Exploring Food and Nutrition Programming for People Living With HIV/AIDS: Interviews With Service Providers in Nova Scotia, Canada.

There is a lack of nutritional programming and resources available for people living with HIV/AIDS (PLWHA) in Nova Scotia, Canada. This is problematic for several reasons, including that adequate food and nutrition knowledge is integrated to effective medical therapy and wellness for PLWHA. The aim of this research was to explore and describe the beliefs, values, and experiences of HIV-service providers involved programming for PLWHA in Nova Scotia. Using a post-structuralist lens, semi-structured interviews were conducted with nine service providers. Thematic analysis of interview transcripts identified four main themes: (1) recognizing the social determinants of health, (2) acknowledging and disrupting layered stigma, (3) understanding the commensality, and (4) navigating and utilizing networks of care. These findings suggest that those developing, delivering, and evaluating food and nutrition-related programming must engage in community-inclusive approaches that recognize the varied social determinants of health that shape the lived of PLWHA, leverage existing networks and resources, and actively disrupt layered stigma. Also, in agreement with existing evidence, participants stressed the value of communicating and supporting the practice of eating together (commensality) and cultivating networks of care.

Understanding the experiences of Black Nova Scotians with community pharmacists.

Background: A history of medical abuse and social inequality confounded by persistent racial discrimination in health care has triggered mistrust between Black patients and health care providers. Although the consequences of systemic racism on health outcomes are well understood, little is known about how they manifest in pharmacy practice. The objective of this study was to explore the experiences of Black Nova Scotians with community pharmacists. Methods: This was a qualitative study that used focus groups and one-on-one interviews. Black Nova Scotians 18 years of age and older who have had interactions with community pharmacists were invited to participate. Focus groups and interviews were audio-recorded, transcribed and analyzed thematically. Results: Two focus groups (n = 10) and 6 one-on-one interviews were held between May and June 2021. Three major themes were identified: 1) difficulties navigating a pharmacy as a Black person, 2) lack of inclusivity and cultural competence in the pharmacy and 3) transactional relationships with pharmacists. Discussion: Most participants felt their race negatively affected the quality of care they received from the pharmacist and that pharmacists were not culturally competent. Most participants did not consider pharmacists to be part of their health care team and described feeling unsafe or uncomfortable in the pharmacy. Conclusions: Pharmacists have an important role in closing the health equity gap. This research highlights the need for pharmacy education to include cultural competence and will be used to guide strategies to improve access to culturally safe pharmacy services for Black Nova Scotians.

"Oh, you're my health care provider?" Recounting the experiences of people of African descent in Nova Scotia pursuing or working in health professions.

BACKGROUND: Increasing, supporting and cultivating diversity in health programs is key to addressing health inequities. We sought to investigate barriers and facilitators that could affect enrolment and success in health professions among people of African descent in Nova Scotia, Canada. METHODS: We conducted semistructured interviews with people who self-identified as being of African descent who resided or grew up in Nova Scotia, who were working in or pursuing a career in a health profession, and who had participated in culturally specific mentorship programs. Semistructured interviews explored participant experiences that shaped their pursuit of a health profession, as a person of African descent. We thematically analyzed transcribed interviews using constructivist grounded theory. RESULTS: We interviewed 23 participants. Thematic coding showed 4 major themes. The theme of "stand on my shoulders" spoke to the importance of mentorship within the Black community. "Growing through pain" spoke to resilience amidst race-related challenges. "Never the student; ever the teacher" showed the repeated need to educate on issues of race or diversity. The final theme, "change," highlighted next steps, including the need for improvement in curricula, for development of Black faculty and for initiatives that offer support. INTERPRETATION: We found that mentorship, particularly within the community, was instrumental to promoting feelings of belonging. However, participants described the need for resilience in the face of discrimination during training and in practice in health care professions. Rather than focusing on their education, many had to educate those around them. Increased representation, support programs and updated curricula are needed to promote change.

Intersectionality, health equity, and EDI: What's the difference for health researchers?

Many countries adopted comprehensive national initiatives to promote equity in higher education with the goal of transforming the culture of research. Major health research funders are supporting this work through calls for projects that focus on equity, resulting in a proliferation of theoretical frameworks including "intersectionality," "health equity," and variations of equity, diversity and inclusion, or EDI. This commentary is geared at individual principal investigators and health research teams who are developing research proposals and want to consider equity issues in their research, perhaps for the first time. We present histories and definitions of three commonly used frameworks: intersectionality, health equity, and EDI. In the context of health research, intersectionality is a methodology (a combination of epistemology and techniques) that can identify the relationships among individual identities and systems of oppression; however, it should also be used internally by research teams to reflect on the production of knowledge. Health equity is a societal goal that operationalizes the social determinants of health to document and address health disparities at the population level. EDI initiatives measure and track progress within organizations or teams and are best suited to inform the infrastructure and human resourcing "behind the scenes" of a project. We encourage researchers to consider these definitions and strive to tangibly move health research towards equity both in the topics we study and in the ways we do research.

Disciplined appetites: Reimagining food and nutrition programs for people living with HIV and AIDS.

AIMS: Medical nutrition therapy is recommended for people living with HIV/AIDS to improve health and wellness; however, there is a lack of food and nutrition programs for people living with HIV/AIDS in Nova Scotia, Canada. The aim of this study was to explore the beliefs, values, and experiences of people living with HIV/AIDS in relation to food and nutrition programs. METHODS: A critical social theory lens with two disciplinary contexts: critical health geography and critical dietetics guided this research. Semi-structured interviews were conducted with 12 people living with HIV/AIDS and analysed for themes. RESULTS: The three main themes were identified: (1) intersections of social determinants of health, wellness, and food security; (2) discursive shaping of food and nutrition in relation to HIV; and (3) the dynamic nature of HIV care. CONCLUSIONS: Participants offered recommendations on how food and nutrition programs might be reimagined to be more accessible, inclusive, and effective for people living with HIV/AIDS.

Adverse childhood experiences and stress among oral health students: a descriptive correlational study.

Background: Stress is a challenge to many post-secondary students and, if prolonged and unmanaged, can affect academic success. Understanding factors that contribute to students' stress is important. One possible contributor may be adverse childhood experiences (ACEs); that is, traumatic events that occur during the first 18 years of life. Inverse relationships between the number of ACEs and indicators of poor mental well-being have been proposed. Objective: To describe ACEs in oral health students (OHS) and the associations between the number and types of ACEs and levels of perceived stress, an indicator of mental well-being. Methods: Invitations to participate in an anonymous online cross-sectional survey were sent to all OHS, 19 years and older, attending Dalhousie University in Halifax, Nova Scotia, Canada. Self-reports of ACEs and perceived stress were collected. Zero-order correlations and regression modelling were used to examine associations. Results: Twenty-six percent (26%, n = 66) of OHS completed the survey. Respondents reported an average of 2.20 ACEs; 34.9% reported ≥ 3 ACEs. Emotional abuse (41%) was the most reported ACE. Associations were observed between numbers of ACEs and stress. Levels of stress increased with the number of ACEs (r = 0.23, p < 0.05). Regression modelling determined levels of stress were not affected by ACE type (F (3,62) = 2.24, p = 0.092). Discussion: This was the first study to examine associations between ACEs and perceived stress in OHS. These students reported greater numbers of ACEs than age-matched general populations. Levels of stress were associated with numbers of ACEs. Conclusion: Faculty in dental and dental hygiene programs should recognize the prevalence of ACEs among OHS and the potential impact on their mental well-being.

Contexte: Le stress est un défi pour de nombreux étudiants du postsecondaire : s'il est ressenti sur une longue période et s'il n'est pas géré, il peut nuire à la réussite scolaire. Il est important de comprendre les facteurs qui contribuent au stress des étudiants. Les expériences négatives durant l'enfance (ENE), c.-à-d. les événements traumatiques vécus au cours des 18 premières années de vie, peuvent constituer l'un de ces facteurs. On a suggéré une corrélation inverse entre le nombre d'ENE et les indicateurs d'un mauvais bien-être mental. Objectif: Décrire les ENE chez les étudiants en santé buccodentaire (ESB) et les corrélations entre les types et le nombre d'ENE d'une part et les niveaux de stress perçus, un indicateur du bien-être mental, d'autre part. Méthodes: On a fait parvenir des invitations à participer à un sondage transversal anonyme en ligne à tous les ESB âgés de 19 ans et plus qui fréquentent l'Université Dalhousie à Halifax, en Nouvelle-Écosse (Canada). On a recueilli des données autodéclarées sur les ENE et le stress perçu. Des corrélations d'ordre zéro et la modélisation par régression ont été utilisées pour examiner les relations entre les données. Résultats: Vingt-six pour cent (26 %, n = 66) des ESB ont répondu au sondage. En moyenne, les répondants ont fait mention de 2,20 ENE, et 34,9 % ont déclaré ≥ 3 ENE. La violence psychologique (41 %) était le type d'ENE le plus largement déclaré. On a constaté des corrélations entre le nombre d'ENE et le niveau de stress. Les niveaux de stress augmentaient avec le nombre d'ENE (r = 0,23, p < 0,05). La modélisation par régression a permis d'établir que les types d'ENE n'avaient pas d'incidence sur les niveaux de stress (F [3,62] = 2,24, p = 0,092). Discussion: Il s'agissait de la première étude à examiner les relations entre les ENE et le stress perçu par les ESB. Ces étudiants ont déclaré un plus grand nombre d'ENE que la même classe d'âge dans la population générale. On a constaté une corrélation entre les niveaux de stress et le nombre d'ENE. Conclusion: Les membres du corps professoral des programmes dentaires et d'hygiène dentaire doivent reconnaître la prévalence des ENE parmi les ESB ainsi que les effets éventuels sur leur bien-être mental.

Exploring current nutritional programming and resources available to people living with HIV in Canada: a scoping review.

OBJECTIVE: The objective of this scoping review was to map the current literature and resources available on nutrition and food programming for people living with HIV in Canada. This review is phase 1 of a 4-phase project, called FoodNOW (Food to eNhance Our Wellness), a community-based nutritional needs assessment of people living with HIV in Nova Scotia, Canada. INTRODUCTION: People living with HIV may experience nutritional challenges, including nutritional deficiencies associated with the virus, food insecurity, and nutrition-drug interactions. Nutritional programming is often required for optimal care for people living with HIV. The literature, however, has not been sufficiently mapped to create a comprehensive picture of available programming. This review has informed the development of subsequent study phases, and will contribute towards shaping and planning food programs, as well as evaluating the need for subsequent systematic reviews. INCLUSION CRITERIA: This review considered literature focused on nutrition and food programming and resources in Canada for people living with HIV. People living with HIV of any age, sex, race, gender identity, or sexual orientation, as well as pregnant and lactating people, were included as the population of interest. METHODS: The databases searched were MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premier (EBSCO), Social Services Abstracts (ProQuest), and Scopus. Sources of gray literature searched included government and organization websites, and Google searches. The database search was conducted in July 2021, and the gray literature searches were conducted in August and October 2021. Searches were limited to evidence published or translated in English. Two independent reviewers conducted title and abstract screening, and potentially relevant results were retrieved in full. Full-text screening and data extraction was conducted by 2 independent reviewers using a data extraction tool designed specifically for the scoping review objectives and research inclusion criteria, and any conflicts were resolved through discussion. Results are presented in both tabular and diagrammatic formats, with a narrative summary. RESULTS: A total of 581 results were screened (published and gray literature). A total of 64 results were included in the review. The 6 reasons for exclusion at full-text review were i) not nutrition and food programming (n= 83), ii) not Canadian (n= 37), iii) duplicates (n= 22), iv) not focused on people living with HIV (n= 6), v) conference abstract (n= 1), and vi) not in English (n= 1). A total of 76 resources were located, as some of the 64 included sources offered more than 1 resource. The 76 resources were organized into 6 categories: i) charitable food provision (n = 21; 27.6%), ii) financial aid (n = 14; 18.4%), iii) nutrition care (n =12; 15.8%), iv) providing access to secondary sources (n= 10; 13.2%), v) food and nutrition expertise (n= 10; 13.2%), and vi) population health promotion (n= 9; 11.8%). Recommendations for future research and programming are discussed. CONCLUSIONS: This scoping review demonstrates that current programming relies heavily on charitable food provision services for people living with HIV and that there is an unequal distribution of resources across Canada. Program expansion to target diverse populations with more equal distribution across Canada may improve overall health outcomes for people living with HIV. Future research is needed to evaluate the effectiveness of available programming and the needs of end users (people living with HIV and their supports). FoodNOW will build on these findings to further explore and address the needs of people living with HIV. REVIEW REGISTRATION: Open Science Framework https://osf.io/97x3r.

"Removing the thorns": the role of the arts in recovery for people with mental health challenges.

BACKGROUND: While the arts have long been associated with mental health, the role of self-directed arts participation in recovery has not been fully explored. METHODS: We explored the question: From the perspectives of people living with mental health challenges, how does participation in and exhibiting or performing one's art impact recovery? Six individual interviews and 19 narratives by artists with mental health challenges associated with an arts exhibit were analyzed using inductive thematic analysis. RESULTS: The data are described by the themes providing structure and continuity, (re)creating our personal stories and building community. Novel findings include ongoing engagement in the arts as providing continuity during turbulent times. The role of the arts in advocacy on mental health was highlighted. CONCLUSION: While artists sometimes perceived paternalism in audience members, the arts provided a powerful means of communicating about mental illness, countering stigma and challenging dominant ways of conceptualizing mental illness.