Enablers and barriers to diabetic retinopathy eye care among first nations and Métis women.

BACKGROUND: Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. OBJECTIVE: This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. METHODS: We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. RESULTS: The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self-efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. CONCLUSIONS: Our study advances knowledge in socio-cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions.

Little Doctors: Agents of change in Indian rural communities.

The child-to-child approach to health advocacy is one that draws on the strengths and agency of children to make a positive impact within their communities. The approach has been popularly used for health education in low- and middle-income countries. This article describes the 'Little Doctors' program that implemented the child-to-child approach in the towns of KC Patty and Oddanchatram, located in remote hilly regions of Tamil Nadu, India starting in 1986 to train middle- and high school children to respond to diseases prevalent in their communities along with practices for preventative measures. The program involved sessions that used a combination of creative instructional methods to engage students and provided take-home messages for them to act on with their families and community. The program was successful in creating a creative learning environment for children, offering a shift from the traditional methods of classroom instruction. Students who successfully completed the program were awarded certificates as 'Little Doctors' in their communities. Although the program did not conduct formal evaluations of the program effectiveness, students reported successfully recalling complex topics such as early signs of diseases like tuberculosis and leprosy that were prevalent in the community during the time. The program experienced several challenges and had to be discontinued despite its continued benefits to the communities.

Critical perspectives on rehabilitation education, practice and process: northern Honduras case study.

BACKGROUND: Rehabilitation services are an integral part of patient care, but in many developing countries, they are not prioritized and either unavailable or easily accessible to those who need them. Although the need for rehabilitation services is increasing in Honduras, rehabilitation workers are not included in the health care model that guides the care provided to communities, particularly in rural and remote areas. To understand the need for providing impactful rehabilitation services in disadvantaged communities, we explored the education and perception of the community relating to rehabilitation, investigated training available for rehabilitation workers, and examined the rehabilitation processes and practices in Northern Honduras from stakeholders' experiences. METHODS: We utilized a qualitative descriptive and interpretive approach grounded in case study methodology to understand rehabilitation education, process, and practice in Northern Honduras. Three rehabilitation centres were purposefully selected as the cases, and participants consisted of rehabilitation workers and managers from these centres. We collected data via interviews and focus group sessions. We analyzed the data via thematic analysis using NVivo version 12. RESULTS: In Northern Honduras, rehabilitation workers' limited training and continuing education, along with awareness about rehabilitation by community members and other health providers influence rehabilitation care. Although policies and initiatives to support people with disabilities and the broader community in need of rehabilitation exist, most policies are not applied in practice. The sustainability of rehabilitation services, which is rooted in charity, is challenged by the small range of funding opportunities strongly affecting rehabilitation care processes and clinical practices. The lack of trust and awareness from the medical profession towards rehabilitation workers sets a major barrier to referrals, interdisciplinary work, and quality of life for individuals in need of rehabilitation. CONCLUSION: This study advances knowledge of the need to increase understanding of rehabilitation care among community members and health providers, improve care processes and resources, and foster interprofessional practice, to enhance the quality of care and promote equitable care delivery, especially in rural and remote communities.

Twelve tips for using ePosters as an active learning strategy.

ePosters (electronic Posters), a modification of traditional paper-based posters have gained popularity in medical education conferences since 2011. ePoster in educational settings differs from the traditional poster in that it allows the ePoster creator to focus on the learning process rather than reporting scientific outcomes. However, there is limited literature comparing ePosters to traditional paper-based posters and their impact on the student learning experience. ePosters as an assessment tool are well suited for online learning. This article presents twelve tips for using ePosters as an active learning strategy in classrooms and describes how to incorporate ePosters as a formative and summative assessment tool in health professions education, at all levels.

Self-directed learning readiness of Indian medical students: a mixed method study.

BACKGROUND: Self-directed learning (SDL) is defined as learning on one's own initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. Medical education institutions promote SDL, since physicians need to be self-directed learners to maintain lifelong learning in the ever-changing world of medicine and to obtain essential knowledge for professional growth. The purpose of the study was to measure the self-directed learning readiness of medical students across the training years, to determine the perceptions of students and faculty on factors that promote and deter SDL and to identify the role of culture and curriculum on SDL at the Christian Medical College, Vellore, India. METHODS: Guglielmino's SDL Readiness Scale (SDLRS) was administered in 2015 to six student cohorts (452 students) at admission, end of 1st, 2nd, 3rd and 4th year of training, and at the beginning of internship in the undergraduate medicine (MBBS) program. Analysis of variance (ANOVA) was used to compare SDL scores between years of training. 5 student focus groups and 7 interviews with instructors captured perceptions of self-direction. Transcripts were coded and analyzed thematically. RESULTS: The overall mean SDLRS score was 212.91. There was no significant effect of gender and age on SDLR scores. There was a significant drop in SDLRS scores on comparing students at admission with students at subsequent years of training. Qualitative analysis showed the prominent role of culture and curriculum on SDL readiness. CONCLUSIONS: Given the importance of SDL in medicine, the current curriculum may require an increase in learning activities that promote SDL. Strategies to change the learning environment that facilitates SDL have to be considered.

Perceptions on mobile health use for health education in an Indigenous population.

Introduction: Indigenous peoples in Canada face numerous health needs and challenges and often have poor health status due to inequitable access to care. Providing culturally appropriate support for health conditions, particularly chronic conditions that require self-management, can assist in averting complications and morbidity. Mobile health is a useful medium for delivering health education across different populations. However, meaningful user involvement is necessary because mobile health interventions suitable for one population may not be appropriate for another. Indigenous people's views will inform the use of mobile health interventions in Indigenous communities. Objective: The study explored the perception of Indigenous women on using mobile health as a tool for receiving health information. Methods: This was a qualitative study, and participants comprised of 22 Indigenous women (First Nations and Métis) with or at risk of diabetes, aged 18-69 years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye care information via text messaging, data were collected via sharing circle discussions and analyzed using thematic analysis. Results: Participants indicated that the nature of messages such as the use of Indigenous languages, the message content, frequency of messages, group activities, and delivery formats such as voice messages, mobile applications, Internet, two-way messaging, and text messages were essential considerations in using mobile health as a tool for receiving health information. Conclusion: Different factors need to be considered in using mobile health as a tool for health education among Indigenous peoples. These factors could be applicable in implementing mobile health solutions in other populations for the management of health conditions.

Diabetic retinopathy awareness and eye care behaviour of indigenous women in Saskatoon, Canada.

Diabetes is a public health challenge in Canada with a disproportionate number of Indigenous people, especially women, living with diabetes. Diabetic retinopathy is a diabetes ocular complication and a common cause of blindness in Canadian adults. Many individuals living with diabetes do not have regular diabetic eye screening. This study sought to determine the diabetic retinopathy awareness and eye care behaviour of Indigenous women with diabetes or at risk of diabetes. This was a quantitative study among 78 Indigenous women (First Nations and Métis) in Saskatoon, Canada. Data on diabetic retinopathy awareness and eye care behaviour were collected via a knowledge, attitude, and practice survey. Participants had high diabetic retinopathy practice mean scores (32.16) than knowledge (30.16) and attitude scores (22.56). Sub-group analysis showed a significant difference in knowledge scores between age, education, and diabetes status, and differences in practice scores between age and education. Although our regression analysis indicated an association between education and knowledge scores (p = 0.024), and diabetes status and attitude scores (p = 0.044), the associations are not conclusive. Indigenous peoples with or at risk of diabetes may benefit from targeted interventions on diabetes and eye care, which could improve eye care awareness and behaviour.

Technology-enhanced learning of community health in undergraduate medical education.

OBJECTIVES: The purpose of this evaluation study was to identify the feasibility of repurposing specific online modules developed by the Public Health Agency of Canada as continuing education modules for front-line practitioners, in teaching clinical epidemiology to undergraduate medical students. Specifically, relevancy of the content, quality of online material, time-effectiveness of using the online component, required resources, and student satisfaction were investigated. METHOD: Both qualitative and quantitative data were collected. Semi-structured interviews were conducted with stakeholders from the Skills Enhancement Program, technical support personnel, instructors, a web administrator and an assignment marker. Surveys measuring student satisfaction were administered to students in the middle of the online component and at the end of the course. Two student focus groups were conducted. As well, other documents (e.g., online materials, course packages) were reviewed. RESULTS: Instructors felt that the content of the modules was appropriate and would enhance learning, although making changes was time consuming. Medical students reported that the content was relevant and they enjoyed the flexibility allowed by the online components. However, students reported that there were too many assignments and too much content for the allotted time frame. CONCLUSION: The Public Health Agency's online content seems to be relevant to medical students, but needs to be fine-tuned further to cater to their specific needs. Instructors required a lot of time to review and revise the content. The time allocated for online content in this course was too little compared to the volume of information. It is feasible to repurpose the online modules in undergraduate medical education.

Impact of mobile health in diabetic retinopathy awareness and eye care behavior among Indigenous women.

BACKGROUND: Diabetes is increasingly widespread among Indigenous people, and diabetic retinopathy (DR) is a diabetes eye complication and a common cause of vision loss among adults in Canada. Indigenous women have a high risk of diabetes which increases their risk for DR. This study explored utilizing mobile health (mHealth) via text messages to provide DR awareness and improve diabetic-eye care behavior. This study identified the changes in DR awareness and eye care behavior due to a mHealth education intervention among Indigenous women with or at risk of diabetes. METHODS: A pre-post study which adopted an embedded concurrent mixed methods approach guided by self-determination theory and the medicine wheel. Study participants were First Nations and Métis women living with or at risk of diabetes in Saskatoon, Canada. Data was collected via sharing circles and a DR knowledge, attitude, and practice survey. Pre-intervention participants' baseline information on DR knowledge and behavior were obtained from participants. After that, participants received daily text messages on diabetes-eye related information for 12 weeks. Post-intervention, the impact of the mHealth intervention on DR awareness and eye care behavior was assessed. RESULTS: Following the intervention, the DR knowledge, attitude, and practice scores significantly improved. Individuals living with diabetes had increased DR attitude and practice post-scores compared to those at risk of diabetes. Older women had a lower pre-post change in practice scores compared to younger women. The mHealth intervention provided a holistic approach to support diabetes-eye care and empowered the study participants to eat healthily, take medication as prescribed, and have regular medical and eye check-ups. CONCLUSIONS: The mHealth education intervention increased DR awareness and fostered a change in diabetes-eye care behavior. Health information via text messaging can motivate, provide support, and empower individuals as well as prevent and manage chronic conditions and reduce the risk of complications.

Mobile medical simulation for rural anesthesia providers: A feasibility study.

INTRODUCTION: Family practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan. METHODS: Using a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience. RESULTS: Financial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap. DISCUSSION: Mobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization's commitment to CME for rural physicians.

INTRODUCTION: Les anesthésistes en pratique familiale (APF) sont des médecins de famille formés pour offrir des soins d'anesthésie. Ils pratiquent souvent dans des hôpitaux ruraux pour faciliter les soins chirurgicaux. Les APF dans les hôpitaux ruraux sont confrontés à divers défis, tels l'isolement professionnel et un nombre limité d'occasions de formation continue formelle. Pour répondre aux besoins identifiés par les APF, nous avons mené une simulation médicale mobile dans une région rurale de la Saskatchewan. MÉTHODES: En utilisant un cadre de modèle logique, nous avons évalué la faisabilité d'un atelier sur une simulation mobile interdisciplinaire d'un jour pour les professionnels de la santé dans un hôpital rural de la Saskatchewan. Dans le cadre de cette étude pilote basée sur des méthodes mixtes, nous avons interviewé les parties prenantes pour explorer leurs perceptions en matière de ressources humaines et financières associées à la prestation de simulations médicales dans des zones rurales. Nous avons eu recours à de multiples scénarios de simulation pour former les participants dans des compétences cliniques et professionnelles. Les participants ont rempli un questionnaire avant et après l'atelier pour évaluer leur expérience. RÉSULTATS: Les ressources financières et humaines comprenaient le coût de location, le transport de mannequins et le temps requis pour créer les scénarios. Les participants (n = 10) ont rapporté avoir amélioré leurs connaissances et que l'expérience en valait la peine. La séance incitait les participants à réfléchir sur leurs lacunes dans certaines procédures ou compétences cliniques et à préciser des stratégies d'apprentissage pour combler leurs lacunes. DISCUSSION: La simulation médicale mobile rapproche l'éducation médicale continue des professionnels de la santé dans une zone rurale, mais le programme a coûté cher. Notre modèle logique peut informer les éducateurs et les administrateurs qui envisagent la simulation médicale mobile pour les médecins dans les zones rurales lorsqu'ils équilibrent les ressources et l'engagement de l'organisation à la formation médicale continue pour les médecins en zones rurales.

Twelve tips for rapidly migrating to online learning during the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has resulted in a massive adaptation in health professions education, with a shift from in-person learning activities to a sudden heavy reliance on internet-mediated education. Some health professions schools will have already had considerable educational technology and cultural infrastructure in place, making such a shift more of a different emphasis in provision. For others, this shift will have been a considerable dislocation for both educators and learners in the provision of education. To aid educators make this shift effectively, this 12 Tips article presents a compendium of key principles and practical recommendations that apply to the modalities that make up online learning. The emphasis is on design features that can be rapidly implemented and optimised for the current pandemic. Where applicable, we have pointed out how these short-term shifts can also be beneficial for the long-term integration of educational technology into the organisations' infrastructure. The need for adaptability on the part of educators and learners is an important over-arching theme. By demonstrating these core values of the health professions school in a time of crisis, the manner in which the shift to online learning is carried out sends its own important message to novice health professionals who are in the process of developing their professional identities as learners and as clinicians.

Rules of engagement-12 tips for successful use of "clickers" in the classroom.

BACKGROUND: Student response system or clickers is an electronic application where a receiver in the instructor's computer captures responses to questions from student keypads. Used effectively, clickers can promote learner engagement and serve to improve learning. It can be used in a variety of ways such as to provide feedback to learners and instructor, to start discussions, for peer evaluation, for formative and summative assessment, to build a learning community, and to experiment on human responses. AIMS AND METHODS: Using our experience in the use of this technology and literature review, we provide twelve tips for successful use of the student response system. RESULTS AND CONCLUSIONS: We have found these strategies useful and envisage that the application of these tips can help maximize learner engagement and learning.

Ultrasound during Critical Care Simulation: A Randomized Crossover Study.

OBJECTIVES: We sought to compare two ultrasound simulation interventions used during critical care simulation. The primary outcome was trainee and instructor preference for either intervention. Secondary outcomes included the identification of strengths and weaknesses of each intervention as well as overall merits of ultrasound simulation during high-fidelity, critical care simulation. The populations of interest included emergency medicine trainees and physicians. METHODS: This was a randomized crossover study with two ultrasound simulation interventions. 25 trainees and eight emergency physician instructors participated in critical-care simulation sessions. Instructors were involved in session debriefing and feedback. Pre- and post-intervention responses were analyzed for statistically significant differences using t test analyses. Qualitative data underwent thematic analysis and triangulation. RESULTS: Both trainees and instructors deemed ultrasound simulation valuable by allowing trainees to demonstrate knowledge of indications, correct image interpretation, and clinical integration (p<0.05). Trainees described increased motivation to develop and use ultrasound skills. The edus2 was the preferred intervention, as it enabled functional fidelity and the integration of ultrasound into resuscitation choreography. Instructors preferred the edus2, as it facilitated better assessment of trainees' skills, thus influencing feedback. CONCLUSIONS: These findings support the use of ultrasound simulation during critical care simulations. The increased functional fidelity associated with edus2 suggests that it is the preferred intervention. Further study of the impact on clinical performance is warranted.

The effects of massage therapy on multiple sclerosis patients' quality of life and leg function.

Background. Massage therapy is a noninvasive treatment that many individuals with multiple sclerosis (MS) use to supplement their conventional treatment. Objective. We hypothesize that massage therapy will improve the leg function and overall quality of life (QoL) of MS patients. Design. A two-period (rest, massage) crossover design was used. Twenty-four individuals with MS ranging from 3.0 to 7.0 on the Expanded Disability Status Scale (EDSS) received Swedish massage treatments for four weeks. Exercise capacity and leg function as well as QoL were assessed using the Six-Minute Walk Test (6MWT) and the Hamburg Quality of Life in Multiple Sclerosis (HAQUAMS) instrument, respectively. Assessments were measured before and after a massage period and a rest period where no massages were employed. Results. The results displayed no significant changes in 6MWT distances or HAQUAMS scores. However, the participants perceived improvement in overall health as expressed in written comments. Conclusions. Massage is a safe, noninvasive treatment that may assist MS patients in managing the stress of their symptoms. Future studies with larger sample size and cortisol measures are warranted.

Changes in self-directed learning readiness in dental students: a mixed-methods study.

The purpose of this study was to identify changes in dental students' self-directed learning (SDL) readiness during their education. Guglielmino's SDL readiness scale (SDLRS) was completed at admission by dental students at the University of Saskatchewan and at the end of each year of training. The response rates varied from year to year. Between twenty-seven and thirty students completed the questionnaire each year at admission (93-100 percent of the entering class). The numbers of participants were lower in succeeding years: numbers used for analysis ranged from eleven to twenty-six; years in which fewer than eleven students participated were not included in the analysis. At admission, the students' mean SDLRS score was 228.98 (on a scale from 58 to 290, with 290 the highest); this score was higher than that of the average adult population (214±25.59). There was no significant effect of years of predental education, prior unsuccessful applications to dental school, interview scores, age, or admission test scores. There was a significant drop in SDLRS scores at the end of the first year for most of the cohorts (p<0.001). In addition to the questionnaire part of the study, two instructors and five first- and second-year students participated in focus groups. Those results showed that the individuals defined SDL narrowly and had similar perceptions of curricular factors that affect SDL readiness. The drop in scores one year after admission and lack of change with increased training suggests that current educational interventions may require re-examination and alteration to those that promote self-direction.

Does medical training promote or deter self-directed learning? A longitudinal mixed-methods study.

PURPOSE: The School of Medicine, University of Saskatchewan curriculum promotes self-direction as one of its learning philosophies. The authors sought to identify changes in self-directed learning (SDL) readiness during training. METHOD: Guglielmino's SDL Readiness Scale (SDLRS) was administered to five student cohorts (N = 375) at admission and the end of every year of training, 2006 to 2010. Scores were analyzed using repeated-measurement analysis. A focus group and interviews captured students' and instructors' perceptions of self-direction. RESULTS: Overall, the mean SDLRS score was 230.6; men (n = 168) 229.5; women (n = 197) 232.3, higher than in the average adult population. However, the authors were able to follow only 275 students through later years of medical education. There were no significant effects of gender, years of premedical training, and Medical College Admission Test scores on SDLRS scores. Older students were more self-directed. There was a significant drop in scores at the end of year one for each of the cohorts (P < .001), and no significant change to these SDLRS scores as students progressed through medical school. Students and faculty defined SDL narrowly and had similar perceptions of curricular factors affecting SDL. CONCLUSIONS: The initial scores indicate high self-direction. The drop in scores one year after admission, and the lack of change with increased training, show that the current educational interventions may require reexamination and alteration to ones that promote SDL. Comparison with schools using a different curricular approach may bring to light the impact of curriculum on SDL.

Research utilization and evidence-based practice among Saskatchewan massage therapists.

While massage therapy (MT) is an increasingly used health care service with a growing evidence base, there is insufficient information about the extent to which MT practice is evidence-based. The purpose of this study was to provide a comprehensive view of Saskatchewan MT's research utilization to inform the development of evidence-based massage therapy practice. The main objectives of the study were to describe MT's perceptions of research, their appraised self-efficacy in research literacy and to identify the characteristic of practitioners who use research. Using a survey design all 815 registered members of the Massage Therapist Association of Saskatchewan were invited to complete a mail-out questionnaire. A total of 333 questionnaires were completed and returned for a 41% response rate. Univariate and logistic regression analysis was conducted using SPSS 17.0. While overall perceptions of research were positive, self-efficacy in research literacy was low and research utilization was limited. Characteristics associated with research use included referring to online research databases and peer-reviewed journals, belief that practice should be based on research, and 20 or greater hours per week of practice. Provincial regulatory status may be the first step to quality service delivery and research literacy training and support is needed for practitioners.