Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.
My research program seeks to answer the following questions:
- How can we make sure we have the right number of health care providers to meet the needs of Canadians now and in the future?
- How can we efficiently organize delivery of primary care to meet the needs of patients? How do we improve access to effective care for underserved groups, including people managing both mental and physical health conditions and recent immigrants and refugees?
I analyse routinely collected data from health care delivery and look at the impact of policy changes using statistical models. I work in partnership with researchers who have complementary skills collecting information through interviews and focus groups. My research teams include patients, care providers, and people who plan health services. This helps make sure we ask questions that matter and that research results will help change our health care system.
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer related deaths mostly due to the absence of symptoms as the cancer develops. This leads to diagnosis after the tumor has already become widely invasive and cannot be surgically removed. Unfortunately, surgical removal of early stage tumors is the most effective treatment option and other treatments, such as chemotherapy, are woefully ineffective.
Thus, there are two major fronts where research could improve the outcomes of pancreatic cancer patients:
- early detection and
- more effective treatments. Early detection requires knowledge of the events associated with tumor development, while improving treatments requires a thorough understanding of pancreatic cancer. It is clear that a 'one-size-fits-all' strategy has largely been ineffective for pancreatic cancer. We hypothesize that this is partly because PDAC is a 'catch-all' diagnosis for tumors that look the same, but may have different properties due to differences during their development. Our research program seeks to identify these differences and ultimately leverage the differences to improve patient outcomes through the development of personalized treatments.
Personal identity–one's psychological sense of personal continuity–is an important aspect of mental health, informing one's motivations, behaviours, and social relations. Disruptions in identity can contribute to prevalent conditions such as personality disorders. Indeed, distorted identity is a core aspect of personality dysfunction and disorder, contributing to considerable negative health and social outcomes–and a prominent challenge for health care providers and systems. Interventions that strengthen identity during young adulthood may be a potent way to mitigate personality dysfunction, preventing entrenched impairment and setting a course for positive mental health.
This proposal features a novel psychosocial intervention aimed at strengthening identity and reducing personality-related dysfunction among vulnerable young adults–tested in a randomized controlled trial. The intervention is designed for use by non-specialists to maximize transferability and impact on access and quality of care. Building on the applicant's work in maladaptive personality and identity, the project is set within a broader program of research on identity-focused intervention, including within early psychosis and recovery from alcohol misuse.
Anemia is a condition in which there is a decrease or destruction of red blood cells causing inadequate transport of oxygen throughout the body. It is a major public health problem affecting ~25% of the global population, or ~9 million Canadians of all ages.
In infants and children, anemia can impair brain development and decrease learning ability. In adults, it can cause fatigue, lower work capacity and increase the risk of adverse pregnancy outcomes (e.g. low birthweight). Causes of anemia can include micronutrient deficiencies (e.g. iron or folic acid), infection and disease, and genetic hemoglobin disorders (e.g. thalassemia). Understanding the causes of anemia is critical to inform appropriate strategies to prevent and treat anemia, and to reduce the risk and burden of disease.
Dr. Karakochuk's research program will seek to improve diagnostic methods and investigate novel biomarkers for anemia and iron deficiency, and assess the risk-benefit of iron and folic acid supplementation programs designed to treat anemia and other chronic diseases. The ultimate goals are to reduce the burden of anemia and to inform safe and effective nutrition policy, programs and interventions for individuals and populations in Canada and globally.
Mental health and substance use (MHSU) challenges are leading health issues facing youth globally. In Canada, 20% of the youth population experiences mental health disorders, and youth aged 15-24 have the highest rates of past year substance use and related harms. To address these concerns, MHSU researchers and advocates argue for a population health approach incorporating promotion, prevention, and treatment within a 'healthy public policy' framework. Yet while much research has focused on the prevention and treatment of youths' MHSU challenges, there has been limited focus on mental health promotion.
Further, while there is growing recognition of the importance of engaging youth in matters that affect their lives, there is a paucity of evidence-based guidance on how to do this effectively. This study contributes to addressing these substantial gaps by exploring how to meaningfully engage youth in the policymaking process to promote MHSU outcomes. Participatory approaches and mixed methods are being used to generate knowledge and inform a framework to guide youth-engaged research and action to better tackle the MHSU needs of Canadian youth.
Infectious diseases remain a serious and constant threat despite the high standards of sanitation and health care enjoyed by the British Columbians. Moreover, British Columbians, living in a major port of entry to Canada, face an increased risk of contact with emerging infectious diseases as exemplified by SARS. An effective disease surveillance system requires multiple health organizations to work together and share information with each other. Advances in genomic technology have improved the detection and characterization of disease-causing microbes and provide public health practitioners a better surveillance tool. Yet, genomic data is voluminous and complex, creating a challenge for our health care system and practitioners. Moreover, contextual data needed to interpret genomic data often contain sensitive and private information making sharing of contextual data across jurisdictions a challenge.
Dr. Hsiao's research program builds innovative technology solutions to improve organizational efficiency, trust, and capacity of BC's public health surveillance network. Our work will stop the spread of diseases, reduce the overall disease burden and health care cost, and ultimately improve the health and well-being of British Columbians.
This program of research will seek to understand how youth and young adults (YYA) with mental health (MH) disorders make decisions about seeking MH services at YYA centres such as Foundry BC. Foundry BC provides health and wellness services to YYAs through integrated service care in communities across BC. Nearly 75% of MH disorders develop before the age of 25, yet less than 20 percent of Canadian YYAs receive appropriate treatment. This can cause serious problems such as relapse, rehospitalisation, increased suicide risk, and can interrupt critical identity development. Currently, there is little to no research that understands how Canadian YYAs making decision about accessing and staying engaged MH services.
This program of research will work closely with Foundry BC to:
- To develop a theoretical framework of service use decision-making and engagement among Canadian YYAs living with MH disorders using mixed-method approaches; and
- Explore barriers that marginalized YYAs with MH disorders face when accessing digital information using mixed method approaches. Ultimately, this research will lead to the development of a YYA MH service use lab in BC that uses mixed-method approaches and an innovative decision-making framework to develop interventions to increase service use among this vulnerable group in BC. This research will work closely with YYAs and parent knowledge users as part of the research team, and mentor highly qualified students to become MH leaders.
One million Canadian women are affected by endometriosis annually. There is little investment in research, and socioeconomic cost, >$4 billion annually in Canada, continue to climb owing to lost productivity, sick days, treatments for frequent pain, infertility and depression. Most critically, affected women may have up to a 10-fold increased risk of developing specific types of ovarian cancer. There are no biological features that predict if endometriosis will result in severe or chronic pain, infertility, or cancer.
In 2017, my work identified cancer mutations in the DNA of endometriosis, a feature seen only in cancer.
Since then, I have established a research program with two goals:
- to examine association between specific mutations and types of endometriosis.
- to understand how other biological features, such as the immune-system, may be affected by mutations and contribute to the establishment of endometriosis, and progression to cancer. Cancer mutations are present in all types of endometriosis, including those with no risk of cancer. Additional work is needed to understand how these mutations influence the biology and symptoms of both endometriosis and their associated cancers, as well as establish management strategies.
Co-leads:
- Lise Olsen
UBC
- Lois McNary
Special Olympics BC
- Tara Nault
Indigenous Sport Physicial Activity and Recreation Council
- Jean-Paul Collet
UBC
- Stephanie Glegg
BC Children’s Hospital Research Institute / BC Children’s Hospital and Sunny Hill Health Centre for Children / UBC
- Mojgan Gitimoghaddam
UBC
- William McKellin
UBC
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Executive sponsor:
- Matt Herman
BC Ministry of Health
- Anne Fuller
Ministry of Children and Family Development
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Few physical recreation programs exist for children with neurodevelopmental challenges, particularly in rural settings and in Indigenous communities.
This project’s goal is to study the implementation of a new physical activity coaching approach (NPAC) for children with neurodevelopmental challenges and their families.
Key components of the approach include personalized child-centred coaching; home-based activity components (using an app); an online networking site for parents and coaches; and social activities for parents. This approach has previously been tested with families in urban settings. The aim is to assess how it can be implemented for those living in rural and Indigenous communities in BC.
The project objectives will be to assess different ways to implement NPAC in diverse communities and to develop a model that outlines the key steps and strategies that can be used with other Indigenous and rural communities. The team will use an Indigenous-inclusive approach and a framework for developing and sharing knowledge that includes community members through all stages of the process. Over the course of three years, the team expects to implement and evaluate the NPAC in a total of 16 sites in close collaboration with their provincial and community-level project stakeholders and partners.
The team seeks to:
- Measure the impacts that implementation of the NPAC across the sites will have on health and well-being at child, family and community levels.
- Examine factors that helped or hindered implementation of the NPAC across the sites and how this information can help to generate a model or set of guidelines to help other rural and Indigenous sites use the NPAC.
- Increase abilities among community members to support physical activity for children and families living with neuro-developmental challenges.
They anticipate the project will contribute to more inclusive and equitable participation in physical recreation for rural and Indigenous families in BC and contribute to their improved health and well-being.
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Executive sponsor:
- Heather Davidson
BC Ministry of Health
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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 to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.
By using a community-based participatory research methodology, the team will bring researchers, key health system decision-makers, technology developers, caregivers 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 two BC health system priorities. Focusing on patients with complex medical conditions as well as the commitment to keeping seniors in their homes as long as safely possible (aging in place), the ATs are 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.
The research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for enhancing access to primary health care, 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.
The project’s objectives are to:
- Contribute to the body of knowledge concerning effective implementation science approaches to the uptake, spread and sustainability of assistive technologies in home and community care settings.
- Provide the provincial health system with a more effective framework for innovative technology assessment and evaluation and to give BC Ministry of Health and provincial health authority staff training opportunities in using the framework.
- Directly improve the uptake, spread and sustainability of promising ATs in British Columbia.
- Develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.
