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Co-leads:
- Heather McKay
University of British Columbia
- Joanie Sims-Gould
University of British Columbia
- Callista Ottoni
CHHM / Vancouver Coastal Health Research Institute
- Kahir Lalji
United Way of the Lower Mainland
- Rebecca Tunnacliffe
BC Recreation and Parks Association
- Marcy Cohen
BC Raising the Profile Project
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Trainee:
- Samantha Gray
University of British Columbia
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In Canada, and elsewhere, there is a continual battle to find effective ways to engage older citizens in physical activity programs. Despite the known benefits of physical activity to counter the risks of a host of chronic diseases, only 13 percent of Canadian seniors meet recommended physical activity guidelines. For over three years, the BC Recreation and Parks Association (BCRPA) and the United Way of the Lower Mainland (UWLM) have been collaborating to address these issues.
Most recently, under the auspices of the Active Aging BC (ABC) program, these organizations came together to co-create, deliver, adapt and evaluate a physical activity intervention (Choose to Move) and disseminate Active Aging grants. ABC (funded by BC Ministry of Health) enhances the health, mobility and social connectedness of low active older adults. The partners are experts in implementation and dissemination of community-based programs. There is also a partnership with the Raise the Profile Project (Cohen) and participation in the Executive Organizing Committee for the Provincial Seniors Summit (November 2017).
As researchers, there is a reliant on data, graphs and figures to convince communities and policy makers at local, provincial and national levels to take action toward improving health. However, the voices of those most affected by inaction speak much louder than researchers can.
The objectives of this award are to:
- Create a short documentary video telling the stories of older adults, their activity coaches and community stakeholders involved in Choose to Move across BC.
- Launch this KT product at the Raising the Profile Project Seniors Summit (November 2017) and the BCRPA annual meet up (April 2018).
- Disseminate this KT product through the research users’ extensive distribution channels.
Ultimately, through life-changing stories, the aim is to raise and change the profile of older British Columbians. With evidence from the Choose to Move impact evaluation, stories will be integrated to illustrate that there are effective, evidence-based solutions to older adult physical inactivity. Practitioners and organizations who serve the needs of the older population will also be made aware of Choose to Move. Finally, through BCRPA, UWLM and RPP channels, this KT product will be disseminated and used to recruit older adult participants into the Choose to Move programs.
Co-leads:
- Quynh Doan
BC Children’s Hospital Research Institute / Provincial Health Services Authority
- Garth Meckler
BC Children’s Hospital Research Institute / Provincial Health Services Authority
- Christy Hay
University of British Columbia
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Trainee:
- Benetta Chin
MD, FRCPC [pediatric], sub-speciality resident
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This award will help establish a standardized approach to acute care for mental health crises at BC Children’s Hospital’s Emergency Department (BCCH ED). BCCH is the only quaternary level PED in BC and receives over 46,000 annual visits, of which almost 1,000 are mental health related. Over an 11-year period, the annual number of mental health visits at BCCH increased by 86 percent, from 529 visits in 2002 to 983 in 2012. Youth with mental health concerns are among the fastest growing segment of the ED population and this is true across North America. Data further shows that repeat visits account for almost one-third of all mental health visits, suggesting a need for improvement in the discharge and follow up processes.
This project will implement a child and youth specific ED protocol for the clinical assessment, management and discharge of patients with mental health concerns at BCCH ED. Supported by a partnership between the Doctors of BC and the BC Ministry of Health (Shared Care), the Child & Youth Mental Health & Substance Use Emergency Department Protocol (CYMHSU ED protocol), which includes HEARTSMAP, a validated clinical assessment tool, is already being implemented in community EDs across BC. Unfortunately, the BCCH ED was not included in the provincial plans and has not benefited from this initiative. This omission may cause non-uniform use of the HEARTSMAP tool and discrepancies in care, discharge planning, and referral/follow up plans for youth seen at BCCH ED compared to the rest of BC.
Scientific evidence will be used to:
- Improve youth and family care by orienting them to the BC mental healthcare system, including information about the role of the emergency department and access to community mental health resources after discharge.
- Help PED clinicians conduct efficient and effective emergency psychosocial assessments with proper documentation, and guide them in choosing the right mental health service at the right time to optimize patient care.
- Evaluate the effectiveness of this implementation program.
To reach these aims, three activities are proposed:
- Customize the CYMHSU ED protocol components for use at BCCH ED.
- Implement the protocol through workshops for clinical end-users.
- Evaluate the effectiveness of the implementation program.
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Co-leads:
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Trainee:
- Emma Schultz
Undergraduate student
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By 2019, the senior population will increase by 20 percent in Kamloops; this outpaces the expected general population increase of 4.8 percent (Interior Health, 2014). This change has forced a need to re-examine the structure and delivery of healthcare services in BC’s central interior. In response, Interior Health (IH) is undergoing a system change to enhance the delivery of primary and community care for frail older adults and those with complex chronic conditions. This “repositioning” or restructuring of healthcare services is anticipated to provide comprehensive and effective community based care for clients.
Since evidence-informed practice in healthcare must include client preferences (DiCenso, Guyatt & Ciliska, 2005), there is an urgent need to consult service users to guide the direction of IH’s decisions on the repositioning of older adults within BC’s central interior. Supported by an IH Evidence-Informed Practice Challenge grant (2016 – 2017), this ROAR (Researching Older Adults Repositioning) study engaged older adults (from Kamloops and nine surrounding rural and remote communities) in research and enabled them to share views on primary and community care in BC’s interior and the repositioning work undertaken by IH.
Taking place over the next year, the TRiP (Translating ROAR into Practice) project is an integrated knowledge translation (iKT) process that will enable the engagement of IH staff (as decision-makers and knowledge users) and older adults (as service users and research participants) in interpreting research findings from the ROAR study. One of the iKT strategies for this project is to hold a summit where study participants and knowledge users, along with representatives from key seniors and/or patient advocacy groups, will work together to develop a plan to ensure findings from the ROAR study effectively make their way into practice at IH.
This award will go towards a dissemination scheme to complement the TRiP project. As part of the proposed scheme, dissemination tools will be developed to make research users aware of the ROAR study findings within IH, BC and beyond. ROAR findings will be shared through publication in an open-access journal and presentations at local venues, and one regional or national aging-related conference.
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Co-leads:
- Shannon Dames
Vancouver Island University
- Wendy Young
Island Health
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Trainee:
- Alexa Garrey
Vancouver Island University
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Healthcare workers experience high rates of stress leave and attrition due to unaddressed mental health needs. While some providers leave the workplace because of burnout, many stay, which compounds the issue and contributes to toxic workplaces and higher patient mortality rates.
New research shows that self-compassion — defined as unconditional positive regard turned inward — is a significant contributor to healthy communities of practice, and promotes the ability to manage workplace stressors (Dames, 2018). The project team will:
- Co-develop an evidence-based curriculum and tools that will inform and improve practice by promoting self-compassion among healthcare providers within Island Health and Vancouver Island University.
- Build capacity for knowledge translation and future research to study curriculum outcomes.
The curriculum will help providers develop an ability to learn of, articulate, and digest emotions in a safe environment of unconditional positive regard for self. When providers lack self-compassion, they are at a higher risk of mental and physical ailments, emotional exhaustion, and burnout. Rather than turning to substances/activities that lead to dissociation or avoidance, this curriculum will enable participants to cultivate a habit of self-soothing by nurturing themselves with loving kindness.
At the end of the Reach award, the research team will have completed a literature review, curriculum, and submitted a grant application to fund a pilot study on Vancouver Island. The curriculum is expected to improve stress resilience among providers, decrease the use of substances to cope with stress or distress, reduce attrition rates due to burnout, and promote relationally healthy communities of practice (CoP, defined by Wenger as a “group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly”). The proposed curriculum will enhance the mental health and well-being of providers; instilling self-compassion in providers is shown to improve experience and outcomes for patients. Those who direct compassion inwardly naturally extend compassion to others.
This Reach award will cover the costs of bringing stakeholders together to develop the curriculum and to draft an application for the pilot study. This project's potential impact on patient and provider outcomes is enormous and well aligned with health authority and provincial priorities.
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Co-leads:
- Leslie Bonshor
Vancouver Coastal Health
- David Hall
Vancouver Coastal Health
- Michael Norbury
Vancouver Coastal Health
- Andrew Day
Vancouver Coastal Health
- Laurel Jebamani
Vancouver Coastal Health
- Krisztina Vasarheiyi
Vancouver Coastal Health
- Brittany Bingham
Simon Fraser University
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Trainee:
- Teila Gabriel
University of British Columbia
- Andreas Pilarinos
University of British Columbia
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Indigenous peoples experience disproportionately poor health and social inequities as the direct result of Canada’s colonial history, including the Indian Act and Residential Schools. Indigenous people face discrimination in accessing health services and are often underrepresented in health research.
The Truth and Reconciliation Commission’s 94 Calls to Action demonstrate the need for system-wide transformation for creating Indigenous cultural safety within health systems. Call to Action 23 calls on all levels of government to improve cultural competency of healthcare professionals. Culturally safe care requires providers to understand how power dynamics created by colonization persistently affect Indigenous people’s health. The regional Aboriginal Health Program at Vancouver Coastal Health is leading innovative activities that use Indigenous methodologies to facilitate system-wide culture change, including cultural safety training at a large acute care facility, embedding Elders and Knowledge Keepers in care systems, and providing cultural practice guidelines to front-line staff.
A Two-Eyed Seeing research team will be formed to integrate Western and Indigenous perspectives on health research. The team will engage with Indigenous communities in three focus group sessions in fall 2018. Feedback will be provided on: respectfully conducting health research with/for Indigenous people; ways research can genuinely serve — not tokenize — communities participating in studies; and the health and wellness themes of highest priority to communities. Focus groups will be held with: (1) Indigenous women attending the Necamat Aboriginal Women’s Village of Wellness held in October in Vancouver’s Downtown Eastside; (2) Musqueam First Nation; and (3) Vancouver General Hospital Indigenous Peoples Advisory Group.
A knowledge translation team — consisting of (at least) one community representative, one knowledge user with knowledge translation expertise, and trainees — will synthesize community feedback to inform the development of content for Research Day and to produce a final report for knowledge dissemination.
The Research Day will be hosted by Vancouver Community health services at Vancouver Coastal Health in spring of 2019 to expand awareness of Indigenous perspectives on health and research among Vancouver Community staff. The morning will include a traditional opening by an Elder, a community panel discussion to explore themes of the focus group sessions, and a keynote presentation. Respected Indigenous leaders and researchers will speak and moderate discussions. In the afternoon, 25 registered Vancouver Community health researchers will attend a workshop on cultural safety and Indigenous research methods.
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Co-leads:
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Trainee:
- Joanna Tulloch
University of Victoria
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Housing is an important structural determinant of health. Positive Living, Positive Homes (PLPH) is a longitudinal, qualitative, community-based research (CBR) study conducted in three British Columbian (BC) communities (Prince George, Kamloops, and Greater Vancouver). PLPH has investigated the complex relationship between housing and health for people living with HIV, and how policies and programs across BC interact with health and wellbeing of PLHIV.
In keeping with the tenets of CBR and the greater/meaningful involvement of people living with HIV/AIDS (GIPA/MIPA) principles, in each site, the team engaged people living with HIV, service providers, and other partners to participate as study team members in study implementation, data analysis, and knowledge translation activities.
Between June 2015 and October 2017, 99 adults living with HIV across the three BC study sites participated in baseline in-depth interviews for PLPH, with follow-up interviews one year later (72 people completed the follow-up interviews). In addition, in-depth, semi-structured interviews were conducted with 42 HIV and/or housing service providers and policy makers working in a range of community and government organizations at the three sites.
A key finding of the study related to the impact of stigma and discrimination across the housing spectrum for people living with HIV. Several participants were denied access to housing upon disclosure of living with HIV. Stigma and discrimination also drove some participants into isolation and away from care and resources related to their health and housing. Given this, the PLPH CBR team recommended that an essential KT tool would be an Online HIV Housing Toolkit that would increase access to housing information for people living with HIV and service providers who support people living with HIV, and ultimately help people living with HIV and service providers better navigate BC’s housing system.
PLPH is led by Dr. Catherine Worthington (Public Health and Social Policy, University of Victoria) and Evin Jones (Pacific AIDS Network (PAN), which holds CIHR HIV/AIDS CBR operating grant funds for the study (2014 – 2018)). PAN is a member-based coalition with almost 50 member organizations responding to HIV, HCV and related issues across BC. PAN is uniquely positioned to develop and host an Online HIV Housing Toolkit because they have developed and hosted many training and online tools for its member agencies and other key provincial partners.
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Co-leads:
- Bernadette Pauly
University of Victoria
- Bill Bullock
Victoria Division of Family Practice
- Karen Urbanoski
CISUR / UVic
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Trainee:
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People who use substances (PWUS) face stigma and discrimination when accessing primary care. Cultural safety has been proposed to reduce provider and system-based stigma. Recently, this team completed a CIHR Strategy for Patient Oriented Research grant, which investigated the meaning of culturally safe primary care for PWUS, with a focus on those also experiencing structural disadvantages (e.g. poverty, racialization). This team comprises of PWUS (community researchers), academic researchers and knowledge users from the Victoria Division of Family Practice and Island Health. Findings included a concept map of cultural safety with eight core areas for reducing substance use related stigma in primary care.
The knowledge translation (KT) objectives are to:
- Raise awareness of the stigma experienced by PWUS in primary care.
- Share understandings of culturally safe primary care for this population.
- Support PWUS to advocate for their own primary care.
- Encourage PWUS, physicians and health planners to collaborate on strategies to improve cultural safety.
- Facilitate the participation of PWUS, physicians and health planners in developing and implementing policies and practices to improve cultural safety in primary care.
Besides local and provincial presentations with knowledge users, a postcard summarizing the findings was produced and distributed it to the community to support PWUS in advocating for their own primary care. We will complete additional plain-language KT materials for this population.
With this Reach award, the team will extend their reach to physicians, other healthcare providers, medical students, and senior level policy makers through two additional activities.
A video will be created to communicate the findings from the perspective of community researchers; it will be available on YouTube and actively promoted for use by senior level health executives and in healthcare curricula in BC post-secondary institutions.
An interactive workshop for primary care providers will be developed and delivered to address barriers and have facilitators implement culturally safe care. This workshop will be developed by the existing team and will be led by PWUS in collaboration with other team members. The workshop will be delivered through newly developed interdisciplinary primary care networks in Nanaimo, Campbell River and Port McNeil with a focus on identifying local practice changes. Besides enhancing the reach of findings from this completed project, the community researchers and graduate trainee will build their personal and organizational capacity for KT.
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Co-leads:
- Sam Liu
University of Victoria
- Karen Strange
Childhood Obesity Foundation
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Trainee:
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Childhood obesity is a major public health challenge in Canada. The BC Ministry of Health funded the knowledge-user (Childhood Obesity Foundation) to design and implement a “made in BC” community-based Childhood Healthy Weights Early Intervention Program (EIP) for children 8-12 years old. However, it has proven challenging to reach families who can’t attend in person. But with improved access to the Internet, web-based lifestyle programs may be well-suited to meet this challenge. In this project, the team will build an interactive web-based childhood obesity prevention program based on the EIP curriculum.
Aims:
- Develop an interactive web-based version of EIP for families whose children are off the healthy weight trajectory.
- Conduct usability testing to further enhance user experience.
- Collaborate with co-lead to disseminate the program across BC.
The web-based program will address major gaps in existing interventions, such as making the program accessible to non-traditional families; this includes Indigenous families, families from multi-cultural or intercultural backgrounds, and those of lower socioeconomic status. The program will also include sessions on sleep hygiene and screen use. This project will consist of three phases. In the first phase (0-5 months), an integrated-KT approach will be used to develop a web-based program (Aim 1). Integrated-KT helps ensure the web-based program is relevant and useful to all stakeholders (e.g. knowledge users, researchers, end-users). At the end of phase two (month 7), it is expected there will be a functional interactive web-based program that has undergone usability testing (Aim 2). In phase three (8-12 months), work will be done with the research user to disseminate the web-based intervention to diverse groups of families with children off the healthy weight trajectory (Aim 3).
This project has potential to be incredibly impactful as a web-based intervention can extend the reach of the Childhood Healthy Weights EIP across BC.
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Co-leads:
- Caroline Sanders
University of Northern British Columbia
- Joanne Hall
Congenital Adrenal Hyperplasia – Living with CAH Support Group, UK
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Trainee:
- Erika Belanger
University of Northern British Columbia
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Following early analysis of data from the Women Health Research Institute (WHRI) grant focusing on wellness in women with congenital adrenal hyperplasia (CAH), it was obvious that there was a need to share, translate, and mobilize knowledge into public and professional domains. Early findings show that menstrual wellness for women with CAH is constrained by the ongoing menstrual taboos, similar for all women. An additional stress factor for women with CAH is the variation in genital anatomy, cycle duration, and the impact of metabolic processes and steroid medication management.
Taboo and limited menstrual information and resources for parents of younger children, patients and health care providers result in knowledge gaps; this limits early and ongoing body wellness conversations. Introducing health concepts linked to menstrual wellness early on can help to reduce stigma and isolation, which builds resilience to support physical health and protect mental wellbeing.
The aim is to build on HealthLinkBC’s “standard” menstrual cycle information by designing a simple, interactive (info)graphic that will lay out the important factors of concern to women with CAH. It is hoped that women will use this KT product when discussing their menstrual (ir)regularities with health care providers (e.g. in specialist and primary care settings). To strengthen product credibility, this interactive (info)graphic will be presented at a WHRI workshop to CAH stakeholders (e.g. women with CAH, parents, health care providers, educators, and advocates); feedback on design, functionality, and content will be incorporated.
This KT work will be launched with provincial events linked to Women’s Day and Rare Disorder Day 2019. In addition, this KT resource will be made freely available via domestic (e.g. Canadian Organization of Rare Disorders (CORD)) and international advocacy and support groups (e.g. dsdfamilies, living with CAH etc.).
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Co-leads:
- Fiona MacDonald
University of the Fraser Valley
- Tannis Driedger
Patient partner
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Trainee:
- Dempsey Wilford
University of Victoria
- Julie Morden
University of the Fraser Valley
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Increasingly, jurisdictions are adopting “apology legislation” that allows clinicians to apologize to patients when an adverse event occurs while disallowing the introduction of the apology in a liability case as evidence of fault or liability.
Apology legislation exists in Canada, Australia, the USA and the UK. In Canada, nine provinces and two territories have adopted apology legislation (BC first adopted in 2006). An apology is defined in Canadian legislation as “Encompassing an expression of sympathy and regret and a statement that one is sorry, or any other words or actions indicating contrition or commiseration, whether or not the words or actions admit or imply an admission of fault” (CMPA website). While apology legislation is established in Canada, little is known about the impact of apologies on various stakeholders, or the impact the legislation has on health care more generally. The existing literature on medical apologies is largely focused on the American context and is often limited to the potential impacts rather than the actual impacts as they are experienced by stakeholders. It is unknown whether impacts are differentiated for specific patient groups, such as Indigenous populations whom, research consistently shows, often experience highly differentiated processes and outcomes in health care.
Data was collected in two provinces (BC and MB) from qualitative interviews with patients who experienced a medical error and who did or did not receive an apology. Data was also collected via interviews with patient safety experts, clinicians, health care administrators, and medical school administrators. There is rich data providing original insight into how and whether giving/receiving an apology improves learning, accountability, patient safety, and healing (for both the patient and clinician). With this data, YouTube videos, op-eds and blog posts will be developed to share the findings with patients, clinicians, and administrators. The dissemination products will emphasize these themes: 1) Various traumas associated with medical errors/mistreatment; 2) The components of a meaningful medical apology for clinicians and administrators; 3) Impacts of apology on both patient and clinician; 4) Indigenous perspectives on medical apologies.
The findings will be presented at the 2019 BCPSQC Quality Forum. Participants at this event include physicians, nurses, pharmacists, allied health professionals and students.
