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Despite the large number of immigrant adolescents in Canada, research on their knowledge of sexual and reproductive health and rights (SRHR) and information needs is nearly nonexistent. A scoping review was undertaken following the PRISMA-ScR statement to identify and assess the existing literature regarding SRHR needs of immigrant adolescents in Canada. Of the 1514 articles retrieved from our search strategy, 15 studies met our inclusion criteria. The results from our review identifies three unique themes related to immigrant adolescents’ SRHR needs: knowledge needs, access to SRHR education and services, and approaches to SRHR education and services. Immigrant adolescents’ knowledge needs includes needs on HIV/STI transmission and protection, unintended pregnancy, sexual activity, family planning, pubertal education, navigating the health care system, and confidentiality legislations. Our results revealed that immigrant adolescents’ access SRHR education and services through both school-based and community-based settings. Lastly, approaches to SRHR education and services for immigrant adolescents should include cultural sensitivity, an intersectional approach, interactive learning, a strength-based approach, and reassuring confidentiality rights. The multi-faceted SRHR needs of immigrant adolescents in Canada demonstrates that future research, program development, and policymaking requires careful consideration of these intersecting forces. Inclusive SRHR education and services can be achieved through the employment of a critical cultural approach and intersectional strategies.

Aim Demands for mental health services in post‐secondary institutions are increasing. This paper describes key features of a response to these needs: ACCESS Open Minds University of Alberta (ACCESS OM UA) is focused on improving mental health services for first‐year students, as youth transition to university and adulthood. Methods The core transformation activities at ACCESS OM UA are described, including early case identification, rapid access, appropriate and timely connections to follow‐up care and engagement of students and families/carers. In addition, we depict local experiences of transforming existing services around these objectives. Results The ACCESS OM UA Network has brought together staff with diverse backgrounds in order to address the unique needs of students. Together with the addition of ACCESS Clinicians these elements represent a systematic effort to support not just mental health, but the student as a whole. Key learnings include the importance of community mapping to developing networks and partnerships, and engaging stakeholders from design through to implementation for transformation to be sustainable. Conclusions Service transformation grounded in principles of community‐based research allows for incorporation of local knowledge, expertise and opportunities. This approach requires ample time to consult, develop rapport between staff and stakeholders across diverse units and develop processes in keeping with local opportunities and constraints. Ongoing efforts will continue to monitor changing student needs and to evaluate and adapt the transformations outlined in this paper to reflect those needs.

As the population of Pakistan has increased beyond 200 million, it is evident that the country's family planning program has been unable to sufficiently expand contraceptive use. To understand the obstacles, researchers have tended to focus on service delivery failures, ‘cultural’ barriers and varying political support. However, a small body of literature documents citizen's suspicions of an ulterior motive underlying Pakistan's family planning program. Often dismissed as unfounded conspiracies, a gap in our knowledge is the role these beliefs might be playing in the failure of the program. Using a critical ethnographic approach, we conduced 242 observations of daily life, 109 informal and 197 in-depth interviews with 41 women and 35 men living in a village in Khyber Pakhtunkhwa. Data were collected between September 2013 and April 2015 and analysed using latent content analysis. Our respondents viewed Western support for family planning as confirmation of their suspicions of the program's hidden agenda. Western military intervention in the region complicated their beliefs about the potential altruistic nature of foreign support for the family planning program. Awareness of rampant corruption among Pakistani government officials had fractured their trust in the state while contributing to the notion that the government was complicit with foreign interference. These considerations coupled with the fact that the priorities of Pakistani Family Planning program did not align with the reality of their lives contributed to the skepticism of family planning. For our respondents, resisting family planning and its ideology was a means to resist the perceived violence inflicted by the West and the complicity of the Pakistani government. These findings signal how geopolitics influence the use of family planning services. By demonstrating the importance of embedding perceptions of family planning programs in their local and global contexts, these findings suggest potential areas for future research in the field.

Breastfeeding is the safest mode of infant feeding during disasters and displacement. Although challenges associated with breastfeeding during humanitarian emergencies are global, they are particularly problematic in low- and middle-income countries such as Pakistan. To examine the factors that affect breastfeeding practices of displaced mothers in disaster relief camps, an integrative review of literature was undertaken. The review suggests that the breastfeeding experiences, behaviors, and practices of displaced mothers are shaped by a combination of gender-based, sociocultural, economic, and geopolitical factors. A thorough understanding of these factors will assist nurses and other stakeholders to improve breastfeeding practices and decrease child deaths in disaster relief camps.

More people are migrating than ever before. There are an estimated 1 billion migrants globally—of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women’s access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

Aim Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. Method We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. Results Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. Conclusions Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

Bhutanese refugees represent one of Canada’s most recent immigrant populations, and little is known about their dietary traditions and habits. The purpose of this study was to improve the wellbeing and health of re-settled refugee Bhutanese women by understanding how culturally informed postpartum food choices are practiced post-migration. As part of a larger community-based participatory research project, semi-structured interviews were conducted with 12 Bhutanese refugee women. The traditional dietary choices that Bhutanese women revealed to be important in the postpartum period were organized into five themes: (1) “foods consumed as part of a regular healthy diet,” (2) “foods to regain strength and heal the body,” (3) “foods to ward off back and joint pain,” (4) “foods to promote lactation,” (5) “foods avoided due to negative effects.” Traditional foods and culturally situated beliefs in the postpartum period play a significant role in the lives of Bhutanese women. Healthcare workers in countries of re-settlement should work with the traditional health and nutritional beliefs of women in this community in order to provide optimal dietary and health recommendations.

Background Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families. Methods The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention. Discussion Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research. Trial registration number Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017). Electronic supplementary material The online version of this article (10.1186/s12888-019-2232-2) contains supplementary material, which is available to authorized users.

People's perceptions of local food environments influence their abilities to eat healthily. PhotoVoice participants from four communities in Alberta, Canada took pictures of barriers and opportunities for healthy eating and shared their stories in one-on-one semi-structured interviews. Using a socioecological framework, emergent themes were organized by type and size of environment. Findings show that, while availability and access to food outlets influence healthy eating practices, these factors may be eclipsed by other non-physical environmental considerations, such as food regulations and socio-cultural preferences. This study identifies a set of meta-themes that summarize and illustrate the interrelationships between environmental attributes, people's perceptions, and eating behaviors: a) availability and accessibility are interrelated and only part of the healthy eating equation; b) local food is synonymous with healthy eating; c) local food places for healthy eating help define community identity; d) communal dining (commensality) does not necessarily mean healthy eating; e) rewarding an achievement or celebrating special occasions with highly processed foods is socially accepted; f) food costs seemed to be driving forces in food decisions; g) macro-environmental influences are latent in food decisions. Recognizing the interrelationship among multiple environmental factors may help efforts to design effective community-based interventions and address knowledge gaps on how sociocultural, economic, and political environments intersect with physical worlds.

Obesity is prevalent among the First Nations population in Canada, with serious associated health risks. Recent studies also indicate that a high percentage of First Nations women are overweight or obese at the start of their pregnancies, with a tendency to retain weight after their children are born. In response to these concerns, a community-based study was conducted in two Cree communities, using qualitative methods to investigate young mothers’ perceptions and concerns about weight gain during pregnancy and challenges to postpartum weight loss. Female Elders were also interviewed to provide some historical context and to give some insight into culturally appropriate responses to the current weight-related health challenges being faced by young mothers. Overall, the study showed that most of the participants—young and old— associated “healthy foods” with traditional foods and “healthy living” with bush life. However, while Elders recounted staying active and eating traditional foods throughout their pregnancies, the younger women tended not to put their knowledge of what constitutes a healthy lifestyle into practice, mainly due to various individual and societal barriers. Some of the barriers identified related to lifestyle changes, including increased consumption of “white man’s foods” and decreased physical activity, as well as to larger social changes, such as the medicalization of pregnancy and diminished community support networks for young mothers. Participants provided insight into how traditional practices could be intertwined with the benefits of contemporary life to help address some of the health issues currently affecting young Cree mothers.

Objective: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period. Design: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves. Results: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors. Conclusion: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.

Background: Food practices throughout the perinatal period have a profound influence on the health and wellbeing of a mother and her child. Following migration, pregnant immigrant women bring with them culturally-situated beliefs about appropriate eating behaviours, while simultaneously encountering new socio-cultural environments that can negatively affect their food choices. Research is needed to inform and improve the provision of culturally appropriate maternal health and nutritional care. Methods: We employed a focused ethnography, photo-voice methods, and photo-assisted interviews to explore and understand South Asian immigrant women’s food choices and practices during the perinatal period and to investigate the intersectionality of these factors in a social context of cultural adaptation and adjustment. Findings: The key themes constructed from the data included (a) general health beliefs, (b) antenatal and postnatal food choices including Ayurvedic medical beliefs, (c) social advice and socio-economic factors.

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions. Language: en

Development of policies and interventions to address health disparities between Indigenous and non-Indigenous populations requires a comprehensive understanding of Indigenous people’s experiences and perspectives of healthcare services. We systematically reviewed the published literature on Canadian Indigenous women’s experiences and perspectives of maternal healthcare during pregnancy, childbirth, and the postpartum period. Major bibliographic databases (including PubMed, CINAHL, EMBASE, SCOPUS, and SSCI) were searched for published studies (1990–March 2015) in English. Reference lists of identified articles were searched to identify additional articles. 92 articles were retrieved for further review, of which 16 studies were included: 8 on maternal healthcare and/or medical evacuation; 3 on gestational diabetes mellitus; 3 on the impact of policies on maternal health; and 2 on maternal weight changes and/or breastfeeding. The included studies described 1043 participants: Indigenous peoples (n=918) and non-Indigenous peoples (n=125) who were mothers or pregnant women (n=814), healthcare providers or workers in a health-related field (n=132), and fathers, Elders, or other community members (n=97). Availability of healthcare resources, healthcare services’ consideration of socio-economic or lifestyle barriers to health, and the impact of colonization on interactions with healthcare providers were main factors that impacted Indigenous women’s maternal health experiences. Medical evacuation was often due to limited maternity care options available in remote communities, and was associated with emotional, physical, and financial stress. This review highlights the importance of consistent health policies and practices for maternal health in Canada and providing culturally safe and patient-centered maternity healthcare services within indigenous communities.

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics. Methods: This four-phase study employed a case study design allowing for multiple means of data collection and different units of analysis. Phase one consists of a scoping review of the literature. Phases two and three incorporate pictorial representations of food choices with semi-structured photo-elicited interviews. This study was undertaken at a Prenatal and Obstetric Clinic, in an urban Canadian city. In phase four, the research team will inform the development of culturally appropriate visual tools for health promotion. Results: Five themes were identified: (a) Perceptions of Health, (b) Social Support (c) Antenatal Foods (d) Postnatal Foods and (e) Role of Health Education. These themes provide practitioners with an understanding of the cultural differences that affect women’s dietary choices during pregnancy. The project identified building collaborations between practitioners and families of pregnant immigrant women to be of utmost importance in supporting healthy pregnancies, along with facilitating social support for pregnant and breastfeeding mothers. Conclusion: In a multicultural society that contemporary Canada is, it is challenging for health practitioners to understand various ethnocultural dietary norms and practices. Practitioners need to be aware of customary practices of the ethnocultural groups that they work with, while simultaneously recognizing the variation within—not everyone follows customary practices, individuals may pick and choose which customary guidelines they follow. What women choose to eat is also influenced by their own experiences, access to particular foods, socioeconomic status, family context, and so on. The pilot study demonstrated the efficacy of the employed research strategies and we subsequently acquired funding for a national study.

In northern Ghana, families traditionally function as the main provider of care. The role of family, however, is becoming increasingly challenged with the social shifts in Ghanaian culture moving from extended kinship to nuclear households. This has implications for the care of women post obstetric fistula (OF) repair and their family members who assist them to integrate back into their lives prior to developing the condition. This research is part of a larger critical ethnographic study which explores a culture of reintegration. For this article, we draw attention to the findings related to the experience of family caregivers who care for women post OF repair in northern Ghana. It is suggested that although family caregivers are pleased to have their family member return home, there are many unanticipated physical, emotional, and economic challenges. Findings lead to recommendations for enhancing the reintegration process and the need for adequate caregiving support.

OBJECTIVES: Detailed assessments of the built environment often resist data reduction and summarization. This project sought to develop a method of reducing built environment data to an extent that they can be effectively communicated to researchers and community stakeholders. We aim to help in an understanding of how these data can be used to create neighbourhood groupings based on built environment characteristics and how the process of discussing these neighbourhoods with community stakeholders can result in the development of community-informed health promotion interventions. METHODS: We used the Irvine Minnesota Inventory (IMI) to assess 296 segments of a semi-rural community in Alberta. Expert raters “created” neighbourhoods by examining the data. Then, a consensus grouping was developed using cluster analysis, and the number of IMI variables to characterize the neighbourhoods was reduced by multiple discriminant function analysis. RESULTS: The 296 segments were reduced to a consensus set of 10 neighbourhoods, which could be separated from each other by 9 functions constructed from 24 IMI variables. Biplots of these functions were an effective means of summarizing and presenting the results of the community assessment, and stimulated community action. CONCLUSIONS: It is possible to use principled quantitative methods to reduce large amounts of information about the built environment into meaningful summaries. These summaries, or built environment neighbourhoods, were useful in catalyzing action with community stakeholders and led to the development of health-promoting built environment interventions.

Background Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated. Discussion The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Over the last number of years there has been growing interest in the use of community-based participatory research (CBPR) for preventing and controlling complex public health problems. Photovoice is one of several qualitative methods utilized in CBPR, as it is a participatory method that has community participants use photography, and stories about their photographs, to identify and represent issues of importance to them. Over the past several years photovoice methodology has been frequently used to explore community health and social issues. One emerging opportunity for the utilization of photovoice methodology is research on community built and social environments, particularly when looking at the context of the neighbourhood. What is missing from the current body of photovoice literature is a critique of the strengths and weaknesses of photovoice as a method for health promotion research (which traditionally emphasizes capacity-building, community-based approaches) and as a method for revealing residents' perceptions of community as a source of health opportunities or barriers. This paper will begin to address this gap by discussing the successes and challenges of using the photovoice methodology in a recent CBPR project to explore community perceptions of the built and social environment (with the ultimate goal of informing community-based chronic disease prevention initiatives). The paper concludes with methodological recommendations and directions for future research.

157 schools. Rural schools had less favourable built environments than urban schools. conclusions: Canadian children, particularly those from rural areas and those attending secondary