Relational practices for meaningful inclusion in health research: Results of a deliberative dialogue study.

INTRODUCTION: The importance of including people affected by research (e.g., community members, citizens or patient partners) is increasingly recognized across the breadth of institutions involved in connecting research with action. Yet, the increasing rhetoric of inclusion remains situated in research systems that tend to reward traditional dissemination and uphold power dynamics in ways that centre particular (privileged) voices over others. In research explicitly interested in doing research with those most affected by the issue or outcomes, research teams need to know how to advance meaningful inclusion. This study focused on listening to voices often excluded from research processes to understand what meaningful inclusion looks and feels like, and asked what contributes to being or feeling tokenized. METHODS: In this deliberative dialogue study, 16 participants with experience of navigating social exclusions and contributing to research activities reflected on what makes for meaningful experiences of inclusion. Using a co-production approach, with a diversely representative research team of 15 that included patient and community partners, we used critically reflective dialogue to guide an inclusive process to study design and implementation, from conceptualization of research questions through to writing. RESULTS: We heard that: research practices, partnerships and systems all contribute to experiences of inclusion or exclusion; the insufficiency or absence of standards for accountability amplifies the experience of exclusion; and inclusive practices require intention, planning, reflection and resources. CONCLUSIONS: We offer evidence-informed recommendations for the deeply relational work and practices for inclusivity, focused on promising practices for cultivating welcoming systems, spaces and relationships. PATIENT OR PUBLIC CONTRIBUTION: This work reflects a co-production approach, where people who use and are affected by research results actively partnered in the research process, including study design, data-generating activities, analysis and interpretation, and writing. Several of these partners are authors of this manuscript.

Is progress being made on Canada's palliative care framework and action plan? A survey of stakeholder perspectives.

BACKGROUND: The legalization of Medical Assistance in Dying in Canada in 2016 provided new impetus for improving palliative care. This commitment to improvement included the development of a National Palliative Care Framework and Action Plan. The purpose of this study was to understand the progress made in palliative care since 2016 from the perspective of persons working and volunteering in palliative care and compare geographic differences. METHODS: A digital survey was developed from goals identified in Canada's Palliative Care Framework and Action Plan and administered online using Qualtrics. Participants were recruited through national palliative care organizations. The survey included both quantitative survey items designed to evaluate improvements across 5 domains and 29 items and included open-ended questions about impacts, innovations, and ongoing challenges. Descriptive statistics were generated for survey domains, items, and demographic variables. Geographic differences were compared using Independent-Samples Kruskal-Wallis test. Qualitative data was analyzed inductively into themes. RESULTS: One hundred fifty surveys met inclusion criteria and were analysed. Overall, the most improvement was reported in palliative care education and the least improvement was reported in support for family caregivers. Items on which respondents reported the most improvement included healthcare provider education in palliative care, advance care planning, and use of technology. Items on which respondents reported the least improvement were respite for family caregivers, access to bereavement services, and in-home support for family caregivers. Notably, rural participants reported more statistically significant improvements in the domains of education, access, and research and data collection than their urban counterparts. However, rural participants reported less improvement in places to die when home is not preferable. The COVID-19 pandemic was a significant contributor to these perceived improvements and ongoing challenges. CONCLUSION: Canada's Framework and Action Plan sets out a roadmap for improving palliative care in Canada. Participants in this survey noted significant improvements in key areas, a notable accomplishment amidst the effects of the COVID-19 pandemic. Some improvements were a result of greater use of distance technology. Further leveraging these improvements will make an important contribution to solving some of the rural and remote palliative care issues that have arisen from Canada's unique geography.

Scaling up a community-led health promotion initiative: Lessons learned and promising practices from the Healthy Weights for Children Project.

The increase in overweight and obesity among children has emerged as an important public health issue. This trend has highlighted the need for accessible and novel approaches to support healthy weights for children and their families to prevent childhood obesity. The purpose of this article is to describe the iterative development and scale-up of a community-led, national-level project to promote healthy weights among Canadian children and families who may be experiencing vulnerabilities. In this project, the Healthy Together program was designed to engage families in an interactive program to support healthy lifestyles. The program also provides a platform for creating supportive environments for healthful lifestyles through practice and policy change. Based on a process evaluation, we describe the iterative development of Healthy Together from Phase 1 through 3 to shed light on processes shaping implementation and scale-up of the program. Lessons learned during each phase were used to refine the program and further expansion. Indicators of successful scale-up include the Healthy Together program's cross-jurisdictional reach and promising evaluation results in real-world conditions. The practice-based program scaling approach provides practical guidance for planning and implementing similar health promotion programs in diverse communities.

A RE-AIM evaluation of Healthy Together: a family-centred program to support children's healthy weights.

BACKGROUND: Healthy Together (HT) is family-centered program to support healthy eating and physical activity designed for implementation in community organizations serving families who may be experiencing vulnerabilities (e.g., related to low income, isolation, ethnicity, immigrant/refugee status, and/or Indigenous background). The purpose of this study was to conduct an evaluation of HT in a real-world, scale-up phase using the RE-AIM framework. METHODS: Using a cross-sectional, non-comparative design, a community-based program evaluation was conducted in 29 organizations implementing HT as part of their core service programs. Data were collected using questionnaires with program participants and facilitators, and interviews with directors of participating organizations. Quantitative data were analyzed using descriptive statistics and qualitative data were content analyzed. RESULTS: With regards to Reach, over 3400 caregivers, children and youth attended community programming that offered HT. Among those attending on the scheduled day for the evaluation, 663 completed the questionnaires. The majority of caregiver respondents (n = 431) were female (92%) and attended with children 0-6 years. Respondents also included children 4-6 years (n = 142) and 7-12 years (n = 65), and youth 13-18 years (n = 25). Effectiveness was demonstrated in reported improvements in physical activity, healthy eating, and strengthened social connections. HT was also widely supported by participants and facilitators. Adoption was influenced by the desire to enrich core service programs for families, HT's fit within existing programs, organizational commitment, and funding support. Implementation experiences indicated that fidelity to the HT program was generally maintained, with some setting specific adaptations. Maintenance of HT was influenced by financial and non-financial resources within community organizations. Most organizations also introduced new initiatives to extend support for healthy eating and physical activity. CONCLUSION: Our findings indicate improvements in healthy eating and physical activity, and social connections among program participants, as well as efforts by community organizations to create environments to support healthy weights. HT was successfully delivered in "real-world" community settings across multiple contexts and with families with diverse backgrounds. This along with strategies to support program implementation and sustainability indicate that HT provides a model for other public health interventions to promote family health and wellbeing. TRIAL REGISTRATION: ClincialTrials.gov NCT03550248. Registered May 25, 2018.

Strategies for Supporting Smoking Cessation Among Indigenous Fathers: A Qualitative Participatory Study.

There is a need for tailored smoking cessation programs specifically for Indigenous fathers who want to quit smoking.The aim of this study was to engage Indigenous men and key informants in guiding cultural adaptations to the Dads in Gear (DIG) cessation program. In Phase 1 of this qualitative participatory study, Indigenous men were engaged in group sessions and key informants in semistructured interviews to gather advice related to cultural adaptations to the DIG program. These data were used to guide the development of program prototypes. In Phase 2, the prototypes were evaluated with Indigenous fathers who were using tobacco (smoking or chewing) or were ex-users. Data were analyzed inductively. Recommendations for programming included ways to incorporate cultural values and practices to advance men's cultural knowledge and the need for a flexible program design to enhance feasibility and acceptability among diverse Indigenous groups. Men also emphasized the importance of positive message framing, building trust by providing "honest information," and including activities that enabled discussions about their aspirations as fathers as well as cultural expectations of current-day Indigenous men. That the Indigenous men's level of involvement with their children was diverse but generally less prescriptive than contemporary "involved fathering" discourse was also a key consideration in terms of program content. Strategies were afforded by these insights for meeting the men where they are in terms of their fathering-as well as their smoking and physical activity. This research provides a model for developing evidence-based, gender-specific health promotion programs with Indigenous men.

Adults' food skills and use of gardens are not associated with household food insecurity in Canada.

OBJECTIVES: To determine the extent to which Canadian adults' food preparation and cooking skills and use of home or community gardens relate to their household food insecurity status; and to compare the food shopping and cooking behaviours of adults in food-secure and food-insecure households. METHODS: Data were drawn from two Rapid Response Modules appended to the Canadian Community Health Survey in 2012 and 2013. The analytic sample comprised 16,496 respondents 18 years and older. Multivariable logistic regression analyses were conducted to determine the association between food insecurity and adults' self-rated cooking abilities, food preparation skills score, use of gardens, food shopping behaviours, and cooking behaviours, while adjusting for socio-demographic characteristics. RESULTS: Adults in food-insecure households did not differ significantly from others with respect to their food preparation skills or cooking ability, and neither variable predicted the odds of household food insecurity when socio-demographic characteristics were taken into account. Adults in food-insecure households were less likely to use a garden for food, but gardening was unrelated to the odds of food insecurity. Shopping with a budget was more common among adults in food-insecure households, but no other differences in food shopping behaviours were observed after adjustment for socio-demographic characteristics. Adults in food-insecure households were as likely as others to adjust recipes to make them healthier, but they had higher odds of adjusting recipes to reduce their fat content. CONCLUSION: Our findings suggest that household food insecurity in Canada is not a problem of insufficient food skills.