Engaging people with lived experiences on community advisory boards in community-based participatory research: a scoping review protocol.

INTRODUCTION: Community-based participatory research (CBPR) is a collaborative research approach that equally engages researchers and community stakeholders throughout all steps of the research process to facilitate social change and increase research relevance. Community advisory boards (CABs) are a CBPR tool in which individuals with lived experience and community organisations are integrated into the research process and ensure the work aligns with community priorities. We seek to (1) explore the best practices for the recruitment and engagement of people with lived experiences on CABs and (2) identify the scope of literature on minimising power dynamics between organisations and community members with lived experience who work on CABs together. METHODS AND ANALYSIS: This scoping review will follow the Arksey and O'Malley methodological framework, informed by Levac et al, and will be reported using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. Detailed and robust search strategies have been developed for Embase, Medline and PsychINFO. Grey literature references and reference lists of included articles published between 1 January 1990 and 30 March 2023 will be considered. Two reviewers will independently screen references in two successive stages of title/abstract and full-text screening. Conflicts will be decided by consensus or a third reviewer. Thematic analysis will be applied in three phases: open coding, axial coding and abstraction. Extracted data will be recorded and presented in a tabular format and/or graphical summaries, with a descriptive overview discussing how the research findings relate to the research questions. At this time, a preliminary search of peer-reviewed and grey literature has been conducted. Search results for peer-reviewed literature have been uploaded to Covidence for review and appraisal for relevance. ETHICS AND DISSEMINATION: Formal ethics approval is not required for this review. Review findings will inform ongoing and future CBPR community advisory board dynamics. REGISTRATION: The protocol has been registered prospectively on the Open Science Framework (https://doi.org/10.17605/OSF.IO/QF5D3).

Family and community resilience: a Photovoice study.

BACKGROUND: Adverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person's risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions as well as positive growth in the face of sudden or challenging life events, trauma, or adversities. This study aimed to identify factors contributing to family and community resilience from the perspective of families who self-identified as having a history of adversity and being resilient during the COVID-19 pandemic. METHODS: This study used Photovoice, a visual participatory research method which asks participants to take photographs to illustrate their responses to a research question. Participants consisted of a maximum variation sample of families who demonstrated family level resilience in the context of the pair of ACEs during the COVID-19 pandemic. Family members were asked to collect approximately five images or videos that illustrated the facilitators and barriers to well-being for their family in their community. Semi-structured in-depth interviews were conducted using the SHOWeD framework to allow participants to share and elucidate the meaning of their photos. Using thematic analysis, two researchers then independently completed line-by-line coding of interview transcripts before collaborating to develop consensus regarding key themes and interpretations. RESULTS: Nine families were enrolled in the study. We identified five main themes that enhanced family resilience: (1) social support networks; (2) factors fostering children's development; (3) access and connection to nature; (4) having a space of one's own; and (5) access to social services and community resources. CONCLUSIONS: In the context of additional stresses related to the COVID-19 pandemic, resilient behaviours and strategies for families were identified. The creation or development of networks of intra- and inter-community bonds; the promotion of accessible parenting, housing, and other social services; and the conservation and expansion of natural environments may support resilience and health.

Experiences of pregnant Venezuelan migrants/refugees in Brazil, Ecuador and Peru: a qualitative analysis.

BACKGROUND: It is estimated that since 2014, approximately 7.3 million Venezuelan migrants/refugees have left the country. Although both male and female migrants/refugees are vulnerable, female migrants/refugees are more likely to face discrimination, emotional, physical, and sexual violence. Currently there is a lack of literature that explores the experiences of pregnant Venezuelan migrants/refugees. Our aim is to better understand the experience of this vulnerable population to inform programming. METHODS: In the parent study, Spryng.io's sensemaking tool was used to gain insight into the gendered migration experiences of Venezuelan women/girls. A total of 9339 micronarratives were collected from 9116 unique participants in Peru, Ecuador and Brazil from January to April 2022. For the purpose of this analysis, two independent reviewers screened 817 micronarratives which were identified by the participant as being about someone who was pregnant, ultimately including 231 as part of the thematic analysis. This was an exploratory study and an open thematic analysis of the narratives was performed. RESULTS: The mean age and standard deviation of our population was 25.77 ± 6.73. The majority of women in the sample already had at least 1 child (62%), were married at the time of migration (53%) and identified as low socio-economic status (59%). The qualitative analysis revealed the following main themes among pregnant Venezuelan migrants/refugees: xenophobia in the forms of racial slurs and hostile treatment from health-care workers while accessing pregnancy care; sexual, physical, and verbal violence experienced during migration; lack of shelter, resources and financial support; and travelling with the hopes of a better future. CONCLUSION: Pregnant Venezuelan migrants/refugees are a vulnerable population that encounter complex gender-based and societal issues that are rarely sufficiently reported. The findings of this study can inform governments, non-governmental organizations, and international organizations to improve support systems for pregnant migrants/refugees. Based on the results of our study we recommend addressing xenophobia in health-care centres and the lack of shelter and food in host countries at various levels, creating support spaces for pregnant women who experience trauma or violence, and connecting women with reliable employment opportunities and maternal healthcare.

Emergency department care experiences among people who use substances: a qualitative study.

BACKGROUND: People who use substances (PWUS) encounter significant barriers to accessing care for their complex health needs. As a result, emergency departments (EDs) often become the first point of healthcare access for many PWUS and are a crucial setting for the study of health inequities. This study aimed to understand the ED healthcare experiences of PWUS with the intent of informing ways of improving the delivery of equitable care. METHODS: This qualitative study was part of a larger cross-sectional, mixed-methods study that examined ED experiences among diverse underserved and equity-deserving groups (EDGs) within Kingston, Ontario, Canada. Participants shared and self-interpreted a story about a memorable ED or UCC visit within the preceding 24 months. Data from participants who self-identified as having substance use experiences was analyzed through inductive thematic analysis. RESULTS: Of the 1973 unique participants who completed the survey, 246 participants self-identified as PWUS and were included in the analysis. Most participants were < 45 years of age (61%), male (53%), and white/European (57%). 45% identified as a person with a disability and 39% frequently struggled to make ends meet. Themes were determined at the patient, provider, and system levels. PATIENT: history of substance use and experience of intersectionality negatively influenced participants' anticipation and perception of care. Provider: negative experiences were linked to assumption making, feelings of stigma and discrimination, and negative perceptions of provider care. Whereas positive experiences were linked to positive perceptions of provider care. System: timeliness of care and the perception of inadequate mental health resources negatively impacted participants' care experience. Overall, these themes shaped participants' trust of ED staff, their desire to seek care, and their perception of the care quality received. CONCLUSIONS: PWUS face significant challenges when seeking care in the ED. Given that EDs are a main site of healthcare utilization, there is an urgent need to better support staff in the ED to improve care experiences among PWUS. Based on the findings, three recommendations are proposed: (1) Integration of an equity-oriented approach into the ED, (2) Widespread training on substance use, and (3) Investment in expert resources and services to support PWUS.

Parental perceptions, attitudes, and beliefs regarding vaccination of children aged 0-5 years: A qualitative study of hill-tribe communities, Thailand.

The widespread availability and use of vaccines have tremendously reduced morbidity and deaths related to infectious diseases globally. However, in hill-tribe communities in Northern Thailand, vaccination rates remain low, and there is limited literature on parental perceptions, attitudes, and beliefs about vaccination for children under five years of age. We conducted a qualitative study employing semi-structured interviews to understand parents' perceptions, attitudes, and beliefs about vaccinations. A purposive sample was used to recruit participants. Data were analyzed using thematic analysis. 74 hill-tribe parents (14 Akha, 11 Hmong, 12 Lahu, 13 Lisu, 12 Karen, and 12 Yao) were interviewed. Four themes emerged from the interviews: 1) traditional beliefs, and practices 2) traumatic experiences, 3) lack of information and effective communication, and 4) trust and support from the community. Findings highlight that it is crucial to build trust by providing knowledge, appropriate information, and advice about vaccinations in order to improve vaccine coverage in children under five years of age in the hill-tribe context.

Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study.

BACKGROUND: Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. METHOD: Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. RESULTS: We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). CONCLUSION: Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.

Impacts of the COVID-19 pandemic on life and learning experiences of indigenous and non-Indigenous university and college students in Ontario, Canada: a qualitative study.

BACKGROUND: The years people spend attending university or college are often filled with transition and life change. Younger students often move into their adult identity by working through challenges and encountering new social experiences. These transitions and stresses have been impacted significantly by the COVID-19 pandemic, which has led to dramatic change in the post-secondary experience, particularly in the pandemic's early months when colleges and universities were closed to in person teaching. The goal of this study was to identify how COVID-19 has specifically impacted the postsecondary student population in Kingston, Ontario, Canada. METHODS: The Cost of COVID is a mixed methods study exploring the social and emotional impacts of the COVID-19 pandemic, with a focus on families, youth, and urban Indigenous People. The present analysis was completed using a subset of qualitative data including Spryng.io micronarrative stories from students in college and university, as well as in-depth interviews from service providers providing services to students. A double-coded phenomenological approach was used to collect and analyze data to explore and identify themes expressed by postsecondary students and service providers who worked with postsecondary students. RESULTS: Twenty-six micronarratives and seven in-depth interviews were identified that were specifically relevant to the post-secondary student experience. From this data, five prominent themes arose. Impacts of the COVID-19 pandemic on the use of technology was important to the post secondary experience. The pandemic has substantial educational impact on students, in what they chose to learn, how it was taught, and experiences to which they were exposed. Health and wellbeing, physical, psychological and emotional, were impacted. Significant impacts were felt on family, community, and connectedness aspects. Finally, the pandemic had important financial impacts on students which affected their learning and their experience of the pandemic. Impacts did differ for Indigenous students, with many of the traditional cultural supports and benefits of spaces of higher education no longer being available. CONCLUSION: Our study highlights important impacts of the pandemic on students of higher education that may have significant individual and societal implications going forward. Both postsecondary institutions and society at large need to attend to these impacts, in order to preserve the wellbeing of graduates, the Canadian labor market, and to ensure that the pandemic does not further exacerbate existing inequalities in post-secondary education in Canada.

Directed content analysis: A life course approach to understanding the impacts of the COVID-19 pandemic with implications for public health and social service policy.

BACKGROUND: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. OBJECTIVES: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. METHODS: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. RESULTS: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. CONCLUSIONS: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency.

Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study.

Introduction: Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand. Methods: In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model. Results: Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model. Conclusion: The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.

Cost of COVID-19: Using life course theory as a lens to understand the consequences of the pandemic.

Context: The COVID-19 pandemic and associated countermeasures have had broad implications across society which will have implications for physical and mental health for years to come. Understanding these experiences through the lens of life course constructs may help communities, service providers including family doctors, and governments to recognize and respond more effectively to the lasting impacts. Objective: To use life course theory to explore the impacts of the COVID-19 pandemic and associated countermeasures on child and family mental, social, and emotional well-being. Study Design: Qualitative study including anonymous micro-narrative collection using Spryng.io software (n=210); in-depth interviews with health and social service providers (n=30). Directed content analysis was used to examine the experiences of the COVID-19 pandemic as they relate to key constructs in life course theory. Setting: Kingston, Frontenac, Lennox and Addington counties in South-Eastern Ontario (pop. 210,000). Population Studied: Participants were recruited to the micronarrative collection through convenience sampling using the online data collection tool, as well as through intentional sampling targeting Indigenous people and people experiencing socio economic deprivation and homelessness. Participants for the in-depth interviews were intentionally recruited as key informants from local health and social service organizations. Results: All of the key constructs of life course theory were relevant when applied to our findings. Our data identified meaningful impacts on life course trajectory components including transitions, turning points, and social pathways, as well as using the principles of agency, life span development, linked lives, timing, and time and place. Conclusions: Our data illustrate the pervasive impact of the COVID-19 pandemic on all aspects of the life course. While service providers and policy makers are attuned to the acute crises currently unfolding, the long term impacts of life course disruption will play out over years, or potentially over the entire lifespan of this cohort. Responses to the pandemic cannot limit themselves to crisis management in the next 12-18 months, but will need to integrate an understanding of life course theory to support long term healing of individuals and communities.

Food worry and mental health outcomes during the COVID-19 pandemic.

BACKGROUND: There is limited and inconsistent literature examining the relationship between food worry and mental health in the context of the COVID-19 pandemic. This study examined the association between food worry and mental health among community dwelling Canadian adults during the COVID-19 pandemic. METHODS: Adults age 16 years and older completed an anonymous online questionnaire between April 1, 2020 and November 30 2020. Measures of pre-pandemic and current food worry, depression (PHQ-2), anxiety (GAD-2), and sociodemographic variables were included. Multivariable logistic regression models were used to determine the association between food worry and symptoms of depression and anxiety. RESULTS: In total, 1605 participants were included in analyses. Worry about affording food was reported by 320 (14.78%) participants. In models adjusting for sociodemographic covariates, compared with people without food worry, participants who had food worry were 2.07 times more likely to report anxiety symptoms (aOR 2.07, 95% CI: 1.43 - 2.98, p < .001) and were 1.9 times more likely to report depressive symptoms (aOR 1.89, 95% CI: 1.39-2.57, p < .0001). Lower income, lower education, and pre-existing mental health conditions were significant predictors of symptoms of depression. Female gender, younger age, lower education, lower income, and pre-existing mental health condition were significant predictors of anxiety symptoms. CONCLUSION: Our study highlights the relationship between food worry and poor mental health. Policy supports such as improved income supports, clinical implications such as screening for food worry in primary care, referral to emergency food programs and support with meal planning may help mitigate mental health symptoms during the current pandemic, during future societal recovery from this pandemic and during future pandemics.

Psychological Impacts of the COVID-19 Pandemic on Rural Physicians in Ontario: A Qualitative Study.

Frontline rural physicians in Canada are vulnerable to the psychological impacts of the COVID-19 pandemic considering their high pre-pandemic burnout rates as compared to their urban counterparts. This study aims to understand the psychological impacts of the COVID-19 pandemic on rural family physicians engaged in full-time primary care practice in Ontario and the stressors behind any identified challenges. Recruitment combined purposive, convenience, and snowball sampling. Twenty-five rural physicians participated in this study. Participants completed a questionnaire containing Patient Health Questionnaire-2 (depression), General Anxiety Disorder-2 (anxiety), and Perceived Stress Scale-4 (stress) screening as well as questions exploring self-reported perceptions of change in their mental health, followed by a semi-structured virtual interview. Quantitative data showed an overall increase in self-reported depression, anxiety, and stress levels. Thematic analysis revealed seven qualitative themes including the positive and negative psychological impacts on rural physicians, as well as the effects of increased workload, infection risk, limited resources, and strained personal relationships on the mental health of rural physicians. Coping techniques and experiences with physician wellness resources were also discussed. Recommendations include establishing a rapid locum supply system, ensuring rural representation at decision-making tables, and taking an organizational approach to support the mental health of rural physicians.

Exploring the impact of COVID-19 on substance use patterns and service access of street involved individuals in Kingston, Ontario: a qualitative study.

This study aims to understand the experiences of street-involved individuals during the COVID-19 pandemic regarding substance use patterns and service access. With the collision of the COVID-19 pandemic and Canadian opioid epidemic came an increase in opioid related overdoses and increased barriers in accessing essential services since March 2020. Semi-structured interviews were conducted in June and July 2021, with 30 street-involved individuals in Kingston, Ontario. Analysis followed a phenomenological approach to qualitative research. Themes were coded by two independent researchers using NVIVO12. COVID-19 had detrimental effects on the lives of street-involved folks who use substances. Increased substance use to combat feelings of isolation and hopelessness related to loss of income and housing was commonly described. Increased fentanyl usage was considered the major contributor to the rise in overdoses over the pandemic. Restrictions on public access to businesses and services disproportionately impacted individuals with limited means. Harm reduction services and mental health support were considered extremely important throughout the pandemic. The coinciding COVID-19 pandemic and opioid epidemic place street-involved individuals who use substances in a uniquely dangerous position. As such, it is imperative that public policy decision-makers consider the differential needs of street-involved community members to provide safe, relevant, and compassionate solutions in future public health emergencies.

Spirituality, Community Belonging, and Mental Health Outcomes of Indigenous Peoples during the COVID-19 Pandemic.

We aimed to assess the association between community belonging, spirituality, and mental health outcomes among Indigenous Peoples during the COVID-19 pandemic. This cross-sectional observational study used online survey distribution and targeted outreach to the local Indigenous community to collect a convenience sample between 23 April 2020 and 20 November 2020. The surveys included demographic information, self-reported symptoms of depression (PHQ-2) and anxiety (GAD-2), and measures of the sense of community belonging and the importance of spirituality. Multivariate logistic regression was used to model the association between the sense of community belonging and spirituality, and symptoms of anxiety and depression. Of the 263 self-identified Indigenous people who participated, 246 participants had complete outcome data, including 99 (40%) who reported symptoms of depression and 110 (45%) who reported symptoms of anxiety. Compared to Indigenous participants with a strong sense of community belonging, those with weak community belonging had 2.42 (95% CI: 1.12-5.24)-times greater odds of reporting symptoms of anxiety, and 4.40 (95% CI: 1.95-9.89)-times greater odds of reporting symptoms of depression. While spirituality was not associated with anxiety or depression in the adjusted models, 76% of Indigenous participants agreed that spirituality was important to them pre-pandemic, and 56% agreed that it had become more important since the pandemic began. Community belonging was associated with positive mental health outcomes. Indigenous-led cultural programs that foster community belonging may promote the mental health of Indigenous Peoples.

Financial stress during COVID-19: implications for parenting behaviour and child well-being.

BACKGROUND: Family financial stress and parenting behaviours are each associated with child behaviours. We sought to explore the association between parent financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour, including overreactive and lax parenting approaches, as a potential mediator to this relationship. METHODS: Cross-sectional sample of parent and child data pairings in Ontario, Canada between April and November of 2020. Linear models were used to describe the relationships between financial worry, child Strengths and Difficulties Questionnaire (SDQ) total difficulties and parenting behaviours measured by the Parenting Scale 8-item (PS-8), which includes measures of both overreactive and lax parenting tendencies. Formal mediation testing was performed to assess the potential mediating role of parenting behaviour. RESULTS: 528 parent and child pairs were enrolled from largely European ancestry (78%), female (93%) and varied household income levels. Analysis revealed increased financial worry during the COVID-19 pandemic was significantly associated with increased child SDQ total difficulties scores (ß=0.23, SE=0.10, p=0.03). This relationship was mediated by reported parenting behaviour, independent of parent education, household income, parent age, parent sex, parent anxiety and child sex (total effect: ß=0.69, p=0.02, average causal mediation effects: ß=0.50, p=0.02, average direct effects: ß=0.19, p=0.08). CONCLUSION: Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional well-being. Parenting behaviours measured by the PS-8 significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child well-being.

Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study.

BACKGROUND: Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar. METHODS: A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research. RESULTS: 46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization. CONCLUSION: A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.

Exploring How Sexual Assault Nurse Examiners Practise Trauma-Informed Care.

BACKGROUND: Sexual violence is a term describing sexual acts where consent is not freely given. Registered nurses employed as sexual assault nurse examiners (SANEs) provide care to address the medical and legal needs of victims/survivors of sexual violence. Trauma-informed care (TIC) is an approach recommended when caring for individuals who have experienced trauma. PURPOSE: The study purpose was to understand how SANEs incorporate trauma-informed approaches in the care of adult and postpubescent adolescent victims/survivors of sexual violence. METHODS: Eight SANEs were purposively recruited to participate in online semistructured interviews. Interview data were analyzed using qualitative interpretive description. RESULTS: Six themes emerged from the analysis: (a) the importance of understanding the patient's experience; (b) personalized connection: developing a safe nurse-patient relationship; (c) choice: the framework of how we do things; (d) rebuilding strengths and skills to support healing and posttraumatic growth; (e) a wonderful way to practise: facilitators and benefits of trauma-informed practice; and (f) challenges to trauma-informed practice. CONCLUSIONS: These findings indicate the perceived value of TIC and the need for enhanced support of providers who deliver TIC. More research is warranted to strengthen the evidence about trauma-informed practice in SANE programs and across healthcare settings.

"I Don't Know Where I Have to Knock for Support": A Mixed-Methods Study on Perceptions and Experiences of Single Mothers Raising Children in the Democratic Republic of Congo.

Introduction and Objectives: It is well-documented that single mothers in sub-Saharan Africa face unique psychosocial challenges which can lead to child health and developmental disadvantages, often impacting life trajectories for both the mother and child. Years of instability, conflict, and widespread poor governance within the Democratic Republic of Congo (DRC) have resulted in magnified challenges for parents, making it more difficult to provide supportive and effective parenting. To address gaps in knowledge regarding the specific challenges experienced and adaptations made among single mothers raising children in contexts of adversity, the present study aimed to investigate the phenomenon of single mother parenting in the DRC. Methods: Cognitive Edge SenseMaker, a mixed-method data collection tool, was used to collect self-interpreted narratives among parents in eastern DRC. Quantitative SenseMaker data were uploaded into Tableau, a data organization and analysis tool, to visualize differences in response patterns between single mother (n = 263) and two-parent family study participants (n = 182). Single mother micronarratives (n = 251) were then coded line-by-line and analyzed thematically. Qualitative themes identified in the single mother micronarratives were used to facilitate a deeper and more nuanced understanding of key quantitative SenseMaker findings. Findings and Conclusions: Our study found that single mothers experienced immense challenges raising children in the DRC, including financial-, health- and parenting-related hardships. Single mothers described negative emotions and higher levels of household adversity while providing for their children in situations of extreme poverty compared to two-parent family respondents. Self-reliance was exhibited among most single mothers in an attempt to overcome challenges, primarily financial barriers, and to prioritize the health and well-being of their children. However, many children still lacked access to sufficient food, education, and healthcare. Limited governmental and social security support for single mothers was identified as contributing to heightened challenges and the self-reliance observed among single mothers. Findings emphasize that additional research and attention should be directed towards identifying the specific needs of, and available resources for, single mothers in different localities in an effort to inform policies and programs that best support families.

Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand.

This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.

Child Maltreatment and Public Health: Do Gaps in Response during the COVID-19 Pandemic Highlight Jurisdictional Complexities?

Objective: Countermeasures introduced during the COVID-19 pandemic produced an environment that placed some children at increased risk of maltreatment at the same time as there were decreased opportunities for identifying and reporting abuse. Unfortunately, coordinated government responses to address child protection since the start of the pandemic have been limited in Canada. As an exploratory study to examine the potential academic evidence base and location of expertise that could have been used to inform COVID-19 pandemic response, we undertook a review of child maltreatment research across three prominent Canadian professional journals in social work, medicine and public health. Methods: We conducted a pre-pandemic, thirteen-year (2006-2019) archival analysis of all articles published in the Canadian Social Work Review (CSWR), the Canadian Medical Association Journal (CMAJ) and the Canadian Journal of Public Health (CJPH) and identified the research articles that related directly to child maltreatment, child protection or the child welfare system in Canada. Results: Of 11,824 articles published across the three journals, 20 research papers relating to child maltreatment, child protection or the child welfare system were identified (CJPH = 7; CMAJ = 3; CSWR = 10). There was no obvious pattern in article topics by discipline. Discussion: Taking these three prominent professional journals as a portal into research in these disciplines, we highlight the potential low volume of academic child maltreatment research despite the importance of the topic and irrespective of discipline. We believe that urgent transdisciplinary collaboration and overall awareness raising for child protection is called for at the time of the COVID-19 pandemic as well as beyond in Canada.