Patient perceptions of the benefits and barriers of virtual postnatal care: a qualitative study.

OBJECTIVE: The objective of this study is to understand the perceptions of new mothers using virtual care via video conferencing to gain insight into the benefits and barriers of virtual care for obstetric patients. METHODS: Semi-structured interviews were conducted with 15 patients attending the Kingston Health Sciences Centre. The interviews were 20-25 min in length and recorded through an audio recorder. Thematic analysis was conducted in order to derive the major themes explored in this study. RESULTS: New mothers must often adopt new routines to balance their needs and their child's needs. These routines could impact compliance and motivation to attend follow-up care. In our study, participants expressed high satisfaction with virtual care, emphasizing benefits related to comfort, convenience, communication, socioeconomic factors, and the ease of technology use. Participants also perceived that they could receive emotional support and build trust with their health care providers despite the remote nature of their care. Due to its ease of use and increased accessibility, we argue that virtual care shows promise to facilitate long-term compliance to care in obstetric patients. CONCLUSIONS: Virtual care is a useful modality that could improve compliance to obstetric care. Further research and clinical endeavours should examine how social factors and determinants intersect to determine how they underpin patient perceptions of virtual and in-person care.

Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses.

BACKGROUND: Transgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses. OBJECTIVES: Our primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault. METHODS: The curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions. RESULTS: Participants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001). CONCLUSIONS: The success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals.

Planning an intersectoral network of healthcare and community leaders to advance trans-affirming care for sexual assault survivors.

Sexual assault against transgender (trans) persons is a complex public health issue requiring the coordinated effort of multiple sectors to address. In response to a global call to improve health equity for persons of diverse gender identities, leaders across health and social service sectors need to enhance collaboration to champion trans-affirming care for sexual assault survivors. In collaboration with Egale Canada Human Rights Trust and the Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, we have undertaken the development of an intersectoral network to connect trans-positive community organizations with hospital-based violence treatment centres to improve support services for trans survivors across Ontario. Guided by the Lifecycle Model for network development outlined by the National Collaborating Centre for Methods and Tools, we describe our approach to planning the intersectoral network, including key insights learned thus far and the potential of the network moving forward.

Examining the Social Patterning of Postpartum Depression by Immigration Status in Canada: an Exploratory Review of the Literature.

Postpartum depression (PPD) refers to a woman's experience with any depressive episode occurring within the first year of the postpartum period (Stewart et al., 2008;53(2):121-4). While PPD is a global phenomenon, the distribution of PPD within populations is not universal. Indeed, evidence from the Canadian literature confirms a significant disparity in PPD outcomes, as the prevalence rate of PPD is markedly increased among immigrant women (Stewart et al., 2008;53(2):121-4), and immigration status emerges as an important risk factor for PPD. However, these two findings alone do not explain the reasons why this particular social patterning emerges. This review essay synthesizes findings on the prevalence and risk of PPD among immigrant women in Canada. It then draws on recent literature to propose three key mechanisms underlying why this social patterning emerges, namely (1) social support, (2) socioeconomic status, and (3) life stressors. These mechanisms are analyzed through the World Health Organization's conceptual framework of the social determinants of health (WHO, 2010; Statistics Canada, 2017). Additionally, this review essay seeks to assess the current state of intervention strategies piloted in Canada for PPD prevention and highlight gaps in the literature on intervention strategies for immigrant women specifically.