Although young people’s mental health remains a public health priority, there continue to be knowledge gaps in what diverse youth identify as facilitators and barriers to accessible, safe, and inclusive mental health services and systems. To date, there is limited information about the broader social factors and forces that shape youth mental health. This research program will study the relationship between social factors and patterns of health service use for youth mental health; the role of racial discrimination in mental health and mental health care, including youth perspectives on their experiences; and ways to improve knowledge mobilization and the implementation of mental health equity interventions. Planned KT activities include in-person and online discussions, community reports, webinars, infographics, social media posts, presentations, and academic publications. This research will generate needed information about youth mental health, racial discrimination, and other social factors that can inform changes in practice, policy, and future research to address health system barriers and improve mental health outcomes for diverse youth.
Program: Scholar
Community partnerships to understand and improve movement behaviours
Participation in physical activity provides people with many health benefits. Despite work to improve population physical activity levels, most people do not participate in enough physical activity to get these health benefits. Physical literacy examines the many factors that contribute to physical activity behaviour (motivation, confidence, physical skills, knowledge, and understanding) using an individual lens, and can be captured within the larger contexts that influence movement behaviours. This individual lens is a useful tool to develop and assess strategies to support equitable access to physical activity. I will develop a rich understanding of the interplay between physical literacy and physical activity, using a community-informed approach to improve our understanding of access to and participation in physical activity for equity deserving populations. In partnership with community groups, I will co-develop understanding of the barriers and facilitators to physical activity, and strategies to support increased movement. This research will inform policy change to create physical activity programs that are relevant and engage communities and support population level participation in health promoting movement.
Exploring the shifting landscape of medication-based drug treatment and safer supply in the fentanyl era: a research program to address the evolving overdose crisis in BC
Canada continues to grapple with an overdose crisis driven by illicitly manufactured fentanyl and novel psychoactive substances (e.g., etizolam, xylazine). The drug treatment landscape is rapidly evolving in response, and includes the implementation and expansion of a number of medication-based drug treatments (e.g., oral and injectable hydromorphone) and prescribed safer supply programs (SSP) that provide pharmaceutical alternatives to the toxic drug supply. However, socio-structural factors have impeded broader expansion and support, and SSP remain controversial with many healthcare providers expressing concern. This ethno-epidemiological research program will gather the views of people who use drugs, policymakers, and health system actors across BC to explore how individual, social, structural and environmental factors shape access to and outcomes from existing and emerging medication-based drug treatment programs and SSP. This is a critical opportunity examine the rapidly shifting drug treatment and overdose response landscape to better inform public health approaches to the ongoing overdose crisis. Knowledge gained will inform and guide future policy and public health developments to improve the lives of people who use drugs.
Evaluating the impact of cannabis exposure and access on substance use trajectories among people who use unregulated drugs during the fentanyl era
The impact of cannabis access and use on the development of high-risk substance use behaviours remains controversial during the opioid overdose crisis. To address this knowledge gap, I plan to:
1. Identify how cannabis access and use impact early substance use careers, including the use of opioids, stimulants and injection drug use among at-risk youth;
2. Analyze how cannabis access and use impact overdose, as well as risk factors for overdose (e.g., binge opioid use) among high-risk subgroups of people who use drugs (e.g., people with chronic pain, HIV);
3. Characterize how cannabis use impacts engagement and effectiveness of addiction treatments. We will also investigate how cannabis use intentions (e.g., recreational vs. therapeutic use) shape addiction treatment outcomes.
This project will analyze data from three studies (N=3,375) of people who use drugs (PWUD). Established partnerships with the BC Ministry of Health and community groups of people with living experience of substance use will support the production of scientific evidence, policy briefings and community resources that will be important to inform clinical and public health practice, as well as policy responses to the overdose crisis during the fentanyl era.
Tailoring health services by contextualizing the person behind patient-reported data
There is growing interest in using patient-reported data collection to improve patient outcomes. The data collected via patients’ reports are generated from the patient’s perspective, which can provide important information about aspects of their health status particularly relevant to their quality of life, including symptoms, functionality, and physical, mental and social health. However, the data collected are merely numbers that do not provide a holistic assessment of a patient’s health. To achieve the full potential of patient-reported data, clinicians would benefit from learning how to translate these data into a patient’s “health story.” My research program is pioneering a new approach for contextualizing patient-reported data with patient stories to optimize their use in practice. The results have the potential to support clinicians in better identifying and addressing evolving needs and enhance person-centred care by facilitating patient-clinician dialogue and adopting education and intervention strategies attuned to the needs of individual patients.
Co-Creating Age and Dementia-Friendly Communities: A Community Engaged Program of Research
Worldwide, there is increased interest in developing age and dementia-friendly communities. This is because communities, organizations, and policy makers recognize the need to make the community setting a place where people can “age in place” and experience quality of life, while living with conditions such as dementia. It is important that older people with dementia have a say in the development of communities meant to support them. As such, this community-engaged research program addresses this need, by engaging directly with people with lived experience. The goal of this research program is to build a Community Action Group (CAG) of people with dementia, and to conduct co-research with the CAG. This means that the CAG will collaborate with the research team to plan and take part in a variety of research activities (such as co-design workshops) that will inform development of age and dementia-friendly communities. This will not only lead to meaningful change in communities, but will empower people living with dementia. Research of this nature will also impact future research by demonstrating the possibilities of collaborating and co-researching with people with lived experience, in order to make meaningful social change happen.
Strengthening mental health in Horn of Africa (IGAD region) and Somalia (MH Care-Somalia).
Globally mental, neurological and substance use disorders (MNS) affect 10%, but jumps to 22% in conflict settings while 75% of persons with MNS in conflict settings such as Horn of Africa region lack access to mental health care. The region has faced decades of conflict and climactic shocks that eroded resilience and coping mechanisms. While the mental health services including its workforce are almost non-existent, it is unlikely the region will be able to train sufficient mental health specialists. That is why we propose developing of regional mental health strategy and enhance capacity through task-sharing using WHO Mental Health Gap Action Program (mhGAP) to train frontline workers. mhGAP is designed to support non-specialist to provide MNS services for conflict-affected communities
The research and KT activities include; regional stakeholder engagement, contextualized training materials, trainers of trainees to ensure local capacity and website/social media presence
The anticipated outcomes and; increased access to services, improved awareness and enhanced workers capacity
Potential impacts. The project aims to strengthen mental health through policy and capacity building with potential to cascade across the region
Decolonizing Planetary Health: Rebuilding Social, Cultural, and Environmental Relationships for Indigenous Well-being
Systemic racism against Indigenous peoples is an enduring problem in British Columbia’s health care system. Education and training programs to date have fallen short in producing necessary structural and systemic change, due in part to the lack of consistently mandated training for health care providers in cultural safety and humility. The overarching goal of this program is to support re-emerging nation-to-nation relationships in Canada as a key determinant of Indigenous health, as a pathway to improving Indigenous experiences of care within the BC health system and creating healthy lands and waters on unceded Indigenous territories. My research program examines how Indigenous peoples are asserting self-determination in community health and wellbeing in response to wide-spread anti-Indigenous racism, and how land-based, Indigenous knowledge may transform relationships. I use storytelling and other knowledge creation methodologies to examine the connection between colonization and Indigenous health and wellbeing, and Indigenous communities’ strategies to exercise self-determination in the face of persistent inequities and injustice. These methodologies are guided by Indigenous community partners and OCAP® principles.
Advancing Equitable Cancer Care: A Innovative Approach to Transformative Action in BC
In BC, some groups face unfair barriers in receiving adequate cancer care due to factors like racism, stigma, discrimination, poverty, mental health and substance use challenges, and/or disabilities. Over the next five years, my research aims to tackle these disparities. First, we will team up with people who know these issues firsthand to form a community-engaged research team. Together we will identify what research is most needed and lead innovative studies to address cancer-related inequities. Our primary focus involves developing a new approach to caring for cancer patients. We will create an equity model of care based on principles of equity-oriented healthcare, integrating trauma-informed care, cultural sensitivity, and strategies for addressing substance use health. Additionally, we will gather patient feedback to continually improve care quality. These new approaches will be piloted in specific cancer clinics to assess their effectiveness. Success means more equitable and improved cancer care for the diverse communities we serve in BC.
Life-course socio-economic adversity and trajectories of aging from early to old age
The way people age varies significantly from one individual to another. This variation is attributed to a combination of factors, including genetics, environment, psychological and social factors, and lifestyle choices. Individuals from lower socioeconomic groups often experience faster physical and mental aging, contributing to a growing health divide and increasing health inequities. Socioeconomic conditions affect not only the rate at which health deteriorates but also the highest level of health a person can achieve, starting from conception. The specific mechanisms of this impact, particularly in early life and in older age, require further research. This research program will analyze data from population cohorts of different ages to understand the influence of social and economic environments on developmental and aging trajectories from early life to old age. It aims to identify factors that might protect individuals from the adverse effects of lower socioeconomic conditions on health and aging. This knowledge will assist in shaping and implementing targeted health policies to improve the health and aging trajectories of the population, thereby reducing health inequities and lessening the burden on the health system.