Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study.

BACKGROUND: Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. OBJECTIVE: This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. METHODS: An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. RESULTS: Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as "eating bitterness," and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as "better than nothing;" it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. CONCLUSIONS: Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing "trickle-up" adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions.

The relationship between religious service attendance and coronary heart disease and related risk factors in Saskatchewan, Canada.

Research suggests that attending religious services could provide small yet important protective benefits against coronary heart disease (CHD) and CHD risk factors (e.g., diabetes, hypertension). The extent to which these benefits apply to Canada deserves study because approximately one-third of adult Canadians attend religious services at least monthly. Therefore, the objective of this study is to examine the association between frequency of religious service attendance and prevalence of (1) CHD, (2) diabetes, and (3) hypertension in Canada. We used the Saskatchewan sample (n = 5,442) of the Canadian Community Health Survey (CCHS-4.1) and built multivariable logistic regression models to evaluate associations between religious service attendance and self-reported CHD, diabetes, and hypertension. After controlling for demographic, socioeconomic and health behavior variables, the association between religious service attendance and prevalence of CHD was not significant (OR = 0.82; 95 % CI 0.61-1.11). However, persons who attended religious services more than once a week exhibited lower prevalence odds of diabetes (OR = 0.60; 95 % CI 0.45-0.80) and hypertension (OR = 0.82; 95 % CI 0.68-0.99) compared to persons who attended less than once a year. The findings of this study are the first to suggest religious service attendance may be associated with a lower prevalence of CHD risk factors in Canada.

Attending religious services and its relationship with coronary heart disease and related risk factors in older adults: a qualitative study of church pastors' and parishioners' perspectives.

A qualitative study was undertaken to explain findings of a cross-sectional study of Canadian Community Health Survey (CCHS) 4.1 data showing older persons who attend religious services more than once a week, compared to persons who do not attend at all, have lower prevalences of coronary heart disease (CHD), diabetes and high blood pressure. Twelve semi-structured interviews with ordained pastors and three focus groups with older parishioners from Canadian churches were conducted. Interviews were transcribed and analyzed for emergent themes through a process of direct content analysis. All participants claimed that religious service attendance (RSA): (1) enhances mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours that lower CHD risk. These three themes appear to be underlying mechanisms that help to explain the inverse association between RSA and the prevalence of adverse health outcomes found in the CCHS 4.1 data.

Beyond the Body: Using Photovoice to Explore Social Determinants of Diabetes With South Asian Adolescents in the Peel Region of Ontario, Canada.

OBJECTIVES: The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities. METHODS: In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups. RESULTS: Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures. CONCLUSIONS: Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.

User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study.

BACKGROUND: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. OBJECTIVE: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. METHODS: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. RESULTS: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants' desires for relationality, accountability, and care. CONCLUSIONS: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing.

Embedding anti-racism in Schools of Public Health: a pathway to accountability for progress towards equity.

The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.

RéSUMé: L'importance de voir la race comme une idée socialement construite continue de produire des différences inéquitables entre les gens et d'établir des relations de pouvoir qui mènent à l'injustice et à l'exposition à la mort. Depuis que le mouvement pour la justice raciale s'est enclenché au début de 2020, il existe une conscience aiguë des disparités raciales historiques entre les écoles de santé publique (ESP) du Canada et un intérêt accru pour le redressement de ces disparités. Des mesures ont été prises pour reconnaître le racisme systémique et accroître la diversité par des réformes structurelles visant à promouvoir l'équité et l'inclusion; cependant, pour aborder le racisme, il faut collectivement arracher les modèles institutionnels racistes qui font encore partie intégrante de l'apprentissage, de l'enseignement, de la recherche, des services et de la participation de la communauté. Dans notre commentaire, nous soulignons le besoin d'un engagement soutenu à établir des repères longitudinaux pour une plus grande équité raciale dans la population étudiante, au sein du personnel et dans le corps professoral, à revoir les programmes d'études pour y inclure les discours historiques et contemporains du colonialisme et de l'esclavage, et à offrir des possibilités d'enseignement faisant appel aux communautés, car elles contribueront à démanteler les moteurs systémiques des iniquités raciales en santé à l'échelle locale et mondiale. Nous promulguons aussi la collaboration intersectorielle, l'apprentissage mutuel et le partage des ressources entre les ESP et les organismes partenaires afin de concrétiser un plan d'action collective continue en faveur de l'équité raciale en santé et de l'inclusion ­ un plan qui sera intersectionnel au Canada et qui rendra des comptes aux communautés autochtones et racisées.

Poor health disparities among racialized students in a Canadian university.

OBJECTIVE: The short report aims to examine differences in self-rated general health across racialized post-secondary students at a university in Ontario, Canada. METHODS: Binary logistic regression analysis was used to examine poor health as an outcome among racialized students as whole, as well as across Asian, South Asian, Afro-Caribbean and Middle Eastern student groups in comparison to white Caucasian post-secondary students. RESULTS: After adjusting for several covariates, racialized students as a whole had 2.43 times the odds of reporting poor general health compared to white Caucasian students. Asian (OR = 2.77; CI = 1.84-4.18; p < 0.05) and South Asian (OR = 2.52; CI = 1.56-4.08; p < 0.05) students were significantly more likely to report poor health compared to white Caucasian students. CONCLUSION: The findings call for further attention to the health needs of racialized post-secondary students living in Canada and creating campuses where diverse student populations feel safe and systemically included.

One Size Does Not Fit All: Diabetes Prevalence Among Immigrants of the South Asian Diaspora.

The risk of diabetes is higher in South Asians compared to the general population. As a result of migration during the twentieth-century postindependence, the South Asian diaspora is incredibly vast. We examined the diabetes prevalence between groups of the South Asian diaspora based on their distinct migration patterns. Population-based health care and immigration administrative data were used to compare crude and standardized diabetes prevalence between immigrants from nine regions of the South Asian diaspora and the non-immigrant population. Diabetes prevalence across groups were also stratified by gender. There were 199,003 South Asian immigrants; 33,882 (crude prevalence of 17.0%) of whom had a diagnosis of diabetes. The nine subgroups varied significantly in the prevalence of diabetes after adjusting for age, sex and income: Sri Lanka 24.3%, Pakistan 22.2%, Fiji 21.5%, Bangladesh 20.7%, the Caribbean 20.4%, India 16.0%, East Africa 13.8%, South Africa 10.8%, and the Middle East 9.6% in comparison to the non-immigrant population 17.8%. Higher prevalence was evident among men compared with women in each subgroup with the exception of Pakistan. Diabetes prevalence is not uniform among South Asians. Our findings highlight potential impacts of their unique migration histories on the risk and burden of diabetes, and move beyond a one size fits all approach in the South Asian population of Ontario to develop targeted interventions.

An Ecological Exploration of Facilitators to Participation in a Mosque-Based Physical Activity Program for South Asian Muslim Women.

BACKGROUND: This descriptive qualitative study informed by an ecological framework explored factors influencing South Asian Muslim women's decisions to participate in a mosque-based physical activity intervention. METHODS: Individual, face-to-face, semistructured interviews were conducted in English, Hindi, or Urdu with 12 South Asian Muslim women at their home or mosque in Ontario, Canada. All interviews were audio-recorded, transcribed verbatim and managed, sorted, and analyzed for themes through a process of descriptive analysis. RESULTS: The participants described as follows: (1) intrapersonal facilitators, which included their feelings, beliefs, and motivations to continue with this intervention; (2) interpersonal facilitators detailing the support that they had received from others during the intervention; and (3) environmental facilitators, which highlighted convenience and access to physical activity opportunities in a local community setting. CONCLUSION: This intervention displayed how South Asian Muslim women were motivated to continue with the mosque-based physical activity intervention due to interpersonal, intrapersonal, and environmental facilitators. The findings can be used to increase further understanding of how mosques may provide culturally and religiously sensitive contexts for physical activity interventions for South Asian Muslim women.

A Pilot Examination of a Mosque-Based Physical Activity Intervention for South Asian Muslim Women in Ontario, Canada.

Low levels of physical activity have been reported in South Asian Muslim women. Mosques could be beneficial in providing physical activity opportunities for Muslim women. This study examined the feasibility, acceptability and effectiveness of a mosque-based physical activity program for South Asian Muslim women in Canada. Sixty-two South Asian Muslim women participated in a 24-week mosque-based exercise intervention. Feasibility, acceptability and effectiveness of the program was evaluated by pre-post survey questions from the Duke Activity Status Index (DASI) and International Physical Activity Questionnaire among 28 women who consented to the research data collection. Nineteen women were assessed pre-and post-intervention. The women demonstrated increase in median scores of self-efficacy (90 pre vs. 100 post; p = 0.004) and the importance of engaging in regular physical activity (90 pre vs. 100 post; p = 0.01). Fewer participants were classified as inactive at the end of the intervention (42 % pre vs. 10 % post; p = 0.006). There was a mean increase in DASI scores (39.2 pre vs. 44.6 post; p = 0.06) reflecting an improvement in peak aerobic capacity and functional quality of life. Culturally relevant structured networks such as mosques are important assets when designing healthy lifestyle interventions for South Asian Muslim women.

Reported Health Behaviour Changes after a Diagnosis of Gestational Diabetes Mellitus among Ethnic Minority Women Living in Canada.

The aim of this cross-sectional study was to examine differences in health behaviours among ethnic minority and Caucasian women after a diagnosis of gestational diabetes mellitus (GDM). Data were derived from medical charts and a questionnaire among a multi-ethnic cohort of 898 Canadian pregnant women diagnosed with GDM attending prenatal diabetes clinics in Ontario, Canada. Health behaviours were compared between ethnic minority and Caucasian women, adjusting for relevant covariates. The mean age was 33.9 ± 6.1 years; 60.0 % self-reported to be part of an ethnic minority group. After adjustment for socio-demographic, behavioural and clinical characteristics, ethnic minority women were more likely to report reducing their meal portion sizes (odds ratio [OR] 1.98; 95.0 % confidence interval [CI] 1.20-3.26) and increasing their physical activity (OR 1.71; 95.0 % CI 1.12-2.62) in response to a GDM diagnosis compared to Caucasian women. Ethnic minority women were more likely to report changes in health behaviours after a GDM diagnosis. Further research is needed to determine the impact of these findings on maternal health and perinatal outcomes, during and after delivery.

Differences in the Prevalence of Overweight Between 10-12-Year-old South Asian and Non-South Asian Children in Toronto, Ontario: Findings from Project BEAT.

OBJECTIVE: The objective of this study is to assess the prevalence of overweight among 10-12-year-old South Asian children in comparison to non-South Asian children. METHODS: This cross-sectional study obtained data from 16 schools in Toronto, Ontario. The analysis included 734 children (260 South Asian and 475 non-South Asian) aged 10-12 years. Height and weight were measured, and body mass index (BMI; kg/m(2)) was calculated according to age- and sex-specific cut points established by the International Obesity Task Force (IOTF). RESULTS: The prevalence of overweight was significantly higher among South Asian children when compared to non-South Asian children (36.9 vs. 23.0 %; p < 0.001). Unadjusted, South Asian children exhibited increased odds for being overweight (OR = 1.96; CI = 1.41-2.73; p < 0.001) compared to non-South Asian children and persisted after the adjustment for socio-demographic covariates but did not remain significant after the inclusion of physical activity and sedentary behaviour variables. The adjusted odds for being overweight was significantly higher among South Asian boys (but not girls) compared to their non-South Asian counterparts (OR = 2.45; CI = 1.32-4.55; p < 0.0001). CONCLUSIONS: The prevalence of overweight differs by ethnic group and gender. South Asian boys have increased odds of being overweight compared to non-South Asian boys. Children of South Asian origin should receive focused attention in public health initiatives to reduce the risk of becoming overweight and the associated metabolic consequences.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model.

PURPOSE: To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches. DESIGN: The study used qualitative methods comprising semistructured interviews and focus groups. SETTING: The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario. PARTICIPANTS: Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults. METHODS: Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data. RESULTS: Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches. CONCLUSION: The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design.

AIMS: Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study. METHODS: The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change. CONCLUSIONS: Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.

Cultural beliefs and coping strategies related to childhood cancer: the perceptions of South Asian immigrant parents in Canada.

The purpose of this study is to describe cultural beliefs and coping strategies related to dealing with childhood cancer identified through a qualitative study of the caregiving experiences of first-generation South Asian immigrant parents of children with cancer. A constructivist grounded theory approach was employed. Families with a child at least 6 months postdiagnosis were recruited from 5 Canadian pediatric oncology centers. In-depth semistructured interviews were conducted in English, Hindi, Punjabi, or Urdu with a sample of 25 South Asian parents. Analysis of interviews involved line-by-line coding and using the constant comparison method. The following 2 central themes related to culture and coping emerged: (a) cultural beliefs about childhood cancer being incurable, rare, unspeakable, and understood through religion and (b) parental coping strategies included gaining information about the child's cancer, practicing religious rituals and prayers, trusting the health care professionals, and obtaining mutual support from other South Asian parents. These cultural beliefs and coping strategies have important implications for health care providers to understand the variations in the perceptions of childhood cancer and coping in order to implement culturally sensitive health care services.

Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: a qualitative study.

PURPOSE: South Asians experience high rates of cardiovascular disease, yet participate in cardiac rehabilitation (CR) at low rates. Drawing on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, this qualitative descriptive study sought to identify cultural factors facilitating South Asians' participation in CR programs. METHODS: Two semistructured interviews were conducted with each of 16 Canadian South Asian participants enrolled in a 12-month CR program. Transcribed data were analyzed for common themes, and categorized in terms of predisposing, enabling, and reinforcing factors. RESULTS: Primary cultural facilitators included descriptions of CR as a "medically supervised" program, family and physician support, and previous knowledge of CR via members of the South Asian community. CONCLUSION: Previous research identified barriers to CR participation in the South Asian community, and this study is the first to identify facilitators. Results suggest that families should be included in patient-education sessions, CR should be reinforced by healthcare providers, and the provider team should recognize cultural preferences.