Neighbourhood walkability and greenspace and their associations with health-related fitness in urban dwelling Canadian adults.

OBJECTIVE: Muscular strength and body composition are important components of health-related fitness (HRF). Grip strength and body fat percent, in particular, are associated with chronic disease and affected by health behaviours. Evidence suggests relationships between the neighbourhood built environment (BE) and HRF exist, however, few studies have focused on grip strength and body fat percent. Therefore, our study aimed to estimate the sex-specific associations between the neighbourhood BE, grip strength, and body fat percent among urban-dwelling Canadian adults. METHODS: We analyzed cross-sectional survey and HRF data collected in 2011-2015 from 4052 males and 7841 females (Alberta's Tomorrow Project, Canada). Grip strength and body fat percent were measured via handgrip dynamometry and bioelectrical impedance analysis, respectively. Walkability (Canadian Active Living Index) and greenness (Normalized Difference Vegetation Index) estimates were linked to participant data. Sex-stratified covariate-adjusted linear regression models estimated the associations between the BE and HRF variables. RESULTS: Walkability was negatively associated with grip strength and body fat percent in males (ß -0.21, 95%CI: -0.31 to -0.11 and ß -0.08, 95%CI: -0.15 to -0.02, respectively) and females (ß -0.06, 95%CI: -0.10 to -0.01 and ß -0.08, 95%CI: -0.14 to -0.02, respectively). Greenness was positively associated with grip strength in males (ß 6.99, 95%CI: 3.62 to 10.36) and females (ß 2.72, 95%CI: 1.22 to 4.22) but not with body fat percent. Controlling for physical activity and sitting did not attenuate these associations. CONCLUSION: Characteristics of the neighbourhood BE appear to be associated muscular strength and body composition, independent of physical activity and sedentary behaviour.

Ethical and Equitable Digital Health Research: Ensuring Self-Determination in Data Governance for Racialized Communities.

Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management.

Involuntary delayed retirement and mental health of older adults.

OBJECTIVE: This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA. METHODS: Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs). RESULTS: Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age. CONCLUSION: The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.

Mediation analysis of the associations between neighbourhood walkability and greenness, accelerometer-measured physical activity, and health-related fitness in urban dwelling Canadians.

OBJECTIVE: To estimate sex-specific associations (total, direct, and indirect effects) between objectively measured neighbourhood walkability and greenness and objectively measured physical activity and health-related fitness including cardiorespiratory and muscular fitness in Canadian adults. METHODS: Neighbourhood walkability (Canadian Active Living Environment) and greenness (Normalized Difference Vegetation Index; NDVI) data were linked to cardiorespiratory (i.e., submaximal step test estimated V̇O2 max) and muscular fitness (i.e., handgrip strength) and accelerometer measured physical activity; Canadian Health Measures Survey). Covariate-adjusted sex-stratified path analyses was conducted to assess if physical activity (light: LPA; moderate: MPA, and; vigorous: VPA) mediated the associations between neighbourhood walkability, NDVI and health-related fitness. Model sample sizes ranged from 987 to 2796 for males and 989 to 2835 for females. RESULTS: Among males, we found indirect effects between neighbourhood walkability and cardiorespiratory fitness via LPA (negative) and VPA (positive). We also found a total effect (negative) between neighbourhood walkability and grip strength and indirect effects between neighbourhood walkability and handgrip strength via LPA (negative) and MPA (negative). Among females, we found a total effect (positive) and direct effect (positive) between neighbourhood walkability and cardiorespiratory fitness, and an indirect effect for neighbourhood walkability and cardiorespiratory fitness via LPA. We found no significant effects related to neighbourhood greenness. CONCLUSIONS: Residing in a neighbourhood with higher walkability may positively affect cardiorespiratory fitness but negatively affect muscular strength. The negative associations between neighbourhood walkability and LPA may offset potential positive associations between neighbourhood walkability and MPA and VPA and their subsequent influence on health-related fitness.

Precision health equity for racialized communities.

In the last three decades, a cohort of genomicists have intentionally sought to include more racially diverse people in their research in human genomics and precision medicine. How such efforts to be inclusive in human genomic research and precision medicine are modeled and enacted, specifically if the terms of inclusion are equitable for these communities remains to be explored. In this commentary, we review the historical context in which issues of racial inclusion arose with early genome and genetics projects. We then discuss attempts to include racialized peoples in more recent human genomics research. In conclusion, we raise critical issues to consider in the future of equitable human genomics and precision medicine research involving racialized communities, particularly as it concerns working towards what we call Precision Health Equity (PHE). Specifically, we examine issues of genetic data governance and the terms of participation in inclusive human genomics and precision health research. We do so by drawing on insights and protocols developed by researchers investigating Indigenous Data Sovereignty and propose exploring their application and adaptation to precision health research involving racialized communities.

Community Ecosystem Mapping: A Foundational Step for Effective Community Engagement in Research and Knowledge Mobilization.

Community engagement is a key strategy for achieving various goals, such as social and environmental change, sustainable development, health promotion, and community building. It involves collaborations and partnerships with the community that help mobilize resources, impact systems, rectify partner dynamics, and function as catalysts for modifying policies, programs, and practices. It also ensures mutual trust among all parties involved, giving community members greater personal agency and involvement potential. We have learned a range of practical aspects of community engagement with communities, particularly with immigrant/racialized communities, by running a community-engaged program of research on the health and wellness issues of immigrant/racialized communities in Calgary, Canada. In this article, we focus on a crucial early step of community engagement-understanding the community ecosystem. The community ecosystem refers to its human, social, and cultural makeups. Understanding this ecosystem requires conscious efforts to comprehend the demography, participate in socio-cultural events, identify community spots, reach out to hard-to-access groups, find the community champions and communication channels/organizations, and reaching out to them to establish relationships. Understanding the community ecosystem allows us to identify the pivotal factors, key actors, and pulse of the community that we are engaging with. This enables us to build mutual trust and goals for research and knowledge mobilization. Subsequently, an empowered, continual, and collaborative partnership becomes possible, resulting in sustained and desirable outcomes.

Color coded health data: factors related to willingness to share health information in South Asian community members in Canada.

Introduction: Data unavailability poses multiple challenges in many health fields, especially within ethnic subgroups in Canada, who may be hesitant to share their health data with researchers. Since health information availability is controlled by the participant, it is important to understand the willingness to share health information by an ethnic population to increase data availability within ethnocultural communities. Methods: We employed a qualitative descriptive approach to better understand willingness to share health information by South Asian participants and operated through a lens that considered the cultural and sociodemographic aspect of ethnocultural communities. A total of 22 in-depth interviews were conducted between March and July 2020. Results: The results of this study show that health researchers should aim to develop a mutually beneficial information-sharing partnership with communities, with an emphasis on the ethnocultural and socio-ecological aspects of health within populations. Conclusion: The findings support the need for culturally sensitive and respectful engagement with the community, ethically sound research practices that make participants feel comfortable in sharing their information, and an easy sharing process to share health information feasibly.

Employing diffusion of innovation theory for 'not missing the mass' in community-engaged research.

INTRODUCTION: Engaging with minority communities, such as immigrants and ethnic minorities, often involves adopting top-down approaches, wherein researchers and policymakers provide solutions based on their perspective. However, these approaches may not adequately address the needs and preferences of the community members, who have valuable insights and experiences to share. Therefore, community-engaged approaches, which involve collaborative partnerships between community members and researchers to identify issues, co-create solutions, and recommend policy changes, are becoming more recognized for their effectiveness and relevance. Yet, prevailing community engagement efforts often focus on easily reachable and already engaged segments of the community, sometimes overlooking the broader population. METHODS: When working with immigrant and racialized communities, we encountered difficulties in engaging the wider community through traditional researcher-led approaches. We realized that overcoming these challenges required innovative strategies rooted in community-based participatory research principles and the diffusion of innovation theory. We recognized that a nuanced understanding of the community's dynamics and preferences was crucial in shaping our approach and building trust and rapport with the community members. RESULTS: The need to bridge the gap between researcher-led initiatives and community-driven involvement has never been more pronounced. Our experience, chronicled in this article, highlights the journey of our research program with an immigrant/racialized community. This reflection enhances our comprehension of community engagement that deliberately strives to reach a larger cross-section of the community. By providing practical methods for reaching the broader community and navigating the intricacies of engagement, we aim to assist fellow researchers in conducting effective community-engaged research across various minority communities. CONCLUSION: In sharing our insights and successful strategies for community engagement, we hope to contribute to the field's knowledge. Our commitment to fostering meaningful collaboration underscores the importance of co-creating solutions that resonate with the diverse voices within these communities. Through these efforts, we envision a more inclusive and impactful approach to addressing the complex challenges faced by minority populations.

Unmet Primary Health Care Needs among Nepalese Immigrant Population in Canada.

BACKGROUND: Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. METHODS: A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. RESULTS: Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26-45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). CONCLUSIONS: UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively.

Conceptualising community engagement as an infinite game implemented through finite games of 'research', 'community organising' and 'knowledge mobilisation'.

Meaningful community engagement process involves focusing on the community needs, building community capacity and employing culturally tailored and community-specific strategies. In the current practices of community-engaged health and wellness research, generally, community engagement activities commence with the beginning of a particular research project on a specific topic and end with the completion of the project. The outcomes of the community engagement, including the trust, partnership and contribution of the community to research, thus remain limited to that specific project and are not generally transferred and fostered further to the following project on a different topic. In this viewpoint article, we discussed a philosophical approach to community engagement that proposes to juxtapose community engagement for the specific short-term research project and the overarching long-term programme of research with the finite game and infinite game concepts, respectively. A finite game is a concept of a game where the players are known, rules are fixed and when the agreed-upon goal is achieved, the game ends. On the other hand, in infinite games, the players may be both known and unknown, have no externally fixed rules and have the objective of continuing the game beyond a particular research project. We believe community engagement needs to be conducted as an infinite game that is, at the programme of research level, where the goal of the respective activities is not to complete a research project but to successfully engage the community itself is the goal. While conducting various research projects, that is, finite games, the researchers need to keep an infinite game mindset throughout, which includes working with the community for a just cause, building trust and community capacity to maximise their contribution to research, prioritising community needs and having the courage to lead the community if need be. Patient or Public Contribution: While preparing this manuscript, we have partnered actively with community champions, activists, community scholars and citizen researchers at the community level from the very beginning. We had regular interactions with them to get their valuable and insightful inputs in shaping our reflections. Their involvement as coauthors in this paper also provided a learning opportunity for them and facilitated them to gain insight on knowledge engagement. All authors support greater community/citizen/public involvement in research in an equitable manner.

Choosing Alternative Career Pathways after Immigration: Aspects Internationally Educated Physicians Consider when Narrowing down Non-Physician Career Choices.

Many developed countries admit internationally educated physicians (IEPs) as highly skilled migrants. The majority of IEPs arrive with the intention of becoming licensed physicians to no avail, resulting in underemployment and underutilization of this highly skilled group of people. Alternative careers in the health and wellness sector provide IEPs opportunities to use their skills and reclaim their lost professional identity; however, this path also includes great challenges. In this study, we determined factors that affect IEPs' decisions regarding their choice of alternative jobs. We conducted eight focus groups with 42 IEPs in Canada. Factors affecting IEPs' career decisions were related to their individual situations and tangible aspects of career exploration, including resources and skills. A number of factors were associated with IEPs' personal interests and goals, such as a passion for a particular career, which also varied across participants. Overall, IEPs interested in alternative careers took an adaptive approach, largely influenced by the need to earn a living in a foreign country and accommodate family needs and responsibilities.

Alternative Careers toward Job Market Integration: Barriers Faced by International Medical Graduates in Canada.

International Medical Graduates (IMGs), who completed their medical degree and training outside Canada constitute a notable portion of the skilled migrants of the country. However, due to a long and uncertain licensure process and limited opportunities many IMGs look for alternative career pathways where they can utilize their learned skills. Alternative careers in the health and wellness sector may offer such opportunities; however, IMGs' success in these pathways were also less evident despite their high potential. In this study, we investigated the barriers that IMGs stated to face when attempting alternative jobs in Canada. Eight focus groups with 42 IMGs in Canada were conducted. Using a thematic analysis approach, we identified that IMGs encounter these barriers in different stages of their resettlement journey in Canada, including both the pre-migration and post-migration phases. In the pre-migration phase, IMGs were not aware of the success rates of the licensing pathways and did not have sufficient information regarding potential alternative careers. In the post-migration phase, the lack of information continues to affect IMGs where IMGs exhaust their resources pursuing alternative careers without proper guidance and support. Further, IMGs struggle with taking preparation for alternative careers by obtaining further certifications and completing other prerequisites for some barriers, such as financial constraints. While looking for jobs, some IMGs perceived systemic discrimination such as non-recognition of their credentials and experience. Furthermore, the mismatch of expectations and limited growth opportunities offered by potential careers serve to disincentivize IMGs from pursuing an alternative career. Addressing the current employment inequity experienced by IMGs in Canada warrants research collaborations between organizations supporting IMGs and policymakers that target known barriers to the pursuit of alternative careers by IMGs.

The Benefits, Challenges, and Strategies toward Establishing a Community-Engaged Knowledge Hub: An Integrative Review.

Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.

A comparison of machine learning algorithms and traditional regression-based statistical modeling for predicting hypertension incidence in a Canadian population.

Risk prediction models are frequently used to identify individuals at risk of developing hypertension. This study evaluates different machine learning algorithms and compares their predictive performance with the conventional Cox proportional hazards (PH) model to predict hypertension incidence using survival data. This study analyzed 18,322 participants on 24 candidate features from the large Alberta's Tomorrow Project (ATP) to develop different prediction models. To select the top features, we applied five feature selection methods, including two filter-based: a univariate Cox p-value and C-index; two embedded-based: random survival forest and least absolute shrinkage and selection operator (Lasso); and one constraint-based: the statistically equivalent signature (SES). Five machine learning algorithms were developed to predict hypertension incidence: penalized regression Ridge, Lasso, Elastic Net (EN), random survival forest (RSF), and gradient boosting (GB), along with the conventional Cox PH model. The predictive performance of the models was assessed using C-index. The performance of machine learning algorithms was observed, similar to the conventional Cox PH model. Average C-indexes were 0.78, 0.78, 0.78, 0.76, 0.76, and 0.77 for Ridge, Lasso, EN, RSF, GB and Cox PH, respectively. Important features associated with each model were also presented. Our study findings demonstrate little predictive performance difference between machine learning algorithms and the conventional Cox PH regression model in predicting hypertension incidence. In a moderate dataset with a reasonable number of features, conventional regression-based models perform similar to machine learning algorithms with good predictive accuracy.

Understanding misinformation infodemic during public health emergencies due to large-scale disease outbreaks: a rapid review.

Aim: The coronavirus disease 2019 (COVID-19) has caused hundreds of thousands of deaths, impacted the flow of life and resulted in an immeasurable amount of socio-economic damage. However, not all of this damage is attributable to the disease itself; much of it has occurred due to the prevailing misinformation around COVID-19. This rapid integrative review will draw on knowledge from the literature about misinformation during previous abrupt large-scale infectious disease outbreaks to enable policymakers, governments and health institutions to proactively mitigate the spread and effect of misinformation. Subject and methods: For this rapid integrative review, we systematically searched MEDLINE and Google Scholar and extracted the literature on misinformation during abrupt large-scale infectious disease outbreaks since 2000. We screened articles using predetermined inclusion criteria. We followed an updated methodology for integrated reviews and adjusted it for our rapid review approach. Results: We found widespread misinformation in all aspects of large-scale infectious disease outbreaks since 2000, including prevention, treatment, risk factor, transmission mode, complications and vaccines. Conspiracy theories also prevailed, particularly involving vaccines. Misinformation most frequently has been reported regarding Ebola, and women and youth are particularly vulnerable to misinformation. A lack of scientific knowledge by individuals and a lack of trust in the government increased the consumption of misinformation, which is disseminated quickly by the unregulated media, particularly social media. Conclusion: This review identified the nature and pattern of misinformation during large-scale infectious disease outbreaks, which could potentially be used to address misinformation during the ongoing COVID-19 or any future pandemic.

Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints of Nepalese Immigrant Community Members.

BACKGROUND: Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature. METHODS: We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis. RESULTS: The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals. CONCLUSIONS: Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access.