Research Location: University of British Columbia

Breaking Barriers: Empowering Primary Care Providers to be Instigators of Change in Hearing Health Care Practice

Health Research BC is providing match funds for this research project, which is funded by the Vancouver Foundation’s Participatory Action Research Investigate Grant. 

 

Up to 65% of adults in British Columbia (BC) aged 60+ will develop hearing loss. Fewer than one-quarter of these adults use hearing health care, with most delaying treatment 7 to 10 years on average. Untreated hearing loss affects health-related quality of life with links to social isolation, depression, greater risk of falls, and reduced financial security. For adults with concerns about their hearing, primary care providers (PCPs) are often a first point of contact for help seeking, and yet for reasons that remain unclear, PCP referrals to hearing health care are inconsistently and infrequently practiced. This problem was identified as a top priority through focus groups conducted in 2020. These graphics illustrate the focus group discussions that led to the development of this research question.

 

We will use a community-based approach to identify reasons for lack of referral and develop strategies that empower primary care providers to be key instigators for increased, timely uptake of hearing health care by individuals with hearing concerns.

 

The research team, all based in BC, is led by Lorienne Jenstad, PhD, an audiologist and associate professor at the University of British Columbia; Brenda Poon, PhD, the research program lead at the Wavefront Centre for Communication Accessibility; and Ruth Warick, PhD, president of the Canadian Hard of Hearing Association, Vancouver Branch. The team works closely with other individuals who have lived experience of hearing loss, physicians, nurses, clinical audiologists, and community organizations.

 

Ultimately we hope that primary care providers and the general public will have better recognition of the importance of hearing health and better understanding of the process to receive hearing health services, leading to timely uptake of hearing health care by individuals with hearing concerns and the potential to improve long-term health outcomes.

FOCUS on Adolescents: A mixed-methods study to optimize COVID-19 recovery and renewal efforts among adolescents in Canada and France

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

The COVID-19 pandemic and its corresponding health, social, and economic implications present potential lasting consequences for inequalities and vulnerabilities to manifest across later phases of the life course — a trend that may have significant impacts for adolescents aged 15-19. For example, school closures and other public health measures (e.g. isolation) have had significant effects on adolescent health — an age group whose need for social engagement and connection are essential for development. However, little is known about how social, economic, and cultural changes related to COVID-19 will affect adolescents’ health and social well-being over time.

 

To fill this knowledge gap, Dr. Rod Knight (principal investigator, assistant professor, UBC Department of Medicine) and Dr. Marie Jauffret-Roustide (co-principal investigator, research scientist, INSERM, University of Paris) are launching an international research study to extend their CIHR-funded France-Canada Observatory on COVID-19, Youth Health, and Social-wellbeing (FOCUS) – a research program launched in June 2020 to evaluate the impact of COVID-19 on youth aged 19-29 living in Canada and France – to include adolescents aged 15-19.

 

The FOCUS on Adolescents project will work alongside a group of adolescents from Canada and France to adapt the FOCUS Study’s program of research to include adolescents in a series of annual interviews and bi-annual national online surveys. At the end of the study, a participatory summit will be held in each country with youth and key stakeholders working with adolescents (e.g. clinicians, community members, policy makers) to identify interventions that best address the social and health needs of adolescents.

 

This research project will provide policy makers and clinicians with high-quality, real-time evidence to inform COVID-19 public health responses to improve health outcomes and reduce health inequities among adolescents.

Progress Update – March 2023

 

Objectives reached so far

One of the first objectives of our research project was to prepare and obtain ethic approvals from all of our university partners in Canada and France to ensure that our proposed research activities with adolescents and young adults will be completed in accordance with Canadian and French institutional ethics requirements. This was a long process, as the procedures and components of each application varied according to each ethics committee. In February 2023, we successfully received ethic approvals to start our data collection activities in Canada and France. In the meantime, we have developed new research partnerships with community organizations that provide health and social services to adolescents and young adults in Canada and France. These partnerships represent key resources and supports to best adapt and design our research activities for adolescents. For example, we held a series of virtual and in-person meetings with community organizations to discuss the content of our online questionnaire and identify a set of strategies to promote the online survey to adolescents and young adults in Canada and France.

 

Impact so far

Using the data collected from the previous FOCUS online surveys conducted in 2020 and 2021 among young adults in Canada and France, we have published two research articles in peer-reviewed scientific journals that provide findings on the changes in alcohol use and the effects of financial support on the mental health among young adults who lost income during the pandemic. These research findings and other ongoing data analyses related to the FOCUS survey have been presented at international conferences and to our community partners as part of our knowledge mobilization activities. These activities allowed us to engage in constructive discussions with health providers and peer workers from community organizations about the influence of the determinants of health on youth health and social wellbeing. These discussions also helped us to best tailor our data collection and analysis plans of the forthcoming FOCUS 2023 survey, which will include adolescents. For example, specific data analyses have been planned to inform community organizations about the health needs and concerns of adolescents and young adults in the current post-pandemic context.

 

Potential influence

Throughout our research project, we will continue to engage with community organizations and FOCUS youth participants to collaborate on the preparation of scientific articles. In order to accelerate the availability of our research findings, we will also develop a set of scholarly and policy-oriented deliverables, including those designed for key decision-makers (e.g., government officials), as well as brief summaries of evidence, which we will promote through media engagement (e.g., media interviews, posts on social media platforms). For example, our research findings will be shared with our existing research networks, including collaborations with key governmental agencies and influential decision makers within Canada and France, in the aim of using new research to optimize the responses to social and health inequities experienced by adolescents and youth.

 

Next steps

This spring, we will launch the FOCUS 2023 online survey among adolescents and young adults living in Canada and France. To promote this survey, we will use different recruitment strategies such as sending email invitation to participants of the previous FOCUS surveys, posting articles on our research partners’ websites and newsletters, and launching a social media advertising campaign to recruit new survey participants. Once the online survey is complete, we will analyze the survey data with statisticians and in

consultation with researchers who have expertise working on adolescents and youth studies. Our community partners will also be involved in this data analysis process through virtual and in-person meetings. We will continue to conduct knowledge mobilization activities by organizing two workshops (one in Canada and one in France) that will bring together FOCUS youth participants, researchers, and key stakeholders in the area of adolescent health (e.g., services providers, policy makers, and community members) to identify strategies to improve adolescent health in Canada and France. Our research team also just received one year of bridge funding from CIHR’s Project Grant Pandemic Preparedness and Health Emergencies Research Priority Announcement stream to extend this work.

 

Useful Links

The DISCO study: Rethinking STI prevention

Syphilis, chlamydia and gonorrhea are three of the most common sexually transmitted infections (STI). Over the last decade, these STIs have seen a resurgence in many parts of Canada, with most infections seen in major urban centres. These infections have primarily affected gay, bisexual, and other men who have sex with men (gbMSM). Recently, a small pilot study found that doxycycline — an inexpensive, well-tolerated antibiotic — given daily may prevent new STIs in gbMSM. Another study looked at the use of doxycycline given after a sexual encounter for prevention of STIs, and the results of this study showed protection against STIs as well. Based on these promising data, along with the concerning increases in STIs seen in Canada, the current study will examine the use of doxycycline as either a daily prevention therapy (preexposure prophylaxis, or PrEP) or an ‘after sex’ prevention tool (postexposure prophylaxis, or PEP) for STIs in gbMSM. While examining for efficacy as its primary goal, this study will also do an examination of some of the potential challenges and concerns associated with the use of a daily antibiotic: drug resistance, tolerability and side effects, and how acceptable this drug is for people to take regularly.

Neuropsychological functioning in treatment resistant schizophrenia

Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.

Sharing the podium: Identifying solutions to meaningfully collaborate with youth in mental health and substance use research

Mental health and substance use (MHSU) are key health concerns for youth in British Columbia. Involving youth in research for these topics improves the development of MHSU interventions and solutions. However, youth may not want to engage in MHSU research due to concerns about confidentiality, stigma, and other barriers. Researchers may also perceive barriers in finding and working with youth researchers.

Our project goal is to identify barriers for youth engagement in MHSU research and recommend solutions for these issues. Two key activities will be used to bring together youths and researchers to identify the perceived barriers for each group and how these barriers can be overcome. These activities include a small-group discussion (utilizing nominal group technique) and a World Cafe. Our team will synthesize these results and outline a list of recommendations for youth engagement in MHSU research. We also plan to use this output to pursue additional funding for a pilot study using these recommendations. The pilot study would measure changes in youth research engagement and research outcomes due to the recommendations.

Team members: Dan Nixon (Providence Health Care and Foundry); Krista Glowacki (UBC); Kirsten Marchand (Providence Health Care and Foundry); Nikki Ow (UBC); Travis Salway (SFU); Hasina Samji (SFU); Steve Mathias (Providence Health Care and Foundry); Renee Cormier (Providence Health Care and Foundry); Anne Gadermann (UBC); Sarah Munro (UBC); Amanda Butler (Providence Health Care and Foundry); Chloe Gao (UBC)

Civility matters: Co-creation of an online toolkit for long-term care home staff

In long-term care (LTC) homes, the number of staff working on a shift is essential to quality care provision; however, it is increasingly apparent that who is on shift is just as important. Quality care is difficult to achieve when staff do not routinely engage with one another in a positive, or civil, manner. Our research, conducted pre-pandemic, revealed the impact of uncivil workplace behaviours on care delivery and staff well-being, an impact that has only been exacerbated by COVID-19. A positive workplace culture requires the cooperation of front-line and leadership staff and access to professional development opportunities that help staff instill and contribute to a collaborative and respectful workplace. Comprised of researchers and union and industry partners, our project team will co-create an online toolkit to support staff to address workplace (in)civility in LTC and promote supportive and collaborative workplace relationships at their worksites.

Specific objectives include: 1) Raising awareness about the nature and impact of workplace incivility in LTC on staff well-being and care delivery; 2) Creating opportunities for staff to engage with practice-based scenarios and resources for addressing workplace (in)civility.

Team members: Saleema Dhalla (SafeCare BC); Jennifer Lyle (SafeCare BC); Leah Laing (UBC); Heather Cooke (UBC); Rhonda Croft (BC Nurses’ Union); Hanif Karim (BC Nurses’ Union); Lisa Kelly (Sienna Senior Living); Cina Oppel (BC Government & Service Employees’ Union); Megan Scott (BC Government & Service Employees’ Union); Georgina Hackett (Hospital Employees’ Union); Anne Bull (Hospital Employees’ Union)

 

Developing educational resources to support patients and clinicians to identify and use self-management apps for bipolar disorder

Over half a million Canadians live with bipolar disorder (BD), a long-term, serious mental health condition that causes extreme mood swings from depression to mania. With optimal treatment, care, and empowerment, people with BD can flourish, but this requires more than just medication. Mobile phone applications (‘apps’) can deliver knowledge on effective self-management strategies for BD and provide real-time support. Despite high interest in mental health apps, a CREST.BD survey showed that in practice few people with BD are using such tools, and clinicians do not feel well equipped to recommend apps to their patients.

This project will develop a suite of patient and clinician-facing educational resources (e.g. webinars, videos, blog posts) in collaboration with people with lived-experience and clinicians. A co-ordinated social media strategy will be developed to increase awareness of these resources.

Expected outcomes include: patients will better understand the potential benefits and risks of mental health apps; patients will improve their digital health literacy by learning strategies to identify safe and secure mental health apps; clinicians will improve knowledge about app evaluation frameworks and informed decision making.

Team members: Natalie Dee (CREST.BD); Emma Morton (UBC); John Torous (Beth Israel Deaconess Medical Centre); Rosemary Xinhe Hu (CREST.BD); Caden Poh (UBC); Laura Lapadat (UBC); Linda Yang (UBC)

 

Tokes in the throat: Health practitioner education on the effects of smoking cannabis in the upper airway

Cannabis was legalized in Canada with the introduction of the Cannabis Act in 2018. This rapid legalization has led to a knowledge gap in doctors. Although most users smoke cannabis, few doctors know the health effects of smoking cannabis in the upper airway. In previously funded work, our team has reviewed the scientific literature and summarized these health effects, both positive and negative. During the COVID19 pandemic, innovative knowledge translation activities are needed. We propose a two-part initiative to educate health practitioners about cannabis, targeting family doctors who are the patient’s gateway to the Canadian health system. First, we will co-design a webinar with the research users on our newly launched provincial ENTCME.org platform. This event will be recorded for asynchronous access. Second, we will co-create infographics to summarize the information and launch a social media campaign on Facebook, Twitter, and Instagram. Reach and effectiveness will be assessed by registration for the webinar and pre- and post-engagement surveys. Performance data from each social media platform will also be analyzed. Our goal is to help doctors guide patients to make informed, evidence-based choices on cannabis usage.

Team members: Brenna Lynn (UBC); Andrew Thamboo (UBC); Emily Deane (UBC); Joel Howlett (UBC); Jobanjit Phulka (UBC); James P. McCormack (UBC); Dinusha Peiris (BC Cancer Agency); M-J Milloy (British Columbia Centre on Substance Use and UBC); Christie A Newton (UBC)

 

Developing a method to implement patient-centered social robotics for pediatric mental health within the BC healthcare system

Could a small, interactive robotic character or pet be used in a hospital to help support children’s mental health? While children are often interested in interacting with robots, the design of these devices rarely incorporates patients and families’ needs and values. For social robots to be ethically implemented in healthcare, they must be developed according to patients’ priorities, supported by high-quality scientific evidence, and well-suited to implementation by real-world healthcare providers.
To address this, I will hold co-creation workshops with children and families with a lived experience of a childhood mental health disorder to identify goals for and barriers to social robot interventions. I will also interview key health services stakeholders who would be most involved in using a robot in the hospital — nurses, CLSs, and others — about advantages, concerns, and obstacles to deploying a social robot for pediatric mental health, as well as proposing a Health Technology Assessment.
Taken together, these research findings will facilitate the development of practice and policy for the evidence-based, patient-centred deployment of social robots to improve the wellbeing of BC children experiencing mental health challenges.

Physical exercise to mitigate the effects of physical inactivity on brain health

Problem: Many older adults experience prolonged bed rest as a result of injury, surgery, or hospitalization and this may have detrimental effects on both their cognitive (i.e. thinking) and physical abilities. Ensuring older adults engage in daily exercise during bed rest may counteract the negative consequences of physical inactivity on cognitive abilities.
Research Overview: Maximizing on an opportunity provided by CIHR and the Canadian Space Agency, we will determine: 1) the effects of 14 days of bed rest on cognitive function in adults aged 55 to 65; 2) the impact of daily sessions of physical exercise in counteracting the effects of bed rest on cognitive function; 3) the mechanisms (i.e. how) by which bed rest and impacts cognitive function and its influencing factors (e.g. sex). Participants will be randomized to a group with either 14 days of bed rest with three physical exercise daily sessions (total of 60 minutes) or a control group (bed rest only).
Potential Impact: Promote the development of novel interventions and rehabilitation strategies to counter the adverse effects of physical inactivity, including bed rest, on cognitive health in older adults during transitions in care.