Since 2016, over 15,000 lives have been lost to BC’s toxic drug poisoning crisis. Smaller urban and rural areas are disproportionately affected, often lacking resources and political support for vulnerable populations. Despite support for evidence-based harm reduction policies from the province and health authorities, municipal leaders have at times prioritized business and property interests over medical evidence and the voices of those impacted. My project will bridge healthcare responses, municipal actions, and the needs of those affected by the crisis. Working with Dr. Sharon Karsten within the research project Walk With Me and our existing partnership with Island Health, I will use document analysis, interviews, and community-engaged methodologies to explore health policy implementation in three Vancouver Island communities (Comox Valley, Nanaimo, Port Alberni), and identify communication and policy gaps between health authorities, municipal governments, and people with lived and living experience. Through direct collaboration, this project will foster connection among municipal staff, healthcare providers, and affected individuals, generating actionable insights to improve crisis responses and build lasting partnerships.
Research Pillar: Health Services Research
Advancing the Health of Victim-Survivors of Sexual Assault: The Role of the Forensic Medical Examination
Sexual assault (SA) is traumatic and causes devastating health impacts such as post-traumatic stress disorder (PTSD), depression, reproductive health issues, and chronic pain. Victim-survivors can opt to attend a post-assault Forensic Medical Exam (FME) which includes emotional support, a health assessment, and the collection of evidence to build a criminal case. The evidence might be photographs of genital injuries, blood samples, or swabs for semen. FMEs address immediate physical health needs (e.g., via STI treatment) and can feel validating for patients, but they can also be traumatic due to their invasive nature and negative reactions from nurses. They can add to the trauma already experienced and worsen the health impacts of SA. Given the lack of research in this area, this project will explore FME experiences to understand how they can be less traumatizing so that negative health impacts are reduced. First, a review of existing research will be conducted. Then both patients and nurses will be interviewed. Prior research has focused on professionals’ views, but in this study, we will hear the other side of the story. Findings could inform FME practice and will be shared with stakeholders via briefing documents and workshops.
Pushing musculoskeletal primary care to new frontiers: Musculoskeletal Comprehensive Assessment and Response in Emergency (MSK CARE) clinic in the Fraser Health Authority
The overall aim of this project is to address gaping holes in how musculoskeletal pain is served in BC emergency departments. We will develop and pilot the Musculoskeletal Comprehensive and Response in Emergency (MSK CARE) clinic in emergency departments in the Fraser Health Authority. This type of clinic diverts patients to a MSK practitioner for triage and management. Similar clinics are running successfully in Australia and Canada (Montréal, Quebec City, Kingston, Calgary, Sherbrooke). In BC, there are no similar clinics like the MSK CARE clinic, despite these types of clinics delivering “shorter wait times, happier patients and expert care.” We will measure whether the MSK CARE clinic can (1) reduce the amount of time patients spend waiting in emergency departments, 2) successfully re-direct (‘divert’) patients from the emergency departments, and (3) is an acceptable and feasible model of care. The findings will be shared through research publications, webinars, café scientifique, and infographics. The findings from this project can provide one solution to assist in tackling overcrowding in the Fraser Health emergency departments and improve access to primary care for all people with musculoskeletal pain in this region.
Understanding the social processes of cancer self-management amongst South Asian older adults with chronic health conditions
Canada is undergoing a socio-demographic shift –as a result, older South Asians (SA) are the largest ethnocultural community in British Columba (BC) and have unique healthcare needs. As a collective, SA immigrants represent a diverse community with a wide range of ethnic, cultural, linguistic, and religious backgrounds, mainly from the Indian subcontinent, including India, Pakistan, Sri Lanka, and Nepal. Statistics reveal that cancer rates among SA older adults are steadily rising. Additionally, many SA older adults face an elevated risk of comorbidities like diabetes, cardiovascular disease, and hypertension. Although comorbidities are common in all older adults, the SA population requires a nuanced approach to understanding their self-management strategies. The increasing SA population is changing the face of Canadian society and those who experience cancer, which is of significant concern for researchers, policymakers, and healthcare providers. The proposed project will provide a unique opportunity to convene with the SA community in BC to understand the current landscape of cancer for older adults and collaboratively develop culturally appropriate and linguistically acceptable community-based models of care.
The Implementation and Effectiveness of a Peer Support Program for People Living with Brain Injury in British Columbia
Knowledge Gap: Brain injury can lead to lifelong health problems, with ongoing strain to health services. Peer support (mentorship between people with shared lived experience) can improve the long-term health of people with brain injury.
Research Description: This study will show how to implement a peer support program in BC and demonstrate the program’s impact on the health of people with brain injury. Peer support workers (n=30) and peer support receivers (n=60) with brain injury will be recruited. One-to-one peer support sessions will be held on Zoom. We will measure the implementation and effectiveness of the program.
KT Activities: I am partnering with clinicians and brain injury communities to co-develop the study. We will present our findings through activities including videos for social media, public events to spur discussion, and journal publications and conference presentations.
Anticipated Outcomes: The peer support program will be implemented across BC, and people with brain injury will experience improved health outcomes.
Research Impact: This study will provide evidence for using peer support for people with brain injury across the province, show its impact on health services, and drive its implementation.
Promoting the sustainability of digital interventions for sexually transmitted and blood-borne infections in Canda: A multi-methods study
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.
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.