The ability to effectively self-manage may empower people with stroke to optimize their recovery, health and wellbeing, and in doing so reduce healthcare costs. However, little is known about how people with stroke self-manage their recovery after hospital discharge, as well as how sociodemographic factors such as biological sex, age, stroke severity, and number of comorbidities impact how stroke survivors self-manage different areas of their lives. Therefore, this one-year longitudinal study aims to explore changes in self-management abilities among people with stroke after they have been discharged from hospital. We will also observe changes in health behaviours, emotions and life roles over the course of one year. Finally, we will also explore the association between self-management abilities, health resource use and costs over time. We hope to inform the development of targeted self-management interventions that consider the optimal timing after stroke to deliver such programs, and that allocate resources effectively for people with stroke that would optimally benefit from self-management support. This research will be presented at scientific conferences and will engage a patient partner in the translation of study findings.
Research Location: University of British Columbia - Okanagan Campus
Integrating Exercise Snacks into Type 2 Diabetes Care: feasibility and management of cardiovascular risk factors
Most people living with type 2 diabetes (T2D) do not achieve enough physical activity and miss benefiting from the powerful health benefits of exercise. “Exercise snacks” are short bursts of exercise lasting 1 minute or less, which can be done sporadically throughout the day. These snacks can be easily performed anywhere using stair-climbing or simple body weight exercises. Incorporating exercise snacks into the daily routine could help to break up sedentary time, regulate blood sugar, and improve blood pressure and fitness levels. This research program aims to explore the positive effects of exercise snacks in individuals living with T2D. Through a combination of lab-based studies and a real-world clinical trial that will deliver an exercise snacks intervention via a Smartphone “app”, we will test if exercise snacks can lower blood sugar and improve cardiovascular health in people with type 2 diabetes. In order to maximize the reach and impact of our research, we will also develop infographics and videos to help teach individuals with T2D how to incorporate exercise snacks into their day. This research aims to empower people living T2D to improve their health, one exercise snack at a time!
Caregiver-Child Sleep and Relationships in Canadian Foster and Kinship Families
Sleep is important for health, yet little is known about sleep in foster and kinship families. In my postdoctoral fellowship, I will lead research to learn about the sleep health, how best to support sleep, and the connection between sleep and caregiver-child relationships for foster/kinship families. In Study 1, we will synthesize research on children’s sleep in foster and kinship care. In Study 2, we will interview foster and kinship caregivers of children aged 0-5 years to learn about the caregiver and child’s sleep, and how sleep influences the caregiver-child relationship. In Study 3, we will compare sleep in foster and kinship families with other families in Canada. In Study 4, foster and kinship caregivers will help us design and test a sleep resource. We are creating an advisory panel to work with us to create research that is useful and interesting to the foster/kinship community, and respectful of different cultures and family dynamics. With the advisory panel, we will share the results in journal articles, at conferences, via webinars, and through foster/kinship organizations. This research will help healthcare professionals and policymakers understand, and help support, the sleep of families in foster and kinship care.
A personalized approach to non-physical practice after stroke
Chronic motor impairments are experienced by 85% of stroke survivors. Recovery of these impairments can be facilitated by repetitive non-physical motor practice including kinaesthetic motor imagery (KMI; the mental rehearsal of movement), visual motor imagery (VMI; specific focus on a mental image) and action observation (AO; passive observation of movement). Yet, effectiveness of these different non-physical practice modes is varied due to highly individualized brain function after stroke. To improve effectiveness, we will assess brain and behaviour changes driven by KMI, VMI, and AO at the individual participant level. We will then design a personalized intervention to show that improvements in motor function are maximized when practice mode is tailored to the individual based on the brain’s response to each mode. This research informs the development of evidence-based interventions after stroke, representing an important step in improving the quality of life of stroke survivors in Canada. Integrated knowledge translation (KT) activities (including engaging key knowledge users), and end-study KT activities (including public lectures of findings) will be conducted.
Precision Nutrition for Digestive Diseases: Bridging the Gap through Translational Nutrition Research (PRECISE Study)
Inflammatory bowel disease (IBD) affects the digestive tract causing stomach pain, diarrhea, fatigue, and weight loss. Patients notice that diet impacts their symptoms and how they feel. While studies have explored the link between diet and IBD and how it develops, a gap exists in understanding how diet can treat inflammation and symptoms. Recent research indicates a crucial role for diet in shaping the microbiome (tiny microbes in our gut), potentially reducing the risk of disease flares. Understanding how diet affects the microbiome in IBD is key to empowering patients to take control of their condition.
Not all patients respond to diet in the same way. My research program will use precision nutrition (PN) to study the different responses to diet therapy based on an individual’s microbiome. In the future, we will aim to provide diet recommendations tailored to the person, leading to better disease management, improved nutritional health, and reduced symptoms.
This research project can impact patients’ daily diet practices and provide crucial guidance for health professionals and patients, which is currently lacking. Also, its potential impacts extend to shaping future policies and research directions in diet for IBD.
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.