"If you don't stop the cycle somewhere, it just keeps going": Resilience in the context of structural violence and gender-based violence in rural Ontario.

Bolstering women's resilience in the context of gender-based violence (GBV) requires attention to structural conditions needed to support women to thrive, particularly in rural communities. This cross-sectional study explored how resilience was influenced by structural violence in rural Ontario among women experiencing GBV (n = 14) and service providers in the GBV sector (n = 12). Interviews were conducted and revealed forms of structural violence that undermine resilience for women experiencing GBV in rural communities, including 1) housing- gentrification, short-term rentals of residential properties, and long waitlists, 2) income- fighting for enough money to survive, 3) safety- abusers gaming the system, and 4) access- successes and new barriers. Structural conditions must be attended to as they are prerequisites required to build resilience.

Breastfeeding experiences of patients in baby-friendly certified hospital settings: protocol for a scoping review.

INTRODUCTION: The Baby-friendly Hospital Initiative is a global programme that is meant to support breastfeeding within organisations. Most of the current literature is focused on implementation and uptake of the programme; however, little is known about the patient experience of breastfeeding within these settings. By exploring this current gap in the literature, we may discover important contextual elements of the breastfeeding experience. The objective of this protocol is to provide a framework for a scoping review where we aim to understand the extent and type of evidence in relation to the patient experience of breastfeeding in Baby-friendly Hospital Initiative (BFHI)-certified settings. METHODS AND ANALYSIS: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The databases to be searched for relevant literature include MEDLINE, Embase, PsycINFO, CINAHL and Scopus in April 2023. A grey literature scan will include reviewing documents from professional organisations/associations. For all sources of evidence that meet the inclusion criteria, data will be extracted and presented in a table format. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Participants in this review will include any individual who delivered their baby in a BFHI-certified setting. Exploring the patient experience will involve reviewing their subjective perceptions of events related to breastfeeding. These events must occur in a BFHI-certified hospital, and therefore, home births and other outpatient settings will be excluded. ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review protocol or the final review. Knowledge gained from this research will be disseminated through the primary author's PhD dissertation work, as well as manuscript publications and conference presentations.

Health-Related Maternal Decision-Making Among Perinatal Women in the Context of Intimate Partner Violence: A Scoping Review.

Globally, it is estimated that 245 million women and girls aged 15 and over have experienced intimate partner violence (IPV) in the past 12 months. Moreover, research has highlighted the disproportionately high prevalence of IPV victimization among pregnant women. IPV can have serious health implications for women and their infants, yet little is known about maternal health-related decision-making by mothers exposed to IPV. To this end, the purpose of this scoping review was to examine what is known regarding health-related maternal decision-making among perinatal women in the context of IPV. Using Arksey and O'Malley's framework, five electronic databases were searched, resulting in 630 articles. Eligible articles were primary studies written in English, included participants who experienced IPV at any time in their life, and reported results focused on maternal health-related decision-making in the context of IPV. Thirty-six articles were screened by the review team, resulting in seven included articles. Three main themes emerged regarding health-related maternal decision-making by mothers experiencing IPV, including suboptimal breastfeeding practices, under-utilization of maternal and child health services, and poor adherence to medical recommendations/regimens that impact health-related outcomes for mother and child. The well-established risk of poorer health outcomes among women experiencing IPV, alongside the findings of this scoping review, calls for further research specifically addressing health-related decision-making among perinatal women who experience IPV.

Exploring Coping Strategies Among Older Women Who Have Experienced Intimate Partner Violence During COVID-19.

This interpretive description study explored coping among older women in Ontario experiencing intimate partner violence (IPV) during COVID-19. Twelve in-depth interviews with older women found age-related normative beliefs played a role in how older women viewed their lives and how they looked beyond their experiences of IPV. Their roles as caretakers and homemakers influenced their response to IPV, and COVID-19 exacerbated feelings of lost time and loneliness. Coping strategies consisted of social support, including telephone formal services and physical activities. Women expressed a lack of appropriate services and financial limitations as barriers. They identified the need for age-appropriate services that acknowledge their unique experiences.

Understanding the Health and Well-being of Women With Multiple Sclerosis.

ABSTRACT: BACKGROUND: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system, and is potentially disabling. Women experience MS more frequently than men at a 3:1 ratio. Current literature suggests that women may experience health, social determinants of health, and disability differentially, and there is a gap in the research examining how gender intersects with MS. METHODS: Interviews were conducted with 23 women with MS. van Manen's hermeneutic phenomenology was used to inform and analyze the data to understand the nature and meaning of health and well-being for participants. RESULTS: A key theme of "enhancing wholeness for women with MS" emerged from the data, which suggests that women with MS view themselves as healthy and "whole" despite living with MS. Supporting factors for physical, mental, and social well-being include the ability to enact human agency within social structures such as with employment or seeking care with MS clinics. The findings informed the development of a figure that depicts the supporting factors of health and well-being for women living with MS. CONCLUSION: The health and well-being of women with MS may be optimally supported by nurses and interdisciplinary healthcare teams through careful consideration as to how agency is enacted within social structures, for example, MS clinics, employment, and social support systems, as well as considerations for social determinants of health.

Vaccine Hesitancy Among Canadian Mothers: Differences in Attitudes Towards a Pediatric COVID-19 Vaccine Among Women Who Experience Intimate Partner Violence.

OBJECTIVES: Vaccine hesitancy (VH) in maternal decision-making is important to understand to achieve community immunity targets and optimize pediatric COVID-19 vaccine adoption. COVID-19 is exacerbating the risk of intimate partner violence (IPV) for women in abusive relationships, a known risk factor for maternal VH. This project aimed to: (1) determine if IPV impacts maternal VH in Canada; and (2) understand maternal attitudes towards routine childhood vaccines and a pediatric COVID-19 vaccine in Canada. METHODS: As part of a cross-sectional, quantitative study, 129 women completed an online survey. IPV was assessed using the Abuse Assessment Screen and the revised, short-form Composite Abuse Scale. The Parent Attitudes about Childhood Vaccines scale evaluated maternal attitudes towards routine vaccinations and a COVID-19 vaccine. Questions informed by the World Health Organization's Increasing Vaccination Model (IVM) evaluated perceived barriers and facilitators to COVID-19 vaccination. RESULTS: In total, 14.5% of mothers were hesitant towards routine childhood vaccines, while 97.0% were hesitant towards a COVID-19 vaccine. Experiencing IPV was significantly associated with maternal COVID-19 VH (W = 683, p < 0.05). Social processes were identified as instrumental barriers and facilitators to COVID-19 vaccination, meaning that social norms and information sharing among social networks are critical in maternal vaccination decision-making. CONCLUSIONS FOR PRACTICE: This study provides novel evidence of maternal IPV significantly impacting VH and the presence of strong maternal VH specific to a COVID-19 vaccine in the Canadian context. Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers, especially mothers who have experienced IPV.

Trauma-Informed Approaches in the Context of Cancer Care in Canada and the United States: A Scoping Review.

Cancer is predominantly understood as a physical condition, but the experience of cancer is often psychologically challenging and has potential to be traumatic. Some people also experience re-traumatization during cancer because of previous, non-cancer-related trauma, such as intimate partner violence or adverse childhood experiences. A trauma-informed approach to care (TIC) has potential to enhance care and outcomes; however, literature regarding cancer-related TIC is limited. Accordingly, the objective of this scoping review was to identify what is known from existing literature about trauma-informed approaches to cancer care in Canada and the United States. A scoping review (using Arksey and O'Malley's (2005) framework) was conducted. The PsycINFO, CINAHL, MEDLINE (Ovid), Embase (Ovid), and Scopus databases, key journals, organizations, and reference lists were searched in February 2022. In total, 124 sources met the review criteria and 13 were included in the final review. Analysis included a basic descriptive summary and deductive thematic analysis using conceptual categories. Theorizations, applications, effectiveness, and feasibility of TIC were compiled, and gaps in TIC and recommendations for TIC were identified. TIC appeared to be growing in popularity and promising for improving cancer outcomes; however, gaps in the theorization, effectiveness, and feasibility of TIC persisted. Many recommendations for the application of TIC were not issued based on a strong body of evidence due to a lack of available literature. Further research is required to develop evidence-based recommendations regarding TIC related to cancer. A systematic review and meta-analysis would be warranted upon literature proliferation.

Resilience is more than Nature: An Exploration of the Conditions that Nurture Resilience Among Rural Women who have Experienced IPV.

Purpose: Intimate partner violence (IPV) is a significant public health concern exacerbated by the pandemic. Experiences of violence vary based on geographic location and living in rural communities has been found, in some contexts, to amplify consequences of IPV. Resilience, the ability to survive and thrive despite facing adversity, has long been a dominant narrative within IPV literature, yet little is known about how resilience is cultivated among rural women experiencing violence. The purpose of this study was to explore how rural women experiencing IPV cultivate resilience. Methods: Using Interpretive Description, in-depth qualitative interviews were conducted with 14 women who experienced IPV and 12 staff from women's shelters across rural communities in Ontario, Canada to elicit perspectives about women's resilience and environmental conditions that may shape resilience in the context of IPV. Results: Women's resilience was cultivated by personal changes aimed at surviving or thriving, and aspects of their environment that enabled or created barriers for resilience. Women adopted a positive, hopeful mindset and bolstered their inner strength through living from a place of integrity, being resolute in decisions, and using mental resistance when faced with doubt. Women faced barriers to resilience in the form of unhelpful help and COVID-19 public health guidelines. Paradoxically, living in a rural community both cultivated and undermined resilience. Conclusions: Supporting women to cultivate resilience through modifying environmental factors to enable personal strengths to flourish is paramount in supporting women who have experienced IPV, particularly in rural contexts.

The Good, the Bad, and the Vision: Exploring the Mental Health Care Experiences of Transitional-Aged Youth Using the Photovoice Method.

Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.

Riding on resilience: impacts of the COVID-19 pandemic on women experiencing intimate partner violence.

The COVID-19 pandemic and resultant public health measures, although helpful in reducing the spread of the disease, have disproportionately impacted women experiencing intimate partner violence (IPV). Despite these adverse circumstances, women continue to show resilience. Although difficult to define, resilience can be conceptualized as a dynamic process in which psychosocial and environmental factors interact to enable an individual to survive, grow, and thrive despite exposure to adversity. This research identifies facilitators and gaps in supports to promoting resilience among urban and rural women experiencing intimate partner violence (IPV) during the COVID-19 pandemic, via an online survey (n = 95) and interviews (n = 19). T-tests, Wilcoxon rank sum tests, and interpretive description were utilized for analyses. Almost 41% of participants experienced an increase in abuse during COVID-19, and resilience significantly decreased during COVID-19 (t(44) = 2.91, p = 0.006). Qualitatively, four parent themes (coercive control, social services, resilience, and future) and seven sub-themes emerged. Changes are needed in accessibility and delivery of support services for women experiencing IPV during COVID-19, and future pandemics.

Experiences of At-Risk Women in Accessing Breastfeeding Social Support During the Covid-19 Pandemic.

BACKGROUND: With strict public health measures implemented in March 2020 due to the COVID-19 pandemic, many breastfeeding parents, who are within an at-risk population, have experienced limited formal and/or informal breastfeeding social support. In the Canadian context, the experiences of these women is unknown. RESEARCH AIM: To explore the experiences of at-risk postpartum breastfeeding women in accessing formal and informal breastfeeding social support during the COVID-19 pandemic. METHODS: This was a prospective, longitudinal interpretive description study using mixed methods. Data were gathered using an online survey and one 52-112-min semi-structured interview at 12-weeks postpartum. At-risk breastfeeding participants were those who lack social support and had at least one of the following: age < 25 years; experiencing or had experienced intimate partner violence; or of low income. We sought participants' experiences of accessing breastfeeding social support during the first few months of the COVID-19 pandemic/lockdown. Seven participants completed the survey and the interview. RESULTS: Participants identified that the COVID-19 pandemic created barriers to accessing formal and informal breastfeeding social support, which stemmed from public health restrictions and difficulties communicating online with families and healthcare providers. Additionally, participants identified that the COVID-19 pandemic/lockdowns facilitated feelings of connectedness, protection, and resiliency. CONCLUSION: We provide preliminary insight into the experiences of trying to access breastfeeding social support during the COVID-19 pandemic. Future researchers should seek to prioritize improved communication and resources in supporting breastfeeding during COVID-19 and future pandemics/lockdowns.

Impacts of COVID-19 on the Coping Behaviours of Canadian Women Experiencing Intimate Partner Violence.

Background: Strict public health measures central to slowing the spread of COVID-19 have, unintentionally, exacerbated risks for women experiencing intimate partner violence (IPV) while impeding their usual coping strategies. The goal of this study was to understand how coping was influenced by COVID-19 for women who have experienced IPV and identify changes in coping strategies and gaps that need to be addressed to support coping. Methods: A qualitatively driven, sequential, cross-sectional design, where quantitative data informed and was embedded within qualitative data collection, was used to explore the experiences of IPV (CAS-R-SF scale) and coping (Brief-COPE scale) specific to IPV of 95 Canadian women. A subset of 19 women was invited to complete an interview exploring coping strategies identified within the survey to contextualize and validate these findings. Results: Survey data subjected to quantitative content analysis identified ten themes, all of which were explored in semi-structured interviews. Thematic interview findings included (1) influence of COVID-19 on coping, (2) coping during COVID-19, and (3) needed coping strategies. Conclusion: COVID-19 had important impacts on the experiences and coping strategies of women who experience IPV. To better support this population in pandemic circumstances, in-person services should be prioritized with an emphasis on accessible and empathetic care. Public health measures in response to COVID-19, and the eventuality of future pandemics, should aim to be gender- and violence-informed.

"I Fell through the Cracks": Navigating the Disjointed Transition from Paediatric to Adult Psychiatric Services.

The transition from adolescence to adulthood is a tumultuous time riddled with stress, confusion, and uncertainty. An abrupt shift in biobehavioural development between the ages of 16 and 24 corresponds with an increase in mental health challenges; thereby necessitating comprehensive and coordinated psychiatric services that bridge pediatric and adult care realms. Unfortunately, this transition is often unsupportive and disjointed, leaving many transitional-aged youth (TAY) overwhelmed and ill-equipped to cope with the increased demands of adulthood independently. Eight TAY with mental health challenges were invited to participate in a PhotoVoice study that explored the strengths and shortcomings of this transition process, through a combination of photography and photo-elicitation focus group discussions. A descriptive qualitative approach was used to analyze all participant dialogue. Four themes emerged from the data: accessibility, coordination, independence, and support. Participant insights illuminated critical gaps in mental health care delivery, but also revealed novel solutions and opportunities for transformational change.

Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma-and-violence-informed care to pregnant women.

AIM: To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD). DESIGN: A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program. METHODS: Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts. RESULTS: In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31). CONCLUSION: The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope. IMPACT: TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care.

Sharing Personal Experiences of Accessibility and Knowledge of Violence: A Qualitative Study.

In North America, the most common societal response to intimate partner violence (IPV) has been the establishment of women's shelters for temporary housing and security. Rurality further compounds the challenges women experiencing IPV face, with unique barriers from their urban counterparts. This study sought to explore the intersection of rural women's health care experiences within the context of IPV. Eight rural women living in Southwestern Ontario, who had experienced IPV, had used women's shelter services, and who had accessed health care services in the preceding 6 months were interviewed. Using a feminist, intersectional lens, we collected and analyzed qualitative data using an interpretive description approach. Findings demonstrated that women were able to identify strengths and opportunities from their experiences, but significant challenges also exist for rural women seeking health care who experience IPV. Our findings underscore the need for filling of policy gaps between health care and the services women use. We propose that further research is needed on alternative, integrated models of shelter services that address health care needs for women experiencing IPV.

A guide to anticipatory guidance for breastfeeding-related pain: A concept analysis.

AIM: This article provides a concept analysis of anticipatory guidance regarding breastfeeding-related pain and establishes a definition to inform the concept's practical use. BACKGROUND: Breastfeeding-related pain is a barrier to achieving optimal breastfeeding outcomes, which can impede maternal and infant health. Education through anticipatory guidance that addresses breastfeeding-related pain can improve breastfeeding outcomes, but no formal definition is currently available for practitioner use. DESIGN: Walker and Avant's protocol for concept analyses was employed. DATA SOURCE: A comprehensive literature review was conducted using CINAHL, PubMed, Scopus, and OMNI. Search terms included anticipatory guidance, breastfeeding, pediatrics, nursing, and lactating. This identified 379 articles, of which six addressed anticipatory guidance for breastfeeding-related pain. REVIEW METHODS: Inclusion criteria asked that literature be available in English and published between 2000 and 2020. RESULTS: Three key characteristics of anticipatory guidance regarding breastfeeding-related pain were identified: timing, content, and intention. Antecedents included maternal intention to breastfeed and interaction with a healthcare provider. Consequences included improved breastfeeding outcomes, enhanced maternal understanding of challenges, and maternal empowerment in relation to pain management. CONCLUSIONS: Anticipatory guidance about breastfeeding-related pain can empower women to sustain breastfeeding in spite of challenges, thus prolonging the breastfeeding period, and subsequently improving infant nutrition and health outcomes.

An Exploration of How Persons Receiving In-Center Hemodialysis Describe How Access to Transportation for Treatment Influences Their Overall Health.

Individuals having in-center hemodialysis treatment re quire transportation services on average six trips a week (three roundtrips for three treatment days), making access to transportation an important component for sustaining the health and well-being of these individuals. This qualitative study aimed to explore how persons receiving in-center hemodialysis treatment explain ways in which access to transportation for such treatment influences their overall health using the World Health Organization's definition of health. Purposive sampling was used to recruit eight participants from a community hemodialysis center in a suburban region of Southwestern Ontario, Canada. Data were obtained using semi-structured individual interviews and analyzed using inductive analysis. Three interrelated themes revealed each patient's experience: reliability, choice, and personal safety.

Evaluation of the Arabic version of the Chronic Pain Grade scale: Psychometric properties.

To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self-reported pain measures is imperative. However, well-validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross-sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short-form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain-related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation.

Critical discourse analysis of policies impacting the intersection of health and experiences of intimate partner violence for rural women in Ontario, Canada.

INTRODUCTION: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women's shelter policies intersect and impact women in rural communities. METHODS: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women's shelter policy, and (3) the hospital policy. RESULTS: The internal analysis of the policies revealed that ODVAP focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care. CONCLUSIONS: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers.

Exploring mothers' experiences of trauma and violence-informed cognitive behavioural therapy following intimate partner violence: a qualitative case analysis.

PURPOSE: Intimate partner violence (IPV) is a pervasive public health issue impacting one in three women, worldwide. Broadly defined as any act of coercive control within the context of an intimate relationship, IPV often results in significant negative health outcomes. Cognitive Behavioral Therapy (CBT), a mainstay treatment for relational trauma, has particular relevance for women undergoing the many transformations associated with the perinatal period. The findings of this case analysis build upon existing literature supporting the positive impact of Trauma and Violence- Informed CBT (TVICBT) for women who have experienced IPV and are living with mental health challenges. METHODS: As part of a larger mixed-methods study, three women who experienced IPV and received TVICBT during pregnancy participated in in-depth, semi-structured interviews to determine the perceived value and acceptability of this intervention. FINDINGS: Insights gained herein, serve to enrich current evidence, suggesting that TVICBT provided during pregnancy may hold promise for the treatment of IPV-related mood and anxiety disorders. CONCLUSIONS: Given that improved perinatal mental health has been linked to enhanced maternal resiliency and quality of life, greater maternal-infant attachment, and positive child health outcomes, this research has the potential to bridge the critical knowledge gap at the intersection of motherhood, trauma, and mental health.