Mealtimes in long-term care (LTC) homes are important for visible minority (e.g. Chinese, South Asian) residents’ well-being and keeps them connected with their families who help at mealtimes. Visiting restrictions during the COVID-19 pandemic meant that some families could not provide mealtime care which had negative effects on residents and families. There is very little research on the mealtime experience for visible minority residents and families and even less on their experiences during the pandemic, even though almost one-quarter of Canadians are from a visible minority group. It is important to understand these experiences to improve mealtimes in LTC homes. This qualitative study will answer the question: what are the mealtime experiences of visible minority residents and their families in LTC? The objectives of this study are to: 1) understand the mealtime experiences of visible minority residents and their families; 2) understand how these mealtime experiences are impacted by social, political, and economic factors; 3) identify ways to improve mealtime care for visible minority residents and families; and 4) share the research findings with stakeholders to improve mealtime care in LTC homes.
Research Pillar: Health Services Research
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.
Transforming prisons and improving health outcomes for people who use drugs: An evaluation of BC’s prison-based therapeutic community
People with substance use disorders (SUD) are more likely than those without SUD to be sent to prison and to experience negative outcomes after release. Prisons are not typically ideal environments to treat complex health issues including SUD. Therapeutic communities (TCs) offer an alternative to traditional forms of punishment, providing the environment for belonging and relationship-building, through activities such as group-based therapy, education/work, and community participation. The proposed study will evaluate Guthrie House, BC’s first and only prison-based TC which opened in 2007 at Nanaimo Correctional Centre. The study aims to identify the TC-related mechanisms of change associated with health and criminal justice outcomes, and will involve three main components: a survey with TC clients, interviews with TC and correctional staff, and linked administrative data analyses. This study has the potential to identify promising approaches to supporting people with SUD who experience incarceration. This work will add meaningfully to the policy initiatives in BC focused on reducing overdose and increasing access to SUD care.
The impact of the COVID-19 pandemic on access to adequate care for serious mental disorders in British Columbia
The Covid-19 pandemic has created new challenges for the treatment of serious mental disorders such as schizophrenia and bipolar disorder. Patient avoidance of health services and the rapid switch from in-person to virtual delivery of services may have created barriers to accessing specialist services. The aim of the current study is to evaluate whether access to adequate psychiatric care for serious mental disorders changed between 2015 and 2022, and particularly after the onset of the pandemic. In addition, we will examine whether any disparities in access by demographic (age, sex, neighbourhood income quintile, geographic location) clinical (diagnosis and presence of substance use disorder) and health system factors have increased or decreased over this time period. Findings from this study will have important implications for the provision of mental health services for serious mental disorders in British Columbia.
Improving access to culturally safe, gender affirming, and trauma-informed abortion services and support for Indigenous women, Two-Spirit and LGBTQIA+ people in Canada
While Canada is currently one out of four countries globally to have no national restriction in law, the 2016 UN Human Rights Commissioner’s report indicated a lack of access to abortion due to cost, knowledge, and geography. For Indigenous Women, Two-Spirit, and LGBTQIA+ people in Canada, additional barriers exist including colonialism and racism. Yet there is an alarming gap in the literature surrounding Indigenous peoples and abortion services — despite knowing that one in three people in Canada will experience an abortion in their reproductive lifetime. The goal of this program of research is to build on existing community knowledge and strengths, advance knowledge around, and remove barriers to abortion services for Indigenous Women, Two-Spirit, and LGBTQIA+ people in Canada. Guided by an Indigenous feminist framework that acknowledges the intersectional experiences of Indigenous women, Two-Sprit, and LGBTQIA+ peoples and abortion access, this program of research will apply an Indigenous methodology to investigate experiences, gather knowledge, and co-develop resources to improve the abortion access gap among Indigenous peoples.
Towards transformative pandemic response, recovery, and preparedness: An intersectional gender analysis of the secondary effects of COVID-19 on women and healthcare providers
The response to COVID-19 has exacerbated gender inequity and gender inequities have limited the effectiveness of the COVID-19 response. This vicious cycle has been entrenched in past pandemics and will recur with future outbreaks, unless it is interrupted by intentionally transformative pandemic preparedness, response and recovery. This requires interdisciplinary research to better understand and respond to COVID-19’s secondary effects — defined as those caused by non-medical interventions to prevent primary effects (infection, morbidity and mortality). Secondary effects have long term health equity implications, with women and healthcare providers disproportionately affected. This research program aims to: 1) advance evidence of secondary effects among women and healthcare providers and 2) determine whether, how and to what effect public health policy has responded to these secondary effects. Three core projects and two collaborating projects will document the lived experiences of women and healthcare providers, while linking municipal, regional, provincial, and national level analysis to inform and promote equity-based pandemic response, recovery, and preparedness in BC and beyond.
Evaluating systems-level interventions to reduce overdose during dual public health emergencies
Over the past two years, the COVID-19 pandemic has exacerbated the ongoing overdose public health emergency in British Columbia (BC). Over 3,700 persons have died from illicit drug-related overdose since April 2020. In the context of the sixth year of the ongoing overdose provincial public health emergency and unprecedented COVID-19 pandemic, there is urgent need to evaluate how changes to the correctional health system and prescribed safer supply interventions have effected overdose. The overarching objective of my research program is to conduct timely and policy-relevant research on overdose that informs response activities throughout the province. This will be achieved by using novel linked health data to identify trends in overdose since the original public health emergency declaration. I will also evaluate provincial interventions introduced to reduce overdose such as prescribed safer supply and systems-level changes to the delivery of health care in correctional settings. This project will directly inform provincial and regional overdose response activities through collaborations with persons with lived experience and knowledge users from the BC Overdose Emergency Response Centre.
Alternative approaches to the criminalization of drugs: A drug policy research program for BC
The criminalization of drugs contributes to a range of health and social harms for people who use drugs (PWUD) across BC and Canada. Criminalization is a barrier for PWUDs access to health and harm reduction services. It also increases overdose and infectious disease risk and contributes to the over-incarceration of PWUD in Canadian prisons. The harms from criminalization are increasingly recognized by policymakers, scholars, and advocates across Canada. In BC, alternative policy models are being considered, including depenalization, decriminalization, police diversion, and safer supply programs. There is a timely opportunity to investigate the decisions, policies, and interventions related to these alternative approaches that aim to promote health equity for PWUD. This community-engaged research program will engage, work closely with, and gather the views of policymakers, health and justice system actors, PWUD, and other communities impacted by illicit drugs, to ensure the relevance, usefulness, and applicability of findings. Knowledge gained from this research is vital to support and promote health equity for PWUD both in BC and beyond.