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Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic. Methods: Canadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID‐19 pandemic. Results: The COVID‐19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID‐19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift. Conclusions: This study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID‐19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners. Patient Contribution: Patient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners. [ABSTRACT FROM AUTHOR]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Background: The focus of this paper is exemplary gerontological nursing interventions that effectively supported families and long‐term care residents in Canada during visiting restrictions resulting from COVID‐19. Objective: The aim was to describe exemplary gerontological nursing interventions that families and long‐term care residents in Canada found supportive during visiting restrictions resulting from COVID‐19. Methods: An analysis of data artefacts including news reports, blogs and social media postings was completed. Results: Thematic analysis resulted in four themes: dedication amidst challenge, innovation and continuous learning, living their nursing values and purposeful knowledge sharing. These themes are described using a framework that depicts four pillars of exemplary nursing practice: professionalism, scholarly practice, leadership and stewardship (Riley, Beal, & Ponte, 2021). Conclusions/Implications for Practice: A link is made between these pillars of exemplary practice and enactment of family‐focused care. Recommendations focused on gerontological nursing approaches that facilitate family‐focused care for older adults residing in long‐term care are included. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

The introduction of digital literacy practices has created a tension in academia, with many academics challenging the view that critical thinking can be fostered on social networks. A quasi-experimental study was conducted on two sections of university-level writing classrooms to determine if there were meaningful differences in the quality of writing and peer feedback generated through in-class draft workshops using traditional methods as compared to draft workshops using a blogging platform. The results indicated that blogs produced a higher quality of writing as measured by grades, f(42) = 11.512, p < .002 and acceptance scores, f(42) = 8.364, p < .006. Furthermore, blog-mediated peer workshops produced a statistically significantly higher number of critical comments, f(42) = 120.438, p < .000; and directive comments, f(42) = 33.861, p < .000. There were no statistically significant differences in the number of editing comments, f(42) = .001, p < .974, and traditional draft workshops produced a statistically significant higher number of naïve comments, f(42) = 14.119, p < .001.Within the study, critical comments were found to correlate positively with learning outcomes, b = 1.115, t(41) = 2.716, p < .01. The findings suggest that blogging software improved learner performance and fostered complex literacy skills. [ABSTRACT FROM AUTHOR]

Introduction: Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well‐being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co‐design methodology. The institute received input from a participant advisory council, co‐design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co‐design approach and the barriers and facilitators to implementing social prescribing in Canada. Methods: We used a qualitative descriptive study design, document analysis, participant observation and semi‐structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co‐design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Results: Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Conclusion: Participants' reflections on the co‐design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co‐design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro‐ and micro‐level settings in which social prescribing is practiced. Patient or Public Contribution: The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing. [ABSTRACT FROM AUTHOR]

Recent research and theorizing has characterized contemporary mothering as medicalized, intensive and risky. The rate of diagnosis of children's mental health issues has grown rapidly, particularly since the 90s. This paper examines the construction of mothering in regard to children's behaviours and mental health through an exploratory and qualitative content analysis of the portrayal of advice to mothers in Chatelaine Magazine, the premier women's magazine published in Canada. The time periods chosen for comparison were 1945-1956 and 1990-2010. The first period was selected because it was a time of dramatic changes that occurred in family, occupational and domestic life for women immediately after World War II. The second represents the modern period. The findings of the paper suggest that mothering was intensive, medicalized and risky in both periods although the conceptualizations of problems differed. [ABSTRACT FROM AUTHOR]

Context: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice‐related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Objective and Population Studied: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusions: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health‐related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients of Public Contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population. [ABSTRACT FROM AUTHOR]

Background: Indiscriminate use of laboratory blood testing in hospitals contributes to patient discomfort and healthcare waste. Patient engagement in low‐value healthcare can help reduce overuse. Understanding patient experience is necessary to identify opportunities to improve patient engagement with in‐hospital laboratory testing. Objectives: To understand patient experience with the process of in‐hospital laboratory blood testing. Methods: We used a qualitative study design via semistructured interviews conducted online or over the phone. Participants were adult patients or family members/caregivers (≥18 years of age) with a recent (within 12 months of interview) experience of hospitalization in Alberta or British Columbia, Canada. We identified participants through convenience sampling and conducted interviews between May 2021 and June 2022. We analysed transcripts using thematic content analysis. Recruitment was continued until code saturation was reached. Results: We interviewed 16 participants (13 patients, 1 family member and 2 caregivers). We identified four themes from patients' experiences of in‐hospital laboratory blood testing: (i) patients need information from healthcare teams about expected blood testing processes, (ii) blood draw processes should consider patient comfort and preferences, (iii) patients want information from their healthcare teams about the rationale and frequency of blood testing and (iv) patients need information on how their testing results affect their medical care. Conclusion: Current laboratory testing processes in hospitals do not facilitate shared decision‐making and patient engagement. Patient engagement with laboratory testing in hospitals requires an empathetic healthcare team that provides clear communication regarding testing procedures, rationale and results, while considering patient preferences and offering opportunities for involvement. Patient or Public Contribution: We interviewed 16 patients and/or family members/caregivers regarding their in‐hospital laboratory blood testing experiences. Our findings show correlations between patient needs and patient recommendations to make testing processes more patient‐centred. To bring a lived‐experience lens to this study, we formed a Patient Advisory Council with 9–11 patient research partners. Our patient research partners informed the research design, co‐developed participant recruitment strategies, co‐conducted data collection and informed the data analysis. Some of our patient research partners are co‐authors of this manuscript. [ABSTRACT FROM AUTHOR]

Introduction: Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden, demand continues to exceed supply. Exploring the perspectives of respite service providers (SPs) and stakeholders (SKs) provides unique insight into families' needs and respite care systems. Methods: We conducted semistructured interviews with 41 respite care SPs and SKs across four Canadian provinces to ascertain perspectives on current and ideal respite care for families of CYSHCN. The analysis included delineating units of meaning from the data, clustering units of meaning to form thematic statements and extracting themes. The second‐level analysis involved applying themes and subthemes to cross‐functional process maps. Findings: Participants noted the critical, but sometimes absent role of Community Service Workers, who have the ability to support families accessing and navigating respite care systems. SPs and SKs identified current respite systems as operating in crisis mode. New findings suggest an ideal respite care system would incorporate advocacy for families, empower families and value CYSHCN, their families and respite workers. Conclusion: The evidence of unmet respite care needs of families of CYSHCN across Canada has long been available. Our findings identifying respite system challenges and solutions can be used by funders and policymakers for planning and enhancing resources, and by healthcare professionals, respite care providers and SKs to understand barriers and take action to improve respite outcomes to meet the respite needs of all families and CYSHCN. Patient or Public Contribution: The research team is composed of patients, researchers, clinicians and decision‐makers along with our Family Advisory Committee (FAC) composed of members of families of CYSHNC. The FAC was formed and met regularly with research team members, knowledge users and collaborators throughout the study to provide input on design, review themes and ensure findings are translated and disseminated in a meaningful way. [ABSTRACT FROM AUTHOR]

Youth have a right to participate in research that will inform the care that they receive. Engagement with children and young people has been shown to improve rates of enrollment and retention in clinical trials as well as reduce research waste. The aim of the study is to gain practical insight on the design of trials specifically on (1) recruitment and retention preferences, (2) potential barriers to research, and (3) study design optimization. Based on this youth engagement, we will co‐design two clinical trials in headaches with youth. Two recruitment strategies were used to recruit 16 youth from across Canada (aged 15–18 years) from an existing youth group, the KidsCan Young Persons' Research Advisory Group (YPRAG) and a new youth group in collaboration with Solutions for Kids in Pain (SKIP). Four virtual, semi‐structured discussion groups were held between April and December 2020, which included pre‐circulated materials and utilized two distinct upcoming planned trials as examples for specific methods feedback. Individual engagement evaluations were completed following the final group session using the Public and Patient Engagement Evaluation Tool. Descriptive results were shared with participants prior to publication to ensure appropriate interpretation. The discussion was centred around three themes: recruitment and retention preferences, potential barriers to participation, and study design optimization. Youth indicated that they would prefer to be contacted for a potential study directly by their physician (not over social media), that they would like to develop rapport with study staff, and that one of the barriers to participation is the time commitment. The youth also provided feedback on the design of the clinical trial including outcome measurement tools, data collection, and engagement methods. Feedback on the virtual format of the engagement events indicated that participants appreciated the ease of the online discussion and that the open‐ended discussion allowed for easy exchange of ideas. They felt that despite a gender imbalance (towards females) it was an overall inclusive environment. All participants reported believing that their engagement will make a difference to the work of the research team in designing the clinical trials. Perspectives from a diverse group of youth meaningfully improved the design and conduct of two clinical trials for headaches in children. This study provides a framework for future researchers to engage youth in the co‐design of clinical trials using online engagement sessions. [ABSTRACT FROM AUTHOR]

Background and Purpose Following hospitalization, seniors are at risk of impaired mobility and increased risk of falling, which can lead to injuries and re-admission. The primary purpose of this paper was to evaluate the ability of hospitalized seniors to use vestibular inputs for balance control. The secondary purpose was to examine the influence of vestibular function and lower limb muscle strength on mobility. Methods Experimental and correlation designs were used. Patients (aged 65-90 years), preparing for discharge from an inpatient geriatric rehabilitation unit, were recruited. Vestibular control of standing balance was measured using the Clinical Test of Sensory Interaction for Balance (CTSIB). Mobility was measured with the Timed Up and Go (TUG) Test. Lower limb muscle maximum voluntary isometric contraction (MVIC) strength was tested with portable dynamometry. Wilcoxon signed rank test, with alpha adjusted for multiple comparisons ( p ≤ 0.017), was used to compare relevant components of the CTSIB. Stepwise regression was used to assess the influence of vestibular impairment on TUG score. Results CTSIBTest6 (median = 7.1 seconds, range = 0.0-30.0) was less than CTSIBTest1 (30.0 seconds, 30.0-30.0) and CTSIBTest4 (30.0 seconds, 10.5-30.0) (W = 136, p < 0.017). MVIC scores (Nm·kg−1, mean ± SD) included hip abduction 0.38 ± 0.2, hip flexion 0.32 ± 0.1, hip extension 0.44 ± 0.2, knee flexion 0.31 ± 0.1, knee extension 0.33 ± 0.2, ankle dorsiflexion 0.12 ± 0.1 and ankle plantarflexion 0.23 ± 0.1. Mean TUG score was 26.1 ± 6.0 seconds. Performance on CTSIBTest6 explained 55% of the variance in TUG scores, whereas hip extension strength explained an additional 6%. Conclusions Seniors awaiting discharge from hospital had impaired vestibular control of balance that was systematically associated with impaired mobility. Evaluating vestibular function prior to discharge from hospital could improve discharge planning with respect to management of impairments that threaten balance and safe mobility. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Patient engagement in patient‐oriented research (POR) is described as patients collaborating as active and equal research team members (patient research partners [PRPs]) on the health research projects and activities that matter to them. The Canadian Institutes of Health Research (CIHR), Canada's federal funding agency for health research, asks that patients be included as partners early, often and at as many stages of the health research process as possible. The objective of this POR project was to co‐build an interactive, hands‐on training programme that could support PRPs in understanding the processes, logistics and roles of CIHR grant funding applications. We also conducted a patient engagement evaluation, capturing the experiences of the PRPs in co‐building the training programme. Methods: This multiphased POR study included a Working Group of seven PRPs with diverse health and health research experiences and two staff members from the Patient Engagement Team. Seven Working Group sessions were held over the 3‐month period from June to August 2021. The Working Group worked synchronously (meeting weekly online via Zoom) as well as asynchronously. A patient engagement evaluation was conducted after the conclusion of the Working Group sessions using a validated survey and semi‐structured interviews. Survey data were analysed descriptively and interview data were analysed thematically. Results: The Working Group co‐built and co‐delivered the training programme about the CIHR grant application process for PRPs and researchers in five webinars and workshops. For the evaluation of patient engagement within the Working Group, five out of seven PRPs completed the survey and four participated in interviews. From the survey, most PRPs agreed/strongly agreed to having communication and supports to engage in the Working Group. The main themes identified from the interviews were working together‐communication and supports; motivations for joining and staying; challenges to contributing; and impact of the Working Group. Conclusion: This training programme supports and builds capacity for PRPs to understand the grant application process and offers ways by which they can highlight the unique experience and contribution they can bring to each project. Our co‐build process presents an example and highlights the need for inclusive approaches, flexibility and individual thinking and application. Patient or Public Contribution: The objective of this project was to identify the aspects of the CIHR grant funding application that were elemental to having PRPs join grant funding applications and subsequently funded projects, in more active and meaningful roles, and then to co‐build a training programme that could support PRPs to do so. We used the CIHR SPOR Patient Engagement Framework, and included time and trust, in our patient engagement approaches to building a mutually respectful and reciprocal co‐learning space. Our Working Group included seven PRPs who contributed to the development of a training programme. We suggest that our patient engagement and partnership approaches, or elements of, could serve as a useful resource for co‐building more PRP‐centred learning programmes and tools going forward. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the lived experiences of grandparents raising their grandchildren with foetal alcohol spectrum disorder (FASD). Specifically, we sought to identify how caregivers make meaning of their experience, what challenges are faced by grandparents while raising a second generation and what positive experiences are encountered. Ten grandparents raising a child with FASD in Ontario, Canada, participated in semi‐structured interviews. Interpretative phenomenological analysis was used to analyse the interviews to determine reoccurring themes. Three main themes were identified: (i) challenges when raising a grandchild with FASD, including kinship adoption struggles and intergenerational issues; (ii) worries about the future, including financial planning and health concerns; and (iii) rewards, such as shifts in priorities and the opportunity to raise a second generation. Grandparents raising their grandchildren with FASD face challenges and thus require specific supports so that they may adequately provide a safe and nurturing home environment for children with often challenging learning and social needs. [ABSTRACT FROM AUTHOR]

Background/Purpose: Despite widespread use of Electronic Health Records (EHR), the promise of benefits has not been clearly realised due, in part, to inadequate physician training. Training for EHR use is a highly complex intervention that occurs in a dynamic socio‐technical health system. The purpose of this study was to describe and critically assess the interplay between educational activities and organisational factors that influenced EHR training and implementation across two different hospitals. Methods: Based in a socio‐technical framework, a comparative qualitative case study was undertaken as well suited to real‐world processes. Semi‐structured interviews were completed (n = 43), representing administrative leaders, staff physicians, residents and EHR trainers from two Canadian academic hospitals. Thematic analysis was employed for analysis. Results: Similar findings were noted at both hospitals despite different implementation strategies. Despite mandatory training, physicians described limited transferability of training to the workplace. Factors contributing to this included standardised vendor modules (lacking specificity for their clinical context); variable EHR trainer expertise; limited post‐launch training; and insufficient preparation for changes to workflow. They described learning while caring for patients and using workarounds. Strong emotional responses were described, including anger, frustration, anxiety and fear of harming patients. Conclusions: Training physicians for effective EHR utilisation requires organisational culture transformation as EHRs impacts all aspects of clinical workflows. Analytic thinking to consider workflows, ongoing post‐launch training and the recognition of the interdependency of multiple factors are critical to preparing physicians to provide effective clinical care, and potentially reducing burnout. A list of key considerations is provided for educational leaders. Physicians and residents report that feeling inadequately prepared for the profound changes electronic health record implementation has on workflow manifests as anxiety, frustration and fear of harming patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to gain insight into the perception of nurses about their roles in medical‐surgical units. Background: As a result of ever‐changing work environments, medical‐surgical nurses find it difficult to know and practice according to the full scope of their roles. Design: A qualitative descriptive study. Methods: Semi‐structured individual interviews were conducted with 21 nurses on three campuses of a large tertiary care hospital located in Quebec, Canada. Thematic analysis was used to construe meaning from the interviews. This research adheres to the Standards for Reporting Qualitative Research guidelines and checklist. Results: The data analysis resulted in three main themes: (i) confusion in nurses' roles and scope of practice; (ii) challenges in the continuity of care and (iii) factors affecting the roles of nurses in medical‐surgical units. Conclusion: Attention must be paid to the care continuum as it represents a critical element for surgical patients' quality and safety of care. Relevance to clinical practice: Medical‐surgical nurses should understand their roles and the factors that limit their full scope of practice in order to provide and manage complex care situations. Additionally, an interdisciplinary approach is a strategy that may better respond to patients' clinical needs across the surgical journey. [ABSTRACT FROM AUTHOR]

Background: Addressing barriers in the environment can contribute to health and quality of life for children with disabilities and their families. The Community Health Inclusion Index (CHII) is a measurement tool developed in the United States to identify environmental barriers and facilitators to community health inclusion. The CHII adopts an adult viewpoint and aspects crucial for children may have been omitted. Aims: This study aimed to develop a comprehensive list of items that are relevant for the community inclusion of children with disabilities in the Canadian context. Methods: The relevance and priority of items generated from a review of existing guidelines and best practice recommendations for community inclusion were rated as a dichotomous response and discussed by an expert panel in relevant fields related to children with disabilities. Results: A total of 189 items from 12 instruments and best practice guidelines were identified. Expert consensus contributed to a relevant and comprehensive list of items. Expert suggestions were considered to refine and reduce the item list. Conclusion: This study highlights the importance of a child version of a community inclusion tool, as the needs of children with disabilities differ from those of adults. It can help communities improve inclusion of children with disabilities and inform health promotion initiatives for this population. [ABSTRACT FROM AUTHOR]

Background: Care aides (certified nursing assistants, personal support workers) are the largest workforce in long‐term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well‐being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID‐19 on care aides working in LTC homes during the first year of the pandemic. Methods: We conducted semi‐structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis. Results: Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full‐time in LTC homes, and 37% worked multiple positions before "one worksite policies" were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID‐19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes. Conclusions: These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID‐19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well‐being and adequately resource this workforce. We recommend improved policy guidelines and interventions. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has significant impact on long‐term care (LTC) residents' health and well‐being. Objectives: This study investigated resident experiences of loneliness during the COVID‐19 pandemic in Canadian LTC homes to offer lessons learned and implications. Methods: 15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one‐on‐one semi‐structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes. Results: Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity. Conclusions: Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences. Implications for practice: Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents' experiences of loneliness due to social isolation and/or grief and enhance their quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Patients discharged following hospitalization for COVID‐19 require clear discharge protocols, information resources and communications to adequately prepare them to safely and successfully transition from hospital to home. Our study focuses on the patients' transition to recovering at home including their hospital discharge preparation and hospital experiences. Methods: A qualitative descriptive study design involved interviewing patients who had been hospitalized for COVID‐19 in one urban Alberta, Canada centre. Purposive sampling was used to select patients from a centralized COVID‐19 hospital patient database stratified by month between March 2020 and February 2021. Other inclusion criteria (e.g., sex and age) were also considered. Semi‐structured interviews with patients were recorded, transcribed and analysed using thematic analysis. Data sufficiency and saturation were determined. Results: Twelve patients shared their lived experiences and recovery journey from COVID‐19. Themes were reported under three main areas as framed by the study aim—the current status of patients recovering at home, including the supports they used to manage; their discharge process and preparation to go home; and their various hospital‐related experiences. Suggestions for improving aspects of the patient journey were also captured. Conclusion: Findings provided details of the needs, information gaps and what matters most to patients when they are recovering from COVID‐19 at home, including their preparation to safely and successfully transition from hospital to home (i.e., feeling well prepared to go home, including being adequately assessed and having clear discharge protocols and communication). Key learnings were applied to improve or develop patient discharge and transition resources. Patient or Public Contribution: A patient/family advisor and patient experience partners were involved throughout the study, codeveloping all aspects, from the study design to the reporting and application of the findings. Leading into the study, patient experiences and feedback regarding the home from hospital recovery journey informed multiple aspects, including the codevelopment of the interview guide. [ABSTRACT FROM AUTHOR]

Objective: It is essential that the embedded process of rural case selection be highlighted and documented to provide reassurance of rigour across rural surgical services supported by generalist surgeons, general practitioners with enhanced surgical skills and general practitioner anaesthetists. This enables feedback and improves the triage and case selection process to ensure the highest quality outcomes. Therefore, this research aims to explore participants' rational criteria for decision making around rural case selection. Design: Participants participated in a series of semi‐structured in‐depth interviews which were coded and underwent thematic analysis. Setting: Six community hospitals in British Columbia, Canada. Participants: General practitioners with enhanced surgical skills, general practitioner anaesthetists, local maternity care providers, and specialists. Results: Based on participant accounts, rural surgical and obstetrical decision‐making processes for local patient selection or regional referral had five major components: (1) Clinical Factors, (2) Physician Factors, (3) Patient Factors, (4) Consensus Between Providers and (5) the Availability of Local Resources. Conclusion: Decision‐making processes around rural surgical and obstetrical patient selection are complex and require comprehensive understanding of local capacity and resources. Current policies and guidelines fail to consider the varying capacities of each rural site and should be hospital specific. [ABSTRACT FROM AUTHOR]

Previous research has examined the multiple meanings of hijab among Muslim women, but a quantitative scale to examine such meanings has yet to be developed. The present study was designed to develop and validate a new scale, Meanings Of The Hijab (MOTH), for measuring multiple meanings associated with wearing a headscarf for Muslim women living in countries where the majority of the population is non‐Muslim. The initial 64‐item scale was employed to 442 Canadian Muslim women, along with the Social Axiom Survey and the Cultural Identity Scale. An exploratory factor analysis led to the development of the MOTH scale with 35 items and five factors. The factors reflect meanings of the hijab in terms of: Expression of Faith Without Hijab, Expression of Modesty and Religiosity, Expression of Personal Identity, Challenges of Wearing Hijab, and Negative Symbolism of the Hijab in the West. The MOTH scale was found to have high internal validity and discriminant validity. In addition, convergent and discriminant validity of MOTH subscales were established by examining their relations with social axioms, ethnic identity, and national identity. [ABSTRACT FROM AUTHOR]

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives. [ABSTRACT FROM AUTHOR]

Objective: To describe the real‐world treatment persistence (defined as the continuation of medication for the prescribed treatment duration), demographics and clinical characteristics, and treatment patterns for patients prescribed erenumab for migraine prevention in Canada. Background: The effectiveness of prophylactic migraine treatments is often undermined by poor treatment persistence. In clinical trials, erenumab has demonstrated efficacy and tolerability as a preventive treatment, but less is known about the longer term treatment persistence with erenumab. Methods: This is a real‐world retrospective cohort study where a descriptive analysis of secondary patient data was conducted. Enrollment and prescription data were extracted from a patient support program for a cohort of patients prescribed erenumab in Canada between September 2018 and December 2019 and analyzed for persistence, baseline demographics, clinical characteristics, and treatment patterns. Descriptive analyses and unadjusted Kaplan–Meier (KM) curves were used to summarize the persistence and dose escalation/de‐escalation at different timepoints. Results: Data were analyzed for 14,282 patients. Median patient age was 47 years, 11,852 (83.0%) of patients were female, and 9443 (66.1%) had chronic migraine at treatment initiation. Based on KM methods, 71.0% of patients overall were persistent to erenumab 360 days after treatment initiation. Within 360 days of treatment initiation, it is estimated that 59.3% (KM‐derived) of patients who initiated erenumab at 70 mg escalated to 140 mg, and 4.4% (KM‐derived) of patients who initiated at 140 mg de‐escalated to 70 mg. Conclusions: The majority of patients prescribed erenumab remained persistent for at least a year after treatment initiation, and most patients initiated or escalated to a 140 mg dose. These results suggest that erenumab is well tolerated, and its uptake as a new class of prophylactic treatment for migraine in real‐world clinical practice is not likely to be undermined by poor persistence when coverage for erenumab is easily available. [ABSTRACT FROM AUTHOR]

Background: Transitioning from pediatric to adult healthcare can be challenging and lead to severe consequences if done suboptimally. The Transition Readiness Assessment Questionnaire (TRAQ) was developed to assess adolescent and young adult (AYA) patients' transition readiness. In this study, we aimed to (1) document the psychometric properties of the French‐language version of the TRAQ (TRAQ‐FR), (2) assess agreements and discrepancies between AYA patients' and their primary caregivers' TRAQ‐FR scores, and (3) identify transition readiness contributors. Methods: French‐speaking AYA patients (n = 175) and primary caregivers (n = 168) were recruited from five clinics in a tertiary Canadian hospital and asked to complete the TRAQ‐FR, the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0), and a sociodemographic questionnaire. The validity of the TRAQ‐FR was assessed using confirmatory factor analyses (CFA). Agreements and discrepancies were evaluated using intraclass correlation coefficients and paired‐sample t tests. Contributors of transition readiness were identified using regression analyses. Results: The five‐factor model of the TRAQ was supported, with the TRAQ‐FR global scale showing good internal consistency for both AYA patients' and primary caregivers' scores (α =.85–.87). AYA patients and primary caregivers showed good absolute agreement on the TRAQ‐FR global scale with AYA patients scoring higher than primary caregivers (ICC =.80; d =.25). AYA patients' age and sex were found to be contributors of transition readiness. Conclusions: The TRAQ‐FR was found to have good psychometric properties when completed by both AYA patients and primary caregivers. Additional research is needed to explore the predictive validity and clinical use of the TRAQ‐FR. [ABSTRACT FROM AUTHOR]

Background: Despite its importance, in-depth analysis of connected speech is often neglected in the diagnosis of primary progressive aphasia (PPA) - especially for the logopenic variant (lvPPA) for which unreliable differential diagnosis has been documented. Only a few studies have been conducted on this topic in lvPPA. Aims: The aim of this study was to describe and compare lexico-semantic and morphosyntactic features of connected speech in participants with lvPPA, in comparison with healthy controls, using three different elicitation tasks (i.e., picture description, story narration and semi-structured interviews). In addition to a number of discourse features, we were particularly interested in the presence or absence of syntactic deficits in this PPA variant in line with recent findings. Methods & Procedures: A prospective group study was conducted to compare lvPPA participants (n = 13) to age- and education-matched healthy controls (n = 13). For each individual, connected speechwas obtained using three tasks: (1) The Cookie Theft picture description; (2) Cinderella Story; (3) Topic-directed interview. Production on each task was recorded, transcribed and analysed according to the Quantitative Production Analysis (QPA) protocol, a tool developed by Berndt et al. (2000) for the analysis of sentence production in aphasia. Differences between lvPPA and healthy controls and among elicitation tasks were analysed using repeatedmeasuresmultilevelmixed-effects regression, separately for each outcome. Outcomes & Results: Four measures were significantly different between lvPPA participants and healthy controls across all elicitation tasks. Specifically, lvPPA participants produced a reduced proportion of open-class words, a higher proportion of verbs, a higher proportion of pronouns and fewer well-formed sentences. For these measures, the difference between lvPPA and healthy controls was consistent among elicitation tasks, except for the proportion of well-formed sentences, where the difference between the two groupswas significantly greater in the story narration task than in the other tasks. Conclusions & Implications: Across elicitation tasks that used the same analysis protocol (i.e., QPA), a similar pattern of deficits in connected speech emerged in lvPPA patients. Importantly, the findings replicate previous studies, which used different elicitation tasks and analysis protocols. Especially in relation to the documented syntactic deficits, these findings provide implications for differential diagnosis in PPA. [ABSTRACT FROM AUTHOR]

Drawing on interviews with civil society actors in the AIDS Service Organization (ASO) sector in Canada, this article explores how these actors contribute to shaping the illness identities of people living with HIV/AIDS in the shadow of efforts to criminalize exposure to HIV. While the biographically disruptive qualities associated with an HIV diagnosis have been addressed in the medical sociology literature, we turn our attention to the key role played by ASOs as interlocutors in this process. Paying specific attention to the intersection of processes of medicalization and criminalization, we ask how they are re‐stigmatizing a condition that has shifted in the public consciousness from its earlier association with deviance and moral culpability. One important implication of our findings concerns the need to take greater account of how the illness identity and experience can be shaped by a 'biography of telling', of a renewed pressure to disclose intimate details of one's health status as a way to perform responsible practices of citizenship. [ABSTRACT FROM AUTHOR]

Purpose: Interprofessional collaboration (IPC) among health professionals is well‐recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre‐licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. Method: A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. Results: Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. Conclusions: Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation. Despite the espoused importance of interprofessional education, professional socialization enabling interprofessional identity formation and promoting collaboration requires curriculum development and strategic recruitment. [ABSTRACT FROM AUTHOR]

Background: Less than 20% of youth who experience mental health difficulties access and receive appropriate treatment. This is exacerbated by barriers such as stigma, confidentiality concerns and lack of mental health literacy. A youth team developed the Wellness Quest: a health literacy tool to enable help‐seeking youth to advocate for themselves. Objective: To evaluate the content, presentation and utility of the Wellness Quest tool among youth. Participants: Participants aged 14 to 26. Methods: A youth research team conducted five focus groups and one online survey to evaluate the Wellness Quest tool. Thematic analysis was used to analyse the qualitative data, and descriptive statistics were used to explore the survey results. Main results: Overall evaluations of the Wellness Quest were positive: participants felt it would be useful during their mental health help‐seeking journey. Participants expressed the need for information about services for specific populations, such as Indigenous, immigrants, refugees and 2SLGBTQ + youth. They expressed that the tool should be available in complementary online and print versions. Discussion: Improving mental health literacy may improve mental health by enabling youth and those who support them to recognize and respond to signs of distress and understanding where and how to get help. The Wellness Quest tool may equip youth with the knowledge to make informed decisions and advocate for their own mental health, thereby facilitating help‐seeking among youth. Patient or public contribution: Youth as service users led all stages of the project, from designing and conducting the study and analysing the data to writing the manuscript. [ABSTRACT FROM AUTHOR]

Context: Having succeeded in being selected for medical school, medical students are not always familiar with failure and yet they are expected to graduate prepared to effectively function in the failure‐burdened arena of clinical medicine. Lacking in the developing literature on learners and failure is an exploration of how this transformation is accomplished. The purpose of this study was to examine how medical students perceive and experience failure during their medical school training. Method: We used a qualitative description methodology to probe the failure experiences of medical students attending a Canadian medical school. Participants were provided with the broad definition of failure used in this research: 'deviation from expected and desired results.'In total, 12 students were sampled, three from each of the 4 years of study, and participated in individual, semi‐structured interviews that were analysed using thematic analysis to identify and describe core themes. Results: At the start of medical school, students admitted limited experience with failure; their early descriptions were self‐centred and binary. Personal stories recounted by preceptors encouraged students and helped them understand that physicians are human and that failure is inevitable. Students felt relatively protected from failures that could impact patients. Both witnessing and participating in a failure event were distressing and sometimes at odds with their expectations. Students expressed a desire to talk about the experience. Conclusions: Medical students described examples of experiencing failure during medical school that transported them from the more certain black and white beginnings of their classroom into the uncertain shades of grey of clinical medicine. What the participants heard, saw and experienced suggests opportunities for classroom teachers to better prepare pre‐clinical students for the inevitability of failure in clinical medicine and opportunities for clinical teachers to engage in open, inclusive conversations surrounding failures that occur on their watch. From black and white to shades of grey, Shepherd et al. explore how students' perspectives on failure and uncertainty shift with the transition to clinical training. [ABSTRACT FROM AUTHOR]

As news headlines report on high‐profile online privacy breaches and the potential negative consequences for users, users are becoming concerned about their privacy. While much research has focused on the concerns of younger generations, few studies have investigated older adults, specifically those aged 65+ years. This study analyzes in‐depth interviews with 40 older adults living in East York, Toronto, Canada, to investigate their online privacy concerns and the strategies they use to mitigate these concerns. We find that East York older adults are mostly concerned about security privacy concerns followed by institutional privacy concerns and only minimally concerned about social privacy. The greatest concerns included information misuse by unknown others and unauthorized access to their personal information. We found that, for some older adults, their high privacy concerns precluded them from taking full advantage of the potential benefits of digital media. East York older adults varied considerably in their use of privacy protection strategies; some older adults used no strategies, while others were eager to protect their privacy using all strategies at their disposal. [ABSTRACT FROM AUTHOR]

With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non‐RCTs = 6, one‐group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi‐country (n = 1). Only two studies focused on minority populations. While author‐developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397–413. [ABSTRACT FROM AUTHOR]

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. [ABSTRACT FROM AUTHOR]

Background: The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator‐associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption. Aims and objectives: To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs. Design: A cross‐sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada. Methods: A questionnaire was completed by 375 nurses working in intensive care units (ICUs). Results: Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors. Conclusions: This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care. Relevance to clinical practice: The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses. [ABSTRACT FROM AUTHOR]

Background: Priority‐setting is a way to focus research and knowledge translation (KT) efforts for community‐based research partnerships (CBRP). Objective: To identify the developmental coordination disorder (DCD) research and KT priorities of stakeholders in Quebec, Canada, and their perceptions regarding the implementation of a CBRP. Design: An advisory committee oversaw the research process including an online survey and four community forums. Setting and participants: The survey was posted online and four community forums were organized. Participants included parents of children with DCD, adults with DCD, health professionals and school staff. Main variables: Stakeholder generated research and KT priorities, and optimal CBPR conditions. Outcome measures: Participants selected their top five priorities based on a predefined list of 16 research and 12 KT priorities determined in collaboration with the advisory committee. They also rated the importance of various CBRP conditions. Preliminary survey results were discussed during the forums. Results: Survey participants (n = 395) identified interwoven research and KT priorities where access to services was considered to be essential: supporting children at school; improving DCD identification and diagnosis; preventing secondary consequences; improving the organization of services and implementing effective services. Forum participants (n = 52) confirmed the relevance of these priorities and supported the establishment of a CBRP inclusive of all stakeholders to improve DCD services, research and KT. Discussion and conclusions: A general consensus emerged among all groups, but adults with DCD were more concerned with employment than were the other stakeholder groups. These findings are presently being used to shape an ongoing, online CBRP. [ABSTRACT FROM AUTHOR]

Aim: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. Background: Little research exists to inform registration policy for internationally educated health professionals. Introduction: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian‐educated nurses, but differences in health systems, education and practice create challenges. Methods: The study setting was a Canadian province. We used a mixed methods approach, with a pre–post‐quasi‐experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre‐ and post‐implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non‐parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. Findings: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. Discussion: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. Conclusion: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. Implications for Nursing Policy: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence. [ABSTRACT FROM AUTHOR]

Objective: Transitioning to interactive e‐textbooks has been considered revolutionary for enhancing student learning. However, adopting this technology has been met with hesitation. This study investigates student and faculty attitudes and utilization of mandatory e‐textbooks in a dental hygiene program. Methods: In 2017, an online questionnaire was distributed to students and a focus group was conducted with faculty to examine their perspectives about using VitalSource™. Using a 5‐point Likert scale with five indicating strongly agree, the questionnaire examined convenience; compatibility with learning style; perceived enjoyment; and usefulness. Open‐ended questions captured benefits and challenges. The focus group gathered faculty perspectives. Questionnaire data were analysed using descriptive statistics. Data from the open‐ended questionnaire questions and focus group transcript followed a narrative analysis process. Results: Survey response was 48% (n = 105). Students scored all factors below neutral. Results from four categories showed convenience (M = 2.75, SD = 0.92); compatibility (M = 1.93, SD = 0.83); perceived effectiveness (M = 2.15, SD = 0.90); and perceived usefulness (M = 2.36, SD = 1.04). A high correlation between all factors suggests they were uniformly rated by students. Majority of students (71%) did not use a textbook greater than once a month. Narrative analysis revealed few benefits; challenges included technical glitches, eyestrain, cost and inability to choose books as desired. Faculty's perspectives aligned with the students, but they appreciated portability of texts and quality of clinical images. Conclusions: Students strongly disliked the platform and the online medium and do not frequently access e‐textbooks but rely on PowerPoint handouts for studying. Faculty felt e‐textbooks do not align with positive learning experiences. [ABSTRACT FROM AUTHOR]

Background: Patient engagement (PE), patients' meaningful involvement in research through partnerships and sensitivity to their expertise, is receiving attention. However, PE initiatives are poorly reported and little is known about patients' perspective on PE. Objective: To document and evaluate the first phase (22 months) of a PE Project for the I‐Score Study which is developing a patient‐reported measure of HIV treatment adherence barriers, we describe the nature of PE conducted, determine the level of PE achieved and present its impacts from the engaged patients' perspective. Setting and participants: A Montreal‐based committee of ten people with HIV was recruited from community and clinical settings and participated in: I‐Score study decision making, knowledge dissemination, research on the experience of people with HIV and the PE project's evaluation. Methods: The evaluation followed a convergent parallel mixed‐methods design. Data collection included participant observation, a satisfaction survey and meeting minutes/transcriptions. Analysis entailed reporting PE activities, generating descriptive statistics and thematically analysing qualitative material. Results: PE consisted of twelve meetings, including two focus groups (needs assessment), in addition to four knowledge dissemination activities. PE levels showed an increase: the first four regular meetings entailed information/consultation, while subsequent meetings reached implication/collaboration. Regarding impacts, patients indicated high and stable satisfaction rates (M = 4.4/5; SD = 0.76). Furthermore, thematic analysis identified "positive interactions," "co‐learning," "self‐determination," and "the collective management of confidentiality" as important PE impacts for engaged patients. Conclusion: This PE Project evaluation highlighted growing engagement levels, high satisfaction rates and the importance of a patient‐centric approach to PE. [ABSTRACT FROM AUTHOR]

Aim: School nutrition policies can improve healthy food access for Indigenous First Nations children in Canada. This study explored First Nations students' perceptions of a school nutrition policy. Methods: The research was a process evaluation of school nutrition policy implementation using a mixed‐methods design. Students in grades 4–12 (n = 94) completed a 17‐question survey to capture their perceptions of the policy. Survey data informed an 11‐question semi‐structured interview guide. Transcripts from interviews with students (n = 20) were analysed using content analysis to identify barriers and facilitators to policy implementation. Results: Key facilitating factors to policy implementation were student support for the policy and taste preferences. Most students (87%) agreed that only healthy foods should be served at school and, in interviews, expressed a preference for healthy food choices. Barriers to policy implementation included foods available at school and lack of communication between students and their teachers and parents. Half (50%) of surveyed students reported that their eating habits at school were average; interviews explained that their diets could be improved by consuming more fruit and vegetables at school. Both surveys and interviews found that communication between students and their parents and teachers about what they ate and drank at school was low. Conclusions: To support children's healthy eating at school, the school nutrition policy could provide clear guidelines on foods permissible in the school, while considering social and environmental barriers to healthy eating. The involvement of First Nations children in the implementation and evaluation of school nutrition policies is recommended. [ABSTRACT FROM AUTHOR]

Background Physical activity ( PA) is beneficial for all people, yet people affected by multiple sclerosis ( MS) find regular PA challenging. These people may include individuals with the disease who have moderate-to-severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care-recipient dyads with moderate-to-severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial. Objective We explored shared experiences of caregiver/care-recipient dyads affected by moderate-to-severe MS about PA and directions for intervention. Methods Six focus groups with 23 people with moderate-to-severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach. Results Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines. Conclusion This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care-recipient dyad with moderate-to-severe MS as a focus for PA intervention. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop, implement and evaluate a workplace continuing education programme about nursing care of hospitalised older people. Background The healthcare system cannot rely solely upon nurses' prelicensure education to prepare them to meet the evolving needs of hospitalised older patients. Over the past decade, there has been a dramatic rise in the proportion of older people in hospitals, yet many nurses do not have specialised knowledge about the unique care needs of this population. Design A multimethod pre-to post-design was employed. Methods Between September 2013 and April 2014, data were collected via surveys, focus groups and interviews. Thirty-two Registered Nurses initially enrolled in the programme of which 22 completed all data points. Three managers also participated in interviews. One-way repeated-measures ANOVAs were conducted to evaluate the effect of the programme and change over time. Qualitative data were analysed using thematic analysis. Results Survey results indicated improvements in perceptions about nursing care of older people but no changes in knowledge. Themes generated from the qualitative data focused on participants' experiences of taking part in the programme and included: (i) relevance of content and delivery mode, (ii) value of participating in the programme and (iii) continuing education in the context of acute care. Conclusions This study illustrated the potential role of workplace continuing education in improving care for hospitalised older people, particularly the potential to change nurses' perceptions about this population. Nurses prefer learning opportunities that are varied in delivery of educational elder-focused content and accessible at work. Organisational leaders need to consider strategies that minimise potential barriers to workplace continuing education. Implications for practice Workplace continuing education can play a key role in improving quality of care for hospitalized older adults and ought to be a priority for employers planning education for nurses. [ABSTRACT FROM AUTHOR]

Problem Street-involved youth experience many barriers to accessing health and social services. There is a literature gap in the literature regarding evidence-based interventions to facilitate engagement with street-involved youth. Methods A qualitative descriptive study of preliminary findings from a large mixed-methods study was undertaken to assess the impact of a resilience-based motivational intervention. This intervention was grounded in frameworks including strengths-based and resilience-based communication using the Seven C's Model of Resilience, positive youth development, and motivational interviewing that are particularly relevant to youth. Individual interviews were conducted with two subsets of youth who participated ( n = 3) or did not participate ( n = 3) in the intervention. Thematic analysis was conducted to identify themes between the intervention and comparison groups. Findings Preliminary themes identified across the sample include (1) establishing a trusting relationship, (2) strengthening self-worth and resilience, (3) focusing on goals, and (4) perceiving a sense of hope and possibility. Conclusions The themes identified the importance of positive relationships with care providers built upon a foundation of trust to engage youth to remain motivated and focused on their goals. [ABSTRACT FROM AUTHOR]

Context Predictive validity studies on the use of the multiple mini-interview ( MMI) have been primarily in medicine. Objectives This study sought to determine the predictive validity of the MMI for performance within a pharmacy programme and on the Pharmacy Examining Board of Canada ( PEBC) Qualifying Examination for licensure, and to compare the predictive validity of the MMI with that of pre-pharmacy grade point average ( GPA) and Pharmacy College Admission Test ( PCAT) score. Methods Admissions data for 223 graduates of the pharmacy programme at the University of Toronto were matched to programme and licensure outcome measures. Multiple linear regression assessed the predictive ability of the MMI, pre-pharmacy GPA, PCAT and covariates for performance in final-year experiential rotations, cumulative GPA ( cGPA) and PEBC- MCQ (multiple-choice question examination) and PEBC- OSCE (objective structured clinical examination) overall and subcomponent scores. Results The PCAT, pre-pharmacy GPA and age significantly predicted the PEBC- MCQ overall score. The MMI was the only significant predictor of overall score on the PEBC- OSCE (β = 0.17, p = 0.02); it also predicted communication and performance subscores. Scores on the PCAT and female gender predicted the communication subscore. Pre-pharmacy GPA, age and female gender significantly predicted cGPA. The MMI was the only significant predictor of institutional/ambulatory rotation score (β = 0.26, p = 0.00). Conclusions The MMI, designed to measure non-academic attributes including communication, motivation and problem-solving skills, was the only admissions tool with significant predictive validity for performance on the PEBC- OSCE national pharmacy certification examination and in an institutional/ambulatory rotation. These findings, from a single cohort of undergraduates, provide the first report of the predictive validity of the MMI for performance on pharmacy licensure examinations and thereby strengthen the evidence for its use in health professions selection. Prior university academic performance significantly predicted cGPA and performance on the PEBC- MCQ. Performance on the PCAT also predicted PEBC- MCQ results. [ABSTRACT FROM AUTHOR]

Using three samples aggregating over 1,000 working adults, we developed and tested a measure of Substantive and Symbolic Corporate Social Responsibility (CSR‐SS). The resultant 14‐item CSR‐SS scale is a reliable and parsimonious measure that is best represented by two broad and distinctive factors—substantive and symbolic attributions of CSR. Our findings provide evidence of a solid nomological network and criterion validity, supporting predictions that when employees attribute CSR as substantive, greater benefits accrue to the individual and the organisation as a whole than when CSR is attributed as symbolic. This measure contributes a valid and reliable tool toward the advancement of micro CSR research on both negative and positive consequences of organisations’ CSR proclaimed initiatives. [ABSTRACT FROM AUTHOR]

Context Over the past few decades, longitudinal integrated clerkships ( LICs) have been proposed to address many perceived short-coming of traditional block clerkships. This growing interest in LICs has raised broader questions regarding the role of integration, continuity and longitudinality in medical education. A study with complementary theoretical and empirical dimensions was conducted to derive a more precise way of defining these three underlying concepts within the design of medical education curricula. Methods The theoretical dimension involved a thematic review of the literature on integration, continuity and longitudinality in medical education. The empirical dimension surveyed all 17 Canadian medical schools on how they have operationalised integration, continuity and longitudinality in their undergraduate programmes. The two dimensions were iteratively synthesised to explore the meaning and expression of integration, continuity and longitudinality in medical education curriculum design. Results Integration, continuity and longitudinality were expressed in many ways and forms, including: integration of clinical disciplines, combined horizontal integration and vertical integration, and programme-level integration. Types of continuity included: continuity of patients, continuity of teaching, continuity of location and peer continuity. Longitudinality focused on connected or repeating episodes of training or on connecting activities, such as encounter logging across educational episodes. Twelve of the 17 schools were running an LIC of some kind, although only one school had a mandatory LIC experience. An ordinal scale of uses of integration, continuity and longitudinality during clerkships was developed, and new definitions of these concepts in the clerkship context were generated. Conclusions Different clerkship designs embodied different forms and levels of integration, continuity and longitudinality. A dichotomous view of LICs and rotation-based clerkships was found not to represent current practices in Canada, which instead tended to fall along a continuum of integration, continuity and longitudinality. [ABSTRACT FROM AUTHOR]

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. [ABSTRACT FROM AUTHOR]

Aim To develop a generic self-management skills scale for use with adolescents diagnosed with a chronic health condition who are aged 12 to 18 years. Background There is a lack of methodologically sound scales for healthcare teams to use to measure self-management skills in adolescents with chronic conditions transitioning to adult care. Methods Adolescents aged 12 to 18 years with a broad range of chronic health conditions, including neurodevelopmental conditions, were recruited from May to August 2013 from nine outpatient clinics at Mc Master Children's Hospital ( Canada). Thirty-two participated in a cognitive interview, and 337 completed a questionnaire booklet. Interviews were used to develop the TRANSITION- Q. Rasch measurement theory ( RMT) analysis was used to identify items that represent the best indicators of self-management skills. Traditional psychometric tests of measurement performance were also conducted. Results The response rate was 92% (32/32 cognitive; 337/371 field test). RMT analysis resulted in a 14-item scale with three response options. The overall fit of the observed data to that expected by the Rasch model was non-significant, providing support that this new scale measured a unidimensional construct. Other tests supported the scale as scientifically sound, e.g. Person Separation Index = 0.82; good item fit statistics; no differential item function by age or gender; low residual correlations between items; Cronbach's alpha = 0.85; test-retest reliability = 0.90; and tests of construct validity that showed, as hypothesized, fewer skills in younger participants and in participants who required assistance to complete the scale. Finally, participants who agreed they are ready to transfer to adult healthcare reported higher TRANSITION- Q scores than did participants who disagreed. Conclusions The TRANSITION- Q is a short, clinically meaningful and psychometrically sound scale. This generic scale can be used in research and in paediatric and adolescent clinics to help evaluate readiness for transition. [ABSTRACT FROM AUTHOR]

Context Efforts are underway in many parts of the world to develop medical education curricula that address the health care issues of indigenous populations. The topic of stereotypes and their impact on such peoples' health, however, has received little attention. An examination of stereotypes will shed light on dominant cultural attitudes toward Aboriginal people that can affect quality of care and health outcomes in Aboriginal patients. Objectives This study examines the views of undergraduate medical students regarding Canadian Aboriginal stereotypes and how they potentially affect Aboriginal people's health. The goal of this study was to gain insight into how medical learners perceive issues related to racism, discrimination and social stereotypes and to draw attention to gaps in Aboriginal health curricula. Methods This study involved a convenience sample of medical learners drawn from one undergraduate medical programme in western Canada. Using a semi-structured interview guide, we conducted a total of seven focus group interviews with 38 first- and second-year undergraduate medical students. Data were analysed using a thematic content analysis approach. Results Medical students recognise that stereotypes are closely related to processes of racism and discrimination. However, they generally feel that stereotypes of Aboriginal people are rooted in reality. Students also identified medical school as one of the environments in which they are commonly exposed to negative views of Aboriginal people. Student responses suggest they see the cultural gap between Aboriginal and non-Aboriginal people as being both a cause and a consequence of discrimination against Aboriginal people. Conclusions The results of this study suggest that teaching medical students about the realities and impacts of stereotypes on Aboriginal peoples is a good starting point from which to address issues of racism and health inequities affecting the health of Aboriginal people. [ABSTRACT FROM AUTHOR]

Objectives Newborn bloodspot screening ( NBS) panels have expanded to include conditions for which treatment effects are less certain, creating debate about population-based screening criteria. We investigated Canadian public expectations and values regarding the types of conditions that should be included in NBS and whether parents should provide consent. Methods Eight focus groups ( FG; n = 60) included education, deliberative discussion and pre-/post-questionnaires. Data were analysed quantitatively and qualitatively. Results Quantitatively, the majority supported NBS for serious disorders for which treatment is not available (95-98, 82%). A majority endorsed screening without explicit consent (77-88%) for treatable disorders, but 62% supported unpressured choice for screening for untreatable disorders. Qualitatively, participants valued treatment-related benefits for infants and informational benefits for families. Concern for anxiety, stigma and unwanted knowledge depended upon disease context and strength of countervailing benefits. Conclusions Anticipated benefits of expanded infant screening were prioritized over harms, with information provision perceived as a mechanism for mitigating harms and enabling choice. However, we urge caution around the potential for public enthusiasm to foster unlimited uptake of infant screening technologies. [ABSTRACT FROM AUTHOR]