Examining the impact of a province-wide physical education policy on secondary students' physical activity as a natural experiment.

BACKGROUND: The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students' moderate to vigorous physical activity (MVPA). METHODS: Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit. STUDY DESIGNS: A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n = 33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012). ANALYSIS: In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students' minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES. RESULTS: In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students' MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (-1.52, 95% CI:-3.47, 0.42), or by covariates. CONCLUSIONS: The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions.

Low caregiver health literacy is associated with non-urgent pediatric emergency department use.

OBJECTIVE: Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use. METHODS: This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method. RESULTS: The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta. CONCLUSION: Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.

RéSUMé: OBJECTIF: Les soignants ayant une faible littératie en santé sont plus susceptibles de surestimer la gravité de la maladie et d'avoir un manque d'adhésion aux comportements favorisant la santé. Notre objectif principal était de faire le lien entre la littératie en santé des soignants et l'urgence d'utiliser les services d'urgence (SU). L'objectif secondaire était d'explorer la relation entre les caractéristiques sociales et démographiques, la littératie en santé et l'urgence de l'utilisation du traitement. MéTHODES: Cette sous-étude était une enquête transversale descriptive avec examen du dossier de santé. Les données ont été recueillies auprès de dix ED pédiatriques canadiens. Les variables étudiées comprenaient la démographie, les détails des visites et la mesure du dernier signe vital de la littératie en santé. Les visites de DS ont été classées en urgence ou non selon la méthode d'utilisation des ressources. RéSULTATS: Le taux de réponse était de 97,6 % (n=2005). L'âge moyen des aidants naturels était de 37,0 (7,7) ans, 74,3 % (n=1950) étaient des mères, 72,6 % (n=1953) parlaient l'anglais comme langue principale, 51,0 % (n=1946) avaient un diplôme universitaire et 45,1 % (n=1699) avaient un revenu familial supérieur à 100 000 $. L'âge moyen (SD) des enfants était de 5,9 (5,0) ans et 48,1 % (n=1956) étaient des femmes. 43,7 % (n=1957) des aidants avaient une faible littératie en santé. Le fait d'être un aidant naturel avec un enfant de moins de 2 ans [aOR 1,83 (1,35, 2,48)] et une faible littératie en santé [aOR 1,56 (1,18, 2,05)] étaient associés à une utilisation plus importante de l'ES pédiatrique non urgente. La variation interprovinciale était évidente : les aidants naturels du Québec étaient moins susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes comparativement à l'Alberta, tandis que ceux de la Nouvelle-Écosse, du Manitoba, de la Colombie-Britannique et de l'Ontario étaient plus susceptibles d'utiliser le DE pédiatrique pour des présentations non urgentes. CONCLUSION: Près de la moitié des aidants naturels qui se présentent aux ÉE pédiatriques au Canada ont une faible littératie en santé, ce qui peut limiter leur capacité à prendre les décisions appropriées en matière de soins de santé pour leurs enfants. Le faible niveau de connaissances en santé des aidants est un facteur modifiable associé à une utilisation accrue de l'ES non urgente. Les efforts déployés pour remédier à cette situation peuvent influencer positivement l'utilisation de la DE.

A national survey of children's experiences and needs when attending Canadian pediatric emergency departments.

BACKGROUND: Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition. METHODS: 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020. RESULTS: Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect. INTERPRETATION: While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.

Enhancing capacity for risk factor surveillance at the regional/local level: a follow-up review of the findings of the Canadian Think Tank Forum after 4 years.

BACKGROUND: National health surveys are sometimes used to provide estimates on risk factors for policy and program development at the regional/local level. However, as regional/local needs may differ from national ones, an important question is how to also enhance capacity for risk factor surveillance regionally/locally. METHODS: A Think Tank Forum was convened in Canada to discuss the needs, characteristics, coordination, tools and next steps to build capacity for regional/local risk factor surveillance. A series of follow up activities to review the relevant issues pertaining to needs, characteristics and capacity of risk factor surveillance were conducted. RESULTS: Results confirmed the need for a regional/local risk factor surveillance system that is flexible, timely, of good quality, having a communication plan, and responsive to local needs. It is important to conduct an environmental scan and a gap analysis, to develop a common vision, to build central and local coordination and leadership, to build on existing tools and resources, and to use innovation. CONCLUSIONS: Findings of the Think Tank Forum are important for building surveillance capacity at the local/county level, both in Canada and globally. This paper provides a follow-up review of the findings based on progress over the last 4 years.

More than "using research": the real challenges in promoting evidence-informed decision-making.

OBJECTIVES AND METHODS: Seventeen focus groups and 53 semi-structured individual interviews involving 205 planners and decision-makers were conducted in all 11 Regional Health Authorities (RHAs) in the province of Manitoba, Canada. Objectives were to explore perspectives on the nature and use of "evidence," and barriers to evidence-informed decision-making (EIDM). RESULTS: In spite of almost universal support in principle for using evidence in decision-making, there was little consensus among participants on what evidence is, what kind of evidence is most appropriate and how "using evidence" can best be demonstrated. Significant skepticism about EIDM was expressed. Issues related to workload, politicized decision-making and organizational factors dominated the discussion of decision-makers. Barriers to EIDM were commonly attributed to factors external to the RHAs. CONCLUSION: Effective strategies to promote EIDM must address the multiple barriers experienced by decision-makers in a complex decision-making environment. Rather than simply focusing on issues of access to evidence or development of individual capacity, strategies must focus on changing decision-making processes to support appropriate use of evidence.