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1.
CMAJ ; 195(7): E259-E266, 2023 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-36810223

RESUMO

BACKGROUND: Uptake of the SARS-CoV-2 vaccine for children aged 5-11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, parental decisions regarding vaccinations have not been studied in-depth. We sought to explore reasons why parents chose to vaccinate or not vaccinate their children against SARS-CoV-2 to better understand their decisions. METHODS: We conducted a qualitative study involving in-depth individual interviews with a purposive sample of parents in the Greater Toronto Area, Ontario, Canada. We conducted interviews via telephone or video call from February to April 2022 and analyzed the data using reflexive thematic analysis. RESULTS: We interviewed 20 parents. We found that parental attitudes toward SARS-CoV-2 vaccinations for their children represented a complex continuum of concern. We identified 4 cross-cutting themes: the newness of SARS-CoV-2 vaccines and the evidence supporting their use; the perceived politicization of guidance for SARS-CoV-2 vaccination; the social pressure surrounding SARS-CoV-2 vaccinations; and the weighing of individual versus collective benefits of vaccination. Parents found making a decision about vaccinating their child challenging and expressed difficulty sourcing and evaluating evidence, determining the trustworthiness of guidance, and balancing their own conceptions of health care decisions with societal expectations and political messaging. INTERPRETATION: Parents' experiences making decisions regarding SARS-CoV-2 vaccination for their children were complex, even for those who were supportive of SARS-CoV-2 vaccinations. These findings provide some explanation for the current patterns of uptake of SARS-CoV-2 vaccination among children in Canada; health care providers and public health authorities can consider these insights when planning future vaccine rollouts.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Criança , SARS-CoV-2 , Vacinação , Pais , Ontário , Conhecimentos, Atitudes e Prática em Saúde
2.
AIDS Care ; 35(8): 1091-1099, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36942573

RESUMO

Levels of HIV stigma remain high, however there is a limited understanding around how different types of stigma interact to impact health. This study uses data from two time points to examine how enacted and internalized stigma lead to worse health through anticipated stigma as a mediator. We recruited 341 participants in Ontario, Canada to complete the HIV Stigma Index survey at baseline (t1) from September 2018 to August 2019 and follow up (t2) approximately two years later. Mediation models were created with enacted and internalized stigma at t1 as the antecedents, anticipated stigma at t2 as the mediator, and physical health, mental health, and overall health at t2 as the outcomes. Only the model with internalized stigma (t1) as the antecedent had anticipated stigma (t2) as a significant mediator contributing to both decreased mental and overall health. This highlights the need to address internalized stigma and the potential for anticipated stigma interventions to be effective at improving the health and wellbeing of people living with HIV.


Assuntos
Infecções por HIV , Humanos , Estigma Social , Saúde Mental , Inquéritos e Questionários , Ontário
3.
BMC Public Health ; 23(1): 888, 2023 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-37189052

RESUMO

INTRODUCTION: Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to understand factors to consider for the design of naloxone distribution programs in point-of-care settings from the point of view of community stakeholders. METHODS: We hosted a multi-stakeholder co-design workshop to elicit suggestions for a naloxone distribution program. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a full-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. RESULTS: A total of twenty-four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling revealed seven considerations for the design of naloxone distribution programs specific to training needs and the provision of naloxone, these are: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. CONCLUSION: To create an naloxone distribution program in emergency departments, family practice and substance use treatment services, stigma is a central design consideration for training and naloxone kits. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.


Assuntos
Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Overdose de Opiáceos/complicações , Overdose de Opiáceos/tratamento farmacológico , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/prevenção & controle , Serviço Hospitalar de Emergência , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Analgésicos Opioides/uso terapêutico
4.
Health Expect ; 25(5): 2440-2452, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35909312

RESUMO

INTRODUCTION: Overdose education and naloxone distribution (OEND) programmes equip and train people who are likely to witness an opioid overdose to respond with effective first aid interventions. Despite OEND expansion across North America, overdose rates are increasing, raising questions about how to improve OEND programmes. We conducted an iterative series of codesign stakeholder workshops to develop a prototype for take-home naloxone (THN)-kit (i.e., two doses of intranasal naloxone and training on how to administer it). METHODS: We recruited people who use opioids, frontline healthcare providers and public health representatives to participate in codesign workshops covering questions related to THN-kit prototypes, training on how to use it, and implementation, including refinement of design artefacts using personas and journey maps. Completed over 9 months, the workshops were audio-recorded and transcribed with visible results of the workshops (i.e., sticky notes, sketches) archived. We used thematic analyses of these materials to identify design requirements for THN-kits and training. RESULTS: We facilitated 13 codesign workshops to identify and address gaps in existing opioid overdose education training and THN-kits and emphasize timely response and stigma in future THN-kit design. Using an iterative process, we created 15 prototypes, 3 candidate prototypes and a final prototype THN-kit from the synthesis of the codesign workshops. CONCLUSION: The final prototype is available for a variety of implementation and evaluation processes. The THN-kit offers an integrated solution combining ultra-brief training animation and physical packaging of nasal naloxone to be distributed in family practice clinics, emergency departments, addiction medicine clinics and community settings. PATIENT OR PUBLIC CONTRIBUTION: The codesign process was deliberately structured to involve community members (the public), with multiple opportunities for public contribution. In addition, patient/public participation was a principle for the management and structuring of the research team.


Assuntos
Medicina do Vício , Overdose de Drogas , Overdose de Opiáceos , Humanos , Naloxona/uso terapêutico , Medicina de Família e Comunidade , Antagonistas de Entorpecentes/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Serviço Hospitalar de Emergência
5.
Healthc Q ; 24(SP): 86-92, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35467517

RESUMO

Equity-Mobilizing Partnerships in Community (EMPaCT) is a novel approach to patient engagement that centres diverse lived experiences and promotes equity-oriented and inclusive partnerships. As an independent community table, EMPaCT is made up primarily of patients/diverse members of community. Researchers and other decision makers come to this table with their projects to learn how to make their project more inclusive and equitable. In this paper, we detail how we used participatory co-design to define, build and grow EMPaCT as an innovative and scalable patient partnership model that promotes bottom-up action for health equity.


Assuntos
Equidade em Saúde , Pesquisa Participativa Baseada na Comunidade , Promoção da Saúde , Humanos , Participação do Paciente , Pesquisadores
6.
BMC Public Health ; 21(1): 1595, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496825

RESUMO

BACKGROUND: Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. METHODS: We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. RESULTS: In the multiple regression analysis, internalized stigma (coefficient = -0.20, p < 0.01) and depression (coefficient = -0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = -0.08, se = 0.03, 95% CI (-0.14, -0.02)] and depression [coefficient = -0.16, se = 0.03, 95% CI (-0.22, -0.11)]. CONCLUSIONS: We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one's HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.


Assuntos
Depressão , Infecções por HIV , Depressão/epidemiologia , Humanos , Ontário/epidemiologia , Preconceito , Estigma Social
7.
BMC Cancer ; 19(1): 264, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30909874

RESUMO

BACKGROUND: Multiple myeloma is a haematological malignancy characterized by significant morbidity and mortality. This study sought to develop an in-depth understanding of patients' lived experiences of relapsed or refractory multiple myeloma (RRMM) and its treatment, and to identify which features of treatment were most important to them. METHODS: Qualitative interviews and focus groups (FGs) were conducted with 32 people living with RRMM across Canada. In Phase 1, interviews focused on participants' accounts of their experiences with the disease and its treatment and laid the groundwork for the FGs (Phase 2). The FGs developed a deeper understanding of patients' treatment priorities. Interview and FG transcripts were coded for emergent themes and patterns. RESULTS: The interviews identified important side effects that had significant impacts on patients' lives, including physical, cognitive, and psychological/emotional side effects. Participants also identified specific treatment features (attributes) that were important to them. These were compiled into a list and used in the FGs to understand patients' priorities. Higher prioritized attributes were: life expectancy, physical and cognitive side effects, and financial impact. Mode of administration, treatment intervals, psychological side effects, and sleep/mood effects were identified as lower priorities. CONCLUSIONS: RRMM and its treatments impact importantly on patients' quality-of-life across a range of domains. Patients prioritized treatment features that could enhance life expectancy, minimize side effects and offset financial burdens. IMPLICATIONS FOR CANCER SURVIVORS: A clear articulation of patient priorities can contribute to efforts to design treatment with patients' concerns in mind, thereby promoting a more patient-centered approach to care.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Mieloma Múltiplo/tratamento farmacológico , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/psicologia , Pesquisa Qualitativa , Recidiva
8.
Qual Health Res ; 27(12): 1765-1774, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28936929

RESUMO

Critical qualitative health researchers typically occupy and navigate liminal academic spaces and statuses, with one foot planted in the arts and social sciences and the other in biomedical science. We are at once marginalized and empowered, and this liminality presents both challenges and opportunities. In this article, we draw on our experiences of being (often the lone) critical qualitative health scholars on thesis advisory committees and dissertation examinations, as well as our experiences of publishing and securing funding, to illuminate how power and knowledge relations create conditions that shape the nature of our roles. We share strategies we have developed for standing our theoretical and methodological ground. We discuss how we use the power of our liminality to hold firm, push back, and push forward, to ensure that critical qualitative research is not further relegated to the margins and its quality and integrity sustained.


Assuntos
Pesquisa sobre Serviços de Saúde , Poder Psicológico , Pesquisa Qualitativa , Dissertações Acadêmicas como Assunto , Docentes de Medicina , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/normas , Humanos , Publicações , Apoio à Pesquisa como Assunto
10.
PLoS Med ; 11(2): e1001588, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24505216

RESUMO

BACKGROUND: Printed educational materials for clinician education are one of the most commonly used approaches for quality improvement. The objective of this pragmatic cluster randomized trial was to evaluate the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes. METHODS AND FINDINGS: All 933,789 people aged ≥40 years with diagnosed diabetes in Ontario, Canada were studied using population-level administrative databases, with additional clinical outcome data collected from a random sample of 1,592 high risk patients. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The primary outcome in the administrative data study, death or non-fatal myocardial infarction, occurred in 11,736 (2.5%) patients in the intervention group and 11,536 (2.5%) in the control group (p = 0.77). The primary outcome in the clinical data study, use of a statin, occurred in 700 (88.1%) patients in the intervention group and 725 (90.1%) in the control group (p = 0.26). Pre-specified secondary outcomes, including other clinical events, processes of care, and measures of risk factor control, were also not improved by the intervention. A limitation is the high baseline rate of statin prescribing in this population. CONCLUSIONS: The educational toolkit did not improve quality of care or cardiovascular outcomes in a population with diabetes. Despite being relatively easy and inexpensive to implement, printed educational materials were not effective. The study highlights the need for a rigorous and scientifically based approach to the development, dissemination, and evaluation of quality improvement interventions. TRIAL REGISTRATION: http://www.ClinicalTrials.gov NCT01411865 and NCT01026688.


Assuntos
Técnicas de Apoio para a Decisão , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/terapia , Educação Médica Continuada/métodos , Infarto do Miocárdio/prevenção & controle , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Adulto , Idoso , Algoritmos , Atitude do Pessoal de Saúde , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/etiologia , Complicações do Diabetes/mortalidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Medicina de Família e Comunidade , Feminino , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Ontário , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
BMC Med Inform Decis Mak ; 14: 117, 2014 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-25495847

RESUMO

BACKGROUND: Management of diabetes mellitus is complex and involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. The objective of this study was to determine the effect of a web-based patient self-management intervention on psychological (self-efficacy, quality of life, self-care) and clinical (blood pressure, cholesterol, glycemic control, weight) outcomes. METHODS: For this cohort study we used repeated-measures modelling and qualitative individual interviews. We invited patients with type 2 diabetes to use a self-management website and asked them to complete questionnaires assessing self-efficacy (primary outcome) every three weeks for nine months before and nine months after they received access to the website. We collected clinical outcomes at three-month intervals over the same period. We conducted in-depth interviews at study conclusion to explore acceptability, strengths and weaknesses, and mediators of use of the website. We analyzed the data using a qualitative descriptive approach and inductive thematic analysis. RESULTS: Eighty-one participants (mean age 57.2 years, standard deviation 12) were included in the analysis. The self-efficacy score did not improve significantly more than expected after nine months (absolute change 0.12; 95% confidence interval -0.028, 0.263; p = 0.11), nor did clinical outcomes. Website usage was limited (average 0.7 logins/month). Analysis of the interviews (n = 21) revealed four themes: 1) mediators of website use; 2) patterns of website use, including role of the blog in driving site traffic; 3) feedback on website; and 4) potential mechanisms for website effect. CONCLUSIONS: A self-management website for patients with type 2 diabetes did not improve self-efficacy. Website use was limited. Although its perceived reliability, availability of a blog and emailed reminders drew people to the website, participants' struggles with type 2 diabetes, competing priorities in their lives, and website accessibility were barriers to its use. Future interventions should aim to integrate the intervention seamlessly into the daily routine of end users such that it is not seen as yet another chore.


Assuntos
Informação de Saúde ao Consumidor/normas , Diabetes Mellitus Tipo 2/terapia , Qualidade de Vida , Autocuidado/métodos , Apoio Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Informação de Saúde ao Consumidor/métodos , Informação de Saúde ao Consumidor/estatística & dados numéricos , Feminino , Humanos , Internet/estatística & dados numéricos , Entrevistas como Assunto , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Ontário , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , Autoeficácia , Adulto Jovem
12.
BMC Med Inform Decis Mak ; 14: 60, 2014 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-25056379

RESUMO

BACKGROUND: To design and test a web-based self-management tool for patients with type 2 diabetes for its usability and feasibility. METHODS: An evidence-based, theory-driven website was created for patients with type 2 diabetes. Twenty-three patients with type 2 diabetes aged ≥ 25 years were recruited from 2 diabetes care centers in Toronto, Canada. We employed focus group methodology to assess acceptability, sustainability, strengths and weaknesses of the self-management website. Based on these results, revisions were made to the website. Three cycles of individual usability testing sessions using cognitive task analysis were conducted with patients with type 2 diabetes. Revisions to the website were made based on results from this testing. RESULTS: We identified five themes concerning participants' experiences of health care and related unmet needs: 1) Desire for information and for greater access to timely and personalized care to gain a sense of control of their disease; 2) Desire for community (sharing experiences with others) to fulfill practical and emotional needs; 3) Potential roles of an online self-management website in self-empowerment, behavior change, self-management and health care delivery; 4) Importance of a patient-centered perspective in presenting content (e.g. common assumptions, medical nomenclature, language, messaging, sociocultural context); 5) Barriers and facilitators to use of a self-management website (including perceived relevance of content, incorporation into usual routine, availability for goal-directed use, usability issues). CONCLUSIONS: Participants outlined a series of unmet health care needs, and stated that they wanted timely access to tailored knowledge about their condition, mechanisms to control and track their disease, and opportunities to share experiences with other patients. These findings have implications for patients with type 2 diabetes of diverse ages, socioeconomic backgrounds, and disease severity, as well as to the design of other computer-based resources for chronic disease management.


Assuntos
Diabetes Mellitus Tipo 2/reabilitação , Gerenciamento Clínico , Aplicações da Informática Médica , Autocuidado , Adulto , Diabetes Mellitus Tipo 2/psicologia , Estudos de Viabilidade , Humanos , Internet , Pessoa de Meia-Idade , Autoeficácia , Apoio Social
13.
Can J Public Health ; 115(1): 40-52, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37796366

RESUMO

OBJECTIVE: To examine factors associated with COVID-19 vaccination (time to vaccination and vaccination status) among healthy young children participating in primary healthcare. METHODS: A cohort study was conducted between November 2021 and September 2022 through the TARGet Kids! primary care research network in Toronto, Canada. Sociodemographic information, child and parent health characteristics, parental vaccine beliefs and child COVID-19 vaccine uptake were collected through parent-reported questionnaires. The primary outcome was time to child COVID-19 vaccination, measured as the time between vaccine availability date and parent-reported child COVID-19 vaccination date. Interval-censored proportional hazard models were used. RESULTS: A total of 267 children age 0 to 13 years were included. The mean child age was 7.6 years, 52.8% (n = 141) were male, 66.5% (n = 141) had mothers of European ethnicity (with missingness), and 68.2% (n = 182) of the children were vaccinated. All parents of vaccinated children had received the COVID-19 vaccination themselves. The rate of vaccination for children was 2% higher with each one-month increase in child age (adjusted HR = 1.02, 95%CI = 1.01-1.03, p < 0.001). Compared to children whose parents had uncertain beliefs, those whose parents had positive beliefs about the importance and safety of COVID-19 vaccination for their children had higher rates of vaccination (adjusted HR = 8.29, 95%CI = 4.25-16.17, p < 0.001; adjusted HR = 5.09, 95%CI = 3.17-8.17, p < 0.001). CONCLUSION: Older child age, parental COVID-19 vaccination, and positive parental beliefs about COVID-19 vaccination were statistically significantly associated with COVID-19 vaccination among healthy young children. Our findings may help to inform policies, practices, and research which aim to strengthen parental vaccine confidence and promote child COVID-19 vaccination.


RéSUMé: OBJECTIF: Examiner les facteurs associés à la vaccination contre la COVID-19 (délai de vaccination et statut vaccinal) chez de jeunes enfants en bonne santé recevant des soins de santé primaires. MéTHODE: Une étude de cohorte a été menée entre novembre 2021 et septembre 2022 par le réseau de recherche en soins primaires TARGet Kids! à Toronto, au Canada. Des données sur le profil sociodémographique, les caractéristiques de santé des enfants et des parents, les convictions parentales à l'égard de la vaccination et la vaccination des enfants contre la COVID-19 ont été recueillies au moyen de questionnaires remplis par les parents. Le résultat principal était le délai de vaccination des enfants contre la COVID-19, mesuré comme étant le temps écoulé entre la date de disponibilité d'un vaccin et la date de vaccination de l'enfant contre la COVID-19 déclarée par le parent. Des modèles de risques proportionnels censurés par intervalle ont été utilisés. RéSULTATS: En tout, 267 enfants de 0 à 13 ans ont été inclus. Ils avaient 7,6 ans en moyenne, 52,8% (n = 141) étaient des garçons, 66,5% (n = 141) avaient une mère d'origine ethnique européenne (avec des données manquantes), et 68,2% (n = 182) étaient vaccinés. Tous les parents des enfants vaccinés étaient eux-mêmes vaccinés contre la COVID-19. Le taux de vaccination des enfants augmentait de 2 % pour chaque mois d'augmentation de l'âge des enfants (rapport de risques instantanés [RRI] ajusté = 1,02, intervalle de confiance [IC] de 95% = 1,01­1,03, p < 0,001). Comparativement aux enfants dont les parents étaient incertains dans leurs convictions, ceux dont les parents croyaient en l'importance et en l'innocuité de la vaccination contre la COVID-19 pour leurs enfants avaient des taux de vaccination plus élevés (RRI ajusté = 8,29, IC de 95% = 4,25­16,17, p < 0,001; RRI ajusté = 5,09, IC de 95% = 3,17­8,17, p < 0,001). CONCLUSION: L'âge plus avancé des enfants, la vaccination parentale contre la COVID-19 et les convictions parentales positives à l'égard de la vaccination contre la COVID-19 présentaient une corrélation significative avec la vaccination contre la COVID-19 chez les jeunes enfants en bonne santé. Nos constats pourraient contribuer à éclairer les politiques, les pratiques et la recherche visant à renforcer la confiance parentale en la vaccination et à promouvoir la vaccination des enfants contre la COVID-19.


Assuntos
COVID-19 , Vacinas , Criança , Feminino , Humanos , Masculino , Pré-Escolar , Adolescente , Recém-Nascido , Lactente , Vacinas contra COVID-19 , Estudos de Coortes , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação , Pais
14.
Implement Sci Commun ; 5(1): 25, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500183

RESUMO

BACKGROUND: The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. METHODS: An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. RESULTS: Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. CONCLUSIONS: We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

15.
BMJ Open ; 14(7): e081694, 2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39025822

RESUMO

OBJECTIVES: Parents' decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians' perspectives on COVID-19 vaccinations for children or their experiences counselling parents in their decision-making. We explored physicians' experiences providing COVID-19 vaccination recommendations to parents and their reflections on the contextual factors that shaped these experiences. DESIGN: We conducted an interpretive qualitative study using in-depth interviews. We analyzed the data using reflexive thematic analysis and a socioecological framework. SETTING: This study involved primary care practices associated with The Applied Research Group for Kids (TARGet Kids!) primary care research network in the Greater Toronto Area, Ontario, Canada. PARTICIPANTS: Participants were 10 primary care physicians, including family physicians, paediatricians and paediatric subspecialists. RESULTS: Participants discussed elements at the individual level (their identity, role, and knowledge), the interpersonal level (their relationships with families, responsiveness to parents' concerns, and efforts to build trust) and structural level (contextual factors related to the evolving COVID-19 climate, health system pandemic response, and constraints on care delivery) that influenced their experiences providing recommendations to parents. Our findings illustrated that physicians' interactions with families were shaped by a confluence of their own perspectives, their responses to parents' perspectives, and the evolving landscape of the broader pandemic. CONCLUSIONS: Our study underscores the social and relational nature of vaccination decision-making and highlights the multiple influences on primary care physicians' experiences providing COVID-19 vaccination recommendations to parents. Our findings offer suggestions for future COVID-19 vaccination programmes for children. Delivery of new COVID-19 vaccinations for children may be well suited within primary care offices, where trusting relationships are established, but physicians need support in staying knowledgeable about emerging information, communicating available evidence to parents to inform their decision-making and dedicating time for vaccination counselling.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Pais , Pesquisa Qualitativa , SARS-CoV-2 , Humanos , Ontário , COVID-19/prevenção & controle , Pais/psicologia , Feminino , Criança , Masculino , Vacinação/psicologia , Tomada de Decisões , Atitude do Pessoal de Saúde , Médicos de Atenção Primária/psicologia , Relações Profissional-Família , Entrevistas como Assunto , Adulto
16.
BMC Med Inform Decis Mak ; 13: 76, 2013 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-23883430

RESUMO

BACKGROUND: Following the completion of treatment and as they enter the follow-up phase, breast cancer patients (BCPs) often recount feeling 'lost in transition', and are left with many questions concerning how their ongoing care and monitoring for recurrence will be managed. Family physicians (FPs) also frequently report feeling ill-equipped to provide follow-up care to BCPs. In this three-phase qualitative pilot study we designed, implemented and evaluated a multi-faceted survivorship care plan (SCP) to address the information needs of BCPs at our facility and of their FPs. METHODS: In Phase 1 focus groups and individual interviews were conducted with 35 participants from three stakeholder groups (BCPs, FPs and oncology specialist health care providers (OHCPs)), to identify specific information needs. An SCP was then designed based on these findings, consisting of both web-based and paper-based tools (Phase 2). For Phase 3, both sets of tools were subsequently evaluated via focus groups and interviews with 26 participants. Interviews and focus groups were audio taped, transcribed and content analysed for emergent themes and patterns. RESULTS: In Phase 1 patients commented that web-based, paper-based and human resources components were desirable in any SCP. Patients did not focus exclusively on the post-treatment period, but instead spoke of evolving needs throughout their cancer journey. FPs indicated that any tools to support them must distill important information in a user-friendly format. In Phase 2, a pilot SCP was subsequently designed, consisting of both web-based and paper-based materials tailored specifically to the needs of BCPs as well as FPs. During Phase 3 (evaluation) BCPs indicated that the SCP was effective at addressing many of their needs, and offered suggestions for future improvements. Both patients and FPs found the pilot SCP to be an improvement from the previous standard of care. Patients perceived the quality of the BCP-FP relationship as integral to their comfort with FPs assuming follow-up responsibilities. CONCLUSIONS: This pilot multi-component SCP shows promise in addressing the information needs of BCPs and the FPs who care for them. Next steps include refinement of the different SCP components, further evaluation (including usability testing), and planning for more extensive implementation.


Assuntos
Neoplasias da Mama/psicologia , Continuidade da Assistência ao Paciente , Serviços de Informação/provisão & distribuição , Avaliação das Necessidades , Médicos de Família/psicologia , Sobreviventes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/prevenção & controle , Canadá , Comunicação , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente/organização & administração , Projetos Piloto , Pesquisa Qualitativa
17.
BMJ Open ; 13(4): e060699, 2023 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-37185194

RESUMO

INTRODUCTION: Placenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals at high risk of major haemorrhage during the third stage of labour. Current research reports on PAS disorder outcomes have highly variable levels of information, which is therefore difficult for investigators to aggregate to inform practice. There is an urgent need to harmonise data collection in prospective studies to identify and implement best practices for management. One approach to standardise outcomes across any health area via the use of core outcome sets (COSs), which are consensus-derived standardised sets of outcomes that all studies for a particular condition should measure and report. This protocol outlines the steps for developing a COS for PAS disorder (COPAS). METHODS AND ANALYSIS: This protocol outlines steps for the creation of COPAS. The first step, a systematic review, will identify all reported outcomes in the scientific literature. The second step will use qualitative one-on-one interviews to identify additional outcomes identified as important by patients and healthcare professionals that are not reported in the published literature. Outcomes from the first two steps will be combined to form an outcome inventory. This outcome inventory will inform the third step which is a Delphi survey that encourages agreement between patients and healthcare professionals on which outcomes are most important for inclusion in the COS. The fourth step, a consensus group meeting of representative participants, will finalise outcomes for inclusion in the PAS disorder COS. ETHICS AND DISSEMINATION: This study has obtained Research Ethics Board approval from Sunnybrook Health Sciences Centre (#2338, #1488). We will aim to publish the study findings in an international peer-reviewed OBGYN journal. REGISTRATION DETAILS: COMET Core Outcome Set Registration: https://www.comet-initiative.org/Studies/Details/1127. PROSPERO REGISTRATION NUMBER: CRD42020173426.


Assuntos
Placenta Acreta , Projetos de Pesquisa , Gravidez , Feminino , Humanos , Placenta Acreta/terapia , Estudos Prospectivos , Avaliação de Resultados em Cuidados de Saúde/métodos , Atenção à Saúde , Técnica Delphi , Resultado do Tratamento , Revisões Sistemáticas como Assunto
18.
BMC Med Res Methodol ; 12: 92, 2012 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-22747922

RESUMO

BACKGROUND: Dialogue is a foundational feature of social life and an important way in which we come to understand one another. In situations of controversy dialogue is often absent because of a range of social barriers. We have developed a new film-based qualitative research method for studying controversial issues in healthcare and social policy. We call this method Brokered Dialogue. Theoretically informed by the traditions in narrative inquiry and visual anthropology, the method is premised on the idea that dialogue possesses features making it unique as a generator of new knowledge and opportunities for social intervention. Film is not only an extraordinarily rich data source, but an excellent medium for knowledge transfer and dissemination. DISCUSSION: The paper introduces the Brokered Dialogue method. We outline its critical steps, including the procedures for sampling, data collection and data analysis of both textual and visual data. Participants in a Brokered Dialogue engage in filmed interviews that capture their perspectives on a given topic; they then share their perspectives with, and pose questions of, one another through the medium of film. Using a participatory editing process, only footage that participants feel comfortable showing to others is incorporated. This technique offers participants a 'safe' space for respectful interaction. The editing process itself is analytic, and the final assembly of footage approximates a dialogue on the topic at hand. A link to a film produced from a project piloting the method is provided to demonstrate its real world application. SUMMARY: Brokered Dialogue is a method for promoting respectful interactions among those with seemingly divergent views on a controversial topic and for discovering critical points of divergence that may represent pathways for improvement. While the end product is a 'film', the goal is to have these films used as catalysts for ongoing respectful dialogue and problem-solving concerning the topic at hand informing relevant practice and policy change. In this paper, we consider Brokered Dialogue's potential future uses and impacts, and how these might be evaluated.


Assuntos
Atitude Frente a Saúde , Difusão de Inovações , Narração , Negociação/métodos , Pesquisa Qualitativa , Problemas Sociais , Humanos , Filmes Cinematográficos , Política Pública , Projetos de Pesquisa
19.
PM R ; 14(8): 971-986, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34259390

RESUMO

BACKGROUND: A common sequela of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance-related goals. OBJECTIVE: To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards to help these youth and their families make treatment decisions. DESIGN: Mixed-methods study. SETTING: Brachial plexus clinic in a pediatric tertiary care center. PARTICIPANTS: Five young adults (21-24 years), 14 youth (8-19 years) and their parents, 15 families (children 2-16 years), and 19 clinicians from a brachial plexus clinic participated in the PtDA development. Seventeen other youth (8-18 years) facing treatment decisions regarding their elbow contracture field tested the PtDA prototype. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In-depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field test the PtDA prototype. RESULTS: Evidence from previously conducted knowledge synthesis and the youth-focused decisional needs assessment qualitative data informed the development of new PtDA prototype, which included a questionnaire-based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field tested the PtDA prototype understood its content, whereas only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. CONCLUSIONS: This new PtDA can be used to help youth with BPBI and their families to make a personal value-based informed decision regarding treatment options for their elbow flexion contracture.


Assuntos
Traumatismos do Nascimento , Plexo Braquial , Contratura , Adolescente , Plexo Braquial/cirurgia , Criança , Contratura/etiologia , Técnicas de Apoio para a Decisão , Cotovelo , Humanos
20.
Res Involv Engagem ; 8(1): 11, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382905

RESUMO

BACKGROUND: Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore, the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening. This can lead to a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. METHODS: This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning module for healthcare providers. The learning module will describe the social context of lung cancer risk and promote access to lung cancer screening by increasing equity at the point of care. We have applied the Generative Co-Design Framework for Healthcare Innovation and detail our study processes in three phases and six steps: Pre-design (establishing a study governance structure); Co-design (identifying research priorities, gathering and interpreting data, co-developing module content); and Post-design (pilot testing the module and developing an implementation plan). DISCUSSION: Patient engagement in research can promote the design and delivery of healthcare services that are accessible and acceptable to patients. This is particularly important for lung cancer screening as those at highest risk of developing lung cancer are also those who are least likely to participate in lung cancer screening. By detailing the steps of our participatory co-design journey, we are making visible the processes of our work so that they can be linked to future outcomes and related impact, and inform a wide range of patient co-led processes.


Lung cancer is the most commonly diagnosed cancer in Canada and is responsible for a quarter of all cancer-related deaths in the country. Screening for lung cancer using tools such as a CT scan can allow us to find lung cancers when they are still small and curable. People can receive a lung CT scan depending on how old they are and for how long they have smoked cigarettes. Certain groups of people, particularly those who have fewer resources such as time and money, and those who experience injustice because of who they are and how they look are less likely to participate in lung cancer screening. We can increase participation in lung cancer screening by educating healthcare providers on appropriate and timely ways to talk to patients about lung cancer screening. In this paper, we outline the steps of a patient-partnered study in which many different stakeholders such as patients, providers and policy-makers have come together with a goal to improve equity in access to lung cancer screening. We will do this by jointly creating an online learning module that will educate healthcare providers on how life experiences shape smoking behaviour and lung cancer risk. The module will also impart key skills on how to deliver care which is timely, appropriate and safe. Once the module is ready it will be freely available to all healthcare providers to support the fair and just delivery of lung cancer screening in the province of Ontario and elsewhere.

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