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Aims: To investigate the feasibility and acceptability of a serious mobile-game intervention on older adults' engagement, affect, and cognitive function. Methods: In this single-subject design, twenty older adults, six of whom living with dementia, participated in a 16-session mobile-game intervention. Before and after the intervention, participants had sessions involving traditional paper-based cognitive activities. Engagement and affect were measured in each session. Cognitive measures were administered before and after the intervention. Acceptability was explored through interviews. Results: After the intervention, there was a statistically significant increase in engagement in 37% of participants, and in affect in 21% of participants. Participants preferred the mobile games to the paper-based activities. Cognitive measures showed improvement in four participants with dementia. Conclusions: Although not conclusive, participants experienced higher levels of engagement and positive affect while playing the mobile games compared to paper-based activities. The results indicate feasibility and acceptability of the mobile game intervention. [ABSTRACT FROM AUTHOR]

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Background: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion. Methods: A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified. Results: Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making. Conclusions: The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a new prenatal education program evaluation tool, the UpStart Parent Survey – Prenatal, in terms of: (a) reliability and validity; (b) sensitivity to change over time; (c) whether results differed for mothers versus fathers; and (d) whether results differed when using an electronic tablet‐computer versus a paper survey. Design and Sample: Psychometric study. Participants were 277 expectant mothers (n = 161) and fathers (n = 106) enrolled in Childbirth Essentials, a 6‐week prenatal education program. Measures: The UpStart Parent Survey – Prenatal is a retrospective pretest/posttest survey with three scales: Parenting Knowledge, Parenting Experience, and Program Satisfaction, and three open‐ended questions. Results: The UpStart Parent Survey – Prenatal is sensitive to change and demonstrated significant positive differences in parenting knowledge and parenting experience. There was no difference in results whether the survey was completed by mothers or fathers. Results were similar whether paper or electronic formats were used. The survey was easy to complete. Conclusion: The UpStart Parent Survey – Prenatal holds promise as a reliable and valid evaluation tool to capture outcomes of brief prenatal education programs that target the general population of expectant parents. [ABSTRACT FROM AUTHOR]

The purpose of the paper was to draw lessons for the field of adapted physical activity from the interrelated literatures on interdisciplinarity, creativity, and team research. In each of these literatures, strategies have been identified that have been found to be useful by previous researchers. Lack of familiarity with these strategies can result in unsuccessful research projects or in the devotion of scarce resources to the reinvention of such strategies. The first section in the paper in particular addresses questions that arose at the 2016 North American Federation of Adapted Physical Activity symposium in Edmonton, Alberta. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research. Objectives: This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process. Methods: Trained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). Results: Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. Conclusion: Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. Patient or Public Contribution: The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants. [ABSTRACT FROM AUTHOR]

Background: With the rise in the Patient Safety Movement, increased attention is drawn to the efficacy and design of healthcare worker education and how that education is researched. Several challenges with current research methodologies used in research on education have been identified in the literature. The need for alternate research methods is recognized. This second paper in a series of four examines the application of Design-Based Research (DBR) to the design, implementation, and evaluation of innovative educational practices in complex practice settings. Methods: This paper describes how an iterative, multiphase DBR framework was implemented to study Infection Control Professionals (ICP) educational practice and evaluate the design and development of an ICP professional development experience to build expertise and change educational practices in the Alberta Health Services (AHS) Infection Prevention and Control (IPAC) program. The efficacy of DBR as an alternative methodology was examined by summarizing the outputs, outcomes, and impacts of study activities and how the defining characteristics of DBR were manifest in the study. Results: Numerous practical and theoretical study outputs and local outcomes resulted in more active and engaged teaching and learning by ICP participants. These outputs and local outcomes impacted the AHS IPAC program, resulting in ongoing ICP educational practice and professional development. The defining characteristics of DBR were effective in systematically designing and engineering change that was relevant and sustainable in the complex context of IPAC practice in the healthcare workplace. Discussion: DBR contributed substantively to the understanding and building of educational expertise and practice in the AHS IPAC program. DBR is well-suited for use beyond the study of educational teaching and learning environments. Although a complex time- and resource-intensive methodological approach, DBR offers a new philosophical research perspective for studying change and interventions in complex contexts. [ABSTRACT FROM AUTHOR]

Despite its historic prominence in group work, there is little empirical research to support our understanding of the professional use of self in group work. This paper reports the results of a SPARC endorsed study, which focused on group workers' experience and struggle with their professional uses of self in groups in responding to diversity. Using focus groups, a semi-structured interview format, and Straussian grounded theory data analysis, two key themes emerged – grappling with professional uses of self and disengagement from professional uses of self. When grappling with professional uses of self, group workers employed intentional self-disclosure, opened space, and supported norms for the expression of diversity, humility, genuineness, and reflexivity. Disengagement occurred in response to fear and often resulted in an overemphasis on group tasks. Our results suggest that the effective professional use of self in the here and now of group dynamics creates a sense of safety for both the group workers and the group members when responding to diversity. The implications of this study highlight the need for a method that supports critical self-reflection in real-time in group and builds capacity for responsibly responding to diversity in groups. [ABSTRACT FROM AUTHOR]

African immigrant children and youth have some of the poorest social and mental health outcomes in Canada. Although parenting challenges have been widely documented as a key driver of these outcomes, limited systematic research has investigated this phenomenon. In this paper, we report the results of a study examining parenting challenges among a sample of African immigrant parents in Alberta, Canada. We relied on the theoretical lens of transnationalism to collect and analyse data from a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), and a range of stakeholders (n = 30). Our thematic data analysis revealed several intricately intertwined parenting challenges, organized around six overarching themes, namely, cultural incompatibility, family tension, state interference, limited social supports, poor access to services, and low socioeconomic status. We present these themes and the policy and service implications of our findings. [ABSTRACT FROM AUTHOR]

Background: Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives: To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design: Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods: The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results: Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion: Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway. Methods: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders. Results: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway. Conclusions: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway. Trial registration: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03508557. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the impact and importance of the physical, social and institutional environments on the outcome of their first fieldwork experience from the perspectives of occupational therapy (OT) and physical therapy (PT) students. PARTICIPANTS: Eighty two percent (n=84) of OT and 65% (n=51) of PT students completed the survey. The majority of students were female, aged 20-25 years, and supervised using a one student to one educator supervision model. METHODS: A paper survey was mailed to all OT and PT students during their junior fieldwork placement. Demographic, nominal score data and responses to closed-ended questions generated descriptive statistics. Qualitative data resulting from the open-ended questions underwent content analysis. RESULTS: OT and PT students' fieldwork experiences and perceptions of their environment were remarkably similar, however, OT students indicated the physical environment (e.g., having a desk, access to a computer) and orientation (e.g., having a tour) were more important to their impressions of the placement as positive. CONCLUSIONS: By knowing how the environment impacts the fieldwork experience for students, stakeholders involved in the fieldwork process are in a better position to identify and be proactive in making changes to improve placement quality. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students' moderate to vigorous physical activity (MVPA). Methods: Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit. Study Designs: A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n =33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012). Analysis: In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students' minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES. Results: In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students' MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (-1.52, 95% CI:-3.47, 0.42), or by covariates. Conclusions: The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/design: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.Discussion: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial Registration: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014. [ABSTRACT FROM AUTHOR]

This paper aims to understand the factors promoting racial microaggression from the perspective of first-generation Black African immigrant youth in Calgary, Alberta, Canada. Most of the literature on Blacks and other visible minorities [1] in Canada is centered on integration challenges, which have been identified in terms of socioeconomic and political marginalization. Within the context of immigrant challenges of navigating the job market, one realizes that many institutionalized factors influence access to opportunities. However, there is little research on immigrant youth, notably Black youth, and their experiences of racial microaggressions in Canadian society. This study fills this gap by offering an understanding of the experiences of microaggressions among Black African youth in Calgary. This city is arguably becoming increasingly diverse with the influx of immigrants from different countries and other Canadian provinces. Drawing on qualitative research methods (40 semistructured interviews with Ghanaian and Sudanese youth immigrants, 20 females and 20 males between the ages of 18 and 30 years), we incorporate meaningful insights from African immigrant youth on racial drivers of microaggressions. The analysis is grounded in critical race theory (CRT). Findings indicate that the youth face marginalization in the labor market during the hiring process (linguistic discrimination), discrimination at the workplace, and exclusion because their names are exploited as identity markers. Overall, policies advocating for an inclusive society need to be strengthened to address these inequalities that are ingrained in Canadian cities. [1] In this study, a visible minority is defined by the Government of Canada as 'persons, other than aboriginal peoples, who are non-Caucasian in race or non-white in colour' (Statistics Canada, 2015). [ABSTRACT FROM AUTHOR]

Aims: To explore the lived experiences of caregivers of people living in long-term care (LTC) homes during the initial phases of the COVID-19 pandemic and potential supports and resources needed to improve caregivers' quality of life. Background: Carers (or care partners) of adults in LTC contribute substantially to the health and well-being of their loved ones by providing physical care, emotional support and companionship. Despite their critical role, little is known about how caregivers have been impacted by the pandemic. Design: An interpretive descriptive approach that incorporated the photovoice method was used. Methods: Using a purposive sampling strategy, six family carers in Ontario, Canada were recruited between September and December 2021. Over a 4-week period, caregivers took pictures depicting their experience of the pandemic that were shared in a virtual focus group. Visual and text data were analysed using thematic analysis with an inductive approach. Findings: Caregivers expressed feelings of frustration, confusion and joy. Emerging themes included: (i) feeling like a 'criminal' amidst visitor restrictions and rules; (ii) experiencing uncertainty and disappointment in the quality of care of long-term care homes; (iii) going through burnout; and (iv) focusing on small joys and cherished memories. Conclusions: The combination of visual and textual methods provided unique insight into the mental distress, isolation and intense emotional burdens experienced by caregivers during the pandemic. Impact: Our findings underscore the need for LTC organizations to work in unison with caregivers to optimize the care of residents and support the mental health of caregivers. Reporting Method: This work adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. Public Contributions: The caregivers included in the study were involved in the cocreative process as active contributors informing the design and validation of the codes and themes. [ABSTRACT FROM AUTHOR]

For First Nations tuberculosis (TB) patients in the Prairie Provinces, the past matters. In this paper, we draw on the analysis of historical statements made by 20 First Nations interviewees with infectious TB to explore the function of talking about the past in relation to a current diagnosis of TB and the implications of historicity on contemporary TB prevention, programming and care. Despite interviewees not being asked directly about past contexts of TB treatment, they talked about historical topics such as the removal of First Nations TB patients from communities for treatment in distant sanatoria, painful and invasive surgical procedures once used to treat TB, and the attitudes that persist due to the ongoing failure to eliminate TB from First Nations communities. In these narratives, past experiences of TB treatment are intimately connected to present-day experiences and context. What happened 'years ago' profoundly affects the health and well-being of people diagnosed with TB today. Attempts to eliminate TB among First Nations peoples in Canada must also address its historical legacy. Understanding the contemporary effects of past TB treatment and mistreatment among First Nations peoples in the Prairie Provinces can also be seen as part of a larger project of truth and reconciliation in Canada, which involves both Indigenous and non-Indigenous Canadians. [ABSTRACT FROM AUTHOR]

Background: Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends.Methods: Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.Results: Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities.Conclusions: Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential. [ABSTRACT FROM AUTHOR]

Background: Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. Methods: First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. Results: We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. Conclusion: This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice. [ABSTRACT FROM AUTHOR]

Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. Objective: The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. Methods: Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. Results: Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. Conclusions: Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase. [ABSTRACT FROM AUTHOR]

king k.m., khan n., leblanc p. & quan h. (2011) Examining and establishing translational and conceptual equivalence of survey questionnaires for a multi-ethnic, multi-language study. Journal of Advanced Nursing 67(9), 2267-2274. Abstract Aim. This paper is a report of techniques used to examine and establish translational and conceptual equivalence of survey questionnaires. Background. A major concern arose about standardization of translated survey questionnaires, when preparing to evaluate differences in acute coronary syndrome presentation in European (White), Chinese and South Asian patients. Methods. The survey questionnaires were first translated by an accredited translation company. Between July and November 2009, materials were taken to like-speaking healthcare reviewers to ensure that the clinical meaning was appropriate. Like-speaking lay reviewers were then asked to make comment about grammar; meaning and understanding of questions; and any concerns about the suitability of graphics. A key informant from each language group reviewed all comments and worked with the investigators and the translation company to create final sets of survey questionnaires. Results. Readability of the questionnaires (too complex or too basic) was the most common concern. A major discrepancy between ethnic groups arose about a graphic of 'squeezing' pain. A hand grasping a balloon was considered appropriate for European and South Asian groups, while a picture of a towel being wrung out was identified as more appropriate for the Chinese. There were no negative comments about the graphics. Soliciting key informants who were highly fluent in both English and the language under study was critical to ensure that the participants' feedback was appropriately reconciled. Conclusion. Traditional forward-backward translation of study materials is insufficient. Translation must be accompanied by a process whereby equivalence and acceptability are also established. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the information needs and preferences of patients who had human papillomavirus--associated head and neck cancer (HNC) and who were aged 18--65 years in the post-treatment phase of recovery. SAMPLE & SETTING: 205 patients who completed treatment for HNC at two large cancer centers in Western Canada. METHODS & VARIABLES: A self-administered survey was completed in paper or online format. Participants were asked about information considered most important, sources of information used during recovery, and sources considered most helpful. RESULTS: Participants wanted information on signs and symptoms of recurrence, cure rates, post-treatment rehabilitation, treatment and recovery time frames, and financial assistance. They identified healthcare providers as the most frequently used and helpful source of information, but also reported that the Internet was useful and that an online information resource would be helpful during recovery. IMPLICATIONS FOR NURSING: Nurses can provide more personalized information for survivors of HNC by contributing to the development of reliable Internet-based resources. The developers of these resources could also consider creating ways to directly link healthcare providers and survivors of HNC who are experiencing problems stemming from diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes. Methods: We conducted 9 focus groups and 2 semi-structured interviews via videoconference. Results: We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers. Conclusions: The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general. [ABSTRACT FROM AUTHOR]

Background: The use of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in pediatric clinical practice can enhance clinical care and bring children and families' perspectives into evaluations of healthcare services. Implementing these measures is complex and requires a thorough assessment of the context of implementation The purpose of this study is to describe the barriers and facilitators to PROMs and PREMs implementation and to recommend strategies for implementing these measures in a pediatric health system. Methods: We used a qualitative descriptive approach to analyse data from interviews to understand the experiences of PROMs and PREMs users across different pediatric settings in a single Canadian healthcare system. Results: There were 23 participants representing a variety of roles within the healthcare system and pediatric populations. We found five main factors that affected implementation of PROMs and PREMs in pediatric settings: 1) Characteristics of PROMs and PREMs; 2) Individual's beliefs; 3) Administering PROMs and PREMs; 4) Designing clinical workflows; and 5) Incentives for using PROMs and PREMs. Thirteen recommendations for integrating PROMs and PREMs in pediatric health settings are provided. Conclusions: Implementing and sustaining the use of PROMs and PREMs in pediatric health settings presents several challenges. The information presented will be useful for individuals who are planning or evaluating the implementation of PROMs and PREMs in pediatric settings. Plain English summary: Patient-reported outcome measures are standardized questionnaires that ask patients about their health and well-being and are useful for tracking patient progress and outcomes of care. Patient-reported experience measures ask patients about their experiences while receiving care and are useful for quality improvement and experience research. Clinicians can use them to help identify patients' needs, monitor a person's health status, and to give extra information that helps with planning treatment. These measures also provide data that health services can use to understand whether their programs are helpful from the patients' perspective. We know that using these measures is beneficial, but there are many challenges to overcome before they are used consistently in a health system. In pediatrics there are special considerations, like whether a caregiver or child should be answering the questions, or whether a parent should be able to see their child's answers. In this study, we interviewed people in the pediatric health system who are successfully using patient-reported outcome and experience measures about the challenges they face and the strategies they find helpful for using these measures. This information will be helpful for people who are planning to start using these measures in pediatric health care. [ABSTRACT FROM AUTHOR]

To test if two e-learning modules – one on cognitive impairment, and one on continence and mobility – in older people would improve the knowledge of nurse members from the Canadian Gerontological Nurses Association and College of Licensed Practical Nurses of Alberta. A pre-post-test design was used to test 88 nurses' knowledge of cognitive impairment and 105 nurses' knowledge of continence and mobility and their perceptions of how the modules contributed to their learning. There was a statistically significant increase in practicing nurses' knowledge about cognitive impairment (0.68 increase), continence (2.30 increase), and its relationship to mobility. Nurses' self-report on the feedback survey demonstrated increases in knowledge, confidence, and perceptions about older people. These results suggest the modules have strong potential to enhance practicing nurses' knowledge about cognitive impairment, continence, and mobility. [ABSTRACT FROM AUTHOR]

Background: Practice based research networks (PBRNs) are increasingly used as a tool for evidence based practice. We developed and tested the feasibility of using software to enable online collection of patient data within a chiropractic PBRN to support clinical decision making and research in participating clinics. Purpose: To assess the feasibility of using online software to collect quality patient information. Methods: The study consisted of two phases: 1) Assessment of the quality of information provided, using a standardized form; and 2) Exploration of patients' perspectives and experiences regarding online information provision through semi-structured interviews. Data analysis was descriptive. Results: Forty-five new patients were recruited. Thirty-six completed online forms, which were submitted by an appropriate person 100% of the time, with an error rate of less than 1%, and submitted in a timely manner 83% of the time. Twenty-one participants were interviewed. Overall, online forms were preferred given perceived security, ease of use, and enabling provision of more accurate information. Conclusions: Use of online software is feasible, provides high quality information, and is preferred by most participants. A pen-and-paper format should be available for patients with this preference and in case of technical difficulties. [ABSTRACT FROM AUTHOR]

In addition to altering public infrastructure and social patterning, the COVID‐19 pandemic has delayed many pelvic organ prolapse (POP) surgeries. POP‐related stigma, symptomology and the experience of waiting for POP surgery can negatively impact women's quality of life and mental health. The experience of preoperative POP patients during the pandemic thus entails a new intersection of gendered, stigmatic and medical realities. Qualitative interviews were conducted with 26 preoperative POP patients as part of a larger qualitative study, 20 of whom spontaneously volunteered information about how the pandemic coloured their experience living with and awaiting surgery for POP. Interviews occurred between January and July 2021, which coincided with the second and third waves of the pandemic in Alberta, Canada, and before full immunisation was available for all Albertans. Pandemic‐related interview excerpts were thematically analysed, and four main findings emerged. (1) Though surgical delay meant living with unpleasant symptoms for longer than anticipated, some sought this out in order to protect vulnerable loved ones from possible hospital‐acquired infection, (2) shifting and unclear hospital policies and logistics resulted in intense preoperative stress, at times causing women to temporarily cease treatment, (3) decreased access to public restroom infrastructure caused women to reduce their outings and (4) the imperative to minimise social gatherings made it easier for women to engage in POP‐related, shame‐based self‐isolation without the notice of friends and family. As they can influence postoperative outcomes and treatment adherence, trends observed should be of interest to clinicians and policymakers alike. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: The early involvement of many actors including health professionals is identified in neuroethics and neurogovernance discussions as crucial in constructing conversations around awareness, reaction, and knowledge development pertaining to the ethical, legal, and societal consequences of neuroscientific or neurotechnological advancements (NA). Occupational Therapists (OTs) have a stake in NA; however, OTs are rarely mentioned within this context. Lifelong learning (LL) could be used to increase OTs knowledge on NA and its consequences. However, LL is rarely mentioned within neuroethics and neurogovernance discussions. OBJECTIVE: The study's purpose is to understand the role of OTs as professionals and citizens in neuroethics and neurogovernance discussions and to examine the utility of LL processes put in place for OTs to empower OTs to contribute in a meaningful way to NA discussions. METHODS: 8 semi-structured interviews with OTs were conducted and analyzed using a directed content analysis. RESULTS: Although participants believed OTs can provide a holistic perspective to neurogovernance discussions, their knowledge on NA and its consequences is limited, and LL is not used as a tool to remain informed about such consequences. CONCLUSION: More education on NA and its consequences throughout their OT degree and through LL opportunities is warranted to facilitate their involvement. [ABSTRACT FROM AUTHOR]

Introduction: Improving health services integration through primary health care (PHC) teams for patients with chronic conditions is essential to address their complex health needs and facilitate better health outcomes. The objective of this study was to explore if and how patients, family members, and caregivers were engaged or wanted to be engaged in developing, implementing and evaluating health policies related to PHC teams. This patient‐oriented research was carried out in three provinces across Canada: British Columbia, Alberta and Ontario. Methods: A total of 29 semi‐structured interviews with patients were conducted across the three provinces and data were analysed using thematic analysis. Results: Three key themes were identified: motivation for policy engagement, experiences with policy engagement and barriers to engagement in policy. The majority of participants in the study wanted to be engaged in policy processes and advocate for integrated care through PHC teams. Barriers to patient engagement in policy, such as lack of opportunities for engagement, power imbalances, tokenism, lack of accessibility of engagement opportunities and experiences of racism and discrimination were also identified. Conclusion: This study increases the understanding of patient, family member, and caregiver engagement in policy related to PHC team integration and the barriers that currently exist in this engagement process. This information can be used to guide decision‐makers on how to improve the delivery of integrated health services through PHC teams and enhance patient, family member, and caregiver engagement in PHC policy. Patient or Public Contribution: We would like to acknowledge the contributions of our patient partners, Brenda Jagroop and Judy Birdsell, who assisted with developing and pilot testing the interview guide. Judy Birdsell also assisted with the preparation of this manuscript. This study also engaged patients, family members, and caregivers to share their experiences with engagement in PHC policy. [ABSTRACT FROM AUTHOR]

Objectives: To examine the comparative performance of EuroQol EQ-5D-5L and Center for Disease Control Healthy Days measures in assessing population health. Methods: Using data from 2014 Alberta Community Health Survey, a cross-sectional population-based survey (N = 7559), conducted in Alberta, Canada, we examined construct validity of the measures as indicators of population health. Differences in EQ-5D-5L index score, visual analogue scale (EQ-VAS), and CDC unhealthy days index across socio-demographic subgroups were tested by Mann–Whitney and Kruskal–Wallis tests using known-groups approach. Results: EQ-5D-5L and CDC Healthy Days provided comparable assessments of population health in this sample. Both measures discriminated between subgroups defined by self-perceived health status, level of education, and material deprivation. The discriminative ability of CDC Healthy Days was limited in capturing variability in health among age groups compared to the EQ-5D-5L. Among participants who reported 0 unhealthy days, the proportion of those with level 3 problems in pain/discomfort varied from 1.1% for participants aged 18–24 to 19.2% for those over 75 years. Conclusions: EQ-5D-5L demonstrated better construct validity than CDC Healthy Days in assessing health in a population-based sample of adults. [ABSTRACT FROM AUTHOR]

Children are exposed to food environments that make nutrient-poor, energy-dense food cheap, readily available and heavily marketed; all conditions with potential negative impacts on diet and health. While the need for programmes and policies that improve the status of food environments is clear, greater public support is needed for governments to act. The purpose of this qualitative collective case study was to examine if community engagement in the Local Environment Action on Food (LEAF) project, a community-based food environment intervention in Alberta, Canada, could build public support and create action to promote healthy food environments. Semi-structured interviews with a purposeful sample of 26 stakeholders from 7 communities explored LEAF's impact and stakeholder experiences creating change. Data collection and analysis were iterative, following Charmaz's constant comparative analysis strategy. Participants reported environmental and community impacts from LEAF. Notably, LEAF created a context-specific tool, a Mini Nutrition Report Card, that communities used to promote and support food environment action. Further, analysis outlined perceived barriers and facilitators to creating community-level food environment action, including level of engagement in LEAF, perceived controllability, community priorities, policy enforcement and resources. Findings from this study suggest that community-based interventions, such as LEAF, can help build community capacity and reduce existing barriers to community-level food environment action. Thus, they can provide an effective method to build public awareness, demand and action for healthier food environments. [ABSTRACT FROM AUTHOR]

Fly-in fly-out (FIFO) work camps are built and organized to ensure that long-distance rotational workers are fed, housed, and mobilized in sync with the pressing yet unpredictable rhythms of resource extraction. Positioned thus 'betwixt and between' the complex relations of work and life (Johnsen and Sørensen, 2015), the work camp is a generative yet hitherto neglected example of the temporal operations of permanent liminality (Bamber et al., 2017). But what does this mean for workers? If camp does the liminal work of managing the temporal challenges of the resource-based mobility regime, how do FIFO workers experience and respond to its inevitable lived consequences? Drawing on rare qualitative fieldwork in Canada's Athabasca Oil Sands, we explain the effects of camp time—disorientation, monotony, and entrapment—and examine the temporal tactics workers deploy to manage those effects, from embracing and disrupting internal camp routines to aligning and syncing with outside and future-oriented temporalities. We argue that workers' tactics make them 'competent liminars' (Borg and Söderlund, 2015) of camp time, which is, in turn, crucial to the latter's disciplining function within the FIFO mobility regime. Our findings invite renewed attention to the temporal mediation accomplished by liminal people and places, especially in organizational contexts aimed at institutionally harnessing social time to productive imperatives. [ABSTRACT FROM AUTHOR]

Background: In 2019, cancer patients comprised over 65% of all individuals who requested and received Medical Assistance in Dying (MAID) in Canada. This descriptive study sought to understand the self-reported symptom burden and complexity of cancer patients in the 12 months prior to receiving MAID in Alberta. Methods: Between July 2017 and January 2019, 337 cancer patients received MAID in Alberta. Patient characteristics were descriptively analyzed. As such, 193 patients (57.3%) completed at least one routine symptom-reporting questionnaire in their last year of life. Mixed effects models and generalized estimating equations were utilized to examine the trajectories of individual symptoms and overall symptom complexity within the cohort over this time. Results: The results revealed that all nine self-reported symptoms, and the overall symptom complexity of the cohort, increased as patients' MAID provision date approached, particularly in the last 3 months of life. While less than 20% of patients experienced high symptom complexity 12 months prior to MAID, this increased to 60% in the month of MAID provision. Conclusions: Cancer patients in this cohort experienced increased symptom burden and complexity leading up to their death. These findings could serve as a flag to clinicians to closely monitor advanced cancer patients' symptoms, and provide appropriate support and interventions as needed. [ABSTRACT FROM AUTHOR]

Background: Web-based surveys are becoming increasing popular. The present study aimed to assess the reliability and validity of the Web-Survey of Physical Activity and Nutrition (Web-SPAN) for self-report of height and weight, diet and physical activity by youth. Methods: School children aged 11-15 years (grades 7-9; n = 459) participated in the school-based research (boys, n = 225; girls, n = 233; mean age, 12.8 years). Students completed Web-SPAN (self-administered) twice and participated in on-site school assessments [height, weight, 3-day food/pedometer record, Physical Activity Questionnaire for Older Children (PAQ-C), shuttle run]. Intraclass (ICC) and Pearson's correlation coefficients and paired samples t-tests were used to assess the test-retest reliability of Web-SPAN and to compare Web-SPAN with the on-site assessments. Results: Test-retest reliability for height (ICC = 0.90), weight (ICC = 0.98) and the PAQ-C (ICC = 0.79) were highly correlated, whereas correlations for nutrients were not as strong (ICC = 0.37-0.64). There were no differences between Web-SPAN times 1 and 2 for height and weight, although there were differences for the PAQ-C and most nutrients. Web-SPAN was strongly correlated with the on-site assessments, including height (ICC = 0.88), weight (ICC = 0.93) and the PAQ-C (ICC = 0.70). Mean differences for height and the PAQ-C were not significant, whereas mean differences for weight were significant resulting in an underestimation of being overweight/obesity prevalence (84% agreement). Correlations for nutrients were in the range 0.24-0.40; mean differences were small but generally significantly different. Correlations were weak between the web-based PAQ-C and 3-day pedometer record ( r = 0.28) and 20-m shuttle run ( r = 0.28). Conclusions: Web-SPAN is a time- and cost-effective method that can be used to assess the diet and physical activity status of youth in large cross-sectional studies and to assess group trends (weight status). [ABSTRACT FROM AUTHOR]

Infectious disease models can be of great use for understanding the underlying mechanisms that influence the spread of diseases and predicting future disease progression. Modeling has been increasingly used to evaluate the potential impact of different control measures and to guide public health policy decisions. In recent years, there has been rapid progress in developing spatio-temporal modeling of infectious diseases and an example of such recent developments is the discrete-time individual-level models (ILMs). These models are well developed and provide a common framework for modeling many disease systems; however, they assume the probability of disease transmission between two individuals depends only on their spatial separation and not on their spatial locations. In cases where spatial location itself is important for understanding the spread of emerging infectious diseases and identifying their causes, it would be beneficial to incorporate the effect of spatial location in the model. In this study, we thus generalize the ILMs to a new class of geographically dependent ILMs, to allow for the evaluation of the effect of spatially varying risk factors (e.g., education, social deprivation, environmental), as well as unobserved spatial structure, upon the transmission of infectious disease. Specifically, we consider a conditional autoregressive (CAR) model to capture the effects of unobserved spatially structured latent covariates or measurement error. This results in flexible infectious disease models that can be used for formulating etiological hypotheses and identifying geographical regions of unusually high risk to formulate preventive action. The reliability of these models is investigated on a combination of simulated epidemic data and Alberta seasonal influenza outbreak data ($2009$). This new class of models is fitted to data within a Bayesian statistical framework using Markov chain Monte Carlo methods. [ABSTRACT FROM AUTHOR]

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

Aims and objectives: This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses' perceptions of their work environments and their intentions to stay employed at their current nursing unit. Design: A cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada. Methods: The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression. Results: Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables. [ABSTRACT FROM AUTHOR]

Objective: Increasing evidence links unhealthy food environments with diet quality and overweight/obesity. Recent evidence has demonstrated that relative food environment measures outperform absolute measures. Few studies have examined the interplay between these two measures. We examined the separate and combined effects of the absolute and relative densities of unhealthy food outlets within 1600 m buffers around elementary schools on children's diet- and weight-related outcomes.Design: This is a cross-sectional study of 812 children from thirty-nine schools. The Youth Healthy Eating Index (Y-HEI) and daily vegetables and fruit servings were derived from the Harvard Food Frequency Questionnaire for Children and Youth. Measured heights and weights determined BMI Z-scores. Food outlets were ranked as healthy, somewhat healthy and unhealthy according to provincial paediatric nutrition guidelines. Multilevel mixed-effects regression models were used to assess the effect of absolute (number) and relative (proportion) densities of unhealthy food outlets within 1600 m around schools on diet quality and weight status.Setting: Two urban centres in the province of Alberta, Canada.Participants: Grade 5 students (10-11 years).Results: For children attending schools with a higher absolute number (36+) of unhealthy food outlets within 1600 m, every 10 % increase in the proportion of unhealthy food outlets was associated with 4·1 lower Y-HEI score and 0·9 fewer daily vegetables and fruit.Conclusions: Children exposed to a higher relative density of unhealthy food outlets around a school had lower diet quality, specifically in areas where the absolute density of unhealthy food outlets was also high. [ABSTRACT FROM AUTHOR]

Outdoor learning offers clear physical, cognitive, social-emotional and academic benefits for children and yet, it is considered a grassroots approach to teaching and learning in elementary schools. We examined teachers' perspectives on barriers and supports for outdoor learning in public elementary schools. Thirty-six teachers in (urban and rural) British Columbia, Alberta, and Ontario (all female; Mean age = 43.84, SD = 10) participated in one of five virtually administered, semi-structured focus groups. Questions/prompts facilitated a discussion on teachers' experiences with barriers and supports for outdoor learning. Thematic analysis was used to identify main themes. Four interrelated themes and further sub-themes were found: 1) Teacher characteristics: interest/motivation to teach outdoors, preparedness, confidence in handling risks; 2) Systemic factors: principal support, school/district policies, funding/resources, curriculum, school schedule; 3) Culture: school culture, societal beliefs about education, family backgrounds; 4) Environmental factors: weather, built/natural environment, hazards. Systemic support is needed to integrate outdoor learning in schools. The findings in this study are relevant to health education specialists particularly focused on elementary school education. [ABSTRACT FROM AUTHOR]

This qualitative study investigated understandings of spousal violence among 17 South Asian men residing in Alberta, Canada using focus groups. Thematic analysis revealed men's ignorance about sexual coercion as a form of abuse, although they had a solid understanding of physical and financial abuse. The men identified novel forms of emotional torture, as well as two types of transnational abuses that occur in their communities which have not emerged from previous studies: framing wives for false crimes across international borders and forced participation in family chain migration. Implications for violence prevention, assessment, intervention, and transnational law enforcement are discussed. [ABSTRACT FROM AUTHOR]

Background: Beliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes.Methods: Using data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest.Results: Men (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual's fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances.Conclusions: These results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives. [ABSTRACT FROM AUTHOR]

Background: Medication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy. The objective of this study was to examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception in older adults with chronic conditions.Methods: A pilot Randomized Controlled Trial (RCT) was conducted using a two-arm parallel assignment model. The intervention group used an MDS as their medication management method. The control group continued to use their current methods of medication management. Block randomization was used to assign participants into the intervention or control group. The inclusion criteria included 1) English speaking 2) age 50 and over 3) diagnosed with one or more chronic condition(s) 4) currently taking five or more oral medications 5) City of Calgary resident. Participants were recruited from a primary care clinic in Alberta, Canada. The study was open-label where knowledge about group assigned to participants after randomization was not withheld. Medication adherence was captured over a continuous, six-month period and analyzed using Intention-to-Treat (ITT) analysis.Results: A total of 91 participants were assessed for eligibility and 50 were randomized into the two groups. The number of participants analyzed for ITT was 23 and 25 in the intervention and control group, respectively. Most of the demographic characteristics were comparable in the two groups except the mean age of the intervention group, which was higher compared to the control group (63.96 ± 7.86 versus 59.52 ± 5.93, p-value = 0.03). The average recorded adherence over 26 weeks was significantly higher in the intervention group than the control group (98.35% ± 2.15% versus 91.17% ± 9.76%, p < 0.01). The self-rated medication adherence in the intervention group also showed a significant increase from baseline to 6-month (Z=-2.65, p < 0.01). The control group showed a non-significant increase (Z=-1.79, p = 0.07).Conclusion: The MDS can be an effective, long-term solution to medication non-adherence in older adults experiencing chronic conditions and taking multiple medications. The technology induces better consistency and improvement in medication taking behaviour than simple, non-technological intervention.Trial Registration: Registered with ClinicalTrials.gov on April 09, 2020 with identifier NCT04339296 . [ABSTRACT FROM AUTHOR]

Aim: To investigate which families with young children with disabilities used disability services and when they used services to inform policy on service delivery.Method: We used linked administrative data from different ministries in Alberta to describe families' use of disability services when their children were between the ages of 3 and 8 years old. Disability was investigated on the basis of the presence of a severe special education code for children, and level of special education code. The outcome was the use of family disability services.Results: Of 31 346 children, 24 761 (79.0%) had no special education code, 3982 (12.7%) had a mild special education code, and 2603 (8.3%) had a severe special education code. Level of special education code was associated with child characteristics and service use. Children with severe special education codes generally were more likely to report service use and have poor outcomes than those with less severe codes. Of note, 26% of children with severe special education codes used family disability services. In addition, among children with severe special education codes, many years of severe coding (compared with fewer years) had the strongest association with family disability service use (prevalence ratio 5.50; 95% confidence interval 4.10-7.37). Associations with family disability service use were seen with mental health, health care, and educational achievement. Interactions between child characteristics and service use were observed.Interpretation: This study provides evidence that families were more likely to use disability services when they were involved with other services, and that use interacts with various factors. The findings highlight the importance of considering service eligibility, referral, and integration. [ABSTRACT FROM AUTHOR]

Background: The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods: Fifteen semi-structured interviews with NPs and other stakeholders in Alberta's primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results: Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP's reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of 'care team' is defined and operationalized. Conclusions: In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province's primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP's ability to reach its goals. [ABSTRACT FROM AUTHOR]

This study explored the barriers that regulated nurse professionals encountered in recognizing and assessing geriatric depression in residential care facilities in the Canadian province of Alberta. The study used a convergent parallel mixed methods design, including a cross-sectional survey (N = 635) and qualitative interviews (N = 14) with regulated nurse professionals. Findings revealed six major barriers to the recognition of geriatric depression in Alberta, including 1) insufficient clinical knowledge and training in geriatric depression; 2) misconceived beliefs about geriatric depression; 3) limited access to resources; 4) unclear depression assessment protocol and procedures in facilities; 5) characteristics of models of care and organizational culture in facilities; and 6) communication difficulties among all stakeholders in the process. Socio-cultural values and beliefs about geriatric depression played a key role in the complex interaction of the various structural and agential barriers to the effective recognition and assessment of depression in residential care facilities in Alberta. [ABSTRACT FROM AUTHOR]

Background: Transitioning from pediatric care to adult-oriented care at age 18 (the age of transfer in most countries and jurisdictions) is a complex process for adolescents and young adults affected by chronic physical health and/or mental health conditions. The role of primary health care (PHC) providers for this population is poorly understood. Perspectives from these providers, such as family physicians and other members of the primary care team, have not been explored in depth. Methods: A total of 18 participants (e.g., family physicians, social workers, nurses) were recruited from 6 Primary Care Networks in Calgary, Alberta, Canada. Semi-structured individual interviews were conducted, and transcribed verbatim. A qualitative description approach was used to analyze the data, and included thematic analysis. Results: Five distinct, yet overlapping, roles of primary health care providers for adolescents and young adults transitioning to adult care resulted from our analysis: (1) being the "common thread" (continuous accessible care); (2) caring for the "whole patient" (comprehensive care); (3) "knowing families" (family-partnered care); (4) "empowering" adolescents and young adults to develop "personal responsibility" (developmentally-appropriate care); and (5) "quarterbacking" care (coordination of specialist and/or community-based care). Participants identified potential benefits of these roles for adolescents and young adults transitioning to adult care, and barriers in practice (e.g., lack of time, having minimal involvement in pediatric care). Conclusions: Input from family physicians, who follow their patients across the lifespan and provide the majority of primary care in Canada, are critical for informing and refining recommended transition practices. Our findings provide insights, from PHC providers themselves, to bolster the rationale for primary care involvement during transitions from pediatric specialty and community-based care for AYAs. Solutions to overcome barriers for integrating primary care and specialty care for adolescents and young adults need to be identified, and tested, with input from key stakeholders. [ABSTRACT FROM AUTHOR]

Child-focused sexual abuse prevention programs were developed in the 1970s in response to significant concerns across North America with respect to children being sexually abused. While program evaluations are common, measures to evaluate these programs, most of which are offered to children in elementary schools, are not widely available. This article reviews the key concepts covered in CSA prevention education programs that comprise the constructs used to measure knowledge/attitude gains post-program. Available measures are reviewed and the psychometrics of two new 10-item versions (one for students in grades 1–2; the other for grades 3–6) of the CKAQ-33, a commonly used tool, are presented and psychometrically assessed with a sample of 7646 elementary school students. [ABSTRACT FROM AUTHOR]

Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne's interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers' experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services. [ABSTRACT FROM AUTHOR]

Background: Large‐scale transformation depends on effective engagement of diverse stakeholders. With the evolution of the role of the 'patient partner' in health‐care decision making, understanding the motivations of these individuals is essential to the success of engagement initiatives. This study reports on motivational factors associated with patient engagement in health care. Methods: Patient co‐investigators and a researcher co‐designed and conducted this study. A survey was administered to patients and family members. Key informant interviews and previous research informed the development of the survey tool. The survey data were analysed using exploratory factor analysis to identify the underlying dimensions in the data. Cronbach's alpha was used to determine reliability. Results: A total of 1449 individuals participated in the survey. Of these, 543 completed and 427 partially completed the survey (67% complete rate). The mean age of the respondents was 54 years. The majority of participants were female, well‐educated, retired, married and lived in an urban centre. Seven motivational factors explained 65% of the total variance. Analysis of internal consistency revealed acceptable reliability for all items. The seven motivations were as follows: Self‐fulfillment, Improving Healthcare, Compensation, Influence, Learning New Things, Conditional and Perks. Conclusion: The results of this research describe a sample of patient and family members currently engaged with health systems. We identified seven motivational factors underlying their engagement. A deeper knowledge of volunteer motivations will not only create meaningful engagement opportunities for patients, but also enable health organizations to gain from the experience of these individuals, thereby enhancing quality and sustainability of patient engagement programmes. [ABSTRACT FROM AUTHOR]