Active Steps: Feasibility of a virtual intervention to promote active lifestyles in children with type 1 diabetes

Diabetes is one of the most common chronic conditions in children; in Canada nearly 30,000 children are affected by this life-threatening disease. Type one diabetes (T1D) is a condition that requires careful management, including frequent monitoring of blood glucose levels and lifelong insulin therapy. Regular physical activity is recommended for better blood glucose control, but fear of hypoglycemia (alarmingly low blood glucose levels) limits physical activity in these children. Few interventions have managed to meaningfully increase physical activity in children with diabetes. With this project, I will develop and test a virtual physical activity intervention. The project will take place in BC’s Interior, including rural and remote communities. It will be the first physical activity intervention for children with T1D in this region. The “Active Steps” project consists of five 45-minte virtual sessions over 12-weeks, addressing T1D related physical activity challenges. Participants will receive workbooks to work through with the physical activity counsellor during the sessions. They will also set their own activity goals and monitor them using a Fitbit Charge 5. To evaluate the program, we will look at how many kids join, how many finish and how well the virtual program works. We will also interview the children and their parents to see if they enjoyed the program. Children’s physical activity before and after the intervention will be measured. This study is an important first step to ultimately inform a larger randomized controlled trial that will aim to demonstrate the effectiveness of the intervention to increase physical activity. 

The study will be conducted by Simran Gill, a PhD student under the supervision of Dr. Christine Voss. Simran is co-funded by the Canadian Consortium of Clinical Trial Training Platform (CANTRAIN-CTTP) and Michael Smith Health Research BC Doctoral Studentship. 

Ethicolegal implications of screening for intimate partner violence-caused brain injury: Co-creating research priorities and practice recommendations

Brain injury (BI) is known as an invisible injury. Intimate partner violence (IPV) is equally invisible, often happening behind closed doors with no witnesses. Almost half of women in Canada report experiencing at least one incident of physical or sexual violence at the hands of a partner in their lifetime, and as many as 92% of women who seek help from abuse at a hospital emergency room or a women’s shelter may have experienced a BI. IPV-caused BI is a public health emergency, overdue for research and attention.

BI can have chronic and devastating health implications. Our research indicates it may also be weaponized against a survivor in family court where custody of, or access, to children is contested, based on assertions the injury makes a mother unfit to parent.

In this project we will bring together experts from legal, community, and health care-focused agencies, to review the research findings, and analyze and prioritize their attendant recommendations. In response, our team will conceive, draft, and disseminate an action plan and position paper designed to inform future research and practice, and spark system change with the hope that this will result in better outcomes for survivors.

Aging in Place: A Perspective from Indigenous Older Adults and Elders

This partnership supports knowledge gathering to understand the choices of Indigenous older adults on where and how they want to choose to age-in-place. Working alongside Indigenous communities we will gather data on what aging-in-place means to Indigenous older adults. Modifying a developed survey, we are co-creating knowledge from across BC reflecting the needs and choices of Indigenous older adults and Elders. We anticipate building on this with our national partners to capture voices of different nations across what is called Canada. Stakeholder and community reports will be co-created with Indigenous communities. The generated evidence will first be reviewed within individual communities and thereafter shared through knowledge exchange events with government, Indigenous leaders and policy makers at the provincial and federal levels. Aging-in-place needs to extend from health (provincially governed) to family services, and housing (federally governed). Activities will be led by an advisory council of the communities from which the knowledge originates. Our goal is capture Indigenous voices, and with intentional listening elevate knowledge to shape policies and practice to support of aging-in-place for Indigenous communities.

Characterizing Traumatic Brain Injury in Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is remarkably prevalent: ~15-50% of women are will likely experience IPV in their life. Following an IPV episode, the survivor can have negative mental health outcomes including: post-traumatic stress disorder, anxiety, and depression. These injury outcomes may be rooted in structural or functional changes in the brain. Currently, there is very little direct evidence for the potential link between IPV and traumatic brain injury (TBI), specifically how the latter may have an influence on the outcome and trajectory of survivors. Following a TBI, neuropathological changes (physiological and anatomical) are reported as a rapid onset of neurological impairments.

Given the subtle nature of the deficits, it is often difficult to determine injury extent, or when a patient has recovered. From a clinical perspective, current diagnosis mainly relies on self-reported symptoms such as: headaches and dizziness. The subjective nature of self-reported symptoms and the possibility of bias, clouds symptom presence and magnitudes. The physiological measures (cerebral autoregulation, autonomic function) in this investigation will serve as objective diagnostic markers to develop advanced screening tools to inform treatments for IPV survivors presenting to shelters. This study has been endorsed by the Ministry of Women’s Health, which will use the findings to alter the manner in which health care and social workers assist with this population.

Envisioning urban Indigenous-led pathways to mental wellness through community-based research in the interior of British Columbia and new partner engagement in the north

Colonialism, racism, and a lack of culturally safe care result in poorer mental health outcomes for Indigenous peoples in Canada. Indigenous-led services grounded in local values and priorities improve culturally safe care and wholistic health for Indigenous peoples. Urban (off-reserve) Indigenous peoples are, however, often excluded from mental health planning that affects them. This is especially felt by urban Indigenous peoples residing in rural and northern areas. Building on established partnerships with five British Columbia (BC) Interior Friendship/Métis Centres, and Interior Health, this research aims to change this. Together we will: 1) renew/strengthen existing relationships; 2) explore local mental wellness needs and priorities; 3) develop community-led pathways for promoting mental wellness; and 4) engage new community and health system partners in Northern BC. Local Elders, community research liaisons, and advisory teams will direct and facilitate information gathering and sharing. This may include surveys, talking circles, and community gatherings. Results will be community-owned, and shared with directions from communities.

Impact of a combined exercise and counselling intervention on mental health in people with spinal cord injury who live with chronic pain: A psychobiological approach

People with spinal cord injury (SCI) who live with chronic pain report poorer mental health (e.g. depression and anxiety symptoms) than those without disability. Poor mental health can further limit social participation (including employment) and physical functioning, and increase the use of health care services. Therefore, there is a need for safe, accessible, and affordable strategies to improve pain and mental health in this population. Exercise may be an effective strategy, but it’s not known if people with SCI living with chronic pain also benefit. Forty-two adults with SCI reporting chronic pain will receive a personalized exercise prescription and weekly exercise counselling. An equal group will go on a waitlist. After six months, we will test for differences in mental health between the groups, and if changes in fitness, pain or social factors can explain these differences. We will interview participants to gather their perspectives on the program, and what we can do better to improve mental health. This study will be the first to test if exercising improves mental health, how much exercise is needed, and the processes by which exercise may improve mental health in people living with SCI and chronic pain.

Improving access to breastfeeding support in British Columbia: Needs assessment of a virtual health intervention

Breastfeeding has numerous benefits for parents and infants. However, many parents encounter challenges with breastfeeding that can lead to early breastfeeding cessation. In addition, persons across British Columbia (BC), especially those in rural or remote regions, cannot access breastfeeding support. This has been especially true during the COVID-19 pandemic, as social distancing protocols and anxiety over personal safety have decreased opportunities for face-to-face interactions. My postdoctoral work will identify effective telehealth strategies and interventions to deliver breastfeeding support to persons living in BC. This study will have three phases: a literature review of effective virtual breastfeeding support; interviews to understand the support needs and acceptance of virtual breastfeeding support among healthcare providers and persons; and development of a clinical guideline for virtual breastfeeding support. Knowledge gained from this study will be used to develop a framework for the provision of virtual breastfeeding support. In addition, it will inform health policy, research, and practice for new parents living in rural BC or those who experience challenges in receiving face-to-face breastfeeding support.

Advancing anti-colonial implementation science and knowledge translation with the xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) research team

xacqanaǂ itkiniǂ (Many Ways of Working on the Same Thing) is a long-term working relationship between Ktunaxa First Nation, Interior Health, University of Victoria, and University of British Columbia – Okanagan. Over the last three years, the xacqanal itkinil team developed a new approach to research that is led by Ktunaxa peoples and reflects Ktunaxa culture. We tested this approach in Ktunaxa communities by hosting a series of gatherings and land-based activities, where community members shared their vision for a healthy community. The team recently received a five-year CIHR Project Grant to build off the first phase of the partnership to work towards Ktunaxa Nation’s vision for a healthy community. We will work with community partners to co-design and implement interventions (i.e. programs, policies, practices), with the aim of transforming the culture of the health system to better serve Indigenous peoples and the wider population. This fellowship will directly contribute to monitoring and evaluating the interventions and their implementation to understand what is working well, what challenges are encountered along the way and how they are addressed, as well as how this work can be carried forward into the future.

Examining motor imagery-related brain function in health and after stroke to leverage its prescription

Many stroke survivors (~85 percent) in Canada experience long-term impairments in arm and hand function. To aid recovery, motor imagery (the mental rehearsal of movement) shows promise as an adjunct therapy. Yet, its effectiveness is varied. We think this is due to a lack of basic knowledge about how motor imagery works. Motor imagery is thought to work similarly to physical therapy, whereby repetitive physical practice drives changes in brain function necessary for learning and recovery. However, we do not know a lot about how motor imagery drives changes in brain function. Using a blended approach not yet taken, we will examine changes in both brain function and behaviour driven by motor imagery. Importantly, we will examine how changes in brain function are altered and can be optimized after stroke, to improve its effectiveness. Findings will provide new information about how motor imagery should be applied to maximize learning and recovery, directly informing its use and prescription in stroke rehabilitation. Overall, this research represents a critical step in improving interventions for stroke recovery, leading to improved daily function and better quality of life for Canadians living with stroke.

Enhancing patient self care and management of atrial fibrillation within primary care

Atrial fibrillation (AF) is the most common heart problem causing an irregular pulse. Individuals who poorly managed their AF risk developing serious problems like stroke and heart failure. Self-care, is when individuals actively maintain health through health-promoting practices, health monitoring, and managing illness. Family doctors and nurse practitioners (primary care providers) provide most of the AF care in BC, and yet are often not able to support their patients’ self-care because of limited time and other more urgent problems. They need new ways to address AF self-care. Teaching patients to self-care for their AF can improve their quality of life, reduce their stress, increase their ability to stay on track with their treatment plan (taking mediations), and can prevent serious problems. This research will study ways to improve self-care practices in primary care by bringing together a group of doctors, nurses, patients and researchers to look at what we already know about AF self-care in the literature and what resources exist in BC to support self-care. Second, they will put together all this information and then have a meeting to identify some of the possible solutions to address AF self-care in practice and research.

Team members: Louann Janicki (Interior Health); Ryan Wilson (UBC Okanagan); Peter Loewen (UBC); Nelly Oelke (UBC Okanagan); Norma Hilsmann (UBC Okanagan); Jessica Baskerville (South Okanagan Similkameen Division of Family Practice); Kim Orwaard-Wong (Interior Health); Kristi Maltby (Interior Health); Cameron Towle (Interior Health); Robert Janke (UBC Okanagan); Ryan Tooby (Divisions of Family Practice – Bella Coola); Tannis Andersen (Interior Health); Pam Hruska (Interior Health); Kaylee Neill (UBC Okanagan); Denis Decleva (AF Patient); Beth Whalley (Central Okanagan Divisions of Family Practice)