'My coupons are like gold': experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers' Market Nutrition Coupon Program.

OBJECTIVE: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers' markets. Our objective was to explore FMNCP participants' experiences of accessing nutritious foods, and perceived programme outcomes. DESIGN: The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.'s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework's domains were coded inductively. SETTING: One urban and two rural communities in British Columbia, Canada. PARTICIPANTS: Twenty-eight adults who were participating in the FMNCP. RESULTS: Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons. CONCLUSIONS: Participation in the FMNCP facilitated access to nutritious foods and enhanced participants' diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants' experiences and outcomes of farmers' market food subsidy programmes.

The adoption, implementation and maintenance of a school food policy in the Canadian Arctic: a retrospective case study.

With increasing childhood obesity rates and type 2 diabetes developing in younger age groups, many schools have initiated policies to support healthy eating and active living. Policy interventions can influence not only health behaviours in students but can also impact these behaviours beyond the school walls into the community. We articulate a policy story that emerged during the data collection phase of a study focused on building knowledge and capacity to support healthy eating and active living policy options in a small hamlet located in the Canadian Arctic. The policy processes of a local school food policy to address unhealthy eating are discussed. Through 14 interviews, decision makers, policy influencers and health practitioners described a policy process, retrospectively, including facilitators and barriers to adopting and implementing policy. A number of key activities facilitated the successful policy implementation process and the building of a critical mass to support healthy eating and active living in the community. A key contextual factor in school food policies in the Arctic is the influence of traditional (country) foods. This study is the first to provide an in-depth examination of the implementation of a food policy in a Canadian Arctic school. Recommendations are offered to inform intervention research and guide a food policy implementation process in a school environment facing similar issues.

Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions.

Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain.

Behavioral responses of terrestrial mammals to COVID-19 lockdowns.

COVID-19 lockdowns in early 2020 reduced human mobility, providing an opportunity to disentangle its effects on animals from those of landscape modifications. Using GPS data, we compared movements and road avoidance of 2300 terrestrial mammals (43 species) during the lockdowns to the same period in 2019. Individual responses were variable with no change in average movements or road avoidance behavior, likely due to variable lockdown conditions. However, under strict lockdowns 10-day 95th percentile displacements increased by 73%, suggesting increased landscape permeability. Animals' 1-hour 95th percentile displacements declined by 12% and animals were 36% closer to roads in areas of high human footprint, indicating reduced avoidance during lockdowns. Overall, lockdowns rapidly altered some spatial behaviors, highlighting variable but substantial impacts of human mobility on wildlife worldwide.

Reducing HIV-related stigma among young people attending school in Northern Uganda: study protocol for a participatory arts-based population health intervention and stepped-wedge cluster-randomized trial.

BACKGROUND: HIV-related stigma negatively impacts HIV prevention, treatment, and care, particularly among children and adolescents in sub-Saharan Africa. Interventions that are culturally grounded and relevant for addressing root causes may reduce the stigma experienced by HIV-positive and HIV-affected young people. This study, to be conducted in a post-conflict, rural setting in Omoro District, Uganda, will develop and evaluate a transformative  arts-based HIV-related stigma intervention rooted in local cultural knowledge to reduce stigma and improve HIV prevention and care for young people living with HIV. The intervention will be delivered to young people attending school by community Elders, with the support of teachers, through the transfer of local cultural knowledge and practices with the aim of re-establishing the important cultural and social role of Elders within a community that has suffered the loss of intergenerational transfer of cultural knowledge throughout a 25-year civil war. METHODS: A formative research phase consisting of interviews with students, teachers, and Elders will inform the intervention and provide data for study objectives. Workshops will be delivered to Elders and teachers in participating schools to build capacity for arts-based, educational workshops to be conducted with students in the classroom. The intervention will be evaluated using a stepped-wedge cluster-randomized trial. Government-funded schools in Omoro District will be randomized into three blocks, each comprised of two primary and two secondary schools (n=1800 students). Schools will be randomly assigned to a crossover sequence from control to intervention condition in 8-week intervals. A process evaluation will be implemented throughout the study to evaluate pathways between intervention development, implementation, and effects. DISCUSSION: This study will generate comprehensive, in-depth participatory research and evaluation data to inform an effective and sustainable protocol for implementing arts-based HIV stigma interventions for young people in school settings. Findings will have widespread implications in post-conflict settings for HIV prevention, treatment, and care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04946071 . Registered on 30 June 2021.

Experiences and Perceived Outcomes of Low-Income Adults During and After Participating in the British Columbia Farmers' Market Nutrition Coupon Program: A Longitudinal Qualitative Study.

BACKGROUND: The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a farmers' market food subsidy program that provides low-income households with coupons valued at $21/wk for 16 weeks to purchase healthy foods at participating BC Association of Farmers' Markets members' markets. OBJECTIVE: This study aimed to explore changes, differences, and similarities in participants' experiences and perceived short-term outcomes during and after participating in the FMNCP. DESIGN: A longitudinal qualitative research approach was used to conduct a recurrent cross-sectional analysis. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Data generation occurred during 2019 FMNCP program (time 1) and 4 to 7 weeks after (time 2) the program year ended. Data at each time point were analyzed separately using directed content analysis, followed by a comparative analysis to identify changes, differences, and similarities between time points. PARTICIPANTS: Twenty-eight adult participants were interviewed during the program; 24 were re-interviewed post program. SETTING: Three communities in British Columbia, Canada. RESULTS: Three themes were generated: temporary relief and engagement; lasting experiences and outcomes; enhancing participant experiences and outcomes. The first theme related to how participants' experiences and perceived outcomes, such as increased financial support and improved diet quality and health, were temporary. The second theme reflected positive lasting experiences and outcomes from participating in the FMNCP, including increased food and nutrition knowledge and enhanced social ties. The third theme focused on enhancing participants' program experiences and outcomes, including increasing the duration of food subsidies. CONCLUSION: The FMNCP temporarily enhanced access to nutritious foods and had lasting positive effects on participants' nutrition-related knowledge and social outcomes. Nevertheless, participants struggled to maintain healthy eating practices post program due to financial constraints. Expanding farmers' market subsidy programs may improve access to nutritious foods; maintain positive dietary, social, and health outcomes for participants; and reach more low-income households.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation.

INTRODUCTION: Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS: In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT03952338.

Sociodemographic Profiles and Clinical Outcomes for Clients on Methadone Maintenance Treatment in a Western Canadian Clinic: Implications for Practice.

INTRODUCTION: Clients on methadone maintenance treatment (MMT) have high attrition rates that are attributed to personal and system-related factors. To develop supportive interventions for these clients, it is imperative to understand social demographic characteristics and challenges that clients in the MMT program face. OBJECTIVES: This article aims to describe (a) the sociodemographic characteristics and clinical profiles of clients in a MMT program, (b) factors that impact their positive clinical outcomes, and (c) the study's implications for practice. METHODS: A retrospective review of 101 randomly selected electronic medical records representing one third of all the records were examined for sociodemographic characteristics, clinical profiles, and outcomes. Descriptive statistics were used to analyze these variables. Interviews with 18 healthcare providers focusing on their experiences of caring for clients in the MMT program were analyzed thematically. RESULTS: The average age of clients on MMT is 35.5 years. Clients had early exposure to alcohol and drugs, and at the time of enrollment to the program, they presented with complex healthcare needs, borne from chronic use, and exposure to adverse traumatic events. Personal and systemic factors impact clients' recovery. These include poverty, homelessness, and inadequate healthcare services. Understanding sociodemographic characteristics, clinical profiles, and clients' challenges is central to the development of supportive interventions that enhance retention to care and recovery.

Nursing care of AIDS patients in Uganda.

This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.