Defining quality of preventive oral health services in a northern First Nations community: a concept mapping study.

INTRODUCTION: In partnership with the Norway House Cree Nation (NHCN) in Manitoba, Canada, this study developed a framework based on how Indigenous parents/caregivers of young children and community-based oral health decision-makers perceive 'quality of preventive oral health services'. METHODS: Concept mapping was used to develop the 'quality of preventive oral health services' framework. This involved brainstorming/idea generation, sorting and rating, visual representation, and interpretation sessions with parents/caregivers (CG) and decision-makers (DM) in Norway House, Manitoba. Using the Concept System's GlobalMax software, a conceptual framework was created that was modified from input from CG and DM groups, which can be visualized through the concept map. RESULTS: The final concept map revealed seven domains of quality preventive oral health services: dental staff character and skills, working with community, responsibilities in preventive education, inclusive preventive oral health strategies, accessibility to appointments, logistics of providing services, and dental environment. CONCLUSION: This study provides insight into the existing gap in oral health services for Indigenous populations. Based on conversations and the concept mapping process, the developed framework can inform the steps to be taken to improve preventive oral health services for Indigenous peoples. The framework has been used to develop a quantitative scale to inform sustainable and impactful change in the quality of preventive oral health services that are meaningful to Indigenous peoples.

Using Concept Mapping to Define Indigenous Housing First in Hamilton, Ontario.

BACKGROUND: The lasting impact of colonization contributes to the disproportionate rates of homelessness experienced by Indigenous people in Canada. METHODS: This study used participatory mixed methods to evaluate an urban, Indigenous-led Housing First program in Ontario to fill knowledge gaps on wise practices addressing the unique dimensions of Indigenous homelessness. Using concept mapping, staff perspectives were engaged to generate 65 unique statements describing program delivery and their interrelationships using a six-cluster map. RESULTS: 'Team's Professional Skills' and 'Spiritual Practices' rated high in importance (mean = 4.75 and 4.73, respectively), and feasibility (mean = 4.31 and 4.33, respectively). While fairly important, 'Partnerships and Agency Supports' was ranked least feasible (mean = 3.89). On average, clusters rated higher in importance than feasibility. CONCLUSION: Concept mapping draws from local knowledge, elicits strong engagement, and captured the holistic and client-centred approach of an Indigenous Housing First Model.

Classism and Everyday Racism as Experienced by Racialized Health Care Users: A Concept Mapping Study.

In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic labor market racism has resulted in an overrepresentation of racialized groups in low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the health care system is structured around a model of service delivery and policies that fail to consider unequal power social relations or racism. This study examines how racialized health care users experience classism and everyday racism in the health care setting and whether these experiences differ within stratifications such as social class, gender, and immigration status. A concept mapping design was used to identify mechanisms of classism and everyday racism. For the rating activity, 41 participants identified as racialized health care users. The data analysis was completed using concept systems software. Racialized health care users reported "race"/ethnic-based discrimination as moderate to high and socioeconomic position-/social class-based discrimination as moderate in importance for the challenges experienced when receiving health care; differences within stratifications were also identified. To improve access to services and quality of care, antiracist policies that focus on unequal power social relations and a broader systems thinking are needed to address institutional racism within the health care system.

Experiences of everyday racism in Toronto's health care system: a concept mapping study.

BACKGROUND: In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS: This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS: Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS: Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study.

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.

Gender differences in felt stigma and barriers to help-seeking for problem gambling.

BACKGROUND: Men and women differ in their patterns of help-seeking for health and social problems. For people experiencing problem gambling, feelings of stigma may affect if and when they reach out for help. In this study we examine men's and women's perceptions of felt stigma in relation to help-seeking for problematic gambling. METHODS: Using concept mapping, we engaged ten men and eighteen women in group activities. We asked men and women about their perceptions of the pleasurable aspects and negative consequences of gambling; they generated a list of four hundred and sixteen statements. These statements were parsed for duplication and for relevance to the study focal question and reduced to seventy-three statements by the research team. We then asked participants to rate their perceptions of how much felt stigma (negative impact on one's own or family's reputation) interfered with help-seeking for gambling. We analyzed the data using a gender lens. FINDINGS: Men and women felt that shame associated with gambling-related financial difficulties was detrimental to help-seeking. For men, the addictive qualities of and emotional responses to gambling were perceived as stigma-related barriers to help-seeking. For women, being seduced by the 'bells and whistles' of the gambling venue, their denial of their addiction, their belief in luck and that the casino can be beat, and the shame of being dishonest were perceived as barriers to help-seeking. CONCLUSIONS: Efforts to engage people who face gambling problems need to consider gendered perceptions of what is viewed as stigmatizing.

Are residents of downtown Toronto influenced by their urban neighbourhoods? Using concept mapping to examine neighbourhood characteristics and their perceived impact on self-rated mental well-being.

BACKGROUND: There is ample evidence that residential neighbourhoods can influence mental well-being (MWB), with most studies relying on census or similar data to characterize communities. Few studies have actively investigated local residents' perceptions. METHODS: Concept mapping was conducted with residents from five Toronto neighbourhoods representing low income and non-low income socio-economic groups. These residents participated in small groups and attended two sessions per neighbourhood. The first session (brainstorming) generated neighbourhood characteristics that residents felt influenced their MWB. A few weeks later, participants returned to sort these neighbourhood characteristics and rate their relative importance in affecting residents' 'good' and 'poor' MWB. The data from the sorting and rating groups were analyzed to generate conceptual maps of neighbourhood characteristics that influence MWB. RESULTS: While agreement existed on factors influencing poor MWB (regardless of neighbourhood, income, gender and age), perceptions related to factors affecting good MWB were more varied. For example, women were more likely to rank physical beauty of their neighbourhood and range of services available as more important to good MWB, while men were more likely to cite free access to computers/internet and neighbourhood reputation as important. Low-income residents emphasized aesthetic attributes and public transportation as important to good MWB, while non-low-income residents rated crime, negative neighbourhood environment and social concerns as more important contributors to good MWB. CONCLUSION: These findings contribute to the emerging literature on neighbourhoods and MWB, and inform urban planning in a Canadian context.

Narcotic analgesic utilization amongst injured workers: using concept mapping to understand current issues from the perspectives of physicians and pharmacists.

BACKGROUND: Work-related injuries result in considerable morbidity, as well as social and economic costs. Pain associated with these injuries is a complex, contested topic, and narcotic analgesics (NA) remain important treatment options. Factors contributing to NA utilization patterns are poorly understood. This qualitative study sought to characterize the factors contributing to NA utilization amongst injured workers from the perspectives of physicians and pharmacists. METHODS: The study employed concept mapping methodology, a structured process yielding a conceptual framework of participants' views on a particular topic. A visual display of the ideas/concepts generated is produced. Eligible physicians and pharmacists (n = 22) serving injured workers in the province of Ontario (Canada) were recruited via purposive sampling, and participated in concept mapping activities (consisting of brainstorming, sorting, rating, and map exploration). Participants identified factors influencing NA utilization, and sorted these factors into categories (clusters). Next, they rated the factors on two scales: 'strength of influence on NA over-utilization' and 'amenability to intervention'. During follow-up focus groups, participants refined the maps and discussed the findings and their implications. RESULTS: 82 factors were sorted into 7 clusters: addiction risks, psychosocial issues, social/work environment factors, systemic-third party factors, pharmacy-related factors, treatment problems, and physician factors. These clusters were grouped into 2 overarching categories/regions on the map: patient-level factors, and healthcare/compensation system-level factors. Participants rated NA over-utilization as most influenced by patient-level factors, while system-level factors were rated as most amenable to intervention. One system-level cluster was rated highly on both scales (treatment problems - e.g. poor continuity of care, poor interprofessional communication, lack of education/support for physicians regarding pain management, unavailability of multidisciplinary team-based care, prolonged wait times to see specialists). CONCLUSIONS: Participants depicted factors driving NA utilization among injured workers as complex. Patient-level factors were perceived as most influential on over-utilization, while system-level factors were considered most amenable to intervention. This has implications for intervention design, suggesting that systemic/structural factors should be taken into account in order to address this important health issue.

Pathways connecting neighborhood influences and mental well-being: socioeconomic position and gender differences.

Few studies have explored how participant socioeconomic position (SEP) and gender is related to perceptions of the pathways connecting neighborhood influences and mental well-being. This research used the concept mapping method, an intensive structured conceptualization process that produces pictorial views of how concepts are connected and interrelated. Thirty-six low and non-low SEP men and women from Toronto, Canada participated in the concept mapping sessions. One hundred and twenty unique neighborhood characteristics were felt to be related to mental well-being and those items were grouped into six distinct clusters. Notable differences in cluster importance by participant SEP status were found. While no overall differences were observed for males verses females, further stratification by both participant SEP and gender suggested that gendered perceptions are not uniform. Participant-created diagrams illustrated how the cluster domains are related to each other and to good mental well-being. These findings are important for uncovering the mechanisms by which neighborhoods differentially affect the mental health of residents from different SEPs and genders.

Neighbourhoods and mental well-being: what are the pathways?

The last decade has seen an acceleration in research examining the impact of neighbourhood characteristics on a health outcomes. Yet, identifying specific pathways by which neighbourhoods affect mental well-being has received less attention. The article describes findings from a qualitative study conducted in Toronto, Ont., Canada, examining the pathways by which neighbourhood characteristics are related to mental well-being. Methods of concept mapping were used to answer our research questions. Participants identified over 100 neighbourhood characteristics grouped into six cluster that were important for either good or poor mental well-being. Clusters were rated in terms of their importance to mental well-being. Finally, participants drew diagrams describing how the neighbourhood factors and domains were contributing to poor and good mental well-being. Concept mapping provides unique contributions and challenges and may provide a useful means of examining specific pathways from neighbourhood to health outcomes.

Research note: ethics of drug treatment research with court-supervised subjects.

The last two decades have seen an acceleration of clinical research on, and treatment advances in, addictive illness. Much important research in this area requires the participation of subjects who themselves suffer from drug dependence and have a strong likelihood of becoming involved in the criminal justice system at some point. However, using court-supervised persons with addictive disorders in drug research raises a number of significant ethical issues. These include, among others, worries about the individual's ability to provide capable, voluntary, informed consent and the obligation of researchers to safeguard sensitive clinical information. A variety of potentially coercive factors can influence court-supervised persons in their decision whether to enter research and can compromise their ability to provide informed consent. In this paper, we explore the ethical issues arising in this research and offer some suggestions for approaches to address these concerns.