Program: Reach Awards

Vaccine Evaluation Centre
 

Co-leads: Dr. Hana Mijovic BC Children’s Hospital, Vaccine Evaluation Centre, Provincial Health Services Authority

Team Members: Dr. Shovita Padhi University of British Columbia, Fraser Health Constance Haselden Island Health

Trainees Clara Rubincam Vaccine Evaluation Center Emily Gemmell Vaccine Evaluation Center

Uptake of childhood vaccines in BC remains below recommended rates, contributing to resurgence of vaccine preventable diseases. Family physicians, nurses, midwives, obstetricians, and pediatricians can play an important role in vaccine counselling and facilitate timely and equitable access to vaccines for pregnant women and children in BC.
 

At the Vaccine Evaluation Center we have interviewed BC parents and healthcare providers about barriers and facilitators to vaccine uptake from infancy to school-age, with the goal of optimizing vaccine counselling and uptake in primary care.
 

Facilitators included: provider(s) consistently recommending vaccines from pregnancy through childhood and continuity of care with trusted provider(s). Barriers included: provider(s) not discussing vaccines or not expressing strong recommendations, poor continuity of care, and difficulties accessing healthcare services.
 

Given the variety of providers involved in the care of BC’s children, we propose an interdisciplinary KT approach to share our research.  We will summarize our findings in a short film ‘Vaccine Booster Talk’ for frontline providers.  The film will be screened at 5 interprofessional education events, followed by discussion sessions.
 

This will provide an opportunity for providers to gain broader understanding of the factors influencing childhood vaccine uptake in BC and engage in interprofessional dialogue on improving counselling and facilitating uptake.

Co-leads: Jill Zwicker University of British Columbia Ivonne Montgomery Sunny Hill Health Centre for Children Giovana Boniface Canadian Association of Occupational Therapists – BC

Trainee: Stephanie Glegg PhD student

This multi-faceted outreach campaign to occupational therapists (OTs) and key policy stakeholders involves five related activities:

1. Integrating the European Academy of Childhood Disability (EACD) guidelines with additional evidence to develop evidence-informed educational materials (The “DCD Advocacy Toolkit”). The Toolkit will support best practices in the assessment, diagnosis and treatment of developmental coordination disorder (DCD).

2. Designing an interactive educational webinar to increase OTs’ knowledge of EACD guidelines for DCD diagnosis and intervention, and of advocacy opportunities. This webinar content will be tailored to engage OTs across BC to apply this evidence in the assessment and treatment of clients with suspected DCD, and to more effectively advocate for diagnoses when appropriate.

3. Developing a briefing note targeted toward the Minister of Children and Family Development (MCFD) and key staff involved in School-Age Therapy and Early Intervention programs at MCFD. The policy brief will summarize the need for services for children with DCD and the role of OTs in its assessment, diagnosis, and treatment.

4. Disseminating the Toolkit, webinar and briefing note, including open-access online hosting; promotion using social media, e-newsletters, blog posts, mailing lists and face-to-face outreach to OTs; face-to-face and teleconference meetings with MCFD; multiple deliveries of the webinar to six established provincial networks of OTs and health administrators that support them; and a dynamic display booth at the Canadian Association of OTs Annual Conference in Vancouver. Combining these activities will optimize the reach to key policymakers and to the 377 pediatric OTs in BC.

5. Evaluating these activities, including completion of the process and the resulting outputs (e.g. resources completed, webinars delivered, outreach activities performed), the reach of each activity (e.g. number of OTs informed of, and accessing the Toolkit, webinars, blog posts, policy makers engaged, etc.), and outcomes (e.g. participant evaluations of the webinars, change in knowledge about the guidelines/best practices and in confidence in advocating for diagnoses). The baseline survey will be re-administered to OTs across BC to evaluate changes in knowledge and self-reported behaviours of all BC OTs (including non-webinar participants) related to both their engagement in advocacy and their use of the clinical guidelines.

Co-leads: Patricia Janssen University of British Columbia Michael Klein BC Children's Hospital / Provincial Health Services Authority Kathrin Stoll University of British Columbia Sheona Mitchell University of Northern British Columbia Saraswathi Vedam BC Women's Hospital + Health Centre / Provincial Health Services Authority Sarah Munro Women's Health Research Institute / Provincial Health Services Authority Sarah Kaufman Fraser Health Tamil Kendall  Ministry of Health Brenda Wagner Vancouver Coastal Health

Team member:  Randi Roy Northern Health Authority

Trainees: E. Nethery PhD student Kelsey Martin BSc student Daphne McRae PhD student

This team will host a provincial workshop to bring together maternity care clinicians who have demonstrated their ability to reduce or maintain low cesarean section rates, with a goal of developing and implementing best practices for minimizing cesarean section rates across BC. Cesarean section is a high volume intervention associated with considerable resources and more recently, with elevated risk for mortality and severe morbidity among women and their newborns. In 2013/14, the Canadian cesarean section rate was 27.3 percent, an absolute increase of 17 percent since the 1990s. Nationally, BC is among the highest, at 32.9 percent. In 2015, the WHO recommended that optimal country-wide cesarean section rates should be 19 percent. This meeting will begin the process to develop evidence-based strategies to work towards this goal in BC.

BC’s rising cesarean section rate arguably illustrates a failure to narrow the gap between best evidence and clinical practice. To mitigate this problem, the workshop will address four objectives:

1. Review rates of cesarean section stratified by Robson criteria (categories of risk) over the previous five years among hospitals represented at the meeting.
2. Identify broad categories of clinical practice that clinicians from these hospitals believe have promoted vaginal birth among healthy women.
   • Detail specific protocols developed to support these changes.
   • Discuss transferability of these protocols to other settings in BC.
   • Identify resources needed in hospitals to support these changes.
   • Develop a plan for health authorities to standardize practice in relation to targeted areas for change.
   • Identify an evaluation strategy for targeted practice change.
3. Establish a forum for ongoing collaboration/mentorship within health authorities by practice leaders in hospitals that have successfully initiated change with sustained results.
4. Define key research questions to be the basis of a vaginal birth research program, and to plan for follow-up meetings or developing research proposals arising from these questions;

Co-leads: Katrina Plamondon  Interior Health Jude Kornelsen  Centre for Rural Health Research / University of British Columbia Amanda McDougall Interior Health Kim Barnes  Interior Health

Trainee: Katrina Plamondon  PhD candidate

Rural communities are both resilient and vulnerable to the complex challenges of accessing and navigating health services. Access to health services, health professional retention and recruitment, and health equity are of persistent concern for rural communities and the health systems that serve them (Smith et al, 2008; Pong et al. 2009; Kullig & Williams 2011; Wanless et al. 2010). Indigenous communities in particular, scattered across the vast rural and remote regions of British Columbia, cope with legacies of colonialism and structural and systemic violence (Kurtz et al., 2008; Czyzewski, 2011). Indigenous rural health research poses urgent and complex equity considerations. For example, research on the risks of violence and HIV among rural Aboriginal women in Canada underscored "the intersecting dynamics of gender, rural living, poverty, racism, and colonialism create risk for Aboriginal women provides a basis for developing policies that aim to strengthen the well-being of women, particularly their economic wellbeing." (Varcoe & Dick, 2008, p. 42).

Building Intersections 2018 is a bi-annual conference that provides a gathering place for inter-professional learning, networking, and partnership building. The conference features leading research and knowledge translation innovations and attracts provincial and national interest across a wide range of disciplines and sectors. The conference tries to create an interactive, participatory, and creative program that sparks partnerships and enables dialogue, learning, networking and exchange. This networking brings together the pentagram partners (researchers, health authorities, administrators, policy and decision makers, and providers) necessary to affect health service transformation (Green-Thompson, McInerney, Woollard, 2017).

The event is led by the Interior Health Research Department in partnership with the Rural Health Services Research Network of BC with further collaboration with Interior Health, other health authorities with a rural-remote geography, academic institutions, community organizations, and professional bodies. This conference will appeal to communities, academics and professionals, municipalities, civil society organizations, patients-as-partners and private organizations interested in cross-sector transdisciplinary intersections for rural health.

Co-leads: Ziba Vaghri  University of Victoria Deborah Chaplain  Vancouver Island Health Authority Bernard Richard Representative for Children and Youth of BC

Team member: Sally (Yue) Lin University of Victoria

Trainee: Lindsay Shaw  MA student

Dr. Ziba Vaghri and her research user co-leads — Mr. Bernard Richard and Ms. Deborah Chaplain — propose a knowledge mobilization symposium with participants from a range of advocacy organizations, policy makers, service providers, and researchers in the areas of child rights and/or early child development (ECD) across British Columbia (BC).

The symposium is a stakeholder engagement event with a goal of improving the state of ECD in BC. It will support evidence-based decision-making by presenting data collected in the pilot of the Early Childhood Rights Indicators (ECRI) in BC. 

ECRI is a comprehensive child rights monitoring tool for young children aged 0 – 8. The innovative ECRI tool is a series of indicators designed to verify the state of rights relevant to young children, as articulated in the United Nations Convention on the Rights of the Child (CRC); it aims to enhance children’s health and development through fulfilling their rights. The user-friendly digitized tool combines the indicators framework with information technology to facilitate the monitoring of existing capacities to support child rights, and to measure their impact on children’s health and development. Such information will be useful for policy makers, researchers, and service providers concerned with evidence-based decision-making.

The symposium objectives are to:

1. Inform stakeholders of the findings of the ECRI BC pilot.
2. Bring guest speakers to present the current state of knowledge on issues outlined in the pilot report to further inform stakeholders.
3. Engage participants in constructive dialogue to discuss priorities for child protection in BC.

The symposium outcomes are to:

1. Raise participants’ awareness of the status of child rights for young children in BC.
2. Increase communication and collaboration between child rights and ECD stakeholders in BC, as these two sectors have traditionally remained disconnected from each other.
3. Build the capacity of stakeholders in promoting child rights, child development, and well-being.

The expected symposium outputs are a summary report, newsletter op-ed article, and policy brief developed by the research trainee under Vaghri’s supervision and in collaboration with attendees of the symposium.

Co-leads: Kristin Campbell University of British Columbia Ryna Levy-Milne  BC Cancer Agency

Team members: Cristina Caperchione  University of British Columbia – Okanagan Guy Faulkner Canadian Institutes of Health Research – Public Health Agency of Canada Barbara Leslie Healthlink BC

Trainee: Sarah Weller MSc student

Cancer survival rates are increasing in BC. This highlights a need for supportive care and guidance during and after cancer diagnosis and treatment to optimize overall health, quality of life, engagement in life roles, and to extend life expectancy. One underutilized strategy in cancer care within Canada is the integration of exercise programming within supportive care. There is compelling research evidence that such programming improves many of the side effects of cancer treatment, quality of life, return to work, re-engagement with other life roles and general health, along with reducing the risk of dying from other chronic conditions. However, there are significant barriers to translating this knowledge into clinical practice:

1. Clinicians report a lack of a referral process to evidence-informed exercise programming in the community provided by qualified exercise professionals.
2. Cancer survivors report unique barriers to obtaining exercise adoption and maintenance guidance, specifically due to concerns about safety of exercise and desire for guidance from trained exercise professionals with experience working with individuals with a cancer diagnosis and the physical limitations related to side effects of treatment.

BC is in a unique position to be a leader in addressing this knowledge translation gap. Cancer care services are primarily delivered by the distributed sites of the BC Cancer Agency, which all reside in one health authority. This allows for a coordinated approach to knowledge translation with provincial reach. BC is also the only province to have a provincial tele-health system called HealthLink BC, which includes access to qualified exercise professionals. This project will partner with the BC Cancer Agency to develop a model of service delivery that addresses these key barriers to translation of a strong body of research by:

1. Providing access to evidence-informed and vetted exercise information and guidance through QEP at HealthLink BC to extend the supportive care services available at BC Cancer Agency sites.
2. A referral process for the healthcare professionals of BC Cancer Agency to connect their patients to these services from a recognized, trusted source.

Co-leads: Tim Oberlander BC Children's Hospital / Provincial Health Services Authority Lorri Puil University of British Columbia Tracy Monk  University of British Columbia Barbara Mintzes University of British Columbia

Team members: Derelie (Dee) Mangin McMaster University Penny Van Esterik York University Saraswathi (Saras) Vedam University of British Columbia

Trainee: Janet Currie PhD candidate

Breastfeeding is important to infant and maternal health, but new mothers often experience difficulties. Domperidone, a gastric motility drug, has been widely used “off-label” to stimulate milk supply, and was prescribed to 19 percent of postpartum women in BC in 2011. Domperidone is subject to Health Canada safety advisories due to QT prolongation, serious cardiac arrhythmias, and sudden death.

This team conducted a CIHR-funded systematic review of domperidone use in breastfeeding. Based on randomized controlled trial (RCT) data, there is a modest (76 ml/day) increase in milk production after preterm birth, but no evidence of infant or maternal health benefits or improved breastfeeding rates. Most use in BC is at high doses (above the 30 mg/day maximum recommended by Health Canada) and after full-term births, for which RCT evidence is lacking. Cardiac risks are increased at high doses. Based on observational studies, these extend to women of reproductive age and infants. Overall, benefits fail to outweigh harm.

This project will carry out knowledge translation activities to disseminate review findings. In April 2017, the team hosted a symposium at UBC to share preliminary results with midwives, lactation consultants, physicians, nurses, academics and policy makers, and to discuss their implications. Many participants were unaware of the lack of evidence supporting use, and expressed an urgent need for additional activities to share results with their networks and with breastfeeding mothers.

This project's goal is to enhance informed shared decision-making when women experience breastfeeding difficulties, aiming to support more judicious domperidone prescribing and use, in keeping with the evidence on benefits and harm. An integrated knowledge translation approach will be used, with planned activities tailored to key stakeholders:

• A webinar for pharmacists, nurse practitioners, midwives and physicians in BC.
• An in-service program to clinicians in urban and rural BC.
• Online resources for consumers for dissemination through BC breastfeeding networks and social media materials (e.g. infographics, “tweetable” key messages).
• A treatment decision support summary for physicians on "Pathways”.
• A Therapeutics Letter, mailed to BC family doctors and pharmacists and posted online (with online podcast).

Information on domperidone will be accompanied by materials on alternative non-drug options to support breastfeeding. All materials will be shared with perinatal and postpartum educators, with the aim of a “snowball” effect. To evaluate knowledge translation outcomes, uptake will be assessed, including shifts in treatment protocols, through clinician and consumer feedback.

Co-leads: Sharon Koehn Centre for Healthy Aging / Simon Fraser University Kahir Lalji United Way of the Lower Mainland

Team members: James Broesch Vancouver Coastal Health Shari Brotman McGill University Ilyan Ferrer University of Calgary Krista James  BC Law Institute Anthony Kupferschmidt West End Senior's Network

Trainee: Laura Kadowaki PhD student

The research project — Intersectional identities and interlocking oppressions: Stories of the everyday among ethnocultural older adults in Canada — collected in-depth life stories and photographs from 19 immigrant older adults in British Columbia (BC) and Quebec. Participants are from immigrant populations (Korean, Filipino, Latin American, Caribbean, Afghani and Pakistani) where little research has been done in Canada, but have diverse backgrounds and journeys, and who have been marginalized. As a result of this project, a narrative photovoice exhibit has been made. The Lived Experiences of Aging Immigrants — presents both their challenges (e.g. trauma, discrimination, poverty, family disruption) and celebrations (e.g. building community, caring for family, faith, resilience). A key aim of the exhibit is to encourage knowledge exchange with service providers and policymakers.

This award will enable the team to present the exhibit to groups who are capable of making or influencing changes at the policy, practice and community level, and who can positively influence the determinants of health and aging for older immigrant adults.

The exhibit will be mounted in different spaces convenient to target groups, and will be a springboard for facilitated discussions where stakeholders will be encouraged to identify and prioritize the actions they can take to effect this change within their spheres of influence. For example, these groups may include senior peer support volunteers, population/community health specialists charged with delivering health promotion programs, or seniors rights advocates who lobby for changes to determinants of health such as housing and transportation. The discussions will encourage participants to take ownership of the initiatives they recommend. Research user team members served as advisory group members on the Intersectional identities project and are strategically situated in health and seniors care contexts in BC. They will identify and facilitate engagement with relevant groups. The Social Planning and Research Council of British Columbia will be engaged to organize and facilitate 10 such events. They will further work with this team to distill and prioritize feedback from all groups into clear recommendations. A final report and policy briefs directed at specific audiences will be generated.

Co-leads: Cristina Caperchione University of British Columbia – Okanagan Kalinka Davis Canadian Men's Health Foundation

Team members: Joan Bottorff University of British Columbia – Okanagan Kate Hunt University of Glasgow Steven Johnson  Athabasca University John Oliffe University of British Columbia

Trainee: Paul Sharp PhD student

Physical activity, healthy eating, and maintaining a healthy weight are associated with improved mental health and reduced risk of cardiovascular disease, type 2 diabetes and cancer. Despite these benefits, many men do not meet recommended physical activity guidelines (i.e. 150 minutes of moderate- to vigorous-intensity physical activity per week) and have poor eating behaviours. Many health promotion programs hold little “manly” appeal and fail to influence men’s self-health practices. Research has revealed that consideration of settings and products that align with men’s values and interests can advance health promotion behaviors.

The HAT TRICK program is a 12-week face-to-face, gender-sensitized intervention for overweight and inactive men focusing on physical activity, healthy eating and social connectedness, delivered in collaboration with a major junior ice hockey team in British Columbia. Recently, HAT TRICK has partnered with the Canadian Men’s Health Foundation (CMHF), a national, not for profit organization with the mission to inspire Canadian men to live healthier lives. Intending to expand the HAT TRICK program across British Columbia, the proposed dissemination activities detailed will be two-fold.

First is developing and refining the facilitation manual to more eloquently detail the delivery of the 12-week HAT TRICK program. The facilitation manual will be revised based on feedback provided during the program’s pilot testing. This resource will also be available to facilitators in print or as a downloadable PDF on the HAT TRICK website and CMHF website.

Second is organizing and delivering a 1.5 day train-the-trainer workshop to prepare facilitators from across British Columbia to deliver HAT TRICK in their community. The train-the-trainer workshop will allow for a focused and concerted education of future facilitators. Potential facilitators will be recruited from local university campuses and have a health-related background (e.g. human kinetics, physiotherapy, nursing, etc.). Two individuals from three locations (six total) will be identified to receive training. Upon completion and evaluation of these dissemination activities, HAT TRICK will be poised to be offered in more communities across British Columbia.