The role of nurses in primary care is poorly understood and many are not working to their full scope of practice. Building on previous research, this knowledge translation (KT) project's aim was to facilitate nurses' capacity to optimise their practice in these settings. A Summit engaging Alberta stakeholders in a deliberative discussion was the primary KT method used. Participants developed ten recommendations for the effective utilisation of nurses in primary care. Several challenges were encountered: ensuring broad stakeholder representation; focusing on solutions versus issues; and using common language across stakeholder groups. Lessons learned through this KT approach are also identified.
Homelessness among Indigenous peoples is an important issue in Canada and internationally. Research was conducted in seven metropolitan areas in the four western provinces of Canada to explore current services with the aim of developing a best practices framework to end homelessness for Aboriginal peoples. Sequential mixed methods were used. Key results found agreement that Aboriginal peoples were overrepresented among the homeless and policy determined the approach to and comprehensiveness of services provided. Funding, lack of time, and lack of resources were highlighted as issues. Gaps identified included a lack of partnership, cross-cultural collaboration, cultural safety, and evaluation and research in service provision. Best practices included ensuring cultural safety, fostering partnerships among agencies, implementing Aboriginal governance, ensuring adequate and sustainable funding, equitable employment of Aboriginal staff, incorporating cultural reconnection, and undertaking research and evaluation to guide policy and practices related to homelessness among Aboriginal peoples.
Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more effectively to develop successful public health ...
Primary Health Care (PHC) teams are an important component of the health system – particularly in terms of integrating care for vulnerable patients living with complex health and social needs. Over the last two decades, PHC teams have been implemented in different forms across Canadian provinces and territories. This article explores the health care policies that shaped the form and functions of PHC team-based care in Québec over the past 20 years (2002-2022). In Québec, the main model of multidisciplinary PHC teams – Family Medicine Groups or Groupe de médecine de famille (GMFs) – were created in 2002. In 2004, structural reforms led to the creation of local health networks (LHNs). LHNs promoted coordinated and collaborative activities between health and social services providers such as GMFs located in the same geographic regions. This was followed by another structural reform of the health system in 2015, leading to the creation of broader territorial health networks with the aim to heighten coordination and collaboration among provider organizations. Various policies have strengthened the PHC team-based model. For instance, the introduction of nurse practitioners, pharmacists, and social workers with extended scopes of practice shaped the configuration of GMFs while enhancing inter-professional collaborative practices. This article highlights important insights that could advance the understanding and creation of future PHC policy initiatives. Les équipes de premières lignes sont une composante importante du système de santé – en particulier en ce qui concerne l'intégration des services pour les patients les plus vulnérables qui ont des besoins sanitaires complexes. Au cours des deux dernières décennies, des équipes de premières lignes ont été mises en œuvre sous différentes formes dans les provinces et les territoires du Canada. Cet article explore les politiques de santé qui ont façonné la forme et le fonctionnement des équipes de premières lignes au Québec au cours des 20 dernières années (2002-2022). Au Québec, le principal modèle de première ligne – les Groupes de médecine de famille (GMF) – a été créé en 2002. Les réformes structurelles de 2004 ont conduit à la création des réseaux locaux de services (RLS). Les RLS ont favorisé des activités coordonnées de collaborations entre les établissements publics, les organisations privées, dont les GMF, et les organisations communautaires localisées sur les mêmes territoires géographiques. Cette initiative a été suivie d'une autre réforme structurelle du système de santé en 2015, qui a conduit à la création de réseaux territoriaux de santé et de services sociaux dans le but d'accroître la coordination et la collaboration entre les établissements. Diverses politiques ont renforcé le modèle d'équipe de première ligne. Par exemple, l'introduction d'infirmières praticiennes spécialisées en première ligne, de pharmaciens et de travailleurs sociaux ayant des champs de pratique élargis a façonné l'évolution du modèle des GMF tout en améliorant les pratiques de collaboration interprofessionnelles. Cet article met en évidence des idées importantes qui pourraient améliorer la compréhension et la création de futures politiques de santé de première ligne.
Background: Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population. Methods: Using descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs' lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health's ability to predict heavy versus light substance use in this group was tested (N = 291). Results: Important distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women's experiences with pregnancy and substance use was provided. Conclusions: This analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women's social, political and historical contexts in relation to their experiences with pregnancy and substance use. ; Health and Social Development, Faculty of (Okanagan) ; Medicine, Faculty of ; Non UBC ; Nursing, School of (Okanagan) ; Obstetrics and Gynaecology, Department of ; Population and Public Health (SPPH), School of ; Reviewed ; Faculty
AbstractIndigenous peoples in Canada often experience a greater burden of poor health and wellness relative to non-Indigenous Canadians due to a legacy of colonisation and racism. However, Indigenous mental wellness outcomes vary by community, and it is essential to understand how a community has been impacted by the determinants to improve mental wellness outcomes. This article shares insight from a research partnership with the Ki-Low-Na Friendship Society, an urban Indigenous community service organisation. The study used a decolonising, qualitative methodology in which urban Indigenous Elders shared their knowledge of mental wellness and experiences of services and supports. Elders described mental wellness holistically, connected to their relationships, land, language and culture. They described several determinants of wellness including identity, poverty, transportation, abuse and trauma. Elders shared experiences of culturally unsafe care and identified colonisation as root causes of poor mental wellness. They shared how some determinants affect urban Indigenous communities uniquely. This included limited transportation to cultural activities outside urban centres, such as medicine picking, the importance of urban organisations (such as Aboriginal Friendship Centres) in developing social support networks, and the role of discrimination, racism and inequitable care as barriers to accessing services in urban centres.
Background: Research partnership approaches that engage community members within the research team (for example, integrated knowledge translation, community-based participatory research) are typically used to enhance the relevance and usefulness of research findings. However, research outcomes generated through partnered research do not de facto address the priorities of those most affected nor take inclusion or power dynamics into consideration. Consensus methods (for example, Delphi, Deliberative Dialogue) can be used to develop evidence-based solutions by addressing the groups' needs and priorities. Limited research has examined how consensus methods are used by research partnerships. Aims and objectives: Using the PRISMA-ScR checklist as a guide, this scoping review sought to better understand the use of consensus methods in research partnerships. Methods: The search strategy involved four databases (MEDLINE, PsycINFO, EMBASE and CINAHL Plus). A total of 6,654 citations were screened, 404 were advanced for full text review, and 34 studies met eligibility criteria. Data from the 34 studies were extracted and iteratively analysed by three members of our research team. Findings: At least 11 different consensus methods were used with variations of the Delphi being most common. Issues of inclusion and power dynamics were rarely discussed. Overall, there was limited reporting of consensus methods, partnership approaches, and/or power dynamics. Discussion and conclusions: This review extends the literature by providing an overview of consensus methods that have been conducted in research partnerships and how they have been executed. We offer initial considerations for conducting and reporting on the use of consensus methods in research co-production.
