More and more people are using digital tools to get tested for STIs. But we don’t know much about how to ensure that the public health benefit of these tools last for a long time. We call this sustainability. In this project, we want to learn how to make the benefit of these tools last. Here is what we will do:
• Review existing research to find out what things people think about when they want digital STI tools to be sustainable.
• Explore the experiences of digital STI testing programs, like BC’s GetCheckedOnline (GCO) and other similar programs. GCO is a program that lets people get tested for STIs online. We will review program documents. We will also interview the people who run the program and those who work with them. We will document the processes and factors that have made their programs sustainable so far.
• Review GCO’s data to see how people use the program. This is important because some people worry that too many people using the program too often might make it hard to keep it going.
Our project will help GCO and other programs like it plan for the future. It will also help us make a plan for how to make these programs sustainable.
Research Pillar: Health Services Research
Exploring the natural history of chronic disease self-management and health resource utilization after stroke
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.
Co-creation of culturally-safe drug checking practices for Indigenous Peoples who use illicit drugs
Indigenous Peoples who use illicit drugs (IPWUID) are disproportionately affected by the drug poisoning crisis. Community-wide drug checking is a potential response to address the problem. Previous research has explored how best to implement drug checking as a response to overdose, as well as how to better include people who use drugs (PWUD) within drug-checking. However, Indigenous Peoples are not well represented in this research and Indigenous research approaches have not yet been undertaken. This study uses Indigenous research methods to better understand the needs and perspectives of IPWUID in accessing new drug checking technologies and services. It also explores the gaps in drug checking services for IPWUID in British Columbia (BC) and examines how unmet drug checking needs may affect their health outcomes. The outcome will be an Indigenous Harm Reduction approach to drug checking to inform new models and knowledge production approaches that best meet the needs of IPWUID.
Advancing Orthopaedics Diagnostic Intelligence: Deep Learning and Generative AI models for Fracture Identification and Dialogue-driven documentation and Decision Making
Accurate radiographic assessment is essential in diagnosing pediatric fractures to prevent misdiagnosis. Pediatric skeleton anatomy exhibits both uniqueness and age-related variability, which enhance the challenges in correct radiograph analysis and diagnostic decisions. Therefore, we propose artificial Intelligence models for radiograph annotation and fracture identification using deep learning and natural language processing to analyze radiographs for fracture detection. Secondly, physicians may overlook crucial questions to pose during the doctor-patient dialogue, which may lead to misdiagnosis and incorrect decision-making. Therefore, we aim to equip the system with Generative Pre-trained Transformer (GPT) models to extract information from the dialogue. Our system extracts the important information, identifies missing information, and auto-documents the extracted information. We will develop a user-friendly software “Ortho-Assistant” with functionalities of automatic radiograph assessment, automatic clinical documentation, and assistance in diagnosis and treatment decision-making. In KT activities, we will publish the outcomes in reputable journals, present at conferences and workshops, and train the undergraduate students.
Engagement and citizenship in long-term care: An exploration of resident and family councils
Resident and family councils refer to groups within long-term care (LTC) homes composed of residents and/or family members who meet on a regular basis to discuss matters of concern. In B.C., LTC residents and their family members have the right to participate in these councils, providing a potential avenue to influence decision-making. However, little is known about these councils, how they work, and whether they enable residents and families to influence change.
My postdoctoral research aims to address this knowledge gap through a qualitative study exploring how LTC councils work, how they engage residents and families in decision-making, and the broader contexts in which they operate. First, we will analyze the legal frameworks governing resident and family councils across Canada and compare how they define councils and the specific rights they afford. To explore how councils operate in practice, we will conduct ethnographic fieldwork in two LTC homes. Researchers will observe council meetings and conduct in-depth interviews with residents, family members and staff. Findings from the study will be used to create user-friendly resources highlighting promising approaches and policy recommendations.
The Road to Recovery Initiative (R2RI): A Prospective Evaluation of a Novel Program for the Delivery and Coordination of Addiction Care in a Canadian Setting
The consequences of substance use have had a devastating impact on British Columbia’s (BC) healthcare system. Since the declaration of the province’s public health emergency in 2016, over 10,000 British Columbians have died from an overdose. The lack of a coordinated addiction treatment system provincially is a significant contributor to BC’s present state. To address this, Providence Health Care is implementing the Road to Recovery Initiative (R2RI), an innovate model of care to address two aspects of BC’s addiction treatment crisis through: 1) increasing access to on-demand addiction care; and 2) reorganizing existing clinical services to support patients at every phase of recovery. The proposed Program of Research seeks to evaluate key health and social outcomes associated with the implementation of R2RI. Participants of this program will be followed for 5 years with data collection focused on: substance use, illness trajectory, community engagement, health care utilization, health risk behaviours, quality of life, overdose, and death. Knowledge gained through this research will identify outcomes associated with the provision of a coordinated addiction treatment system and will inform successful scale-up of this new approach.
Co-Developing a Learning Health System with People with Lived/Living Experience of Substance Use: a response to the toxic drug poisoning crisis
Walk With Me was developed by Dr. Karsten and her research team throughout the past four years with intent to combat stigma and create systems change in relation to the toxic drug poisoning crisis – a public health emergency that has enacted more deaths in BC than suicides, car accidents and homicides combined. This team has been working in Vancouver Island communities of various sizes, and within Island Health acute care facilities, to better understand the ways in which the drug poisoning crisis is impacting communities and systems. Through deep listening, peer engagement and leadership, and collaborative design, the team has developed recommendations designed to close service gaps and reduce stigma. In the summer of 2022, Island Health released its first Harm Reduction Policy. Stemming from this release is an opportunity to deepen this existing partnership, through the co-creation of a Harm Reduction Learning Health System. This system, developed through patient/peer insights and leadership, and alongside clinicians, management and staff, will enable Island Health to respond effectively to a rapidly-evolving public health crisis.
Transforming health services following traumatic brain injury through peer-support
Traumatic brain injury affects approximately 450 people every day in Canada and is a leading cause of disability nationally and globally. These injuries can lead to life-long disability and health problems, and people who sustain them often experience decreased quality of life, poor mental health, and long-term unemployment.
There is a critical gap in the development and delivery of programs and services that help people with traumatic brain injury to improve their health. Current health services focus on areas of impairment rather than personally-important priorities for rehabilitation. In addition, participatory research, which engages people with traumatic brain injury and community organizations as active partners, is underused in the development of rehabilitation programs.
My goal is to implement a peer support program for people with traumatic brain injury. I will use a partnered approach, in which people with traumatic brain injury and members of their community are leaders in the project. This will ensure that the research answers to their needs and values. Ultimately, this research will improve the access to services, health, and quality of life of people with traumatic brain injury in Canada.
Nini nanaghintsan ?anh (is your mind tired?): The Healing Journeys of Indigenous Adolescents Navigating Pathways to Urban and Online Wellness Supports
Due to the historical and ongoing effects of colonization, Indigenous youth experience higher rates of mental illness. As Indigenous youth, it is particularly difficult to access mental health care in Canada. Many Indigenous youth are reluctant to seek help when they are in crisis. Indigenous youth and families advocate it would be better if more culturally-responsive wellness supports were available. This research project will use oral traditions and storytelling to ask Indigenous youth (aged 12 to 24) about their healing journeys when accessing wellness supports in urban and online spaces. This project will work in partnership with Foundry BC to collaborate with local Indigenous communities. In Phase 1, Indigenous youth will join Sharing Circles to create collective stories about what holistic wellbeing means to them and how they access wellness supports in community and online settings. In Phase 2, Indigenous youth will be asked to complete a survey about their mental health care access, cultural identity, technology use, and holistic wellbeing. The findings from this study can inform culturally-resurgent practices to help transform the way Indigenous youth are engaged in wellness supports across urban and online spaces.
Promoting integrated mental health care services and supports for refugees in BC
Approximately 84 million people worldwide were forcibly displaced during 2021, including refugees, who have been forcibly displaced by conflict. It is estimated that 1 in 5 people in settings affected by conflict have a mental disorder. Evidence shows that many refugees require mental health support post migration as a result of trauma, and post migration stress. Mental health conditions such as depression, anxiety, Post Traumatic Stress Disorder, and psychosis are much more prevalent among refugees than among host populations. Post migration, refugee mental health is determined by stressors of acculturation such as employment, housing and access to health care.
Limited knowledge exists on how mental health services work to promote refugee mental health in high income countries like Canada. Barriers to mental health care include service fragmentation and provider knowledge about the determinants of refugee mental health. The goal of my research is to develop and conduct an evaluation of existing mental health services and supports for refugees in BC. Findings will inform primary health care services, mental health services and settlement services about what promotes integrated mental health care for refugees in BC.