The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model.

Introduction: We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. Methods: We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. Results: Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). Conclusion: The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).

Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. DESIGN AND SETTING: Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). PARTICIPANTS: 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. INTERVENTION: This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. OUTCOME MEASURES: The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS: Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. CONCLUSIONS: Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03157999.

Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial.

BACKGROUND: Older adults (> 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. METHODS: Participants will be considered eligible if they are > 65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. DISCUSSION: A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. TRIAL REGISTRATION: # NCT03157999 . Registration Date: April 4, 2017.

An Assessment of the Validity of an Audio-Video Method of Food Journaling for Dietary Quantity and Quality.

OBJECTIVE: To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment. DESIGN AND SETTING: Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food. VARIABLES MEASURED: Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients. ANALYSES: Using mean scores for each variable, Wilcoxon signed-rank test and Spearman's correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability. RESULTS: With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70. CONCLUSIONS: The AV method may be a meaningful alternative to diary recording in a free-living setting.

Workload of French-speaking family physicians in francophone rural and northern communities in Ontario.

INTRODUCTION: Previous studies have shown that French-speaking family physicians (FSPs) in Ontario are less numerous in areas with high proportions of francophones. The purpose of the current study was to assess whether the degree of concordance between physicians' language of competence and the linguistic profile of the community in which they practise is associated with workload and to explore variations in this relation in rural and northern regions of the province. METHODS: This was a secondary analysis of the 2013 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey. We analyzed the primary practice location and language of competence of family physicians/general practitioners. We compared the practice characteristics of FSPs and non-French-speaking physicians (NFSPs) by the proportion of the francophone population, geographic location (north vs. south) and community size (urban vs. rural). RESULTS: Data for 10 548 family physician/general practitioners were analyzed. In areas densely populated by francophones, FSPs worked more hours per week on average and had a greater mean number of patient visits than NFSPs. Non-French-speaking physicians working in areas densely populated by francophones had fewer patient visits per hour on average than FSPs. In most cases, the results were particularly accentuated in rural and northern communities. CONCLUSION: Our findings suggest that, compared to NFSPs, the demands placed on FSPs are disproportionately greater in communities where the need for French-language health care services is greatest and the supply of FSPs is the smallest. Our results underline the importance of properly preparing family physicians to work in areas densely populated by francophones.

INTRODUCTION: Des études antérieures ont révélé que les médecins de famille francophones (MFF) en Ontario sont moins nombreux dans les régions à forte population francophone. L'objectif de cette étude était de déterminer si le degré de concordance entre la langue de compétence des médecins et le profil linguistique de la collectivité dans laquelle ils exercent est associé à la charge de travail, et d'examiner les variations de cette relation dans les régions rurales et nordiques de la province. METHODS: Il s'agit d'une analyse secondaire des données du sondage de 2013 sur le renouvellement annuel de l'inscription à l'Ordre des médecins et chirurgiens de l'Ontario. Nous avons déterminé le principal lieu de pratique et la langue de compétence de médecins de famille et d'omnipraticiens. Nous avons comparé les caractéristiques de la pratique des MFF et des médecins de famille non francophones (MFNF) par rapport à la proportion de la population francophone, l'emplacement géographique (nord par opposition à sud) et la taille de la collectivité (urbaine par opposition à rurale). RESULTS: Nous avons analysé les données provenant de 10 548 médecins de famille ou omnipraticiens. Dans les régions à forte population francophone, les MFF travaillaient en moyenne davantage d'heures par semaine et accueillaient en moyenne plus de patients que les MFNF. Les médecins non francophones qui travaillaient en régions à forte population francophone accueillaient en moyenne moins de patients par heure que les MFF. Dans la plupart des cas, les résultats étaient particulièrement marqués dans les collectivités rurales et nordiques de la province. CONCLUSION: Nos résultats suggèrent que les demandes imposées aux MFF sont disproportionnées par rapport à celles imposées aux MFNF dans les collectivités où le besoin de services de santé en français est le plus élevé et où la disponibilité de MFF est la plus faible. Nos résultats mettent en lumière l'importance de bien préparer les médecins de famille à travailler dans les régions à forte population francophone.

A strategic initiative to foster interprofessional collaboration: A case report using a men's healthy living programme.

Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.

Barriers to offering French language physician services in rural and northern Ontario.

INTRODUCTION: Rural and Northern Ontario francophones face many health-related challenges including poor health status, a poor supply of French-speaking physicians, and the potential for an inability or reduced ability to effectively communicate with anglophone healthcare providers. As such, it can reasonably be expected that rural and Northern Ontario francophones experience barriers when receiving care. However, the experience of physicians working in areas densely populated by francophones is largely unexplored. This paper identifies barriers experienced by French-speaking and Non-French-speaking rural and Northern Ontario physicians when serving francophone patients. METHODS: A series of key informant interviews were conducted with 18 family physicians practicing in rural and urban francophone communities of Northeastern Ontario. Interviews were analyzed using a thematic analysis process. RESULTS: Five categories of barrier were identified: (1) language discordance, (2) characteristics of francophone patients, (3) dominance of English in the medical profession, (4) lack of French-speaking medical personnel, and (5) physicians' linguistic (in)sensitivity. Some barriers identified were unique to Non-French-speaking physicians (eg language discordance, use of interpreters, feelings of inadequacy), some were unique to French-speaking physicians (eg limited French education and resources), and some were common to both groups (eg lack of French-speaking colleagues/staff, added time commitments, and the particularities of Franco-Ontarian preferences and culture). CONCLUSIONS: Healthcare providers and decision makers may take interest in these results. Although physicians were the focus of the present article, the barriers expressed are likely experienced by other healthcare providers, and thus the lessons learned from this article extend beyond the physician workforce. Efforts must be made to offer educational opportunities for physicians and other healthcare providers working in areas densely populated by francophones; these include linguistic and cultural sensitivity training, in addition to teaching strategies for the practice of 'active offer' of French-language services. In sum, the present study outlines the importance of linguistic concordant communication in healthcare delivery, and describes some of the challenges faced when providing French-language services in rural and Northern Ontario.

Strategies for improved French-language health services: Perspectives of family physicians in northeastern Ontario.

OBJECTIVE: To identify strategies to improve the quality of health services for Francophone patients. DESIGN: A series of semistructured key informant interviews. SETTING: Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. METHODS: Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection­data analysis process and were analyzed using a detailed thematic approach. MAIN FINDINGS: Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non­French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). CONCLUSION: Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist.

Evaluating the reliability of assessing home-packed food items using digital photographs and dietary log sheets.

OBJECTIVE: To assess the reliability of manual data entry for home-packed food items by using digital photographs and dietary log sheets. METHODS: Data from 60 lunches were entered by researcher A and B independently. Researcher B re-entered researcher A's items within 1 week. Researcher B then re-entered her items 4 weeks from the initial entry point. RESULTS: The inter-rater reliability intraclass correlation coefficient (ICC) was 0.83 for total kilocalories and ranged from 0.75-0.87 for macronutrients. The intra-rater reliability ICC was 0.92 for total kcal and ranged from 0.90-0.92 for macronutrients. The inter-rater ICCs for the 5 selected micronutrients ranged from 0.33-0.83, whereas the intra-rater ICCs for these micronutrients ranged from 0.65-0.98. CONCLUSIONS AND IMPLICATIONS: This method of data entry is feasible and its reliability is promising for macronutrient investigations. Continued assessment of this method for investigations related to micronutrient content is recommended.

Promising quantities, disappointing distribution. Investigating the presence of French-speaking physicians in Ontario's rural Francophone communities.

INTRODUCTION: Previous studies have suggested that there may be a lack of French language healthcare services in the province of Ontario. The purpose of this study was to determine if physicians in Ontario who expressed a proficiency in providing services in the French language are located in 'Francophone communities'. METHOD: Responses from 10,968 Ontario-based family physicians (FPs) certified by the College of Family Physicians of Canada and uncertified general practitioners (GPs) who responded to the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey were analysed and compared to the 2006 census of the population of Ontario. Main outcome measures were the number of FP/GPs categorized by their language of competency to conduct medical practice and the number of people categorized by their first official language spoken. The physician-to-population ratio was then compared for different groups of communities in Ontario categorized by the degree of francophonie of the community: strong French communities, with a Francophone population ≥25%; moderate French communities, with a Francophone population of 10-24%; and weak/no French communities, with a Francophone population <10%. RESULTS: There are 5.6 French speaking FP/GPs for every 1000 Francophones in communities with a French population less than 10%. This ratio is considerably greater than what was found in moderate French communities (3.4 FP/GPs) and strong French (1.3 FP/GPs). Overall the lowest ratios were found in rural strong French communities both in southern and northern Ontario (0.8 FP/GPs and 0.9 FP/GPs respectively). The ratio for all of Ontario was 0.7-1.3. CONCLUSIONS: As the number of Francophones increases in a community, the availability of French-speaking FP/GPs actually decreases, particularly in rural northern Ontario. Furthermore, there is a paradoxical relationship between the potentially high number of FP/GPs in the province with French-language capabilities and the perceived deficiencies in the availability of French language medical services.

Recommendations for Tobacco Control on Post-Secondary Campuses that are Geographically Isolated.

BACKGROUND: Many Ontarians continue to report exposure to second-hand smoke in public spaces. Completely smoke-free environments are the preferred and socially responsible option for non-smoking policies; however, when considering the variety of landscapes in which post-secondary institutions are located, 'a one size fits all' smoking policy is unrealistic to implement and enforce. The purpose of the study was to: 1) gain a better sense of the prevalence of smoking and exposure to second-hand smoke in a post-secondary context that is geographically isolated; 2) assess the awareness of existing non-smoking initiatives; and 3) identify preferred approaches for tobacco control. METHODS: An online survey was distributed in 2012 to all members of the Laurentian University community. Descriptive statistics are presented, using frequency distributions, and group comparisons are reported, using Chi-Square analyses. RESULTS: A total of 1282 persons completed the survey. Nearly 80% of respondents reported that they had been exposed to second-hand smoke in the past month on campus and the majority of respondents felt that smoking should only be allowed in Designated Outdoor Smoking Areas (51.5%); including 37.3% of daily smokers and occasional smokers. CONCLUSION: Institutions with a geographically isolated campus, which limit options to divert smokers from public entrances, should consider the use of Designated Outdoor Smoking Areas. Implementation will create immediate reductions in the prevalence of smoking at building entrances and in high traffic locations and will therefore protect non-smokers from the dangers of environmental tobacco smoke.

Examining the geographic distribution of French-speaking physicians in Ontario.

OBJECTIVE: To determine how many physicians in Ontario express a proficiency in providing services in the French language, and to assess the geographic distribution of such physicians. DESIGN: Population-based analysis of the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey. SETTING: Ontario. PARTICIPANTS: A total of 22 688 GPs, FPs, and other specialists certified by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada who responded to the survey. MAIN OUTCOME MEASURES: First official language spoken and languages of competency to conduct practice. RESULTS: The physician-to-patient ratio by first official language spoken is 1 physician per 138 Francophone patients in Ontario. There is 1 French-speaking GP or FP for every 297 Francophone patients, and most French-speaking physicians are located in southern Ontario (91.4%), at a ratio of 1 physician per 111 Francophone patients. The most promising French-speaking physician-to-Francophone patient ratios are found in southern Ontario (1:248 for GPs and FPs, and 1:202 for other specialists) and in urban Ontario (1:266 for GPs and FPs, and 1:209 for other specialists). CONCLUSION: Clearly, there is a promising number of physicians, relative to the amount of French-speaking residents in Ontario, who identified a competency in offering services in French. However, while the number of physicians who indicated a self-assessed competency to deliver health services in French is promising, it is the maldistribution of such services that is of concern. Thus, efforts must be made to attract French-speaking physicians to areas where there is the greatest demand, particularly in the northern part of the province.

Examining school-based pedometer step counts among children in grades 3 to 6 using different timetables.

BACKGROUND: Advocates for the implementation of the Balanced School Day (BSD) schedule argue that this schedule will increase opportunities for physical activity. However, the relationship between this scheduling change and its impact on physical activity has not been examined. Thus, this study assessed levels of physical activity in students attending 2 different schools: 1 using the BSD and the other using the Traditional School Day (TSD) schedule. METHODS: Participation of students between grades 3 and 6 was sought. Data were collected over 4 school days using pedometers. Independent Sample t tests and 1-way analysis of variance (ANOVA) were performed. RESUTLS: A total of 117 students participated. Overall, average daily step counts for boys (6972 ± 1952) were significantly higher than girls (5742 ± 1495; p < .001). These average step counts represent 47% and 48% of the recommended amount of steps needed for health benefits for children between the ages of 6 and 12. The average daily step count for students using the BSD schedule was 6017 (±1666), while the average daily step count for students using the TSD schedule was 6788 (±1987). The difference in steps (771) was statistically significant (p = .03). CONCLUSIONS: These results do not support claims that the BSD offers increased physical activity. In fact, these results suggest that students enrolled in schools using the BSD schedule may have reduced daily physical activity. In addition, these results demonstrate that overall school-based physical activity is less than half of the recommended level; independent of school scheduling.

"Thinking outside the pack": examining physically active smokers and implications for practice among Ontario residents.

INTRODUCTION: It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths. Recent public health interventions have likely contributed to a steady decline in rates of smoking over the past decade. Nevertheless, innovative and cost-effective approaches to smoking cessation remain a public health priority. The purpose of this study was to profile physically active smokers. METHOD: Data from the Canadian Community Health Survey 2007-2008-Ontario Sharing File were used. Responses from 41,800 persons aged 12 years and older were assessed to compare (a) the sociodemographic characteristics of physically active smokers to physically active nonsmokers in Ontario and (b) the types of leisure-time physical activities that are more commonly practiced among active Ontario smokers to active nonsmokers. RESULTS: Pearson χ(2) and independent samples t tests revealed that active smokers were more likely to be male, younger, single, and less educated and to have lower income than active nonsmokers. Active smokers were also more likely to report inexpensive, low-intensity, and solitary leisure-time physical activities. CONCLUSION: Our findings have important implications for physical activity promotion among smokers. Physical activity interventions for smokers need to be tailored differently than for nonsmokers.

Differences in occupational, transportation, domestic, and leisure-time physical activities: do geographical location and socio-cultural status matter?

BACKGROUND: Researchers have recently expressed their concern for the health of Francophones and rural dwellers in Canada. Their levels of physical activity may explain part of the observed differences. However, little is known about the physical activity levels of these 2 groups. The purpose of this study was to assess levels of physical activity among a sample of Francophones and rural dwellers. The study also assessed the associations of various types of physical activity to measures of health status. METHODS: A quota-based convenience sample of 256 adults from Northern Ontario was surveyed using the IPAQ and the SF-12. RESULTS: There were no significant differences in activity levels between language groups (P = .06) or geographical groups (P = .22) on the combined dependent variables based on MANOVA. Leisure-time physical activity scores were consistently associated to better physical component summary scores of the SF-12. CONCLUSIONS: Implications for practice include that leisure-time physical activities have been at the forefront of public health promotion, and our findings support this approach. Further, population specific interventions are indeed important, however, within this Canadian context when identifying target groups one must look beyond sociocultural status or geographical location.

Psychometric properties of the IPAQ: a validation study in a sample of northern Franco-Ontarians.

BACKGROUND: The International Physical Activity Questionnaire (IPAQ) has received significant attention since the late 1990s. As it currently stands, its long version has been translated in English, German, Icelandic, Korean, Polish, Spanish, Turkish, and Vietnamese. However no data originating from the self-administered long version (last 7 days) of the IPAQ (IPAQ-SALV) is available for French Canadians. This study developed a self-administered long version (last 7 days) of the IPAQ in Canadian French (IPAQ-SALVCF) and assessed its psychometric properties. METHODS: The original IPAQ-SALV was linguistically translated, back-translated, and then reviewed in a focus group to ensure its meaning had been retained. Data were collected on a sample of 34 Francophones from Northern Ontario, and the results compared with step counts assessed by 7-day pedometer recording. Test-retest reliability was examined with a 24-hour delay between questionnaire completion on day 8 and day 9 of the protocol. Convergent validity was assessed by comparing IPAQ-SALVCF (last 7 days) results to average step counts over a 7-day period. RESULTS: Intraclass correlation coefficients (ICC) revealed that the IPAQ-SALVCF results were stable between days. The ICC for total activity scores was highest at 0.93 (CI: 0.86 to 0.97). Total activity scores were also significantly related to pedometer step counts (Pearson r = .66 P < .01). These results confirm those obtained in prior research. CONCLUSION: The IPAQ-SALVCF is a reliable and valid measure of physical activity for French Canadians.

Coaching in northern canadian communities: reflections of elite coaches.

This study addressed geographical uniqueness in relation to elite coaching. The study explores the complexities associated to coaching in northern Canadian communities, and how unique geographical surroundings can affect coaching success. The views of fourteen National and International elite coaches from different northern Canadian communities are included within the study. The respondents were from 9 different sport backgrounds and averaged 17.1 years of coaching experience (range: 8-30 years). Data were gathered using a structured open-ended questionnaire, a focus group, and a follow-up in-depth semi-structured interview. Content was analyzed to uncover emergent themes. Based on the respondents' views, there is indication that despite numerous adversities, rural coaches experience advantages that are unavailable in larger urban centers. Precisely, there is evidence that northern Canadian coaches acquire unique skills while responding to the demands placed on them within their unique communities. Generalizations in regards to coaching development strategies across physical locations are questioned following the findings of the current study. Key PointsThe study explores the complexities associated with coaching in northern Canadian communities and how unique geographical surroundings can affect coaching success.From the respondents' views, there is indication that northern Canadian elite coaches are subject to numerous adversities.Despite numerous adversities, northern Canadian elite coaches experience advantages that are unavailable in larger urban centers.Including context specificity within the elite coaching literature could help to better understand this profession.