Year: 2018

Embedding health care technologies in real-world contexts: Developing the scale-up, spread and sustainability of assistive technologies in homes, communities and health systems

Co-leads:
Executive sponsor:

  • Heather Davidson
    BC Ministry of Health

Too often, promising technological innovations are not adopted, are abandoned, or face other serious challenges to their uptake, spread and sustainability in real-world contexts, including in people’s homes, community settings, or health systems more broadly.

This project aims to apply a new framework for theorizing and evaluating this phenomenon. The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be app/node/5126lied to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.

By using a community-based participatory research methodology, this work will bring researchers, key health system decision-makers, technology developers, care-givers and older adults together into an inquiry team, focused on overcoming challenges to embedding ATs in end users’ real-world contexts and identifying positive factors that support their uptake, spread and sustainability.

This project will directly address the health system priority of services for seniors with complex medical conditions and the commitment to keeping seniors in their homes as long as safely possible (aging in place). The ATs in this project will be focused on improving the health and quality of life of older adults living with complex care needs, and multiple, chronic health conditions as well as the onset of frailty.

This research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for accomplishing this, as many of the innovations are aimed at making communication and interventions between older adults and their primary health care practitioners, including physicians, nurses and home support workers more effective.

This project will work towards directly improving the uptake, spread and sustainability of promising ATs in British Columbia, and will develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.

Breaking the cycle of recurrent fracture: Scaling up a fracture prevention program in British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Teresa O’Callaghan
    Fraser Health

Low-trauma fractures (fractures that occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis, leading to significant disability and even death for patients.

One low-trauma fracture often leads to a cycle of recurrent fracture. For example, half of patients who suffer a hip fracture have a history of past fracture. In BC, the cost for osteoporosis-related fractures has been estimated at $269 million for hospitals, the medical services plan, and Pharmacare alone.

Despite the availability of effective treatments that reduce future fracture risk by up to 50%, fewer than 20% of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been recognized and adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who “captures” the patient at the point of orthopedic care for the low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure sustainability and follow-through of the initiated interventions to prevent further fractures.

In 2012, the Secondary Fracture Prevention Research Team at Fraser Health brought together osteoporosis and fall prevention experts locally, nationally and internationally, to develop an FLS model that fit the context of the BC health care environment. In 2014, the model was implemented at Peace Arch Hospital (PAH) in BC. A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions received by low trauma fracture patients in the FLS group compared to a control group. FLS is now a permanent program at PAH.

This project will explore how the FLS model implemented at one hospital in BC can be successfully adapted and scaled-up to other hospital sites within BC. The Consolidated Framework for Implementation Research will inform the implementation strategy and the RE-AIM model will frame the process and outcome evaluation. The key outcome will be to inform an FLS implementation strategy that can be used to scale up to other hospital sites across BC, improving patient quality of life after low trauma fractures and decreasing health care costs related to recurrent fractures.

Implementing an evidence-based exercise program to reduce falls in community-dwelling seniors

Co-leads:
Executive sponsor:

  • Megan Oakey
    PHSA

Each year, 30% of seniors fall at least once, and half of those fall more than once. In fact, nine out of ten hip fractures result from falls.

Fortunately, falls are preventable. There is strong evidence that the Otago Exercise Program, which consists of strength and balance training, can reduce falls in this population. Seniors who have had a fall recently are the group most likely to benefit from the Otago program, but only 28% of people who start the program end up continuing with it over time.

It has recently been shown that exercise coaching with the use of consumer wearables, such as a Fitbit, is feasible and can help older people with chronic disease to stay active.

In this project, exercise coaching will be adapted for seniors who have had a recent fall, and then two visual feedback approaches will be tested for implementing the Otago Exercise Program within two BC health authorities – Fraser Health and Provincial Health Services Authority. The success of these approaches will be measured by the degree to which the coaching is delivered as intended by a provider, and the degree to which the exercise program is followed by seniors at 6 and 12 months.

Given the serious consequences, falls prevention is a high priority in BC. To this end, this team includes national leaders in falls prevention and implementation science, as well as health system partners and a prominent national patient group.

A culturally safe pathway for scaling up a patient-centred mHealth technology in northern BC (WelTel Haida Gwaii)

Co-leads:
Executive sponsor:

  • Ciro Panessa
    Northern Health

Rural and remote areas in northern BC experience a greater burden of chronic disease than the rest of the province. The management of chronic disease in primary care settings on Haida Gwaii, in particular, is limited by remoteness and the lack of continuity in outpatient care. The delivery of care to diverse populations in northern BC, including First Nations, requires innovative approaches due to constraints on health system resources.

WelTel is an evidence-based digital health intervention (EBI) that links patients and care providers via text messaging to enhance the timeliness, access to, and quality of chronic disease care. With funding from Doctors of BC, WelTel currently serves 120 patients at Xaayda Gwaay Ngaaysdll Naay/Haida Gwaii Hospital & Health Centre (XGNN). Feedback has been positive on its usefulness, but it has not yet been adopted widely and equitably for patients with chronic disease.

Scaling up WelTel could improve chronic disease management in rural and remote areas of northern BC, address BC health system priorities and advance inter-organizational and patient-centred care. Establishing a process for implementing health innovations that are culturally appropriate will speed up adoption of EBIs in the future.

The goals of this research are to enroll a majority of chronic disease patients in WelTel at XGNN, to expand across primary care on Haida Gwaii, and serve as a model for rural BC. This will include conducting rigorous implementation science research, and a continuation of existing work to construct a mobile health EBI evaluation tool. This will be modified from the Consolidated Framework for Implementation Research (mCFIR) tool which identifies facilitators and barriers associated with expansion to ensure equitable access for all patients.

The mCFIR tool will be complemented with the He Pikinga Waiora Implementation Framework (HPWIF), a community-based participatory framework rooted in Indigenous self-determination. HPWIF will explore critical cultural intricacies and direct the ethical conduct of research in these communities.

This research is poised to explore the complexities of providing care in Haida Gwaii and establish a culturally safe pathway for implementation of EBIs within the community and in similar settings.

Developing a curriculum that promotes self-compassion among healthcare providers

Co-leads:

Trainee:

  • Alexa Garrey
    Vancouver Island University

Healthcare workers experience high rates of stress leave and attrition due to unaddressed mental health needs. While some providers leave the workplace because of burnout, many stay, which compounds the issue and contributes to toxic workplaces and higher patient mortality rates.

New research shows that self-compassion — defined as unconditional positive regard turned inward — is a significant contributor to healthy communities of practice, and promotes the ability to manage workplace stressors (Dames, 2018). The project team will:

  1. Co-develop an evidence-based curriculum and tools that will inform and improve practice by promoting self-compassion among healthcare providers within Island Health and Vancouver Island University.
  2. Build capacity for knowledge translation and future research to study curriculum outcomes.

The curriculum will help providers develop an ability to learn of, articulate, and digest emotions in a safe environment of unconditional positive regard for self. When providers lack self-compassion, they are at a higher risk of mental and physical ailments, emotional exhaustion, and burnout. Rather than turning to substances/activities that lead to dissociation or avoidance, this curriculum will enable participants to cultivate a habit of self-soothing by nurturing themselves with loving kindness.

At the end of the Reach award, the research team will have completed a literature review, curriculum, and submitted a grant application to fund a pilot study on Vancouver Island. The curriculum is expected to improve stress resilience among providers, decrease the use of substances to cope with stress or distress, reduce attrition rates due to burnout, and promote relationally healthy communities of practice (CoP, defined by Wenger as a “group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly”). The proposed curriculum will enhance the mental health and well-being of providers; instilling self-compassion in providers is shown to improve experience and outcomes for patients. Those who direct compassion inwardly naturally extend compassion to others.

This Reach award will cover the costs of bringing stakeholders together to develop the curriculum and to draft an application for the pilot study. This project's potential impact on patient and provider outcomes is enormous and well aligned with health authority and provincial priorities.

Vancouver community health research through an Indigenous lens: A collaborative learning workshop using two-eyed seeing

Co-leads:

  • Leslie Bonshor
    Vancouver Coastal Health
  • David Hall
    Vancouver Coastal Health
  • Michael Norbury
    Vancouver Coastal Health
  • Andrew Day
    Vancouver Coastal Health
  • Laurel Jebamani
    Vancouver Coastal Health
  • Krisztina Vasarheiyi
    Vancouver Coastal Health
  • Brittany Bingham
    Simon Fraser University

Trainee:

  • Teila Gabriel
    University of British Columbia
  • Andreas Pilarinos
    University of British Columbia

Indigenous peoples experience disproportionately poor health and social inequities as the direct result of Canada’s colonial history, including the Indian Act and Residential Schools. Indigenous people face discrimination in accessing health services and are often underrepresented in health research.

The Truth and Reconciliation Commission’s 94 Calls to Action demonstrate the need for system-wide transformation for creating Indigenous cultural safety within health systems. Call to Action 23 calls on all levels of government to improve cultural competency of healthcare professionals. Culturally safe care requires providers to understand how power dynamics created by colonization persistently affect Indigenous people’s health. The regional Aboriginal Health Program at Vancouver Coastal Health is leading innovative activities that use Indigenous methodologies to facilitate system-wide culture change, including cultural safety training at a large acute care facility, embedding Elders and Knowledge Keepers in care systems, and providing cultural practice guidelines to front-line staff.

A Two-Eyed Seeing research team will be formed to integrate Western and Indigenous perspectives on health research. The team will engage with Indigenous communities in three focus group sessions in fall 2018. Feedback will be provided on: respectfully conducting health research with/for Indigenous people; ways research can genuinely serve — not tokenize — communities participating in studies; and the health and wellness themes of highest priority to communities. Focus groups will be held with: (1) Indigenous women attending the Necamat Aboriginal Women’s Village of Wellness held in October in Vancouver’s Downtown Eastside; (2) Musqueam First Nation; and (3) Vancouver General Hospital Indigenous Peoples Advisory Group.

A knowledge translation team — consisting of (at least) one community representative, one knowledge user with knowledge translation expertise, and trainees — will synthesize community feedback to inform the development of content for Research Day and to produce a final report for knowledge dissemination.

The Research Day will be hosted by Vancouver Community health services at Vancouver Coastal Health in spring of 2019 to expand awareness of Indigenous perspectives on health and research among Vancouver Community staff. The morning will include a traditional opening by an Elder, a community panel discussion to explore themes of the focus group sessions, and a keynote presentation. Respected Indigenous leaders and researchers will speak and moderate discussions. In the afternoon, 25 registered Vancouver Community health researchers will attend a workshop on cultural safety and Indigenous research methods.

Positive Living, Positive Homes: The online HIV housing toolkit

Co-leads:

Trainee:

  • Joanna Tulloch
    University of Victoria

Housing is an important structural determinant of health. Positive Living, Positive Homes (PLPH) is a longitudinal, qualitative, community-based research (CBR) study conducted in three British Columbian (BC) communities (Prince George, Kamloops, and Greater Vancouver). PLPH has investigated the complex relationship between housing and health for people living with HIV, and how policies and programs across BC interact with health and wellbeing of PLHIV.

In keeping with the tenets of CBR and the greater/meaningful involvement of people living with HIV/AIDS (GIPA/MIPA) principles, in each site, the team engaged people living with HIV, service providers, and other partners to participate as study team members in study implementation, data analysis, and knowledge translation activities.

Between June 2015 and October 2017, 99 adults living with HIV across the three BC study sites participated in baseline in-depth interviews for PLPH, with follow-up interviews one year later (72 people completed the follow-up interviews). In addition, in-depth, semi-structured interviews were conducted with 42 HIV and/or housing service providers and policy makers working in a range of community and government organizations at the three sites.

A key finding of the study related to the impact of stigma and discrimination across the housing spectrum for people living with HIV. Several participants were denied access to housing upon disclosure of living with HIV. Stigma and discrimination also drove some participants into isolation and away from care and resources related to their health and housing. Given this, the PLPH CBR team recommended that an essential KT tool would be an Online HIV Housing Toolkit that would increase access to housing information for people living with HIV and service providers who support people living with HIV, and ultimately help people living with HIV and service providers better navigate BC’s housing system.

PLPH is led by Dr. Catherine Worthington (Public Health and Social Policy, University of Victoria) and Evin Jones (Pacific AIDS Network (PAN), which holds CIHR HIV/AIDS CBR operating grant funds for the study (2014 – 2018)). PAN is a member-based coalition with almost 50 member organizations responding to HIV, HCV and related issues across BC. PAN is uniquely positioned to develop and host an Online HIV Housing Toolkit because they have developed and hosted many training and online tools for its member agencies and other key provincial partners.

Knowledge mobilization for reducing stigma and creating culturally safe primary care

Co-leads:

  • Bernadette Pauly
    University of Victoria
  • Bill Bullock
    Victoria Division of Family Practice
  • Karen Urbanoski
    CISUR / UVic

Trainee:

  • TBC

People who use substances (PWUS) face stigma and discrimination when accessing primary care. Cultural safety has been proposed to reduce provider and system-based stigma. Recently, this team completed a CIHR Strategy for Patient Oriented Research grant, which investigated the meaning of culturally safe primary care for PWUS, with a focus on those also experiencing structural disadvantages (e.g. poverty, racialization). This team comprises of PWUS (community researchers), academic researchers and knowledge users from the Victoria Division of Family Practice and Island Health. Findings included a concept map of cultural safety with eight core areas for reducing substance use related stigma in primary care.

The knowledge translation (KT) objectives are to:

  1. Raise awareness of the stigma experienced by PWUS in primary care.
  2. Share understandings of culturally safe primary care for this population.
  3. Support PWUS to advocate for their own primary care.
  4. Encourage PWUS, physicians and health planners to collaborate on strategies to improve cultural safety.
  5. Facilitate the participation of PWUS, physicians and health planners in developing and implementing policies and practices to improve cultural safety in primary care.

Besides local and provincial presentations with knowledge users, a postcard summarizing the findings was produced and distributed it to the community to support PWUS in advocating for their own primary care. We will complete additional plain-language KT materials for this population.

With this Reach award, the team will extend their reach to physicians, other healthcare providers, medical students, and senior level policy makers through two additional activities.

A video will be created to communicate the findings from the perspective of community researchers; it will be available on YouTube and actively promoted for use by senior level health executives and in healthcare curricula in BC post-secondary institutions.

An interactive workshop for primary care providers will be developed and delivered to address barriers and have facilitators implement culturally safe care. This workshop will be developed by the existing team and will be led by PWUS in collaboration with other team members. The workshop will be delivered through newly developed interdisciplinary primary care networks in Nanaimo, Campbell River and Port McNeil with a focus on identifying local practice changes. Besides enhancing the reach of findings from this completed project, the community researchers and graduate trainee will build their personal and organizational capacity for KT.

Develop a web-based childhood healthy weights early intervention program

Co-leads:

  • Sam Liu
    University of Victoria
  • Karen Strange
    Childhood Obesity Foundation

Trainee:

  • TBC

Childhood obesity is a major public health challenge in Canada. The BC Ministry of Health funded the knowledge-user (Childhood Obesity Foundation) to design and implement a “made in BC” community-based Childhood Healthy Weights Early Intervention Program (EIP) for children 8-12 years old. However, it has proven challenging to reach families who can’t attend in person. But with improved access to the Internet, web-based lifestyle programs may be well-suited to meet this challenge. In this project, the team will build an interactive web-based childhood obesity prevention program based on the EIP curriculum.

Aims:

  1. Develop an interactive web-based version of EIP for families whose children are off the healthy weight trajectory.
  2. Conduct usability testing to further enhance user experience.
  3. Collaborate with co-lead to disseminate the program across BC.

The web-based program will address major gaps in existing interventions, such as making the program accessible to non-traditional families; this includes Indigenous families, families from multi-cultural or intercultural backgrounds, and those of lower socioeconomic status. The program will also include sessions on sleep hygiene and screen use. This project will consist of three phases. In the first phase (0-5 months), an integrated-KT approach will be used to develop a web-based program (Aim 1). Integrated-KT helps ensure the web-based program is relevant and useful to all stakeholders (e.g. knowledge users, researchers, end-users). At the end of phase two (month 7), it is expected there will be a functional interactive web-based program that has undergone usability testing (Aim 2). In phase three (8-12 months), work will be done with the research user to disseminate the web-based intervention to diverse groups of families with children off the healthy weight trajectory (Aim 3).

This project has potential to be incredibly impactful as a web-based intervention can extend the reach of the Childhood Healthy Weights EIP across BC.

Developing and disseminating an interactive menstruation (info)graphic (I’M IN)

Co-leads:

  • Caroline Sanders
    University of Northern British Columbia
  • Joanne Hall
    Congenital Adrenal Hyperplasia – Living with CAH Support Group, UK

Trainee:

  • Erika Belanger
    University of Northern British Columbia

Following early analysis of data from the Women Health Research Institute (WHRI) grant focusing on wellness in women with congenital adrenal hyperplasia (CAH), it was obvious that there was a need to share, translate, and mobilize knowledge into public and professional domains. Early findings show that menstrual wellness for women with CAH is constrained by the ongoing menstrual taboos, similar for all women. An additional stress factor for women with CAH is the variation in genital anatomy, cycle duration, and the impact of metabolic processes and steroid medication management.

Taboo and limited menstrual information and resources for parents of younger children, patients and health care providers result in knowledge gaps; this limits early and ongoing body wellness conversations. Introducing health concepts linked to menstrual wellness early on can help to reduce stigma and isolation, which builds resilience to support physical health and protect mental wellbeing.

The aim is to build on HealthLinkBC’s “standard” menstrual cycle information by designing a simple, interactive (info)graphic that will lay out the important factors of concern to women with CAH. It is hoped that women will use this KT product when discussing their menstrual (ir)regularities with health care providers (e.g. in specialist and primary care settings). To strengthen product credibility, this interactive (info)graphic will be presented at a WHRI workshop to CAH stakeholders (e.g. women with CAH, parents, health care providers, educators, and advocates); feedback on design, functionality, and content will be incorporated.

This KT work will be launched with provincial events linked to Women’s Day and Rare Disorder Day 2019. In addition, this KT resource will be made freely available via domestic (e.g. Canadian Organization of Rare Disorders (CORD)) and international advocacy and support groups (e.g. dsdfamilies, living with CAH etc.).