Program: Reach Awards

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.

Co-leads: Suzanne Lewis Pacific Autism Family Network / University of British Columbia Dawn McKenna Pacific Autism Family Network

Team member: Caylee Raber Emily Carr University

Trainee: TBC

The objective is to support research dissemination and knowledge translation in the autism spectrum disorders (ASD) community by co-designing a web-platform that will facilitate the uptake of research evidence by families and individuals with ASD. This platform will link research users to credible sources of information, research, and services by acting as a knowledge broker and research wayfinding system.

ASD is a growing condition impacting society in profound ways; it is the most common neurological disorder in children, affecting approximately 60,000 people in BC. There is an urgent need for a more fulsome approach to the dissemination of knowledge to families about best practices, new research, evidence-based treatments and support. Families are essentially left to their own devices to make critical decisions about what services are most beneficial for their child and hence where best to direct their funding. This is critical because the earlier treatment is started, the better the outcome.

The Pacific Autism Family Network’s (PAFN) mandate is to be a Knowledge Centre of Excellence: bringing together state of the art resources for research, information, learning, assessment, treatment and support across BC. Since 2015, PAFN has collaborated with the Health Design Lab (HDL) at Emily Carr University to better understand the communication challenges and needs of researchers and families in the ASD community. Through this collaboration in 2016/17, it was found that access to reliable and credible research for families is a significant challenge due to barriers including time, money, location, language and format. To improve knowledge exchange, researchers and families identified the need for a web-platform that will curate credible ASD research for families and disseminate it through more diversified and accessible communication modes.

To meet this challenge of co-designing the web-platform, workshops with the ASD community will be held. Based on input from researchers and research-users, the HDL will design and prototype a web-platform. This will facilitate knowledge exchange and support research users (families and self-advocates) in making informed decisions based on best-practice research. It will also enable researchers to connect with families to support their research endeavors creating direct linkages and ongoing connectivity with the ASD community.

Co-leads: Lori Brotto  Women's Health Research Institute / Provincial Health Services Authority Lana Barry Self Management BC / University of Victoria

Team members: Christine Clark  Thinking Box Carolin Klein Vancouver General Hospital Nicole Prestley Women's Health Research Institute

Trainee: TBC

Chronic genital pain affects up to 12 percent of women and is characterized by painful, distressing, and anxiety-evoking intense sensations when the vulva/vagina is touched. The multidisciplinary team at the University of British Columbia completed a grant-funded trial of group psychological skills training for women with this condition and found both experimental treatments to lead to statistically and clinically meaningful improvements for women. A 90-second infographic video (#ItsNotInYourHead) was then developed with the help of a media design partner and engaged patients. The video conveys two compelling messages:

1. Chronic genital pain is common and you are not alone.
2. There is evidence that psychological treatments can be very effective in managing symptoms.

The intention is to develop a targeted plan for widespread dissemination of the video to the target audience — primarily women (patients) who may experience chronic genital pain. This video will also be disseminated to other audiences who may benefit from the information, including women’s partners, health care providers, hospital policy makers, and the general public. The project goals are to:

1. Develop a social media outreach campaign.
2. Capture metrics associated with various forms of social media used to distribute the video.

The evaluation plan ensures that KT goals have been achieved. The overarching goal is to facilitate the update of scientific evidence from the grant-funded trial by women (and other key stakeholders) who can directly use this new knowledge.

Co-leads: Kimberly Miller Simon Fraser University Vanessa Bland  Vancouver Coastal Health

Team members: Sandra Dawson  Patient partner Laura Johnston Community Legal Assistance Society Erin Michalak University of British Columbia Jessica Wang  Patient partner

Trainee: Iva Cheung  PhD student

Under the provincial Mental Health Act, patients involuntarily hospitalized for a mental disorder must be informed of their rights upon admission. But in a 2011 survey of short-stay mental health patients, 43 percent of respondents said they were not explained their rights in an understandable way. Qualitative research by Iva Cheung suggests this gap may be due to inconsistent rights-advice practices and an ineffective communication tool.

Clinicians use a statutory form to give rights advice to involuntary patients, but user testing of this form with people with lived experience has uncovered weaknesses in the document, from the patient’s perspective, as a communication tool.

With this award, the research team aims to apply evidence from that user testing to create a new suite of rights-advice communication tools and a training program for clinicians to implement these tools. Two patient partners on the team will co-create the communications, which will be user tested with people with lived experience, to make them as clear and useful to patients as possible. The team’s research user co-lead, an experienced resource nurse with a mentorship role and access to 11 psychiatric units, will contribute her knowledge of rights-advice practices and clinical workflows to ensure that the tools will be practical to use in hospital settings. The legal expert on the team will review the tools for legal accuracy.

The research user co-lead will champion this research in her workplace and help develop an interactive training program for clinicians who give rights advice. This training will

• Introduce the new communication tools.
• Emphasize the importance and potential therapeutic benefits of rights advice.
• Refresh clinicians’ knowledge of salient parts of the Mental Health Act.
• Support clinicians in establishing strategies for implementing rights advice in practice.

Expected outcomes:

• Patients will know they have Mental Health Act rights.
• Patients will better understand their rights and how to exercise them.
• Clinicians will improve their knowledge about the Mental Health Act.
• Clinicians will gain strategies for implementing rights advice in their workflow.

The activities of this team, with a balance of researcher, clinician, and patient representation, align well with integrated knowledge translation best practices and with the health authority’s priority of providing patient-centred care.

Co-leads: Lise Olsen  University of British Columbia – Okanagan Rachelle Hole Centre for Inclusion and Citizenship / University of British Columbia Vicki Cairns Autism Okanagan Kelowna

Team member: Alison McManus University of British Columbia – Okanagan

Trainee: Matthew Ferrier Undergraduate student Zarka Kiktavy MSW student Crystal Shannon MSN student

This project aims to communicate and stimulate stakeholder interest in developing strategies to better support Okanagan families with autism spectrum disorder children, thus enabling them opportunities to pursue safe and active recreation.

The activity will be a one-day symposium at the Okanagan campus with a proposed date of March 2018. The short term goals are to share research findings and build a stronger network and researcher/practice connections. The long term goals are to build a community of interest, identify and agree on key areas of needed practice and policy change in the Okanagan, and develop a strategy through a funding proposal to enact such changes. Specific objectives of this activity include:

1. For a symposium planning group to oversee the development of the symposium activities and strategies.
2. Raising awareness among stakeholders about research in this area.
3. Providing a forum for interaction between attendees and researchers on this topic.
4. Providing an opportunity for stakeholders in the Okanagan communities to become involved in developing an ongoing plan based on current research evidence for furthering research and intervention development.