrolled in the study: individuals admitted for rehabilitation following SCI (n = 20) and informal (n = 7) and formal (n = 48) caregivers. Iterative feedback was gathered from rehabilitation inpatients during ongoing interactions and via post-discharge exit questionnaires, from informal caregivers via one-on-one interviews, and from formal caregivers via series of focus groups at various phases throughout the design process. Three main themes emerged from the analysis: (1) being individualized and user friendly (i.e., developing an app that is simple and easy to use to facilitate universal uptake), (2) targeting goals to promote self-management (i.e., adopting self-management skills relative to personal goals and confidence), and (3) increasing participation and support-seeking to facilitate lifestyle change (i.e., encouraging leisure activities to facilitate community integration). Key stakeholder perspectives contributed to the development of a self-management mobile app that will be evaluated in future research. [ABSTRACT FROM AUTHOR]

This qualitative study explored the experiences and patterns of recovery of Chinese-born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in "survival" recovery in the short term and "thriving" recovery in the long term, with survival strategies extending into the thriving phase of recovery during their complex path to it. The survival recovery phase included accessing culturally sensitive mental health care and obtaining social and instrumental support to help ensure safety, manage stress, and treat psychiatric symptoms. The thriving phase of recovery was described as involving six components: developing an explanatory model with their health care provider; undertaking a process of narrative reflection and prioritizing self-care; engaging in interdisciplinary care team support; engaging the support of family and friends; exploring spiritual and existential supports; and creating goals for the future and a sense of mastery. Through these six avenues, the women began to experience a sense of self-efficacy and agency that improved their ability to cope with stress and pressure, leading to building a life with meaning. The interviews provided insights into how clinical care can be improved and how practitioners can implement a more recovery-oriented approach to practice. [ABSTRACT FROM AUTHOR]

Later life care practices are closely entangled with the ideals of independence and dependence. Based on an interpretive analysis of qualitative interviews with 34 people aged 65–100 receiving home care in Ontario, Canada, this article explores older people's subjective interpretations of caring for themselves (i.e. independence) and receiving support from others (i.e. dependence). Findings suggest that individuals construct subjective meanings of independence in relation to their changing physical capacities, and in the context of their relationships with family members, friends and formal care providers. First, participants considered their care activities to be a way of maintaining independence when they undertook certain practices with the intention of staving off dependency and future decline. Second, when they accepted assistance, many engaged in care relations that allowed them to preserve an independent identity in the face of limits to physical self-sufficiency. Third, participants reached the limits of independence when they lacked adequate assistance, and were unable to care for themselves in desirable ways. Findings illustrate how objective circumstances related to social and financial resources as well as access to formal services shape subjective interpretations, allowing some older people to hold on to independent identities while exacerbating feelings of dependency among others. [ABSTRACT FROM AUTHOR]

Available evidence suggests that self-help treatments may reduce problem gambling severity but inconsistencies of results across clinical trials leave the extent of their benefits unclear. Moreover, no self-help treatment has yet been validated within a French Canadian setting. The current study therefore assesses the efficacy of a French language self-help treatment including three motivational telephone interviews spread over an 11-week period and a cognitive-behavioral self-help workbook. At-risk and pathological gamblers were randomly assigned to the treatment group (n = 31) or the waiting list (n = 31). Relative to the waiting list, the treatment group showed a statistically significant reduction in the number of DSM-5 gambling disorder criteria met, gambling habits, and gambling consequences at Week 11. Perceived self-efficacy and life satisfaction also significantly improved after 11 weeks for the treatment group, but not for the waiting list group. At Week 11, 13% of participants had dropped out of the study. All significant changes reported for the treatment group were maintained throughout 1, 6 and 12-month follow-ups. Results support the efficacy of the self-help treatment to reduce problem gambling severity, gambling behaviour and to improve overall functioning among a sample of French Canadian problem gamblers over short, medium and long term. Findings from this study lend support to the appropriateness of self-help treatments for problem gamblers and help clarify inconsistencies found in the literature. The low dropout rate is discussed with respect to the advantages of the self-help format. Clinical and methodological implications of the results are put forth. [ABSTRACT FROM AUTHOR]

Skin self-examination (SSE) is a crucial preventive health behaviour in melanoma survivors, as it facilitates early detection. Physician endorsement of SSE is important for the initiation and maintenance of this behaviour. This study focussed on the preliminary validation of a new nine-item measure assessing physician support of SSE in melanoma patients. English and French versions of this measure were administered to 188 patients diagnosed with melanoma in the context of a longitudinal study investigating predictors and facilitators of SSE. Structural validity was investigated using exploratory factor analysis conducted in Mplus and convergent and divergent validity was assessed using bivariate correlations conducted in spss. Results suggest that the scale is a unidimensional and reliable measure of physician support for SSE. Given the uncertainty regarding the optimal frequency of SSE for at-risk individuals, we recommend that future psychometric evaluations of this scale consider tailoring items according to the most up-to-date research on SSE effectiveness. [ABSTRACT FROM AUTHOR]

AimThis qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows.BackgroundThe Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows.MethodsOver a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015.FindingsKey issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change. [ABSTRACT FROM PUBLISHER]

Objectives: To compare the effect of a 6‐month community‐based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self‐efficacy, self‐management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. Design: Multisite, single‐blind, parallel, pragmatic, randomized controlled trial. Setting: Four communities in Ontario, Canada. Participants: Community‐dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159). Intervention: Client‐driven, customized self‐management program with up to 3 in‐home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. Measurements: Quality‐of‐life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey (SF‐12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES‐D‐10), Summary of Diabetes Self‐Care Activities (SDSCA), Self‐Efficacy for Managing Chronic Disease, and healthcare costs. Results: Morbidity burden was high (average of eight comorbidities). Intention‐to‐treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28–5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02–6.56, P = .01), and CES‐D‐10 (mean difference = −1.45, 95% CI = −0.13 to −2.76, P = .03). No group differences were seen in PCS score, anxiety, self‐efficacy, or total healthcare costs. Conclusion: Participation in a 6‐month community‐based intervention improved quality of life and self‐management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs. [ABSTRACT FROM AUTHOR]

Background: In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective. Methods: We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure. Results: PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals. Conclusion: We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology. [ABSTRACT FROM AUTHOR]