Breaking Barriers: Empowering Primary Care Providers to be Instigators of Change in Hearing Health Care Practice

Up to 65% of adults in British Columbia (BC) aged 60+ will develop hearing loss. Fewer than one-quarter of these adults use hearing health care, with most delaying treatment 7 to 10 years on average. Untreated hearing loss affects health-related quality of life with links to social isolation, depression, greater risk of falls, and reduced financial security. For adults with concerns about their hearing, primary care providers (PCPs) are often a first point of contact for help seeking, and yet for reasons that remain unclear, PCP referrals to hearing health care are inconsistently and infrequently practiced. This problem was identified as a top priority through focus groups conducted in 2020. These graphics illustrate the focus group discussions that led to the development of this research question.

 

We will use a community-based approach to identify reasons for lack of referral and develop strategies that empower primary care providers to be key instigators for increased, timely uptake of hearing health care by individuals with hearing concerns.

The research team, all based in BC, is led by Lorienne Jenstad, PhD, an audiologist and associate professor at the University of British Columbia; Brenda Poon, PhD, the research program lead at the Wavefront Centre for Communication Accessibility; and Ruth Warick, PhD, president of the Canadian Hard of Hearing Association, Vancouver Branch. The team works closely with other individuals who have lived experience of hearing loss, physicians, nurses, clinical audiologists, and community organizations.

Ultimately we hope that primary care providers and the general public will have better recognition of the importance of hearing health and better understanding of the process to receive hearing health services, leading to timely uptake of hearing health care by individuals with hearing concerns and the potential to improve long-term health outcomes.

Mental health needs and technological interventions for social connectedness amongst older adults

Older adults are one of the most at-risk groups in the COVID-19 pandemic, both to the negative effects of the virus and on their social connections. In order to stop the spread of COVID-19, social distancing and stay-at-home orders have been put in place. As a result of these steps, places that older adults go to socialize, for example seniors’ community centres, have been forced to close. The aim of this project is to work with a not-for-profit community centre, the West End Seniors Network (WESN), to disseminate the finding from a project where we examined the social connectedness of seniors during the COVID-19 pandemic. The mission of WESN is to enhance the quality of life of older adults by providing social, recreational, educational and supportive programs and services that foster connection and inclusion in the broader community. WESN is the second-largest independent seniors’ centre in Vancouver with over 900 active members; however, due to COVID-19 WESN was forced to close its doors. Through this project we will work with WESN staff and community members to disseminate ways that we can develop stronger social connections. Through interviews with staff, community members, and older adults, we identified what worked, and what did not work to better seniors COVID-19 experience. We will use this information to inform policy-makers, other community centres, and older adults of the ways that we can improve social connections during the pandemic. Through this project we can use the lessons learned and relationships built in this project in larger
programs and with more partners.

Digital interventions to improve social connectedness and mental wellbeing of vulnerable older adults during COVID-19 and beyond

Indira Riadi, as a PhD candidate and student lead under the supervision of Dr. Theodore Cosco, is being co-funded by MSFHR and Mitacs as part of a studentship program led by Mental Health Research Canada in partnership with the Mitacs Accelerate program, designed to develop the brightest Master’s students conducting research in mental health.

 

During her internship, Indira will work with the West End Seniors Network, Vancouver’s second largest not-for-profit seniors centre, to identify ways to improve the social lives and mental wellbeing of ethnic and gender/sexual minority seniors during COVID-19 and beyond. This project hopes to explore the mental health priorities of these populations, investigate what has been done (with specific emphasis on digital interventions), and identify successful and unsuccessful interventions to help raise social connectedness and alleviate mental distress among marginalized older adults in Vancouver.

 

Funding Competition: Mental Health Research Canada – Mitacs Studentship Program
Funders: MSFHR; Mitacs

Adapting breath/air communications to rural, remote and Indigenous ways of living

Breathing is living. In recent years, policies that impact lung health and air quality have led people to change how they go about daily life. Traditionally, these policies are crafted by experts and specialists, with little input from the public. More effective policies could be developed by enhancing public participation and collaboration in the policy process. The overarching goal of our work is to improve the sharing and exchange of information about lung health policies with people living in rural, remote, and Indigenous communities.

This study uses design methods to adapt lung health policy communications for rural, remote, and Indigenous communities. The connections we create will be facilitated by two streams of outreach activities:

Stream 1 — AIRWISE-CONNECT — creates a community advisory group with Indigenous and non-Indigenous community members in northern British Columbia. This group will meet four times over a year to participate in a human-centred design process and interactive group meetings. During these meetings, we will adapt a previously developed website: www.airwisebc.ca.

Stream 2 — AIRWISE-VISION — develops a working relationship with the Witset First Nation Band Council and community members to better inform policies and practice. We will draw on the Design Justice method to create new breath/air policy communications that honour the traditional knowledge and practices in Witset.

The principal investigator, Sonya Cressman, a health economist at Simon Fraser University and the Centre for Clinical Epidemiology and Evaluation, will lead the study with co-Investigators: Brian Fisher and Dawn Hoogeveen at SFU and collaborators: Renelle Myers (BC Cancer), Anthony Noonan (Executive Director, Witset First Nation), Anne- Marie Nicol (SFU), and Chris Carlsten (Legacy for Airway Health).

This project is jointly funded by a Social Sciences and Humanities Research Council Connection Grant and Health Research BC, through its match funding initiative.

General and inexpensive saliva-based viral RNA testing by direct imaging

In the absence of a vaccine and/or effective treatment, rapid and robust testing is vital not only to reduce the transmission and spread of SARS-CoV-2, but also for paving the way to safely reopen borders and reinstating the world economy. Most Covid-19 tests are performed using nasopharyngeal swabs that are sent to a hospital or public health laboratory to be processed for RT-PCR analysis using expensive equipment by technically trained staff. The specificity of such amplification-based tests makes them superior to many other detection tests. However, the occurrence of false-negative results due to the low levels of viral RNA found in such samples, as exemplified by recent problems with Spartan Cube1, suggests that avoiding nucleic acid amplification entirely and switching to the direct detection of viral RNA could be highly advantageous for SARS-CoV-2 detection.

Funded by the CIHR Rapid Research Opportunity and MSFHR, Dr. Peter Unrau is leading a team of researchers to develop a new saliva-based viral testing strategy for use in the current Covid-19 pandemic. Dr. Unrau (professor in RNA biochemistry) and co-investigator Dr. Forde (professor in biological physics) will coordinate a research team at Simon Fraser University. They will work in collaboration with David Rueda, a professor in single-molecule imaging at Imperial College London.

This COVID-19 research will allow the development of a fast, inexpensive and sensitive viral RNA test that, in principle, could be used for point of care testing at home. The proposed SARS-CoV-2 RNA single-molecule imaging test will be highly specific, will rely on simple well-understood chemistry, and will include an inexpensive imaging device that connects to a cell phone. An additional benefit of this device is that test procedures can easily be adapted for the screening of other RNA pathogens in the future.

Funding competition: CIHR Operating Grant: COVID-19 Rapid Research Funding Opportunity – Diagnostics

Funders: CIHR; MSFHR

End of award update – January 2022

Most exciting outputs
We have developed a prototype device able to test for viral pathogens in spit. This device can report results easily over the internet and has many potential rapid testing applications.

Impact so far
Reliable and inexpensive point of care diagnostic technology is extremely important during a pandemic for both primary and community health care. As can be seen with the explosive spread of the Omicron coronavirus variant, RT-PCR test centers are overwhelmed and there is no coherent way to report point of care test results to centralized government agencies. We have developed an inexpensive (< $100 if mass produced) point of care instrument that via the internet can simply and reliably report test results to centralized data centers. This device accepts modular test cartridges, which could, with further development, offer a broad range of test services at low cost. Such a device has many uses, but could easily be imagined to play an important role in rural and remove health care locations in the future. While now only a proof of principle prototype, future investment should result in a device able to provide a health benefit to BC citizens.

Potential future influence
Inexpensive point of care tests are difficult to develop and implement. Our device offers a potential solution to this global problem.

Next steps
We are seeking further investments by third parties to commercialize our prototype technology.

Useful link
Laboratory website: https://www.rnabiochemistry.com/

A resident/family-centered, team-based quality improvement collaborative approach to comprehensive pandemic preparedness in long-term care homes

Dr. Akber Mithani’s team is one of two BC research teams being co-funded by MSFHR and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Patient Safety Institute.

Practices that show promise to improve response to the COVID-19 pandemic in long-term care homes need to be quickly implemented. These practices relate to outbreak preparation, prevention and response; COVID-19 and non-COVID-19 care; staffing; and presence of family.  

Our research team will study the experiences of long-term care teams as they conduct projects to implement promising practices to address gaps in their pandemic response. The teams will include residents, family, staff and management in six long-term care homes across Fraser Health. They will use a shared approach involving quality improvement training, engagement support, and the use of an online app to share learning between homes.

Key questions to be answered are:

  1. How can an online shared approach be used by team members within long-term care homes to improve pandemic response?
  2. How can this approach help in knowledge sharing across long-term care homes to promote best practices in pandemic response?

The lessons learned from the projects will inform strategies for pandemic response, which will be shared with other long term care homes across Fraser Health. The findings of this study will add to the efforts of 14 research teams across Canada as part of a larger initiative aiming to improve pandemic response in long-term care.

Funding Competition: CFHI-led Implementation Science Teams (IST) – Strengthening Pandemic Preparedness in Long-Term Care (LTC) Funding Opportunity

Funders: MSFHR; BC Ministry of Health

Implementation of the “one high risk site only” policy – its impact on staff, family and LTC residents

Dr. Joanie Sims-Gould’s team is one of two BC research teams being co-funded by MSFHR and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Patient Safety Institute.

It is essential that we stop the spread of the COVID-19 virus in long-term care. The Public Health Agency of Canada instituted evidence-based, rapid redesign and resource redeployment practices to protect the health and ensure the safety of staff, residents and their families. Measures included strict visitation and “one high risk site” staffing policies, prohibiting LTC staff from employment in more than one facility. Our mixed methods, exploratory study will focus on implementation and impact of the “one high risk site” staffing policy on staff, family and residents in 4 LTC facilities in 2 British Columbia health authorities. We are guided by the Consolidated Framework for Implementation Research (CFIR). 

We have the necessary expertise to conduct this study that spans implementation science, LTC, quantitative and qualitative methods and knowledge translation (KT). Our team includes early (Havaei – co-PI, Hung), mid-career (Sims-Gould – PI) and established (Macphee, Phinney, Robinovitch, McKay) researchers, and trainees (Franke, Staempfli) together with committed and passionate LTC administrators (Keselman, Lee, Kirk, Strath), senior health authority executives (Mak, Sorensen) and Min of Health (Neilson) partners and KU. Two collaborators offer expertise in implementation measures (Lewis) and national LTC policy (Tamblyn-Watts).

Short-term outcomes: Knowledge users are positioned to immediately translate evidence into practice to inform LTC improvements at the facility level. We will share results through the LTC+ Acting on Pandemic Learning Together Initiative. Facilities that signed up to participate in this initiative have immediate access to results of our study across jurisdictions.

Long-term outcomes: Lessons learned about positive and negative consequences of the “one high risk site” policy can be applied in other jurisdictions. We will provide a roadmap to effectively implement future policies in response to COVID-19 in LTC settings. Partnerships we develop foster future collaborations and capacity building among academics and the LTC sector.

Funding competition: CFHI-led Implementation Science Teams (IST) – Strengthening Pandemic Preparedness in Long-Term Care (LTC) Funding Opportunity

Funders: MSFHR; BC Ministry of Health

Evaluation of innovative risk mitigation services in the context of dual crises of COVID-19 and overdose among people who use opioids in Vancouver, BC

Through funding from the Canadian Institute of Health Research (CIHR) and MSFHR, Principal Investigators Dr. Kanna Hayashi, Research Scientist at the BC Centre on Substance Use (BCCSU) and St. Paul’s Hospital Chair in Substance Use Research and Assistant professor in the Faculty of Health Science at Simon Fraser University (SFU) along with Dr. Kora DeBeck, Research Scientist at the BCCSU and Associate Professor in the SFU School of Public Policy aim to conduct preliminary evaluation of two novel measures introduced by the BC government in March 2020 to address the dual crisis of overdose and COVID-19.

 

Specifically, these measures include expanding the opioid agonist treatment (OAT) prescription guidelines and pandemic prescribing of pharmaceuticals (e.g. opioids) to people who use illicit drugs. By providing pharmaceutical alternatives to the toxic illicit drug supply, the interventions are intended to reduce physical encounters involved in obtaining illicit drugs and the use of toxic street drugs, thereby supporting both overdose and COVID-19 prevention efforts. To date, however, the impacts of these interventions have not been evaluated.

 

The proposed BC-based research aims to fill critical knowledge gaps by examining the reach and preliminary impacts of pandemic prescribing and expanded OAT prescription services among people who use opioids in urban Vancouver. Through this work, the research team, which consists of highly productive investigators and knowledge users with direct clinical and policy expertise, seeks to inform efforts to improve the delivery and effectiveness of the interventions.

 

Funding Competition: CIHR Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery Funding Opportunity

Funders: CIHR; MSFHR


Progress Update – August 2022

Most significant outputs so far

We have successfully conducted interviews with 1,264 people who use drugs (including 911 people who use opioids) in Vancouver between July 2020 and November 2021, meeting our target sample size. We have developed multiple infographic summaries of data from the first wave of surveys (conducted in 2020), showing access to and perceived effects of the risk mitigation services among people who use drugs. These findings have been shared with and presented to a range of stakeholders, including those involved in developing and implementing the clinical guidelines for opioid agonist therapies and risk mitigation prescribing. In addition, two manuscripts have been developed in collaboration with people with lived/ing experiences, addiction medicine physicians, clinician scientists and policy makers. One of the manuscripts that demonstrated low awareness of risk mitigation prescribing among people who use drugs has recently been accepted for peer-reviewed publication. The other manuscript will also be submitted for peer-reviewed publication soon.

Impacts so far

Our study findings have already been utilized to inform the implementation of the Prescribed Safer Supply initiative. Building on the risk mitigation prescribing, the BC government launched the Prescribed Safer Supply initiative in 2021 and put more emphasis on overdose prevention. At their request, we shared our study findings with the BC Ministry of Mental Health and Addictions.

Potential influence

Our research has significant potential to continue to inform policies and programs regarding safer supply and opioid agonist therapies. Of note, as safer supply initiatives are rapidly evolving, we have amended our survey questionnaire on an ongoing basis in an effort to capture the potential impacts of policy developments in a timely manner. Importantly, we have engaged a range of stakeholders (e.g. people with lived/ing experiences, addiction medicine physicians, policy makers, etc.) in developing and updating the survey questions so that the data we collect are meaningful and useful for informing further developments of these new interventions.

Next steps

As more recently collected data have become ready for analyses, we plan to develop more infographic summaries and analyses/manuscripts in this area. As we have done to date, we plan to continue to engage stakeholders in developing and disseminating the research outputs.

Useful links

Tracking the Prevalence and Incidence of Modifiable Suicide Risk Factors During the COVID-19 Pandemic to Inform Targeted Suicide Prevention in British Columbia

Problem: Half of Canadians report worsened mental health since the COVID-19 pandemic began disrupting our lives this Spring. These impacts, combined with rising prevalence of known suicide risk factors such as unemployment and financial hardship, social isolation, alcohol and substance use, relationship strain and domestic violence, have raised concerns that of rising suicide risk in the Canadian population. Canada loses 3,800 to 4,500 lives to suicide each year. Suicide death and bereavement confer long-term psychological and social risk to families and communities. A small increase in suicide rate can thus result not only in excess loss of life, above and beyond the direct impacts of the pandemic, but also confer long-term vulnerability in our communities.

 

Research: In collaboration with an international team of researchers led by investigators Shanaya Rathod and Peter Phiri in the UK, our Canadian team aims to characterize the specific mental health and related cognitive impacts of the COVID-19 pandemic to inform evidence-based policy that can mitigate secondary mental health and suicide risk. We will conduct three pan-Canadian general population surveys, in September 2020, December 2020, and March 2021. For each survey, we will recruit at least 5,000 community adults, balanced by sex, age, and geographic region. Surveys will focus on Canadians’ emotional, physical, and cognitive wellbeing across distinct phases of the pandemic. In addition, we will work with mental health service leaders, providers and users to co-create supplemental surveys to assess the mental health experiences and needs of three potentially vulnerable groups: frontline health workers, Indigenous peoples, and people living in rural or remote areas. Our results can inform mental health strategies by identifying where, with whom, and what kind of intervention is needed to effectively reduce suicide risk in the population. Support from MSFHR and the BC Ministry of Health will enable us to over-sample British Columbians so that we can understand mental health needs within this province and identify sectors or populations with mental health needs.

 

Research Team: Our interdisciplinary research team, led by Co-PIs Brianna Turner, Theone Paterson, and Chris Lalonde, includes psychology, social work, and sociology researchers, as well as community knowledge users representing the United Way of the Lower Mainland, the Ontario Association of Social Workers, and the Canadian Mental Health Association.

 

Website: https://onlineacademiccommunity.uvic.ca/covidmentalhealth

 

Funding Competition: CIHR Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery Funding Opportunity

 

Funders: CIHR; MSFHR

 

Keywords: Suicide Prevention, Mental Health, Sleep, Depression, Substance Use, Social Connectedness, Public Health, Survey

 


Progress Update – July 2022

 

Most significant outputs so far
The current study examined mental health impacts of the COVID-19 pandemic across adults in three large samples of Canadians (Ns=5000-7000). So far, we have learned that older adults reported better mental health and more social connectedness relative to younger adults during the pandemic. Loneliness predicted negative mental health across all ages, while social support buffered the effect of loneliness in older adults.

We also observed slight increases in rates of suicidal ideation (SI) across the three surveys, from 4.1% in the first survey (Fall 2020) to 5.8% in the final survey (Fall/Winter 2021). Odds of reporting SI were higher for survey respondents who were under 35 years old, had pre-existing mental health concerns, had quarantined due to suspected or confirmed COVID-19 exposure, encountered potential exposure to COVID-19 at work, were medically vulnerable toward COVID-19 infection, and were insecurely employed or unemployed. These associations, in turn, were mediated by psychological experiences, particularly depression and thwarted belongingness. We are working to further understand vulnerability to suicidal thinking in our data, and to identify possible policy targets to bolster mental health.

 

Impacts so far
We have shared our results with the CanCOVID network, at a BC Ministry of Health Knowledge Translation event, and the Canadian Psychological Association.

 

Potential Influence
We plan to share a final report of our results with the BC Ministry of Health, and hope to work with them in identifying possible strategies for monitoring and responding to mental health needs following the pandemic. We are also working on developing a set of videos this summer to summarize main study results, which we hope will increase uptake and impact among the general public as well as policy makers and health professionals.

 

Next Steps
We are working on two follow-on surveys that focus specifically on mental health among healthcare workers and people living in rural and remote communities in BC, with an aim to complete data collection in mid-July. As mentioned, we are creating videos to summarize study results that can be shared publicly and with stakeholders (mental health providers, policy makers). We anticipate submitting our major paper for publication this summer.

Addressing the dual public health crises of COVID-19 and overdose

A team led by Dr. Amanda Slaunwhite, Senior Scientist with the BC Centre for Disease Control and an adjunct professor in the School of Population and Public Health, were awarded $75,000 from the Michael Smith Foundation for Health Research and $777,439 from CIHR as part of the Novel Coronavirus (COVID-19) Rapid Research Funding Opportunity. The researchers will assess the impact of the new risk-mitigation guidance that permits prescribing of pharmaceutical alternatives to the toxic drug supply. Researchers will determine the effects of the pandemic and risk mitigation measures on COVID-19 infection, continuity of care for treatment of substance use disorders and non-fatal and fatal overdose in BC. The researchers will also identify barriers and facilitators to implementation from the perspectives of people who use substances, prescribers, harm reduction workers, and other providers and community members.

The team is led by principal investigators at UBC, the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria (Dr. Bernie Pauly and Dr. Karen Urbanoski) and Simon Fraser University (Dr. Bohdan Nosyk and Dr. Natt Hongdilokkul). The team includes co-investigators and collaborators from the First Nations Health Authority, Ministry of Mental Health and Addictions, BC Centre on Substance Use, the BCCDC-based Compassion Inclusion and Engagement (CIE) (PEEP) peer network, Provincial Health Services Authority, BC-Yukon Association of Drug War Survivors and Public Health Agency of Canada.

Funding Competition: CIHR Operating Grant: COVID-19 Rapid Research Funding Opportunity – Social Policy and Public Health Responses

Funders: CIHR; MSFHR


Progress Update – July 2022

Most exciting outputs so far

Briefly, our research activities to date suggest that prescribed safer supply has many benefits to persons who receive medications, however implementation and access was uneven across the province. Prescribed safer supply opioids have reached approximately 7,000 persons since March 2020 and indications from preliminary administrative health data suggest that the intervention may protect against mortality. Participants who received safer supply reported many positive benefits, however access to these medications is very limited due to limited prescribers.

The project is concluding over the next few months as we transition into a new CIHR-funded longer-term evaluation project. As of June 2022, we have pivoted from data collection and analysis to knowledge translation activities including the development of peer reviewed manuscripts. There are over 10 manuscripts under development.

We have published the study protocol in BMJ Open. We have also publicly posted Knowledge Updates and Infographics about emerging results on the BCCDC website. These results have also been disseminated through the BC Overdose Emergency Response Centre list-serv. Some examples are:

Knowledge translation has been ongoing since the project began. Our knowledge translation efforts are co-led by persons with lived experience who have been heavily engaged in the project. There has been international and national interest in this project and we have been invited to present to many audiences including the New Zealand Drug Foundation:

Impacts so far

This project has had a direct impact on the Province of BC’s prescribed safer supply policy directive and program implementation strategies. The results of this project are cited in several policy and clinical guidance documents including: 

Potential Influence

This project has had a significance influence on our future research activities by providing an opportunity for researchers from UVic, SFU and UBC to partner with persons with lived experience, the First Nations Health Authority and other health system partners to work together to better understand prescribed safer supply in BC. These partnerships have led to many new successful grants from CIHR, Providence Health Care, Health Canada and the Office of the Representative for Children and Youth.

Next Steps

We have several new grants, including awards from CIHR and Health Canada, that have been funded in the past six months to continue our work in this area. This includes three projects:

  • Mathematical Modeling Prescribed Safer Supply (NPI: Nosyk) – Funded by CIHR, 2021-2024
  • Evaluating prescribed safer supply among formerly incarcerated persons during an overdose public health emergency (NPI: Slaunwhite)- Funded by SUAP Health Canada, 2022-2023
  • A mixed methods evaluation of safer supply initiatives to reduce illicit drug overdose in BC (NPI: Urbanoski) – Funded by CIHR, 2022-2026