'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health.

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

Integrated knowledge translation guidelines for trainees in health research: an environmental scan.

BACKGROUND: Collaborative health research, such as integrated knowledge translation (IKT), requires researchers to have specific knowledge and skills in working in partnership with knowledge users. Graduate students are often not provided with the opportunity to learn skills in how to establish collaborative relationships with knowledge users in the health system or communities, despite its importance in research. The objective of this environmental scan is to identify available guidelines for graduate trainees to use an IKT approach in their research. METHODS: We conducted an environmental scan with three separate systematic searches to identify guidelines available to support graduate students in engaging in an IKT approach to research: (i) a customized Google search; (ii) a targeted Canadian university website search; and (iii) emails to administrators of graduate studies programmes asking for available guidelines and documents designed for graduate students. Data were extracted using a standardized data extraction tool and analysed using a directed content analysis approach. Due to the minimal results included based on the a priori eligibility criteria, we returned to the excluded records to further review the current state of the environment on trainee support for IKT research. RESULTS: Our search strategy yielded 22 900 items, and after a two-step screening process with strict inclusion criteria three documents met the eligibility criteria. All three documents highlighted the need for an IKT plan for knowledge user involvement throughout the research process. Furthermore, documents emphasized the need for tangible steps to guide graduate students to engage in effective communication with knowledge users. Due to the lack of documents retrieved, we conducted a post hoc content analysis of relevant IKT documents excluded and identified five themes demonstrating increased education and engagement in an IKT approach at an interpersonal and organizational level. CONCLUSION: We identified three documents providing guidance to trainees using a collaborative approach in their health research. This scan highlighted two key findings including the importance of supporting trainees to engage knowledge users in research and preparing an IKT plan alongside a research plan. Further research is needed to co-design guidelines to support graduate students and trainees in engaging in an IKT approach.

Attitudes Toward Influenza Vaccination Administration in the Emergency Department Among Patients: A Cross-Sectional Survey.

INTRODUCTION: Influenza is a serious, vaccine-preventable illness. The current vaccination rates in Canada are below target rates, highlighting the potential need for more convenient ways to receive vaccinations. Wait times to be seen in Canadian emergency departments are escalating, and using the time spent waiting to offer and administer an influenza vaccine could potentially improve ease of access to immunization for some Canadians. METHODS: The aim of this cross-sectional study was to gauge public interest and identify perceived barriers and facilitators to influenza vaccine availability in a Canadian emergency and trauma center. Anonymous questionnaires were completed by a convenience sample of adult patients classified as low acuity (n = 151) as 1 arm of a 2-arm study. RESULTS: Of the unvaccinated patients, 34.6% expressed willingness to be vaccinated in the emergency department. The patients who had received a vaccine in the previous year were significantly more willing to accept the vaccine in the emergency department (χ2 [1] = 23.78, P < 0.001). The 3 top factors associated with having received vaccination in the previous year include trust in vaccine information (χ2 [2] = 27.34, P < 0.001), immunity preferences (χ2 [2] = 32.25, P < 0.001), and beliefs about efficacy (χ2 [2] = 44.90, P < 0.001). DISCUSSION: Patients classified as low acuity were supportive of ED influenza vaccination. In addition, some of the unvaccinated participants had unmet education needs (ie, regarding trustworthy sources of vaccine information, immunity, and vaccine efficacy) that would require addressing before they would likely consider receiving influenza vaccination in future during their ED visit.

Attitudes Toward Influenza Vaccination Administration in the Emergency Department Among Health Care Providers: A Cross-Sectional Survey.

INTRODUCTION: Influenza is a burdensome and vaccine-preventable infectious disease. Lack of time was reported as a common barrier by Canadians who did not receive their influenza vaccine. Increasing convenient access to vaccination increases uptake, and a potential setting for vaccine administration is the emergency department, where long wait times are common. METHODS: A cross-sectional survey to gauge health care provider support and perceived barriers and facilitators to delivering influenza vaccine was conducted at 1 emergency and trauma center in Halifax, Nova Scotia. Anonymous questionnaires were completed by a convenience sample of emergency nurses, physicians, and paramedics (n = 82). RESULTS: In total, 86% (n = 68) of health care providers supported vaccination in the emergency department when sufficient staffing and resources were available. When asked to consider implementation of influenza vaccination in the emergency department based on current staffing and resources, only 59% (n = 48) supported making vaccination available. Most surveyed health care providers preferred screening for vaccination at triage (57%) and supported a nurse-initiated protocol for vaccine administration (74%). After Bonferroni correction, there was no significant association between preference for when to vaccinate and being a nurse or physician (χ2(2) = 6.208, P = 0.05). The highest risk patient groups with the lowest provider endorsement of vaccination were people involved in poultry culling (77%) and pregnant women (83%). DISCUSSION: Surveyed health care providers were supportive of ED influenza vaccination. However, this study revealed additional barriers that need to be addressed to effectively launch such a program.

Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel.

INTRODUCTION: University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students. METHODS: This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students' use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques. RESULTS: Key linkages between opportunity and motivation were found to influence students' access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use. CONCLUSIONS: This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students' use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students' sexual health behaviour.

Is physician dismissal of vaccine refusers an acceptable practice in Canada? A 2018 overview.

Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007. In light of the recent strengthening of Ontario's school immunization requirements that include stiffer steps to qualify for a medical, conscience, or religious belief exemption, physicians and health care workers may be under more pressure from vaccine refusers in their practice leading some to contemplate dismissal or even consider no longer offering immunizations at all in their practice. Given the challenges that vaccine refusers may present, we offer an overview for managing vaccine refusal by parents/patients in a medical practice.

Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model.

BACKGROUND: University students are within the age group at highest risk for acquiring sexually transmitted infections and other negative health outcomes. Despite the availability of sexual health services at university health centres to promote sexual health, many students delay or avoid seeking care. This study aimed to identify the perceived barriers and enablers to sexual health service use among university undergraduate students. METHODS: We used a qualitative descriptive design to conduct semi-structured focus groups and key informant interviews with university students, health care providers, and university administrators at two university health centres in Nova Scotia, Canada. The semi-structured focus group and interview guides were developed using the Theoretical Domains Framework and COM-B Model. Data were analyzed using a directed content analysis approach, followed by inductive thematic analysis. RESULTS: We conducted 6 focus groups with a total of 56 undergraduate students (aged 18-25) and 7 key informant interviews with clinicians and administrators. We identified 10 barriers and enablers to sexual health service use, under 7 TDF domains: knowledge; memory, attention and decision-making processes; social influences; environmental context and resources; beliefs about consequences; optimism; and emotion. Key linkages between students' social opportunity and motivation were found to influence students' access of sexual health services. CONCLUSIONS: We identified barriers and enablers related to students' capability, opportunity and motivation that influence sexual health service use. We will use these findings to design an intervention that targets the identified barriers and enablers to improve students' use of sexual health services, and ultimately, their overall health and well-being.

INCREASING THE REPRESENTATION OF THE BLACK POPULATION IN THE HEALTH PROFESSIONS IN CANADA.

Increased representation of the Black population in the health care system is central to decrease health disparities, enhance access to services, and improve health outcomes and quality of care. Current strategies for recruitment and retention of the Black population in higher education in the health fields are explored. The added value of mentorship programs are presented as a promising approach for addressing the high rates of attrition of the Black population in health professional education institutions.

Adverse event following immunization surveillance systems for pregnant women and their infants: a systematic review.

BACKGROUND: The World Health Organization's Strategic Advisory Group of Experts on Immunization has declared that maternal immunization is a key priority. Robust adverse event following immunization (AEFI) surveillance systems that capture outcomes in pregnant women and their infants are needed to ensure the safety of maternal immunization programs. We sought to identify the active and passive AEFI surveillance systems for pregnant women and their offspring described in the literature. METHODS: A systematic literature review was conducted of the MEDLINE, CINAHL, and EMBASE databases from 1990 to 2014. English-language articles were reviewed if they included pregnant women as the population of interest and described the surveillance method used. RESULTS: Of 619 articles retrieved from the search, 16 met the criteria for review. These included reports of AEFI surveillance for pregnant women, their offspring, or both. The majority of reports (11/16) came from the USA and described findings on two active and four passive AEFI surveillance systems, only three of which specifically targeted pregnant women. The remaining five articles described one-time AEFI surveillance programs, all in high-income countries. CONCLUSION: There are no published reports outside of the USA of ongoing AEFI surveillance systems that specifically target pregnant women or their offspring. There may be AEFI surveillance systems that capture events in these populations that have not been reported in the literature. A survey of immunization program managers and national regulatory authorities is needed to determine the current status of AEFI surveillance for pregnant women and their offspring globally.

Revisualising 'porn': how young adults' consumption of sexually explicit Internet movies can inform approaches to Canadian sexual health promotion.

The Internet offers an invaluable opportunity to re-imagine ideas, constructs and disciplines to create innovative sexual health promotion interventions. To gain insight into what young adults (aged 19-28) may be seeking in online sexual resources and approaches, this study explored how young people perceived their sexual health to be influenced by their consumption of the highly utilised sexual medium of Sexually Explicit Internet Movies [SEIM]. Employing an exploratory, qualitative methodology, data were collected through semi-structured interviews with 12 urban, heterosexual young adults, who self-identified as having consumed SEIM for a period of at least one year. All interviews were audiotaped with permission, transcribed verbatim and the data were analysed to identify emergent thematic concepts. Participants described utilising SEIM as an all-inclusive sexual forum to learn more about the positive aspects of sexual health, in a context that they viewed as being devoid of alternatives. Young adults' perceptions of the utility of SEIM suggest that it would be beneficial to create novel, sex-positive online sexual health interventions. Further exploration is clearly warranted on how Internet resources that are related to sexual health, such as SEIM, can be utilised to facilitate innovative approaches to online sexual health promotion.

Honouring Stories: Mi'kmaq Women's Experiences with Pap Screening in Eastern Canada.

Mi'kmaq women are reported to have lower rates of Papanicolaou (Pap) screening and higher rates of cervical cancer than non-Aboriginal women. This qualitative participatory study used postcolonial feminist perspectives and Indigenous principles to explore Mi'kmaq women's experiences with Pap screening within the contexts that shaped their experiences. Community facilitators assisted with the research process. Talking circles and individual in-depth interviews were conducted with 16 Mi'kmaq women. Also, health-care providers were interviewed in 2 Mi'kmaq communities. The findings indicate that historical and social contexts are shaping Mi'kmaq women's screening experiences and that these experiences are diverse, as are their understandings about screening. Some women were accessing regular screening despite challenging personal circumstances. The results highlight the need for nurses and other health-care providers to understand the uniqueness of each woman's experiences with Pap screening. Improvements in screening rates depend on multifaceted nursing approaches developed in partnership with Mi'kmaq women.

Selon les données, les Micmaques subissent le test de Papanicolaou (Pap) en plus petite proportion que les femmes non autochtones et présentent un taux plus élevé de cancer du col de l'utérus. La présente étude qualitative et participative adopte une approche féministe postcoloniale et s'appuie sur les principes autochtones pour examiner la façon dont les Micmaques vivent le dépistage du cancer du col de l'utérus (test de Pap), et les différents contextes où leur expérience de ce dépistage prend forme. Des animateurs communautaires ont pris part au processus de recherche. Des cercles de discussion et des entrevues individuelles approfondies ont eu lieu auprès de 16 Micmaques. Des fournisseurs de soins de santé ont également fait l'objet d'entrevues dans deux communautés micmaques. Les constatations indiquent que les contextes social et historique contribuent à façonner l'expérience vécue par les Micmaques au moment du test de Pap et que cette expérience varie, de même que la compréhension qu'ont les femmes du dépistage. Certaines femmes participent à un dépistage régulier, malgré une situation personnelle difficile. Les résultats obtenus font ressortir la nécessité pour les infirmières et les autres fournisseurs de soins de santé de comprendre le caractère unique de l'expérience de dépistage vécue par chaque femme. L'amélioration des taux de dépistage est tributaire de la mise en place d'approches à multiples facettes des soins infirmiers élaborées en partenariat avec les Micmaques.

University Students' Sexual Health Knowledge: A Scoping Literature Review.

Sexual health plays an important role in the well-being of university students. The literature shows that the majority of university undergraduates are sexually active and at high risk of contracting sexually transmitted infections (STIs); however, the breadth and degree of the literature on their sexual health knowledge is unclear. The purpose of this scoping review was to gain a deeper understanding of the state of research on the sexual health knowledge of university/college students globally. A 5-stage framework was used to guide the review and to characterize the literature on sexual health knowledge. Articles published in English between 2000 and 2014 were reviewed if they included university students as a population of interest and described the methods used to measure sexual health knowledge. Of the 2,386 articles retrieved, 91 met the criteria. The majority of the articles (n = 79) used a cross-sectional design to investigate students' knowledge about HIV/AIDS (n = 45), STIs (n = 23), HPV (n = 9), and contraception (n = 24). The review highlights gaps in the literature and in findings relating to the research dominance of various geographic locations, common research designs, the wide range of measurement tools used, and the variety of sexual health knowledge outcomes of interest. The review provides a useful description of the literature on sexual health knowledge among university/college students and some recommendations for moving the field forward.

La santé sexuelle joue un rôle important dans le bien-être des étudiants universitaires. La littérature indique que la majorité des étudiants de premier cycle sont actifs sexuellement et présentent un risque élevé de contracter une infection transmissible sexuellement (ITS). Toutefois, l'étendue et la profondeur des études et travaux de recherche sur la connaissance que possède cette population des questions de santé sexuelle demeurent mal connues. L'objectif de la présente revue de la littérature est de mieux comprendre l'état actuel de la recherche sur la connaissance qu'ont les étudiants universitaires et de niveau collégial à l'échelle mondiale des questions de santé sexuelle. Un cadre d'analyse en cinq étapes a été utilisé pour orienter l'exercice d'examen et caractériser la littérature quant à la question des connaissances relatives à la santé sexuelle. Un corpus d'articles publiés en anglais entre 2000 et 2014 a été évalué de manière à repérer les études ayant comme population cible les étudiants universitaires et proposant une méthode pour mesurer les connaissances de cette population en matière de santé sexuelle. Parmi les 2 386 articles évalués, 91 répondaient à ces critères. La majorité d'entre eux (n = 79) s'appuyaient sur un modèle d'étude transversale pour examiner les connaissances des étudiants concernant le VIH/sida (n = 45), les ITS (n = 23), le virus du papillome humain (n = 9) et la contraception (n = 24). Cette revue de la littérature a permis de relever des lacunes dans les études et travaux de recherche ainsi que dans leurs conclusions concernant la prédominance de certaines régions géographiques dans la recherche, la présence de modèles de recherche communs, la grande diversité des outils de mesure utilisés et la variété des résultats liés aux connaissances en matière de santé sexuelle ciblés par les études. L'article fournit une description utile de la littérature touchant la question des connaissances en matière de santé sexuelle chez les étudiants universitaires ou de niveau collégial et formule certaines recommandations afin de contribuer à la progression de ce domaine de recherche.

Exploring the Meaning of Sexuality, the Body, and Identity After Birth Using Feminist Poststructuralism.

OBJECTIVE: To explore how sexual health in the postpartum period is influenced by and negotiated through relations of power. DESIGN: Discourse analysis informed by feminist poststructuralism. SETTING: Telephone interviews conducted in Nova Scotia, Canada. PARTICIPANTS: Eleven women who gave birth in the last 1 to 6 months and lived in Nova Scotia. METHODS: We recruited participants through social media and invited them to share their experiences after birth through individual interviews. Using Baxter's approach to discourse analysis, we focused on identifying how participants created meaning within their experiences. RESULTS: We identified two main themes: Negotiating Change and Renegotiating Identity. Participants defined their bodies in new ways that could be sexual and/or nonsexual and created new meaning(s) of their identities as mothers and as sexual beings after birth. CONCLUSION: The meaning of the body and identity are intricately connected and significantly affect how sexual health is experienced by women during the first 6 months after birth. As such, it is critical that care providers prioritize, acknowledge, and validate how women in the postpartum period choose to define their sexuality, identity, and bodies to ensure the provision of person-centered care.

Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study.

Background: School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views. Study design: Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023. Methods: The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. Results: Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. Conclusions: We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.

Identifying H1N1 and COVID-19 vaccine hesitancy or refusal among health care providers: a scoping review.

OBJECTIVES: The objective of this review was to describe and map the evidence on COVID-19 and H1N1 vaccine hesitancy or refusal by physicians, nurses, and pharmacists in North America, the United Kingdom and the European Union, and Australia. INTRODUCTION: Since 2009, we have experienced two pandemics: H1N1 "swine flu" and COVID-19. While severity and transmissibility of these viruses varied, vaccination has been a critical component of bringing both pandemics under control. However, uptake of these vaccines has been affected by vaccine hesitancy and refusal. The vaccination behaviors of health care providers, including physicians, nurses, and pharmacists, are of particular interest as they have been priority populations to receive both H1N1 and COVID-19 vaccinations. Their vaccination views could affect the vaccination decisions of their patients. INCLUSION CRITERIA: Studies were eligible for inclusion if they identified reasons for COVID-19 or H1N1 vaccine hesitancy or refusal among physicians, nurses, or pharmacists from the included countries. Published and unpublished literature were eligible for inclusion. Previous reviews were excluded; however, the reference lists of relevant reviews were searched to identify additional studies for inclusion. METHODS: A search of CINAHL, MEDLINE, PsycINFO, and Academic Search Premier databases was conducted April 28, 2021, to identify English-language literature published from 2009 to 2021. Gray literature and citation screening were also conducted to identify additional relevant literature. Titles, abstracts, and eligible full-text articles were reviewed in duplicate by 2 trained reviewers. Data were extracted in duplicate using a structured extraction tool developed for the review. Conflicts were resolved through discussion or with a third team member. Data were synthesized using narrative and tabular summaries. RESULTS: In total, 83 articles were included in the review. Studies were conducted primarily across the United States, the United Kingdom, and France. The majority of articles (n=70) used cross-sectional designs to examine knowledge, attitudes, and uptake of H1N1 (n=61) or COVID-19 (n=22) vaccines. Physicians, medical students, nurses, and nursing students were common participants in the studies; however, only 8 studies included pharmacists in their sample. Across health care settings, most studies were conducted in urban, academic teaching hospitals, with 1 study conducted in a rural hospital setting. Concerns about vaccine safety, vaccine side effects, and perceived low risk of contracting H1N1 or COVID-19 were the most common reasons for vaccine hesitancy or refusal across both vaccines. CONCLUSIONS: With increased interest and attention on vaccines in recent years, intensified by the COVID-19 pandemic, more research that examines vaccine hesitancy or refusal across different health care settings and health care providers is warranted. Future work should aim to utilize more qualitative and mixed methods research designs to capture the personal perspectives of vaccine hesitancy and refusal, and consider collecting data beyond the common urban and academic health care settings identified in this review.

Identifying and addressing the impacts of the COVID-19 pandemic on school-based immunisation programmes in the Canadian Maritimes: a mixed methods study protocol.

INTRODUCTION: The COVID-19 pandemic highlighted the importance of keeping up to date on routine vaccinations. Throughout the pandemic, many routine vaccine programmes in Canada were paused or cancelled, including school-based immunisation programmes (SBIP). This resulted in decreased coverage for many vaccine-preventable diseases. While the effects of the pandemic on SBIP have been described in other provinces, its effects in the Maritime region (ie, Nova Scotia, New Brunswick and Prince Edward Island) have yet to be understood. We aim to determine how these programmes were affected by COVID-19 and associated public health measures in the Canadian Maritimes by (1) identifying and describing usual and interim catch-up programmes; (2) exploring stakeholders' perceptions of SBIP through interviews; and (3) designing recommendations with stakeholders to address gaps in SBIP and vaccine coverage. METHODS AND ANALYSIS: A sequential, explanatory mixed methods study design will be used to address the objectives during the study period (September 2022-December 2023). First, an environmental scan will describe changes to SBIP and vaccine coverage over a period of five school years (2018/2019-2022/2023). Findings will inform semistructured interviews (n=65) with key stakeholders (eg, health officials, healthcare providers, school officials and parents and adolescents) to explore perceptions of SBIP and changes in parental vaccine hesitancy during the pandemic. These data will be integrated to design recommendations to support SBIP during two stakeholder engagement meetings. Analysis will be guided by the behaviour change wheel, a series of complementary tools and frameworks to simplify behaviour diagnosis and analysis in public health research. ETHICS AND DISSEMINATION: Ethics approval for this study has been obtained from Dalhousie University's Health Sciences Research Ethics Board (Ref: 2022-6395). Informed consent will be obtained from participants prior to participating in an interview or stakeholder engagement meeting. Study findings will be disseminated through conference presentations, publications and infographics.

From high hopes to disenchantment: A qualitative analysis of editorial cartoons on COVID-19 vaccines in Canadian newspapers.

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake.

Ill-informed consent? A content analysis of physical risk disclosure in school-based HPV vaccine programs.

OBJECTIVES: This study examines the accuracy, completeness, and consistency of human papilloma virus (HPV) vaccine related physical risks disclosed in documents available to parents, legal guardians, and girls in Canadian jurisdictions with school-based HPV vaccine programs. DESIGN AND SAMPLE: We conducted an online search for program related HPV vaccine risk/benefit documents for all 13 Canadian jurisdictions between July 2008 and May 2009 including follow-up by e-mail and telephone requests for relevant documents from the respective Ministries or Departments of Health. The physical risks listed in the documents were compared across jurisdictions and against documents prepared by the vaccine manufacturer (Merck Frosst Canada), the National Advisory Committee on Immunization (NACI), the Society of Obstetricians and Gynecologists of Canada (SOGC), and a 2007 article in Maclean's Magazine. RESULTS: No jurisdiction provided the same list of vaccine related physical risks as any other jurisdiction. Major discrepancies were identified. CONCLUSIONS: Inaccurate, incomplete, and inconsistent information can threaten the validity of consent/authorization and potentially undermine trust in the vaccine program and the vaccine itself. Efforts are needed to improve the quality, clarity, and standardization of the content of written documents used in school-based HPV vaccine programs across Canada.

Identifying COVID-19 and H1N1 vaccination hesitancy or refusal among health care providers across North America, the United Kingdom, Europe, and Australia: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe and map the evidence on COVID-19 and H1N1 vaccination hesitancy or refusal among physicians, nurses, and pharmacists across North America, the United Kingdom, Europe, and Australia. INTRODUCTION: When global pandemics occur, including the coronavirus (COVID-19) pandemic, which originated in 2020, and the swine flu influenza pandemic (H1N1) of 2009, there is increased pressure for pharmaceutical companies and government agencies to develop safe and effective vaccines against these highly contagious illnesses. Following development and approvals, it then becomes essential that priority populations, including frontline health care providers, opt to receive these vaccinations to prevent illness and potential transmission to their patients. However, vaccine hesitancy or refusal has played a significant role in suboptimal vaccination rates globally. As health care providers, including physicians, nurses, and pharmacists, often administer vaccines, their vaccination views and behaviors are of great importance because they can directly affect the vaccination decisions of their patients. INCLUSION CRITERIA: The review will identify factors affecting COVID-19 and H1N1 vaccine hesitancy or refusal among physicians, nurses, and pharmacists across a range of countries. Published and unpublished evidence, including quantitative, qualitative, mixed methods research, and gray literature, will be eligible for inclusion. METHODS: This scoping review protocol will follow JBI methodology. The search strategy will be developed with support from a health sciences librarian scientist to identify relevant evidence. Screening and data extraction will be conducted by two reviewers, with findings summarized and presented through narrative descriptions, tables, and figures.

Nova Scotia Strong: why communities joined to embrace COVID-19 public health measures.

OBJECTIVE: To explore Nova Scotian experiences, barriers, and facilitators associated with pandemic public health measures (PHM), including COVID-19 vaccination. METHODS: We conducted semi-structured, individual interviews with Nova Scotians between May and August 2021, during the third wave of COVID-19 cases and provincial lockdown. Participants were recruited across the province from three sectors: decision makers, community leaders, and community members using purposive and snowball sampling. Direct content analysis and thematic analysis were used to identify key themes via the Theoretical Domains Framework. RESULTS: The experiences of 30 Nova Scotian interviewees clustered around four themes: Communication of PHM, Responsibly Observing PHM: A Community Coming Together, Navigating PHM, and Vaccine Confidence & Hesitancy. Consistent communication of PHM through briefings with the chief medical officer of health and provincial channels reduced misinformation and encouraged PHM compliance. While adherence was high throughout the province, inconsistent enforcement of these measures proved challenging to individuals navigating PHMs. A high level of COVID-19 vaccine confidence and acceptance was identified, and a strong sense of provincial pride prevailed in keeping COVID-19 numbers and transmission low. CONCLUSION: This study provides insights into Nova Scotians' unique experiences with COVID-19 PHM. Provincial public health experts and government leaders communicated PHM with various levels of success, Nova Scotia Strong, a sentiment of unity and communitarianism that sprang from public response to tragic events. Future work should aim to include under-represented communities to facilitate broader inclusion.

RéSUMé: OBJECTIF: Explorer les expériences des Néo-Écossais et les éléments qui entravent ou qui favorisent les mesures sanitaires pandémiques (MSP), dont la vaccination contre la COVID-19, en Nouvelle-Écosse. MéTHODE: Nous avons mené des entretiens individuels semi-directifs avec des Néo-Écossais entre mai et août 2021, au cours de la troisième vague de cas de COVID-19 et de confinement dans la province. Des participants de trois groupes (décideurs, responsables locaux et résidents) ont été recrutés dans toute la province à l'aide de sondages intentionnels et cumulatifs. Nous avons utilisé l'analyse directe de contenu et l'analyse thématique pour cerner les principaux thèmes à l'aide du cadre des domaines théoriques (cadre TDF). RéSULTATS: Les expériences des 30 Néo-Écossais interrogés s'articulaient autour de quatre thèmes : Communication des MSP, Observance responsable des MSP : une communauté qui se rassemble, S'y retrouver dans le dédale des MSP et Confiance envers les vaccins et hésitation vaccinale. La communication cohérente des MSP lors des breffages du médecin-hygiéniste en chef et par les canaux provinciaux a réduit la mésinformation et encouragé l'observance des MSP. Cette observance était élevée à l'échelle de la province, mais l'application incohérente des mesures a rendu difficile pour les gens de s'y retrouver dans le dédale des MSP. Un niveau élevé de confiance et d'acceptation des vaccins contre la COVID-19 a été observé, et un profond sentiment de fierté provinciale a pris le dessus pour réduire le nombre de cas et la transmission de la COVID-19. CONCLUSION: Cette étude vient éclairer les expériences uniques des Néo-Écossais face aux MSP liées à la COVID-19. Les spécialistes provinciaux de la santé publique et les chefs du gouvernement ont communiqué les MSP de façon coordonnée et ont bénéficié du sentiment d'unité et de l'esprit communautaire (Nova Scotia Strong) qui ont émergé dans la population à la suite d'autres tragédies. Les démarches futures devraient chercher à inclure les communautés sous-représentées.