Program: Reach Awards

Co-leads: Debra Sheets University of Victoria Marilyn Malone Island Health

Trainee: Mathilde Cervantes University of Victoria Timothy Lukyn University of Victoria Michaella Trites University of Victoria Sebastian Santana University of Victoria

Over half a million Canadians are living with dementia, and 25,000 new cases are diagnosed each year. The estimated costs of dementia exceed 10.4 billion per year (Alzheimer Society of Canada, 2018). Dementia refers to a set of symptoms that include progressive, degenerative declines that affect memory, reasoning, the ability to communicate, judgment, and mood (Dugeon, 2010; Wetzels et al., 2010).

Alzheimer's is the most common cause of irreversible dementia and the numbers of people with dementia are projected to double by 2031. One of the biggest issues facing people living with dementia is the stigma and social isolation they face within their communities. Social isolation and loneliness significantly affect the quality of life of persons living with dementia and their caregivers. Social engagement can delay or reduce dementia symptoms and possibly decrease the rate of disease progression (Tuokko & Smart, 2018).

An intergenerational dementia choir can allow persons living with dementia to participate and contribute in meaningful ways to the broader community. Our research on intergenerational choirs indicates that they can significantly reduce the stigma of dementia and the social isolation. Choirs are inexpensive and common in most communities but a social movement is needed to make them dementia friendly.  Knowledge mobilization of our research findings will encourage stakeholders to explore ways to sustain and replicate our innovative intergenerational choir program.  

Co-leads: Liam Brunham  University of British Columbia  Fred Hazen St. Paul's Hospital

Team Members: Lubormira Cemakova BC FH Registry  Dr. Durhane Wong-Rieger Canadian Organization for Rare Diseases

Trainee: Dr. Miles Marchand University of British Columbia

Familial Hypercholesterol (also called FH) is the most common inherited form of high cholesterol, and affects 1 in 250 British Columbians. FH leads to lifelong elevation in blood cholesterol and up to 10-times increased risk for developing heart disease, which often occurs at a young age. Most patients with FH have not been diagnosed, and may not be receiving appropriate treatment.

Research into FH has advanced rapidly over the past several years, and we now know significantly more about the genetic causes of FH, how to diagnose it, and the best available treatments. Communicating and disseminating the results of this research to patients and their family members are critical to translate these research findings into improvements in care of these patients. The purpose of this proposal is to hold a patient forum on FH which will include lectures from physicians, nurses, dieticians, genetic counsellors and patients, as well as interactive small group sessions.

The goals of the forum are to disseminate research advances to patients with FH and empower patients to become advocates for the community with FH. With this funding we will be able to offer a number of travel grants to support patients from outside Vancouver to attend. 

Co-leads: Mario Brodani University of British Columbia  Kinnon Ross Providence Health Care

Trainee: Dr. Abiola Adeniyi Michael Siarkowski Maxine Harjani

Canadians suffering from drug addiction and mental illness experience higher rates of poor oral health than their counterparts. They may also experience stigma and discrimination by dental and dental hygiene providers while accessing much needed dental care services. There has been a call 'to teach cultural diversity' broadly within dental and dental hygiene education to foster practice that is inclusive, sensitive to diversity, socially responsible, and without prejudice.

The project team will:

1. Include those in the community affected by drug addiction and mental illness to co-develop an evidence-based undergraduate dental curriculum that will inform dental and dental hygiene practices within the University of British Columbia, and
2. Pilot this curriculum with the incoming class of 2020/21 undergraduate students to aid in skill-set development.

The team will co-develop an interactive curriculum based on a flipped classroom concept in a safe environment focused on educating oral heath care providers who are compassionate, fair, and socially responsible. The central research question is:  'How can we foster an interactive and open dialogue about social responsibility, in a transformative learning environment, when caring for those suffering from mental illness and/or addiction?'  

The above question is broad enough to be transferable to other health care disciplines and this new curriculum will be made available to them.  

Co-leads: Richard Sawatzky Trinity Western University Jae-Yung Kwon International Society for Quality of Life Research, University of British Columbia

Trainee: Ronak Brahmbhatt Trinity Western University

Patient reported outcomes (PROs), which allow patients to report on their physical and mental health and wellbeing, are increasingly used in clinical practice and decision making. However, patients may not be consistent in how they interpret and respond to these questions.

Differences in the meaning of PROs across individuals or over time are known as differential item functioning (DIF) and response shift (RS). Ignoring these differences could lead to erroneous healthcare decisions. Although there are statistical methods to adjust for DIF and RS, these are complex to interpret and apply. To address this, our team is developing resources on DIF and RS (introductory video, webinar, and analysis software code).

Building on this prior work, we now propose to facilitate wider uptake of knowledge for interpreting and analyzing PROs by developing a webinar that includes case studies and an online interactive learning module specifically for clinically-oriented audiences (clinicians and decision support analysts).

Expected outcomes include:

1. Increased awareness of DIF and RS and their implications for clinical practice and decision making, and
2. increased ability to analyze and interpret PROs data while accounting for DIF and RS. 

 

Co-leads: Martha MacKay University of British Columbia  Nardia Strydom Providence Health Care, Vancouver Coastal Health

Trainee: Rachel Neal Concordia University

Heart disease patients have twice the risk of having depression compared to others. This results in poor quality of life and higher rates of death and complications. Treatment for depression can reduce depression symptoms, improve quality of life, and may lessen poor outcomes.

A first step to treating depression is diagnosis. We have implemented pre-discharge depression screening on the cardiac inpatient units at St. Paul's Hospital. This information is then sent to their primary care provider (PCP). However, we are unsure of the best way to get this information to PCPs. We also believe there are barriers to PCPs helping cardiac patients with depression, such as low awareness of its association with bad cardiac outcomes, little time for screening and few community mental health resources. We propose a 4-phase approach to address these barriers.

To start, we will solicit input from some PCPs (from urban and rural settings) on ways to receive information about depression screening of recently hospitalized patients, and the barriers faced in helping depressed cardiac patients.

We will then develop resources for both patients and PCPs, such as an infographic (patients) and web-based resources on the 'Pathways'site (PCPs), followed by implementation of the PCP communication process and evaluation of the web-based resource usage.

Finally, we will introduce our screening protocol to nursing leaders at BC's large cardiac centres, to promote broad uptake of this practice. 

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.