Research Pillar: Health Services

Walking away from depression: Leveraging physical activity to treat symptoms and improve well-being in individuals with major depressive disorder

Major depressive disorder (“MDD”) is a chronic condition characterized by sadness and loss of pleasure. MDD is a leading cause of disability (WHO, 2020), and costs the Canadian economy billions each year (CAMH, 2021; CASHC, 2016). In 2016, the Canadian Network for Mood and Anxiety Treatment recognized exercise as a first-line treatment for MDD. This statement should have revolutionized care: not only does exercise reduce symptoms, but it also improves health and quality of life. However, the past five years have seen little progress in “mainstreaming” exercise as a treatment option. This means patients are being denied access to a safe and effective treatment.

We are left with a question: How can we get more people with MDD more active more often?

The purpose of my postdoctoral fellowship is to answer this question. I will oversee a program of research that examines how British Columbia’s public health system can provide exercise as a treatment for MDD. I will investigate barriers to uptake; strategies to overcome barriers; and engage in program development and evaluation. This research will be conducted in collaboration with patients, healthcare providers, and communities to ensure it is feasible, relevant, and sustainable.

Mapping the Continuum of Respectful Experiences (CORE) in perinatal care among historically marginalised women and people in British Columbia

Evidence of disrespect and abuse during pregnancy and birth is increasing globally; however, little is known about the experiences of childbearing people in BC and high-quality data is needed, to address this serious issue. While it is essential to ensure a positive birthing experience regardless of the person’s background, research suggests that racialized and minority groups are more likely to report disrespectful treatment by care providers and are less likely to access high-quality care during pregnancy and birth.

In my study, I plan to analyze the pregnancy and birth stories from childbearing people, using several data sources and analysis approaches. Body mapping is a participatory method of data collection that will help to depict experiences of respect, disrespect and abuse. My goal is to create a Continuum of Respectful Experiences (CORE) model to describe complex, multi-layered experiences each birthing person may encounter during perinatal care. This model can be used as a tool to change patterns in care provision. It can teach care providers ways to reduce disrespect and abuse; enable person-centered decision making and understand the needs of people with different identities.

Understanding critical care nurses’ prioritization of patient care

Delirium is a complication of a critical care (CC) admission. Although usually reversible, it can lead to long-term impaired thinking, poor mental health and increased mortality. Upwards of 80% of people admitted to CC will experience delirium. Research has been done to understand delirium and to prevent it. Factors that are known to help prevent delirium include a day-night routine, encouraging movement, and reducing sedating medications. CC nurses have control over many of these factors, but implementing strategies to prevent delirium remains sub-optimal. The lack of information about how CC nurses prioritize care to prevent delirium in the busy healthcare system leaves limited guidance for making change. This study aims to examine how CC nurses prioritize delirium-related patient care and to identify challenges and opportunities for change. The research will use surveys and interviews to gather data. This research is important for identifying gaps and opportunities to implement delirium prevention strategies needed to improve patient outcomes. The findings will allow CC teams to create a system to support a change in practice to improve the care and outcomes of patients.

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.

Evaluating the safety, efficacy, effectiveness, and immunogenicity of meningococcal vaccines across the age spectrum

Meningitis is a serious inflammation of the lining surrounding the brain and spinal cord, caused by viral or bacterial infections. One in ten people who develop meningitis will die, and 20% will experience serious, lifelong consequences, such as hearing loss or brain damage. The World Health Organization (WHO) has called for full prevention and control of this disease by 2030. Our team is collaborating with the WHO to develop evidence-based immunization strategies for this initiative. My research project will pool data from all previous vaccine studies on meningococcal group B (MenB), to assess the safety and protective effect of different MenB vaccines. Our goal is to use that data to answer questions such as, “How safe current meningococcal group B vaccines are?”; “How long they can protect us from getting the disease?”, and “How many doses are needed and on which schedule?”. Findings from this research will guide WHO strategies on dosing and timing of vaccines, to eradicate meningitis by 2030.

An iKT, interpretivist, feminist, multi-method study examining the experience of, and models of treatment for, acute postpartum mental illness

Postpartum depression is common, affecting 10-15% of women, and increases risk for suicide. Postpartum psychosis is rarer (approximately 1/1000 women), but is a psychiatric emergency. Women with postpartum psychosis or severe postpartum depression need care in hospital to protect their health, and the health of their families. Currently in Canada, these hospital stays separate women from their babies, which can be traumatic for mother and baby. In other countries, Mother-Baby Psychiatric Units (MBUs) admit both mother and infant for care. This study will investigate whether MBUs are suitable for Canada, or whether another model of care would be better for Canadian families. To do this, we will conduct three sub-studies. Sub-study 1 will amplify women’s stories of the experience of a hospital stay for postpartum mental illness in Canada. Sub-study 2 will describe the frequency and predictors of hospitalization for postpartum mental illness. Sub-study 3 will provide a rich picture of the MBU model of care through a case study of five international MBUs. By understanding how to best meet the needs of women and families living with serious postpartum mental illness, we aim to improve mental health outcomes across generations.

Building on the strengths of first responders as a critical first point of contact: Improving emergency care in remote Indigenous communities

Applying an ethnographic and story-based approach, the objective of this project is to develop a deeper understanding of the unique challenges faced by first responders in four remote Indigenous communities on the West Coast of Vancouver Island. Working collaboratively with first responders and community health leaders, this project will identify: existing community supports; interventions that can improve the experiences and effectiveness of first responders; and an assessment of these interventions. First responders provide a critical first point of contact for serious injury or accidents in many remote Indigenous communities. These positions are often held by unpaid volunteers with little access to supports such as training and post-incident clinical debriefing. Despite these challenges, they provide an invaluable service to their communities, access to emergency services has been identified as contributing to the health disparities faced by Indigenous communities. Improving effectiveness of first responders in emergency situations will require building on the strengths already present within communities, by identifying avenues for more sustainable first response services and support.

Housing, homelessness, and care trajectories among young people who use drugs in Vancouver

The proposed study will employ longitudinal qualitative and ethnographic methods to examine how urban young people who use drugs (YPWUD) navigate experiences of housing and homelessness across time. Cities like Vancouver are creating more comprehensive and integrated systems of services for YPWUD, including programs that aim to simultaneously address their housing and care needs (e.g. supportive housing with on-site access to harm reduction, opioid agonist therapies). Innovative social science research is needed to describe how particular supportive and temporary modular housing models can both ameliorate and exacerbate health and social harms among YPWUD, including overdose. The proposed anthropological and community-based participatory action research study will generate new knowledge to support the development, adaptation and scale up of targeted housing and substance use care interventions for YPWUD. Working together with a Youth Advisory Council comprised of YPWUD and youth co-researchers, study findings will be disseminated via youth-driven outputs aimed at a broad public; presentations and community reports for youth, their providers and key decision makers; and press releases, media interviews, and social media engagement.

Advancing health equity in the cancer care sector: Identifying organizational and contextual factors impacting the integration of equity-oriented healthcare for marginalized populations

Alarming differences exist in cancer outcomes for people who are marginalized. Due to racism, discrimination and stigma, these groups experience extreme difficulties accessing cancer care and are diagnosed with cancers so late they have higher rates of preventable death than other groups. Some of these differences can be addressed using equity-oriented healthcare (EOHC), which directs resources to those with the most need, and reduces mismatches between health services and the actual needs of marginalized people. However, EOHC has not been studied within the context of cancer care. This study is about understanding the organizational contexts and conditions needed to build capacity for EOHC within cancer care in BC. We will: 1) conduct an environmental scan to identify strategies used elsewhere (Canada, internationally) to deliver EOHC in cancer care; 2) observe and interview key informants and healthcare providers who are trying to use EOHC in delivering cancer care, and marginalized patients who are trying to access cancer services, to better understand factors that support the provision of EOHC in cancer care. Results will be used to develop recommendations and action strategies to support cancer organizations to deliver EOHC.

Investigating what matters to youth: A mixed-methods study of youth-centred opioid treatments and their outcomes

Since 2016, approximately 1,200 youth in British Columbia (BC) between the ages of 15 and 24 have died from opioid-related overdoses. This has left families and communities to mourn the loss of their loved ones.

These overdose deaths can be avoided by getting youth the help they need, as early as possible. However, most of the currently available help has focused on adults, under the assumption that what works for adults will also work for youth. Unfortunately, research in BC has recently found that this is not the case. Instead, existing options for help do not meet youths’ opioid treatment needs.

The main goal of this study is to determine how to best help youth who use opioids. To meet this objective, we will engage youth, parents/caregivers and service providers in a research study. This study will explore priorities for opioid use treatment delivery. It will also determine how to best define the benefits of opioid use treatment for youth.

The findings of this study will help service providers and policy makers to deliver opioid treatments in a way that will better meet youths’ unique needs. The findings will also help future researchers to make sure that they are studying what matters most to youth.

End of Award Report – June 2025

 

Results

My multi-methods research has generated the following key findings related to youth-centred approaches to reducing the harms of non-medical opioid use:
(1) Youths’ substance use service needs significantly increased during the pandemic;
(2) The diagnostic incidence of mental and substance use disorders has increased among youth in BC, particularly among females;
(3) Youth using non-medical prescription opioids in BC have complex health and social care needs, which may be addressed by comprehensive care models, like Integrated Youth Services;
(4) Opioid agonist treatment remains an acceptable and effective evidence-based intervention for youth using non-medical opioids; however, a developmentally-appropriate approach is needed to improve youths’ engagement with this treatment;
(5) A developmentally-appropriate and youth-centred model of care for opioid agonist treatment delivery includes four foundational pillars: (1) trusting and collaborative relationships; (2) adaptable and flexible services; (3) low barrier services; and (4) holistic services.

 

Impact

My research has been shared with several provincial institutions and organizations who lead development and implementation of programs and policies for youth substance use health in BC, including Foundry, BC Children’s Hospital, the BC Centre for Disease Control, and the BC Ministry of Health, leading to the identification of several priority areas, including early intervention for substance use, youth overdose research and prevention, and expansion of opioid agonist treatment.  My research has culminated in a draft youth-centred model of care for opioid agonist treatment that will be validated and implemented across the network of 17 community-based Foundry centres in BC. My research is informing the development of a comprehensive substance use service strategy across the network of 17 community-based Foundry centres in BC. My research has provided opportunities for training and capacity building among youth (n=4) with lived/living substance use experience and several undergraduate (n=1) and graduate students (n=7).

 

Potential Influence

My research has the potential to improve the quality of care for youth substance use and youths’ substance use health outcomes. My research has identified promising practices for earlier identification and intervention of youth substance use, developing a youth-centred model of care for delivering and implementing opioid agonist treatment, and informing directions for ongoing monitoring and evaluation of these practices.

 

Next Steps

My five-year research vision is to lead a multi-methods program of research focused on the individual, community, and systems-level impacts of Integrated Youth Services. This research will be hosted at the University of British Columbia’s School of Population and Public Health (SPPH) where I will hold the position of Assistant Professor (Partner), in collaboration with Foundry (BC’s Integrated Youth Service initiative). My research will use integrated knowledge translation, qualitative methods, and quantitative methods to study these impacts. This program of research offers substantial training opportunities in health services research and youth mental health and substance use for graduate students and postgraduate fellows/trainees.