Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence. / Tendances et motivations associées à la polyconsommation de substances : une revue rapide des données qualitatives.

INTRODUCTION: Polysubstance use-the use of substances at the same time or close in time-is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use. METHODS: We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar. RESULTS: We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria ("high"). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Self-medication for a pre-existing condition was also the intention behind sequential or simultaneous use. CONCLUSION: Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis.

Revisiting the Innovation Strategy performance measurement process: insights from practice.

Performance measurement (PM) aims to ensure transparency and effectiveness in public spending. More specifically, it provides a foundation that allows funders to determine whether an intervention has achieved its stated objective, thus improving understanding of what interventions should be funded in the future. Ideally, performance measurement should help us understand "what works, for whom, and in what context." Unfortunately, more often than not, performance reports are limited to a collection of indicators that make it difficult to answer this question. Based on our work with the Public Health Agency of Canada Innovation Strategy (PHAC-IS), we offer several recommendations to address this issue and support the performance measurement process, especially for complex interventions. We discuss the importance of contextualizing results to better understand impact and associating these results to a well-defined intervention. We also suggest using a validated tool to improve data collection and analysis and critically appraise the methods used to collect impact information. The integration of these key considerations will save time in data analysis and ensure funded recipients are not overburdened by the data collection process. Although this commentary is presented within the context of a complex multi-year population health funding program, we believe our approach can be applied to any performance management process and ultimately improve decisions such as whether an intervention should be continued, scaled up, or adapted to different contexts.

RéSUMé: La mesure du rendement vise à garantir la transparence et l'efficacité des dépenses publiques. Plus précisément, elle fournit une base qui permet aux bailleurs de fonds de déterminer si une intervention a atteint son objectif énoncé, améliorant ainsi la compréhension des interventions qui devraient être financées à l'avenir. Idéalement, la mesure du rendement devrait nous aider à comprendre « ce qui fonctionne, pour qui et dans quel contexte ¼. Malheureusement, la plupart du temps, les rapports sur le rendement se limitent à un ensemble d'indicateurs qui font en sorte qu'il est difficile de répondre à cette question. Sur la base de notre travail avec la Stratégie d'innovation de l'Agence de la santé publique du Canada (SI de l'ASPC), nous proposons plusieurs recommandations pour traiter cette question et soutenir le processus de mesure du rendement, en particulier pour les interventions complexes. Nous discutons de l'importance de contextualiser les résultats pour mieux comprendre les répercussions et d'associer ces résultats à une intervention bien définie. De plus, nous suggérons également d'utiliser un outil validé pour améliorer la collecte et l'analyse des données, et évaluer de manière critique les méthodes utilisées pour recueillir les renseignements sur les répercussions. L'intégration de ces considérations clés permettra de gagner du temps dans l'analyse des données et garantira que les bénéficiaires financés ne seront pas surchargés par le processus de collecte de données. Bien que le présent commentaire soit présenté dans le contexte d'un programme pluriannuel complexe en matière de financement de la santé de la population, nous pensons que notre approche peut être appliquée à tout processus de gestion du rendement et, en fin de compte, améliorer les décisions visant à déterminer si une intervention devrait être poursuivie, étendue à plus grande échelle ou adaptée à différents contextes.

Supporting Indigenous families in the Cree territory: lessons from the  Mashkûpímâtsît Awash initiative.

OBJECTIVE: We describe the adaptation of an early childcare and development program to the Indigenous context of the Cree territory in Québec. We also share lessons on the challenging implementation of home visits by Indigenous family support workers (FSWs), which is a critical component of the intervention. PARTICIPANTS: Â Mashkûpímâtsît Awash (AMA) aims to enhance the health and well-being of pregnant mothers, young children, and their families by providing intensive interdisciplinary care and follow-up. Indigenous female FSWs from the community are the key frontline workers and cornerstone of the program. SETTING: AMA is implemented as part of the multidisciplinary services provided by the Community Miyupimaatisiiun Centres (primary health care centres) in three pilot communities of Eeyou Istchee. INTERVENTION: AMA builds on family centredness and cultural safety, integration of services, and creation of family-friendly communities. It emphasizes the role of female local Indigenous FSWs in providing culturally safe outreach services in the form of home visits. OUTCOMES: The main challenge was conducting home visits. FSWs' view of the pertinence of home visits, as well as their personal stories, seemed to influence their motivation to conduct home visits. Their level of experience appeared to facilitate home visits. Encouraging creativity, fostering autonomy, ensuring a step-by-step implementation, and promoting communication were found to create a supporting environment to facilitate home visits. IMPLICATIONS: Hiring local Indigenous workers is necessary to ensure that early childhood development programs are culturally safe. Success of such programs relies on team management, provision of culturally adapted training, and quality of the ongoing emotional support provided to the FSWs.

Collaborative development and implementation of a knowledge brokering program to promote research use in Burkina Faso, West Africa.

Despite efforts expended over recent decades, there is a persistent gap between the production of scientific evidence and its use. This is mainly due to the difficulty of bringing such knowledge to health workers and decision-makers so that it can inform practices and decisions on a timely basis. One strategy for transferring knowledge to potential users, that is, gaining increasing legitimacy, is knowledge brokering (KB), effectiveness of which in certain conditions has been demonstrated through empirical research. However, little is known about how to implement such a strategy, especially in the African context. The KB program presented here is aimed specifically at narrowing the gap by making scientific knowledge available to users with the potential to improve health-related practices and decision making in Burkina Faso. The program involves Canadian and African researchers, a knowledge broker, health practitioners, and policy-makers. This article presents the collaborative development of the KB strategy and the evaluation of its implementation at year 1. The KB strategy was developed in stages, beginning with a scoping study to ensure the most recent studies were considered. Two one-day workshops were then conducted to explore the problem of low research use and to adapt the strategy to the Burkinabè context. Based on these workshops, the KB program was developed and brokers were recruited and trained. Evaluation of the program's implementation after the first year showed that: 1) the preparatory activities were greatly appreciated by participants, and most considered the content useful for their work; 2) the broker had carried out his role in accordance with the logic model; and 3) this role was seen as important by the participants targeted by the activities and outputs. Participants made suggestions for program improvements in subsequent years, stressing particularly the need to involve decision-makers at the central level.