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In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans. [ABSTRACT FROM AUTHOR]

This paper offers an examination of gay–straight alliance (GSA) members’ engagement with sex education, sexual health, and prejudice and discrimination in Canadian public high schools. It explores how five students’ (four straight and one gay-identifying) participation in GSAs served as a springboard for learning about and challenging stereotypes; prejudice; and discrimination directed at lesbian, gay, bisexual, trans, and queer/questioning (LGBTQ) people. Queer theory provided the theoretical underpinnings of the study, offering a lens through which to examine the heteronormative underpinnings of education, and a means to interpret how homophobic discourses circulate in school and society. Empirical data were obtained via observational notes from visits to nine GSAs and semi-structured interviews with the five GSA members. Findings suggest that straight allies can use their heterosexual privilege to address LGBTQ issues with their peers. Through GSA involvement, participants learned to interrogate and combat stereotypes about LGBTQ people and HIV-related myths, as well as to engage in queer discussion and political action. [ABSTRACT FROM PUBLISHER]

This paper investigates the nature of the relationship between satisfaction with high school sexual health education and the pursuit of a post-secondary human sexuality course. In an initial study, first-year university students who received high school sexual health education in Ontario completed a questionnaire which assessed their satisfaction with sexual health education and asked whether students were pursuing or intended to pursue a human sexuality course in university. Students who were less satisfied with high school sexual health education and, in particular, those who did not rate sexual health education as contributing to their understanding of themselves as sexual beings, were more likely to pursue a university-level course. A second qualitative study investigated potential reasons underlying this correlation. Eleven first-year students enrolled in a human sexuality course were interviewed about (a) their satisfaction with their high school sexual health education and (b) their reasons for taking the course. The findings suggest that dissatisfaction with sexual health education may be a result of students perceiving they had not learned enough personally relevant information and/or received a biased education in high school. These factors, which seem to determine dissatisfaction, may motivate students to pursue additional education in university. [ABSTRACT FROM PUBLISHER]

Sexuality is an aspect of health and development that is often overlooked among people with physical disabilities, particularly adolescents. Studies have demonstrated that youth with physical disabilities show considerably lower levels of sexual knowledge and receive inadequate sex education compared to their peers without such disabilities. The data for this paper are part of a qualitative study that explored the experiences, barriers and challenges associated with sex education for youth with physical disabilities from the perspectives of young people themselves, their parents and the health professionals who work with them. The findings from this study highlight the tendency for parents, educators and health professionals to place the responsibility of delivering sex education to young people with physical disabilities on someone else who they believe to be more appropriately qualified to handle these types of situations. As a result, the findings illustrate that adolescents with physical disabilities do not always receive the necessary combination of comprehensive sex education within school environments, specialized information from health professionals, and informal sex education from family and peers that they require in order to gain the knowledge and skills needed to understand their own sexual capabilities and make informed decisions about their sexual health and intimate relationships. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is the most common endocrine syndrome that disproportionally affects women of childbearing age (~8% to 13% of women worldwide). If unmanaged, it can lead to chronic, lifelong complications. Over the past decade, improvements in diagnostic guidelines have not produced an expected reduction in the diagnostic timeframe. We examined the potential reasons underlying this diagnosis delay. Participants first constructed a diagnostic timeline and then charted and reflected on their diagnosis journeys. Through a reflexive thematic analysis, five themes represented the most common diagnostic trajectory: (a) dismissal of adolescents' early symptoms, (b) negative diagnostic encounters, (c) wariness of treatment options, (d) uncertainty for the future, and (e) self-education and advocacy. Our findings lead us to argue for education of physicians and allied professionals to strengthen patient-centered care delivery to women with a focus on building in training supports that include critically informed, social justice foundations. [ABSTRACT FROM AUTHOR]

Purpose: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. Methods: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. Results: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. Conclusions: Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities. [ABSTRACT FROM AUTHOR]

Purpose: Access to primary care can help mitigate the negative impacts of social inequity that disproportionately affect Indigenous people in Canada. Despite this, however, Indigenous people cite difficulties accessing care. This study seeks to understand how Indigenous mothers—typically responsible for the health of their infants—living in urban areas, experience selecting and using health services to meet the health needs of their infants. Results provide strategies to improve access to care, which may lead to improved health outcomes for Indigenous infants and their families. Methods: This qualitative interpretive description study is guided by the Two-Eyed Seeing framework. Interviews were conducted with 19 Indigenous mothers and 5 primary care providers. Results: The experiences of Indigenous mothers using primary care for their infants resulted in eight themes. Themes were organized according to three domains of primary care: structural, organizational and personnel. Conclusions: Primary care providers can develop contextual-awareness to better recognize and respond to the health and well-being of Indigenous families. Applying culturally safe, trauma and violence-informed and family-centred approaches to care can promote equitable access and positive health care interactions which may lead to improved health outcomes for Indigenous infants and their families. [ABSTRACT FROM AUTHOR]

Family-centered approaches offer significant promise regarding the enhancement of child and family safety. Child protection workers find value in working alongside families, whereas families appreciate having a voice in decision-making processes. The introduction of Family Group Conferencing (FGC) in New Zealand in 1989 prompted the exploration of family partnership options internationally. This study, focusing on Ontario, Canada, examines the expansion of FGC from a local pilot in 1998 to a current province-wide initiative. The internal and external factors that have promoted and inhibited change were investigated. Interviews and a focus group were used to elicit the perspectives of Alternative Dispute managers and key informants. Participants concluded that the FGC program has been successful as a result of multilevel and multipronged change efforts. However, the long-term viability remains in question, primarily because of unstable funding and uneven buy-in, on provincial levels and within child welfare agencies. To ensure sustainability current strengths should be built upon, employing the same intentional, strategic planning that characterized the introduction of FGC into the province. The Ontario experience provides pointers for interested parties wishing to embed FGC and other family-centered approaches in daily child welfare practice. [ABSTRACT FROM PUBLISHER]

There is growing attention to the training and education of Personal Support Workers, or PSWs, who work in community, home and longterm care settings supporting older people and people with disabilities. In Ontario, Canada, amid a volatile policy landscape, the provincial government launched an effort to standardise PSW education. Using qualitative methods, this study considered the question: What are the central educational issues reflected by students, working PSWs and key informants, and are they addressed by the PSW programme and training standards? Phase one was a public domain analysis completed between January and March 2014 and updated for major developments after that period. Phase two, completed between August 2014 and March 2015, included 15 key informant interviews and focus group discussions and mini-phone interviews with 35 working PSWs and current PSW students. According to the participants, the central educational issues are: casualisation of labour that is not conveyed in educational recruitment efforts, disconnect between theory and working conditions, overemphasis on long-term care as a career path, and variability of PSW education options. While the standards should help to address the final issue, they do not address the other key issues raised, which have to do with the structural organisation of work. There is thus a disconnect between the experiences of students, PSWs and key informants and the policy decisions surrounding this sector. This is particularly significant as education is often touted as a panacea for issues in long-term and community care. In fact, the curriculum of some of the PSW programmes, especially those in public college settings, is robust. Yet, the underlying issues will remain barring a structural overhaul of the organisation of long-term and community care sectors founded on a social revaluing of older people and the gendered work of care. [ABSTRACT FROM AUTHOR]

Objective. We sought to document pathways between under/unemployment and health among racialized immigrant women in Toronto while exploring the ways in which gender, class, migration and racialization, as interlocking systems of social relations, structure these relationships. Design. We conducted 30 interviews with racialized immigrant women who were struggling to get stable employment that matched their education and/or experience. Participants were recruited through flyers, partner agencies and peer researcher networks. Most interviews (21) were conducted in a language other than English. Interviews were transcribed, translated as appropriate and analyzed using NVivo software. The project followed a community-based participatory action research model. Results. Under/unemployment negatively impacted the physical and mental health of participants and their families. It did so directly, for example through social isolation, as well as indirectly through representation in poor quality jobs. Under/unemployment additionally led to the intensification of job search strategies and of the household/caregiving workload which also negatively impacted health. Health problems, in turn, contributed to pushing participants into long-term substandard employment trajectories. Participants’ experiences were heavily structured by their social location as low income racialized immigrant women. Conclusions. Our study provides needed qualitative evidence on the gendered and racialized dimensions of under/unemployment, and adverse health impacts resulting from this. Drawing on intersectional analysis, we unpack the role that social location plays in creating highly uneven patterns of under/unemployment and negative health pathways for racialized immigrant women. We discuss equity informed strategies to help racialized immigrant women overcome barriers to stable work that match their education and/or experience. [ABSTRACT FROM PUBLISHER]

Introduction: Aboriginal children in Canada are at a higher risk for overweight and obesity than other Canadian children. In Northern and remote areas, this has been linked to a lack of affordable nutritious food. However, the majority of Aboriginal children live in urban areas where food choices are more plentiful. This study aimed to explore the experiences of food insecurity among Métis and First Nations parents living in urban areas, including the predictors and perceived connections between food insecurity and obesity among Aboriginal children. Methods: Factors influencing children's diets, families' experiences with food insecurity, and coping strategies were explored using focus group discussions with 32 parents and caregivers of Métis and off-reserve First Nations children from Midland-Penetanguishene and London, Ontario. Four focus groups were conducted and transcribed verbatim between July 2011 and March 2013. A thematic analysis was conducted using NVivo software, and second coders ensured reliability of the results. Results: Caregivers identified low income as an underlying cause of food insecurity within their communities and as contributing to poor nutrition among their children. Families reported a reliance on energy-dense, nutrient-poor foods, as these tended to be more affordable and lasted longer than more nutritious, fresh food options. A lack of transportation also compromised families' ability to purchase healthful food. Aboriginal caregivers also mentioned a lack of access to traditional foods. Coping strategies such as food banks and community programming were not always seen as effective. In fact, some were reported as potentially exacerbating the problem of overweight and obesity among First Nations and Métis children. Conclusion: Food insecurity manifested itself in different ways, and coping strategies were often insufficient for addressing the lack of fruit and vegetable consumption in Aboriginal children's diets. Results suggest that obesity prevention strategies should take a family-targeted approach that considers the unique barriers facing urban Aboriginal populations. This study also reinforces the importance of low income as an important risk factor for obesity among Aboriginal peoples. [ABSTRACT FROM AUTHOR]

A qualitative study was undertaken to explain findings of a cross-sectional study of Canadian Community Health Survey (CCHS) 4.1 data showing older persons who attend religious services more than once a week, compared to persons who do not attend at all, have lower prevalences of coronary heart disease (CHD), diabetes and high blood pressure. Twelve semi-structured interviews with ordained pastors and three focus groups with older parishioners from Canadian churches were conducted. Interviews were transcribed and analyzed for emergent themes through a process of direct content analysis. All participants claimed that religious service attendance (RSA): (1) enhances mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours that lower CHD risk. These three themes appear to be underlying mechanisms that help to explain the inverse association between RSA and the prevalence of adverse health outcomes found in the CCHS 4.1 data. [ABSTRACT FROM AUTHOR]

The province of Ontario hosts nearly a half of Canada's temporary foreign migrant farm workers (MFWs). Despite the essential role played by MFWs in the economic prosperity of the region, a growing body of research suggests that the workers' occupational safety and health are substandard, and often neglected by employers. This study thus explores farm owners' perceptions about MFWs occupational safety and general health, and their attitudes towards health promotion for their employees. Methods Using modified grounded theory approach, we collected data through in-depth individual interviews with farm owners employing MFWs in southern Ontario, Canada. Data were analyzed following three steps (open, axial, and selective coding) to identify thematic patterns and relationships. Nine employers or their representatives were interviewed. Results Four major overarching categories were identified: employers' dependence on MFWs; their fragmented view of occupational safety and health; their blurring of the boundaries between the work and personal lives of the MFWs on their farms; and their reluctance to implement health promotion programs. The interaction of these categories suggests the complex social processes through which employers come to hold these paradoxical attitudes towards workers' safety and health. There is a fundamental contradiction between what employers considered public versus personal. Despite employers' preference to separate MFWs' workplace safety from personal health issues, due to the fact that workers live within their employers' property, workers' private life becomes public making their personal health a business-related concern. Farmers' conflicting views, combined with a lack of support from governing bodies, hold back timely implementation of health promotion activities in the workplace. Conclusions In order to address the needs of MFWs in a more integrated manner, an ecological view of health, which includes the social and psychological determinants of health, by employers is necessary. Employers and other stakeholders should work collaboratively to find a common ground, harnessing expertise and resources to develop more community-based approaches. Further research and continuous dialogue are needed. [ABSTRACT FROM AUTHOR]

Background: Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. Methods: Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. Results: Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. Conclusions: Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition included inadequate notification procedures, lack of formal assistance finding new physicians, and unsatisfactory experiences seeking care during unattachment. The participants' accounts reveal opportunities for a stronger system presence during transition and a need for further research into alternative models of primary care delivery. [ABSTRACT FROM AUTHOR]

Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs ( n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike. [ABSTRACT FROM AUTHOR]

Background: In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. Methods: A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. Results: Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. Conclusion: Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis. [ABSTRACT FROM AUTHOR]