Comparing urban and rural young adult cancer survivors' experiences: a qualitative study.

INTRODUCTION: Large administrative data set analyses demonstrate that geography has a significant impact on access to health care and subsequent health outcomes. In general, rural populations have poorer access to healthcare services. This article explores the reality of this issue for young adult cancer survivors. METHODS: Data was of a subset of 30 participants from a larger qualitative study that examined cancer survivorship issues for young adult cancer patients in Canada. The subset of participants are from New Brunswick, a predominantly rural province in Eastern Canada with a population of 750,000 spread out over a large geographical area, and from Canada's largest metropolis center, Greater Toronto Area, with a population of around 6 million. RESULTS: Analysis of the qualitative data using constructivist grounded theory revealed several expected and unexpected differences between the two geographically distinct groups. The rural group of young adult cancer survivors reported more frequent episodes of delayed diagnosis and lower levels of community support compared to the urban participants. The urban young adult cancer survivors discussed out-of-pocket expenses for cancer treatment more often than the rural participants. Many rural participants made it clear that they were keenly aware that not all cancer care services were readily available where they lived, and yet they reported considerably higher levels of satisfaction with the cancer care that they received than the urban participants. CONCLUSION: Despite the lack of important cancer services in rural areas, rural young adult cancer survivors expressed higher levels of satisfaction with their care than did urban cancer survivors. It appears that levels of satisfaction are related to expectations. Rural participants were aware of the more limited services available and felt that their cancer care practitioners provided the best care possible given the limited resources. Urban participants may have higher expectations of cancer care and felt that the cancer care they received fell below expectations. In the future, researchers may want to focus on cancer care expectations, satisfaction levels and psychosocial outcomes in greater detail.

A survey of Canadian websites providing information about female urinary incontinence.

OBJECTIVE: Urinary incontinence (UI) is a prevalent health issue that has significant detrimental effects on quality of life. The Internet offers a unique vehicle for incontinent women to access information that could facilitate conservative self-help therapy. An evaluation of Canadian websites offering female UI information was conducted to determine their quality and readability. METHODS: We evaluated websites using published general quality criteria for health sites and a quality assessment tool compiled by the authors for specific UI information derived from published, peer-reviewed clinical practice guidelines. Three health care professionals reviewed sites for quality, Canadian content, and interactivity. The readability of health information was also evaluated. RESULTS: Fifty-six Canadian sites (18 professional, 22 organizational, 16 commercial) were evaluated. Significant agreement was found among the raters' evaluations on all measures. For all sites, the mean scores were general quality, 9/14; specific UI quality, 30/122; reading ease, 37/100; grade level, 10.9. The median score for Canadian content was high, but for interactivity it was low. The only significant difference between site types was for general quality (F [2,165]=3.38, P=0.036). Post hoc Tukey's tests showed a significant difference between organizational and commercial sites, with organizational sites having higher general quality. CONCLUSION: Canadian websites providing female UI information have moderately high general quality, low specific UI information quality, minimal interactivity, and more than minimal Canadian content. The reading level of most sites is too high for average consumers. A webliography of the best sites has been developed to guide patients.

Promoting multidisciplinary relationships: a pragmatic framework for helping service providers to work collaboratively.

Multidisciplinary teamwork is increasingly considered the ideal way to provide mental health services. This is especially the case when working with children or families. However, there is little easy-to-use information available to help practicing professionals recognize and overcome barriers to working in multidisciplinary settings. There are even fewer resources intended for use across disiplines. This paper offers a practical approach to help mental health professionals identify barriers to teamwork and create solutions to those barriers.

Female urinary incontinence health education on the Internet: pitfalls and opportunities.

The prevalence and demographics of urinary incontinence (UI) in Canada demand new initiatives to provide both health education and care to the growing number of incontinent women. The Internet, and the Web sites on it, offer an opportunity to provide information on female UI health to patients, health-care professionals, and other caregivers in a time and location convenient to them. Internet usage in Canada is increasing, and women are more likely than men to access Web health information. However, problems such as access to reliable health information do exist, as the quality of Web sites and the information on them varies from excellent to poor. Potential quality control mechanisms include codes of conduct, quality labels, user guides, and filtering systems, but there is uncertainty about which method is best. As the Internet precipitates a shift in care toward prevention of disease, and enhancement of health, a new role for health professionals emerges: to educate patients about and guide them to wise use of the Internet.

Welfare babies: poor children's experiences informing healthy peer relationships in Canada.

Positive peer relationships among children living in poverty are important for their well-being, resiliency and mental and physical health. This paper explicates the 'felt experience' of children living in poverty, and the implications of these experiences for healthy peer relationships, from a re-analysis of two qualitative research studies in Canada examining children living in food insecure circumstances. Poor children feel deprived, part of the 'poor group', embarrassed, hurt, picked on, inadequate and responsible. Poor children internalize their own lack of social resources in feelings of deprivation. They experience negative feelings relative to their peers-inadequacy, embarrassment and hurt. Children do identify group membership but it is not used as a social resource, as it could be, but rather as a symbol of social segregation. Children also feel responsible for ameliorating some of the effects of their poverty and this seems to strengthen their relationship with their mothers. This could equally be translated into peer-related support, such as standing up to poor bashing, or engaging constructively with higher social class peers. Health promotion strategies that seek to foster positive peer relationships and enhance children's sense of belonging should offer novel social environments in which poor children can engage a variety of peers.