1,720,995 research outputs found
A web-based social network tool (GENIE) for supporting self-management among high users of the health care system: feasibility and usability study
No full textBackground: primary care providers are well positioned to foster self-management through linking patients to community-based health and social services (HSSs). This study evaluated a web-based tool—GENIE (Generating Engagement in Network Involvement)—to support the self-management of adults. GENIE empowers patients to leverage their personal social networks and increase their access to HSSs. GENIE maps patients’ personal social networks, elicits preferences, and filters local HSSs from a community service directory based on patient’s interests. Trained volunteers (an extension of the primary care team) conducted home visits and conducted surveys related to life and health goals in the context of the Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) program, in which the GENIE tool was implemented. GENIE reports were uploaded to an electronic medical record for care planning by the team.Objective: this study aims to explore patients’, volunteers’, and clinicians’ perceptions of the feasibility, usability, and perceived outcomes of GENIE—a tool for community-dwelling adults who are high users of the health care system.Methods: this study involved 2 primary care clinician focus groups and 1 clinician interview (n=15), 1 volunteer focus group (n=3), patient telephone interviews (n=8), field observations that captured goal-action sequences to complete GENIE, and GENIE utilization statistics. The patients were enrolled in a primary care program—Health TAPESTRY—and Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. NVivo 11 (QSR International) was used to support qualitative data analyses related to feasibility and perceived outcomes, and descriptive statistics were used for quantitative data.Results: most participants reported positive overall perceptions of GENIE. However, feasibility testing showed that participants had a partial understanding of the tool; volunteer facilitation was critical to support the implementation of GENIE; clinicians perceived their navigation ability as superior to that of GENIE supported by volunteers; and tool completion took 39 minutes, which made the home visit too long for some. Usability challenges included difficulties completing some sections of the tool related to medical terminology and unclear instructions, limitations in the quality and quantity of HSSs results, and minor technological challenges. Almost all patients identified a community program or activity of interest. Half of the patients (4/8, 50%) followed up on HSSs and added new members to their network, whereas 1 participant lost a member. Clinicians’ strengthened their understanding of patients’ personal social networks and needs, and patients felt less social isolation.Conclusions: this study demonstrated the potential of GENIE, when supported by volunteers, to expand patients’ social networks and link them to relevant HSSs. Volunteers require training to implement GENIE for self-management support, which may help overcome the time limitations faced by primary care clinicians. Refining the filtering capability of GENIE to address adults’ needs may improve primary care providers’ confidence in using such tools
Adoption of a Population Health Approach in Sexual Health Programs and Services within Public Health in Ontario: A Multi-phase Mixed Methods Study
Full text linkSince 2018, the Provincial Government of Ontario has begun transformation within the public health sector, which emphasizes the increased application of a population health approach. The goal of this transformation is to maximize the contribution of public health in improving the health of Ontarians by moving from a reactive to a proactive model that is focused on prevention. To support this transformation the standards that guide the programs and services provided through public health units underwent modernization in 2018. The emphasis of the modernized standards is about expanding the scope and reach of public health, by supporting the role of population health in the development and delivery of programs and services. This thesis used quantitative data to examine the extent that a population health approach was implemented in sexual health programs and services in public health units across Ontario. Qualitative data was gathered to explore public health managers’ and supervisors’ perceptions of barriers and facilitators that influenced the implementation of this approach. A mixed-methods study was used to determine if the qualitative findings helped our understanding of the quantitative results. This multi-phase mixed methods study involved four sequential phases. Phase 1 and 2 involved instrument development which included a literature review, input from experts, and testing; in phase 3 instrument administration was conducted; and phase 4 involved interviews with sexual health managers and supervisors. A qualitative descriptive approach was used as part of phases 1, 2, and in phase 4 for data collection and analysis using focus groups and semi-structured interviews with sexual health managers and supervisors delivering sexual health programs and services. The instrument was developed based on Health Canada’s Population Health Key Elements Template with multiple activities listed under each element and was administered in phase 3. Descriptive statistics were used to analyze this data. The Consolidated Framework for Implementation Research (CFIR) guided the development of the interviews for phase 4 and the qualitative analysis. Quantitative data showed that some population health elements were implemented more than others. For example, Address Determinants of Health and their Interactions was implemented by most health units while Employ Mechanisms for Public Involvement was implemented by a few. Qualitative data revealed that most factors influencing the implementation of a population health approach fit within CFIR’s domains of the inner and outer setting. For example Address Determinants of Health and Their Interactions and Focus on the Health of Populations were highly implemented by health units, due to factors such as organizational culture, and access to data. On the other hand, the elements Collaborate Across Sectors and Levels and Employ Mechanism for Public Involvement were less often implemented which were influenced by resources (e.g., human and financial) that were available to the health unit. This study fills an existing gap in the research and offers evidence of how to implement a population health approach within sexual health programs and services in public health.ThesisCandidate in PhilosophyTraditionally, sexual health programs and services provided by Ontario public health units have focused on providing services for individuals, such as clinic services. More recently, there has been a shift in public health to apply a population health approach, which focuses attention on addressing the broader social and economic influences on health. This is viewed as important to improving the health of communities and disadvantaged groups within those communities. It is not known to what extent this shift in the approach to sexual health services or programs is being implemented within Ontario public health units. Therefore, it is important to understand how public health units have moved towards a broader approach in sexual health and what challenges they have faced. This thesis examines how much sexual health programs and services have implemented a population health approach within sexual health programs and services in public health units. It also explores what helped or hindered this change. Some key population health activities (e.g., using evidence to plan programs, offering clinic services) have been implemented but not all (e.g., working with community partners, participating in primary research). An example of a barrier to implementation is having a lack of resources (human and financial). New knowledge from this study can support public health organizations to apply a broader population health approach in sexual health programs and services
A DEVELOPMENTAL EVALUATION OF THE COMMUNITY NURSE NETWORKER PILOT
Full text linkThe Community Nurse Networker (CNN) pilot project represents an innovative collaboration between primary care, public health and municipal stakeholders, including a local neighbourhood resident planning team in a priority neighbourhood in Hamilton, Ontario. This pilot linked primary care to ongoing community development work. The goal of the CNN pilot was to address issues beyond physical health, and to consider issues related to the social determinants of health, or where people, live, work, and play. This developmental evaluation study used a qualitative descriptive approach (Sandelowski, 2000, 2010). Multiple perspectives and sources were used to describe the implementation of the CNN pilot, the following were collected and analyzed: Interviews (N=5), a focus group (participants = 11), documents (N=90), and a survey (N=1). The implementation of the pilot was described by the following foci: (a) conceptualization of the CNN’s roles and activities, (b) perceived barriers and enablers in implementing the CNN pilot, (c) perceived impacts of the intervention, and (d) perceptions surrounding the value of a nurse in the CNN position. The CNN pilot is a unique intervention, demonstrating how primary care can be a leader within the community, engaging with health and social services organizations and hard to reach populations. The findings of this study supported the ongoing development of the CNN position. It provided an example of a nurse-led intervention, with an integrative approach to primary care, community development, social, and health services. This study illustrates the potential for strengthened partnerships between primary care and the community within priority neighbourhoods.ThesisMaster of Science (MSc
A Mixed Methods Study of Social Capital and Health Among Adults in Rural Ontario
Full text linkSocial capital has shown the potential to benefit health, and therefore is an important concept to take up within nursing. However, the lack of consensus about how social capital should be defined and measured leads to challenges translating existing evidence into health promotion practice. Further, there is some literature suggesting that social capital may not benefit the health of rural residents in the same way as it does for urban residents. Therefore, there is a need for research that helps advance our conceptual knowledge of social capital while examining the concept and its impact on health for rural residents. This thesis involved a sequential explanatory mixed methods study to understand how rural residents experience social capital and how it impacts their health. In the first phase, I began with an exploratory factor analysis of the 2013 General Social Survey data. This revealed the underlying factors that made up social capital for urban and rural residents of Ontario. Logistic regression analysis indicated that four of the six social capital factors were positively associated with health. There were no differences between rural and urban residents in the factors revealed, nor in the influence of the factors on health, however rural residents scored higher on several social capital factors. In the second phase, interviews and focus groups in two rural Ontario communities helped explain the findings and explored how rural residents experienced social capital in their daily lives. The friendly and helpful social context helped elucidate why rural residents had high social capital scores, yet the structural context contributed to difficulties accessing social capital for some groups. Together, the data from both study phases help advance our knowledge of social capital with important implications for nursing practice.ThesisDoctor of Philosophy (PhD)There has been a lot of attention to the topic of social capital and how it may benefit health. Social capital means the resources someone has access to because of belonging to a social network. This thesis aimed to understand what makes up social capital, how it influences health, whether there are differences in its impact between urban and rural residents, and how people living in two rural communities experience it in their daily lives. Quantitative analysis showed that some components of social capital benefited physical and mental health while others did not. Rural residents were not impacted any differently by social capital, however they had higher scores on several of its components than urban residents. Interviews and focus groups helped explain how the friendly and helpful social context of the rural environment contributed to high social capital, yet structural challenges meant some community members had difficulty accessing its benefits
“When you’re in the office, it means you managed to get somewhere”: perceptions of adolescents with anxiety or mood disorders of accessing primary care for mental health services
No full textIn Ontario, the majority of children and youth with mental illnesses access primary care as their initial source of mental health services (Institute for Clinical Evaluative Sciences, 2017). Primary care can be an ideal setting for accessing mental health services to prevent symptoms from worsening (Cappelli & Leon, 2017). Adolescence is a time when young people experience several developmental changes and transitions, making them susceptible to mental illnesses (Government of Canada, 2011). Examining adolescents’ perceptions of access is critical to examining how primary care is accommodating their mental health needs (Cappelli & Leon, 2017).
The primary purpose of this study was to explore the perceptions of adolescents, living in Hamilton, Ontario, with an anxiety or mood disorder, of accessing primary care for mental health services. Perceptions regarding the role of primary care nurses in facilitating access was also explored.
Qualitative interpretive descriptive methods were utilized. Data collection included: demographic survey, semi-structured interviews, photo-elicitation project, field notes, and reflexive journaling. Analysis was guided by an access framework (Penchansky & Thomas, 1981) and ecological model (McLeroy et al., 1988).
Adolescents ages 15 to 18 years (n=10) participated. Adolescents perceived access to primary care for mental health services as a difficult and complex process involving multiple stages including: feeling uncertain about their mental health concerns and if they required help, seeking informal support from parents and friends to initiate receiving help, and obtaining mental health services from primary care.
Implications of this study include addressing adolescents’ developmental needs in care through implementing an individualized-approach and supporting development throughout emerging adulthood. Primary care practitioners must provide information to adolescents and parents about mental health concerns and services during routine interactions. Greater organizational support would enable primary care nurses to have an active role in delivering mental health services and providing comprehensive care.ThesisMaster of Science in Nursing (MSN
Enhancing a Home Care eHealth Application for Stroke Survivors with Multiple Chronic Conditions – Bringing Primary Care into the Circle of Care
Full text linkThe Canadian elderly population living with multiple chronic conditions (MCCs) is increasing. Multiple health care settings need to be involved in patients’ care management with this vulnerable group. Therefore, meaningful collaboration and communication among health care providers in different sectors, especially at transition points, is highly desirable. This study focuses on the co-design of an expansion of an existing eHealth App (MyST) to include primary care providers who are in the stroke survivors’ circle of care. MyST was originally developed for the home care sector and is currently accessible by home care providers, patients and their caregivers.
Primary care providers, another group of users of the proposed enhanced version of MyST, were not engaged in the design process. The objective of this study is to identify this user group’s requirements and develop specifications for the design and development of MyST 2 to be implemented in real practice settings.
Persona-scenario co-design methodology was used for data collection. Two persona scenario discussion sessions were conducted with 5 health care professionals from different primary care practices. Three nurses participated in one session, and a dietitian and a social worker participated in another session. Participants in groups created personas and scenarios where their persona interacted with members of the circle of care using MyST 2.
Eight themes were identified in the data analysis process: Inter-professional team communication, Patient safety approach, Access to non-medical information, Facilitation of referral to community services and resources, Patient-centred care, System integration, Clinic EMR as a complementary tool, and Implementation considerations. Related to each theme, a list of design specifications was created, including required modules and features, and implementation specifications such as hardware requirements, team members’ responsibilities, MyST 2 use policies, patient privacy, and provider training. The identified requirements will also inform the design and development of future Apps that support patients with MCCs who require home care.ThesisMaster of Science (MSc
A Qualitative Description of Stakeholder Perceptions of Factors Influencing Implementation of School-Based Vision Screening in Ontario
Full text linkIn Canada, nearly 25% of school-aged children have vision problems. Common childhood vision disorders include amblyopia, refractive errors, and strabismus. Early identification and treatment of these disorders can prevent long-term vision loss and improve academic achievement. In 2018, the Ontario Ministry of Health and Long-Term Care legislated universal childhood vision screening of all senior kindergarten students. Although studies have explored the effectiveness of these interventions, few have explored the barriers and facilitators to program implementation. This study used a qualitative descriptive approach to examine the perceptions of key informants regarding the factors influencing the implementation of school-based vision screening in Ontario, and the role of nurses in supporting implementation. Semi-structured interviews were conducted with parents (n = 3), optometrists (n = 3), clinical research personnel (n = 2), public health staff (n = 5), school staff (n =2), and community vision program personnel (n = 2) from across Ontario. The Consolidated Framework for Implementation Research (CFIR) was used to frame the analysis. The following factors were found to influence vision screening implementation: (1) student and parent needs; (2) presence of external partnerships; (3) dedication of tangible resources; (4) presence of internal networks and communications; and (5) the cost, complexity, and perceived quality of the vision screening program. Participants reported that public health nurses’ knowledge and skills, and their position within schools, communities, and the health system, facilitated vision screening implementation. This study suggests that a comprehensive and coordinated approach is necessary when implementing school-based vision screening programs. Future research examining vision screening implementation should consider the use of the CFIR to guide all phases of the implementation process, and explore the experience and perspectives of vision screening implementation of students, non-English speaking families, and those who had experienced failed vision screening.ThesisMaster of Science (MSc)In Canada, nearly 25% of school-aged children have vision problems. In 2018, the Ontario Ministry of Health and Long-Term Care passed a law requiring that all senior kindergarten students have their vision screened. This study used a qualitative descriptive approach to explore the perceptions of key informants regarding factors influencing implementation of school-based vision screening in Ontario, and the role of nurses in supporting implementation of this practice. The Consolidated Framework for Implementation Research was used to frame the analysis. The results of this study suggest that a comprehensive and coordinated approach is necessary when implementing school-based vision screening programs. Furthermore, participants reported that public health nurses’ knowledge and skills, and their position within schools, communities, and the health system, facilitated vision screening implementation. Therefore, public health units are encouraged to strategically utilize public health nurses when implementing vision screening. Practice, policy, education, and future research implications are discussed
Efficacy of web-based tailored health communication for behavioural modification in sun safety: A comparative study of tailored and response independent information delivery
Full text linkExposure to ultraviolet (UV) radiation is the single most important risk factor for skin cancers. The incidence and severity of skin cancers are on the rise in most parts of the world including Canada. Melanoma is the most aggressive form of skin cancer with a poor prognosis.
It is possible to calculate the approximate time required to develop sunburn based on the skin type of an individual and the UV index of the region of residence. A tool was constructed for this purpose using various web technologies such as PHP and JavaScript. The tool was named SUNBUC as an acronym for Sun Burn Calculator. There were two phases of the study: 1. Usability testing and 2. A controlled trial, which was designed to test the impact of the tool on the sun protection behaviour of the respondents over a period of 3 months. The null hypothesis was that tailored information and response independent information has a similar impact on sun safety behaviour as measured by the frequency of usage of sun protection methods such as sunscreen. Ethics board approval was obtained for the study.
The usability of the online survey and SUNBUC was tested on five respondents using the think-aloud method and evaluated using the System Usability Scale. The evaluation showed average usability and system modifications were made according to the findings of the think-aloud study.
The controlled trial design consisted of the control group with 48 respondents and intervention group with 53 respondents. Post intervention survey responses were obtained from 46(96\%) and 48(91\%) respondents belonging to the control and intervention groups respectively. Having implemented SUNBUC, findings showed no significant difference between the respondents who used the tool and the control group in short-term sun protection behaviour. However, many respondents felt that SUNBUC gave them a sense of control over their behaviour, a proximal determinant of the behaviour itself as per the Theory of Planned Behaviour.ThesisMaster of Science (MSc
Exploring the implementation and delivery of primary care services for transgender individuals: An Ontario case study
No full textTransgender individuals represent one of the most marginalized and underserved populations in healthcare. Issues such as discrimination, lack of practitioner experience and knowledge, and a deficiency of services have contributed to the healthcare barriers experienced by transgender individuals. There is a lack of literature demonstrating how primary care services are delivered to transgender individuals and a need for research that helps advance our knowledge about the delivery and implementation of primary care services for this population. This thesis explores how primary care services are delivered and implemented from a perspective that acknowledges the complexities of the healthcare needs of the transgender population.
A multiple-case study design was used to explore the implementation and delivery of primary care for transgender individuals in Ontario within different delivery models of primary care and through diverse roles of primary care team members. Normalization Process Theory, an implementation theory and conceptual framework, was used in this study to understand and explain the dynamic processes that occur during implementation of interventions in healthcare, and guide data collection and analysis. Three cases representing different models of primary care delivery in Ontario were identified, all of which provide primary care services to transgender individuals. These models included a solo physician Fee-For-Service practice, a Family Health Team and a Community Health Centre. The multiple sources of data collection strategies used were interviews, a survey, documental evidence, and field notes. Participants included multiple members of the primary healthcare team, such as practitioners, clinical support staff and executive directors. This study helps to advance our knowledge of the delivery and implementation of primary care services for transgender individuals. Implications for nursing practice, including highlighting the need for curricula changes and understanding the nursing role, are discussed.ThesisDoctor of Philosophy (PhD)Primary care, such as a family doctor, is where people get day-to-day healthcare. Worldwide, transgender individuals encounter barriers to appropriate healthcare, in particular access to practitioners who understand their health needs. This thesis aims to explore how primary care services are delivered to transgender individuals in Ontario, through a study that examined different ways services are provided, from a family doctor working alone in a clinic to a clinic with a team of practitioners (e.g., family doctors, nurse practitioners, nurses, counsellors). Interviews with practitioners, a survey, and clinic documents showed that primary care for transgender individuals is part of regular primary care services; whether delivered via a rapid access specialty clinic or embedded into regular primary care services, study participants were easily able to integrate primary care for transgender individuals into their routine work. However, evidence also highlighted the need for practitioners to obtain specialized knowledge of transgender needs
Empowering Ontario Public Health Nurses to Address the Causes of Poverty: A Qualitative Descriptive Study
Full text linkResearch has demonstrated repeatedly that income and income distribution are powerful determinants of health. While Ontario public health units are mandated to promote health and reduce health inequities, they have done little to help eliminate poverty, instead focusing on individual behaviours such as smoking, diet, and physical activity – an approach likely to worsen health inequities, rather than mend them. Public health nurses (PHNs) across Canada recognize poverty as a powerful determinant of health, yet have expressed challenges in their ability to take meaningful action to address it (Cohen, 2006b; Reutter & Ford, 1996). The study sought insight into how Ontario public health units can strengthen PHNs socio-political efforts to address the causes of poverty. A qualitative descriptive design was used to explore PHNs’ views, while an Appreciative Inquiry approach was used to draw on participants’ successful past experiences in addressing the causes of poverty and their thoughts for the future. Organizational factors thought to empower PHNs’ socio-political efforts to address the causes of poverty were identified using Kanter’s Structural Theory of Power in Organizations as a starting conceptual framework. Fifteen PHNs participated in face-to-face or telephone interviews. Qualitative content analysis was used to describe participants’ affirmative experiences, empowering organizational attributes, and desired actions and supports for the future. Three overall themes emerged with respect to empowering organizational attributes: authorities within the health unit ‘permit and provide’, active associates ‘help each other out’, and external allies ‘contribute and collaborate’. Factors beyond the health unit that would support anti-poverty work were also identified. Findings suggested that action to address the causes of poverty is within the reach of PHNs, and is consistent with their role and the public health mandate, but requires leadership support and political buy-in in order to maximize its effectiveness.Master of Science (MSc
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