Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada.

OBJECTIVE: FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. DESIGN: We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model. SETTING: Individuals living in Alberta, Canada. PARTICIPANTS: In total, fifteen adults with T2DM and experiences of household food insecurity. RESULTS: People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy). CONCLUSION: Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.

"I haven't really gone through things like this": Young long-term care workers' experiences of working during the COVID-19 pandemic.

BACKGROUND: Long-term care (LTC) facilities were hard hit by the COVID-19 pandemic in Canada. Using life course theory concepts, we looked for conditions that led to worker moral distress -i.e. pain or anguish over not being able to take right action - and how life stage may influence experiences. OBJECTIVE: To illuminate the experiences of adults under the age of 30 who stepped into, and/or persevered in, working in LTC during the pandemic, recognizing that this emerging workforce represents the future of LTC in Canada. METHODS: This secondary analysis uses interview data from a sub-sample of 16 young workers between 18 and 29 years of age who had been working in Canadian LTC facilities for between 8 months and 7 years. RESULTS: Young workers expressed feeling guilt about mourning the loss of socially significant milestones as these milestones paled by comparison to the loss of life and consequences of resident isolation they witnessed at work. To manage feelings of moral distress, young workers attempted to maintain high standards of care for LTC residents and engaged in self-care activities. For some workers, this was insufficient and leaving the field of LTC was their strategy to respond to their mental health needs. CONCLUSION: The life stage of young LTC workers influenced their experiences of working during the COVID-19 pandemic. Interventions are needed to support young workers' wellbeing and job retention.

Dementia and dignity of identity: A qualitative evidence synthesis.

In the late stages of dementia, individuals rely on others for their wellbeing and this creates an ethical imperative for responsive dementia care. Through a qualitative evidence synthesis of literature on what constitutes responsive dementia care, we identified dignity of identity as a central theme. Dignity of identity is the status each of us holds in relation to others and reflects our past experiences and our aspirations for the future. We did a qualitative evidence synthesis of 10 qualitative studies conducted with a total of 149 research participants, 95 of whom had dementia, and 54 of whom were paid and family member caregivers to people with dementia. Using "new materialism disability studies" as our theoretical framework, we illustrate how environments, both material and discursive, shape the abilities of people with dementia in residential care settings (RSCs) to live well and we use our findings to point to ways forward in dignity of identity-enhancing dementia care practice. Echoing the literature, we observe that people with dementia have the virtual capacity to live with dignity of identity and illustrate how material conditions and discourse influence the transition of dignity of identity in people with dementia from a virtual capacity to an actual capacity and how demonstrated capacity in turn influences material conditions and discourse surrounding care for people with dementia in RSCs. We call for a greater acknowledgement within literature on dignity and dementia of structural barriers to dignity of identity-enhancing care. The COVID-19 pandemic has shown us the fatal consequences of insufficient material conditions in RCSs and we hope that on a societal level there is improvement to both the material conditions in RCSs as well as an improvement in discourse about those who live and work in RCSs.

High intelligence may exacerbate paediatric inflammatory response to SARS-CoV-2 infection.

The body's innate and acquiredimmunesystems are critical in responses to a wide spectrum of assaults, including SARS-CoV-2 infection. We identify studies of autoimmunity to support our hypothesis that a high intelligence quotient (IQ) may put children at increased risk for severe COVID-19 sequelae; especially those whose viral load is high and/or who develop multisystem inflammatory syndrome in children (MIS-C). MIS-C is associated with a higher risk of COVID-19 morbidity and death, even in otherwise healthy children. As information and evidence about SARS-CoV-2 infection continue to expand, our hypothesis suggests adding a potentially intriguing piece to the pandemic puzzle for further investigation. Drawing on a select review of published research and case reports, we discuss immune dysregulation in paediatric patients with a high IQ, including post-infection cytokine expression in the myocardium. Further, we provide a review of 27 paediatric (≤19 years; median age 16) cases of severe COVID-19 outcomes, drawn from media sources published between March and September 2020, in which we identify possible evidence of a 'hyper brain, hyper body' response to infection. We aver these cases are noteworthy given that paediatric death with COVID-19 disease is remarkably rare, and the estimated prevalence of a high IQ (or giftedness) is only 2% in the general population. These observations warrant prospective and retrospective studies of autoinflammatory markers and mechanisms to elucidate any special psychoneuroimmunological vulnerability in children with a high IQ, as such studies may raise implications for how and when prophylactic medical care is provided to children.

Meta-synthesis of fathers' experiences raising children on the autism spectrum.

Parents raising children with autism have distinct experiences that influence their well-being, relationships, engagement with the public, and interaction with education and healthcare systems. However, experiences of fathers of children with autism have been largely overlooked by researchers. This meta-synthesis is our synthesis of qualitative accounts of fathers' experiences and we included peer reviewed and gray literature articles that: (1) reported primary qualitative research, (2) included fathers of children with autism as participants, and (3) reported qualitative findings on the first-hand experiences of fathers of children with autism. Studies were appraised for quality and many theoretical and methodological deficiencies identified. Six studies met quality appraisal criteria and three main themes of findings from these studies were generated: (1) adaptation and concern with the future, (2) the importance of cultural context, and (3) reverence for one's child and new opportunities. Fathers' experiences illuminate a need for father-oriented resources that recognize fathers' value in children's lives.

A Mixed Methods Study on the Barriers and Facilitators of Physical Activity Associated with Residential Relocation.

Despite evidence suggesting that neighbourhood characteristics are associated with physical activity, very few mixed methods studies investigate how relocating neighbourhood, and subsequent changes in the built environment, influences physical activity. This sequential mixed methods study estimates associations between changes in overall physical activity and transportation walking and cycling and changes in objectively assessed neighbourhood walkability (quantitative phase) and describes perceived barriers and facilitators to physical activity following residential relocation (qualitative phase). During the quantitative phase, self-reported changes in transportation walking, transportation cycling, and overall physical activity following residential relocation were measured using a 5-point scale: (1) a lot less now, (2) a little less now, (3) about the same, (4) a little more now, and (5) a lot more now. Walkability improvers reported a slight increase in transportation walking (mean = 3.29, standard deviation (SD) = 0.87), while walkability decliners reported little or no perceived change in their transportation walking after relocation (mean = 2.96, SD = 1.12). This difference approached statistical significance (p=0.053). Furthermore, walkability decliners reported a slight decrease in transportation cycling (mean = 2.69, SD = 0.96), while walkability improvers reported little or no perceived change in their transportation cycling after relocation (mean = 3.02, SD = 0.84). This difference was statistically significant (p < 0.05). Change in walkability resulting from relocation was not significantly associated with perceived change in overall physical activity. Our qualitative findings suggest that moving to a neighbourhood with safe paths connecting to nearby destinations can facilitate transportation walking and cycling. Some participants describe adjusting their leisure physical activity to compensate for changes in transportation walking and cycling. Strong contributors to neighbourhood leisure physical activity included the presence of aesthetic features and availability of recreational opportunities that allow for the creation of social connections with community and family.

Neighbourhood Built Environment Influences on Physical Activity among Adults: A Systematized Review of Qualitative Evidence.

Qualitative studies can provide important information about how and why the built environment impacts physical activity decision-making—information that is important for informing local urban policies. We undertook a systematized literature review to synthesize findings from qualitative studies exploring how the built environment influences physical activity in adults. Our review included 36 peer-reviewed qualitative studies published from 1998 onwards. Our findings complemented existing quantitative evidence and provided additional insight into how functional, aesthetic, destination, and safety built characteristics influence physical activity decision-making. Sociodemographic characteristics (age, sex, ethnicity, and socioeconomic status) also impacted the BE’s influence on physical activity. Our review findings reinforce the need for synergy between transportation planning, urban design, landscape architecture, road engineering, parks and recreation, bylaw enforcement, and public health to be involved in creating neighbourhood environments that support physical activity. Our findings support a need for local neighbourhood citizens and associations with representation from individuals and groups with different sociodemographic backgrounds to have input into neighbourhood environment planning process.

Quality Group Home Care for Adults with Developmental Disabilities and/or Mental Health Disorders: Yearning for Understanding, Security and Freedom.

BACKGROUND: The purpose of this study was to uncover and understand factors influencing quality of care received by adults with developmental disabilities and/or mental health disorders living in group homes. METHODS: The present authors conducted a secondary analysis of data from nine focus group discussions with adults with developmental disabilities and/or mental health disorders, and their family and paid caregivers (N = 52). To focus the analysis, the present authors drew on the research literature to craft a model of quality of group home care using concepts of social inclusion and self-determination, and corresponding staff approaches that include active support and person-centred care. RESULTS: Social inclusion and self-determination for adults in group homes are facilitated by staff approaches and manifest in residents being understood and experiencing security and freedom. CONCLUSIONS: The present authors offer recommendations for group home resources, training, communication and outcome measures that promote residents' being understood and experiencing security and freedom.

The Effects of an E-Mental Health Program and Job Coaching on the Risk of Major Depression and Productivity in Canadian Male Workers: Protocol for a Randomized Controlled Trial.

BACKGROUND: Major depression (MDE) is prevalent in men and affects men's health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to seek help for emotion and stress-related issues. Therefore, innovative solutions tailored for men are needed. With rapid development of the Internet and information technologies, one promising solution that has drawn considerable attentions is electronic mental (e-mental) health programs and services. OBJECTIVE: The objective of our study is to evaluate the effectiveness of the e-mental health program BroHealth on reducing the risk of having MDE and improving productivity and return to investment. METHODS: The target population is Canadian working men who are at high risk of having MDE (N=1200). Participants will be recruited using the method of random digit dialing across the country and workplace advertisement. Eligible participants will be randomly allocated into the following groups: (1) a control group, (2) a group receiving BroHealth only, and (3) a group receiving BroHealth and telephone-based job coaching service. The groups will be assessed at 6 and 12 months after randomization. The primary outcome is the risk proportion of MDE over 12 months, which will be assessed by the World Health Organization's (WHO's) Composite International Diagnostic Interview-Short Form for Major Depression. Intention-to-treat principle will be used in the analysis. The 12-month proportions of MDE in the groups will be estimated and compared. Logistic regression modeling will be used to examine the effect of the intervention on the outcome, controlling for the effects of baseline confounders. RESULTS: It is anticipated that the randomized controlled trial (RCT) will be completed by 2018. This study has been approved by the Conjoint Health Research Ethics Review Board of the University of Calgary. The trial is funded by a team grant from the Movember Foundation, a global charity for men's health. BroHealth was developed at the Digital Emergency Medicine, University of British Columbia, and the usability testing has been completed. CONCLUSIONS: BroHealth was developed based on men's needs. We hypothesized that BroHealth will be an effective, acceptable, and sustainable product for early prevention of MDE in workplaces. CLINICALTRIAL: Clinicaltrials.gov NCT02777112; https://clinicaltrials.gov/ct2/show/NCT02777112 (Archived by WebCite at http://www.webcitation.org/6lbOQpiCG).

Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results From a Canadian National Survey.

BACKGROUND: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs. OBJECTIVES: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). METHODS: A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. RESULTS: High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%), and "having access to quality information and resources about work stress issues" (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. CONCLUSION: E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's preferences and perceived barriers to enhance the acceptability of this approach.