Indigenous birth support worker (IBSW) program evaluation: a qualitative analysis of program workers and clients' perspectives.

BACKGROUND: The Indigenous Birth Support Worker (IBSW) Program provides Indigenous women with respectful, culturally safe, and trauma-informed care and supports women and families during labor and delivery. Located in the Jim Pattison Children's Hospital (JPCH) Maternal Care Centre in Saskatoon, Saskatchewan, Canada, the program served 1023 clients between December 2019 and January 2021. METHODS: The study objective was to explore the perspectives of the IBSWs and program clients one year post-implementation. The research plan was developed in collaboration with the IBSW program director and manager, IBSWs, and partners from the First Nation and Métis Health departments within the health region. A focus group with four IBSWs and individual interviews with ten clients who received services were conducted using a qualitative research design. RESULTS: Thematic analysis revealed that clients greatly appreciated and respected the IBSWs' cultural support and their compassionate, nonjudgmental, and safe care. IBSWs emphasized the importance of culturally safe and client-centered treatment, more effective pain management solutions, and that relationships with Elders and community healthcare personnel should be built and strengthened to improve pregnancy and postnatal care delivery. IBSWs desire to work with community healthcare providers to provide prenatal care and build relationships before delivery. IBSWs advocated for collaborative cooperation with community healthcare professionals and rural healthcare teams to enable a smooth care flow to and from communities. CONCLUSION: The Indigenous Birth Support Worker (IBSW) Program provides safe and client-centred care to Indigenous women during pregnancy, labour, and postpartum, consistent with the six principles proposed by BC perinatal services. IBSWs advocate for and assist Indigenous women in obtaining quality healthcare, provide traditional and cultural support, and positively affect mental health. However, the evaluation has revealed that healthcare provider insensitivity towards Indigenous clients persists. There is a need for greater role clarity and collaboration with healthcare practitioners to ensure evidence-based healthcare of the highest standard. This requires a commitment to addressing systemic issues and implementing broader calls to action and justice proposed by the Truth and Reconciliation Commission Calls to Action, the Missing and Murdered Indigenous Women and Girls Calls for Justice, and the United Nations Declaration on the Rights of Indigenous Peoples. The IBSW program offers vital support to Indigenous women during childbirth, but it must be viewed in the context of ongoing colonialism and the need for reconciliation and decolonization, requiring genuine collaboration with Indigenous peoples.

Wellness Wheel Clinics: A First Nation community-partnered care model improving healthcare access, from healthcare providers' perspectives.

First Nation people residing in rural and remote communities have limited primary healthcare access, which often affects chronic disease management leading to poor health outcomes. Individuals with lived experiences of chronic disease and substance use, along with health directors, advocated for improved services. Subsequently, an urban healthcare team in partnership with four First Nation communities developed an Outreach clinic to address healthcare access barriers. Established in 2016, this community-led clinic improves primary care access and chronic disease management in First Nation communities. Employing a qualitative research design, interviews were conducted with 15 clinic providers and 9 community members to explore the clinic's 1-year post-implementation impacts. Thematic data analysis indicated that engagement and approval by community leadership, support from Elders and community members and collaboration with existing community healthcare staff were crucial for establishing the Outreach clinic. Initial logistical challenges with space allocation, equipment, medical supplies, funding, staffing, medical records and appointment scheduling were resolved through community consultation and creative solutions. A nurse coordinator ensured continuity of care and was integral to ensuring clients receive seamless care. The commitment of the outreach team and the collective goal of providing client-centered care were instrumental in the clinic's success. In partnership with communities, access to healthcare in First Nation communities can be enhanced by coordinating Outreach clinics through existing community healthcare facilities.

Exploring arts-based interventions for youth substance use prevention: a scoping review of literature.

INTRODUCTION: There is a rise in problematic substance use among Canadian youth, which is precipitating a public health crisis. Interventions are needed to empower youth to mitigate substance use risks. Active youth involvement in substance use prevention is urgently needed to increase uptake and ownership of the process and outcome of the intervention. Arts-based interventions are ideal participatory action approaches that can empower young people to be active agents in substance use prevention. These approaches can help promote health, reduce harm, and change behaviours. Scoping reviews are a vital tool that can help the research team identify relevant interventions that can be adapted to a community. METHODS: This scoping review explores various arts-based substance use prevention interventions for youth. The scoping review used the iterative stages of Arksey and O'Malley to search Portal ERIC, Ovid MEDLINE, C.I.N.A.H.L., E.M.B.A.S.E., Web of Science, and A.P.A. PsycInfo and grey literature from Canadian Centre on Substance Use and Addiction and websites suggested by the Canadian Agency for Drugs and Technologies in Health. Inclusion criteria are a) articles utilizing arts-based intervention on substance use prevention; b) studies with a clearly defined intervention; c) intervention targeting the youth (age 12-17) and d) publications written in English. Thematic analysis was used to identify the main themes from the included articles. RESULTS AND DISCUSSION: Themes identified in a thematic synthesis of these studies included a) the intent of the intervention; b) intervention characteristics; and c) the perceived effectiveness of interventions. Art-based interventions increased knowledge and changed attitudes and practices on substance use among youth. Making the interventions aesthetically appealing and engaging, active youth involvement in the development of the intervention and developing youth-centred interventions which attended to the realities they faced were central to the success of these interventions.

Liver health events: an indigenous community-led model to enhance HCV screening and linkage to care.

Despite high prevalence of hepatitis C virus (HCV), linkage to care and treatment for Indigenous people is low. In an Indigenous community in Saskatchewan, Canada a retrospective review identified 200 individuals (∼12% prevalence) had HCV antibodies though majority lacked ribonucleic acid (RNA) testing, and few received treatment despite availability of an effective cure. Following Indigenous oral traditions, focus group discussions were held with key community members and leadership. Participants emphasized the need for a community-based screening and treatment programme. A team of community members, peers and healthcare professionals developed a streamlined screening pathway termed 'liver health event' (LHE) to reduce stigma, reach undiagnosed, re-engage previously diagnosed, and ensure rapid linkage to care/treatment. LHEs began December 2016. Statistics were tracked for each event. As of July 2019, there were 10 LHEs with 540 participants, 227 hepatitis C tests and 346 FibroScans completed. This represented 294 unique individuals, of which 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of LHEs, these were adapted and implemented in 10 other communities in this region, resulting in 17 additional LHEs. This intervention is reaching the undiagnosed and linking clients to care through a low-barrier and de-stigmatizing approach. It has facilitated collaboration, knowledge exchange and mentorship between Indigenous communities, significantly impacting health outcomes of Indigenous people in this region.

Individuals residing in geographically isolated Indigenous communities often face multiple barriers trying to access healthcare services in Saskatchewan Canada. Consequently, many individuals who have HCV antibody (Ab), often lack confirmatory RNA test and experience delays in linkage to HCV treatment. A collective decision was made by pertinent stakeholders including community members, peers, community healthcare staff, Chief and leadership to improve access to screening and linkage to HCV treatment in community. A streamlined HCV screening pathway referred to as LHEs was developed by an Indigenous community. Since implementation in December 2016, 10 LHEs were delivered in community, with 540 participant visits, 227 hepatitis C tests conducted, and 346 FibroScans completed. Out of 294 unique individuals who attended, 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of the LHEs in reaching the undiagnosed, this screening pathway has been adapted and implemented in at least 10 additional Indigenous communities in Saskatchewan, Canada.

Perceptions of mental health and utilization of mental health services among new immigrants in Canada: A qualitative study.

The impact of immigration on individuals' overall health, including mental health, is complex. New immigrants' concepts of mental health, mental healthcare utilization, and their knowledge of existing services in Regina, Canada were explored using a hermeneutic phenomenological approach. Three focus groups were conducted with 37 participants recruited from English language classes provided by a non-governmental organization in the city. Irrespective of country of origin, participants recognized the impact of mental health on general wellbeing. Access to existing mental healthcare was hindered by language barriers, inadequate information about existing healthcare services, and individuals' perceptions about what and when services should be accessed. Despite challenges, participants viewed relocation positively and exhibited resilience when dealing with daily stress. Participants had knowledge gaps surrounding the role of family physicians in managing mental health conditions. Information on ways to access existing healthcare services should be delivered in collaboration with community organizations serving new immigrants.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study.

BACKGROUND: Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country. METHODS: An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees. RESULTS: A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues. CONCLUSIONS: The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.

Prenatal alcohol history - setting a threshold for diagnosis requires a level of detail and accuracy that does not exist.

BACKGROUND: The revised 2015 Canadian Guidelines requires a more specific prenatal alcohol exposure (PAE) threshold for a Fetal Alcohol Spectrum Disorder (FASD) diagnosis. The unintended consequences of adhering to the suggested PAE threshold for an FASD diagnosis and the challenges professionals face in obtaining an accurate PAE history were explored. METHODS: Using a mixed methods study design, the study was carried out in two parts (Quantitative and Qualitative). PAE history and FASD diagnosis was reviewed retrospectively from 146 patient charts referred for an FASD assessment between 2011 and 2016. The challenges experienced when collecting the PAE history were explored through interviews with 23 professionals. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). RESULTS: Of 146 assessments, only 21.9% met the revised 2015 PAE guidelines while 79.4% met the previous 2005 PAE criteria. Of 146 clients, 54.1% met brain criteria for FASD yet of those only 29.1% met the revised PAE criteria whereas 70.9% did not and therefore could lose their FASD diagnosis under a diligent application of PAE level suggested in the 2015 Guidelines. Thematic analysis of the interview data indicated that obtaining a reliable PAE history was challenging and a combination of methods are employed to get credible information. CONCLUSION: Confirming PAE history can be difficult, but ensuring reliable and accurate details on quantity, frequency, and timing of exposure is impossible in a clinical setting. Three out of every four individuals in the present study lost their FASD diagnosis following implementation of 2015 Canadian FASD Guidelines. A threshold might also imply that alcohol consumption below threshold is safe. The 2015 Canadian Guidelines need further refinement regarding the PAE criteria.

Blastomycosis in Southern Saskatchewan 2000-2015: Unique presentations and disease characteristics.

In the literature, cases of blastomycosis in Canada have been documented in provinces bordering the Great Lakes, including Ontario and Quebec, as well as Manitoba. This is the first study to our knowledge reporting cases of mycosis seen in southern Saskatchewan suggesting a broader area of endemicity. We searched the Regina Qu'Appelle Health Region (RQHR) Microbiology Laboratory for all culture-confirmed cases of Blastomyces from January 2000 to December 2015 and identified 15 cases. Thirteen cases were reviewed, identifying common presenting symptoms, misdiagnosis, comorbidities, travel history, time from presentation to diagnosis, diagnostic specimen, treatment, and clinical outcome. Nine patients had no travel to areas known to be endemic to environmental blastomycosis. Eight patients presented with respiratory symptoms, four with skin lesions, four with constitutional symptoms, and one presented with chest pain after a fall. Initial misdiagnosis occurred in nine (69%) of the 13 cases, and all six patients that died of the disease were misdiagnosed. These six patients (46%) were acutely ill with refractory disseminated disease, leading to respiratory failure. It is probable that Blastomyces is present as an endemic fungus in the soil of southern Saskatchewan. Possibly due to a lack of awareness of this pathogen in the area, initial misdiagnoses were common and likely contributed to significant morbidity and mortality.

Attention capture without awareness in a non-spatial selection task.

Distractors presented prior to a critical target in a rapid sequence of visually-presented items induce a lag-dependent deficit in target identification, particularly when the distractor shares a task-relevant feature of the target. Presumably, such capture of central attention is important for bringing a target into awareness. The results of the present investigation suggest that greater capture of attention by a distractor is not accompanied by greater awareness of it. Moreover, awareness tends to be limited to superficial characteristics of the target such as colour. The findings are interpreted within the context of a model that assumes sudden increases in arousal trigger selection of information for consolidation in working memory. In this conceptualization, prolonged analysis of distractor items sharing task-relevant features leads to larger target identification deficits (i.e., greater capture) but no increase in awareness.

Serum Interleukin (IL)-6, Lipid Profile, and Association With Disease Severity in Patients With Psoriasis: A Cross-Sectional Study.

OBJECTIVES: This study estimated the lipid profile and inflammatory biomarker (interleukin-6, IL-6) levels in patients with psoriasis and explored the association between lipid profiles and inflammatory biomarkers (IL-6) in assessing the severity of the disease. METHODOLOGY: This cross-sectional study was conducted in the Department of Biochemistry, in association with the Department of Dermatology, at the Veer Surendra Sai Institute of Medical Sciences and Research, Burla, from November 2022 to June 2023. A fully automated analyzer (Cobas C311, Roche Diagnostics, Mannheim, Germany) was used to estimate the lipid profile, while the enzyme-linked immunosorbent assay (Erba, Transasia Bio-medicals Ltd., Mumbai, India) was used to estimate the inflammatory marker (IL-6). Data were analyzed using Statistical Package for the Social Sciences version 21.0 (IBM Corp., Armonk, NY). An unpaired t-test was conducted to examine the relationship between two variables. A p value of <0.05 was considered significant. The correlation among IL-6, lipid profile, and psoriasis area severity index (PASI) score was analyzed using Pearson's correlation coefficient. Quantitative data were expressed as means and standard deviations. RESULTS: Of the 102 study participants, 68 had psoriasis alone, and 34 had psoriasis with arthritis (psoriatic arthritis, PsA). Higher mean serum concentrations of IL-6, total cholesterol (TC), low-density lipoprotein, and triglycerides were found in patients with PsA compared to those with psoriasis alone. In patients with PsA, TC and IL-6 showed a strong positive correlation with the PASI score. In contrast, high-density lipoprotein showed a negative correlation with PASI (r = -0.036, p < 0.05). CONCLUSION: In conclusion, our study revealed lipid profile abnormalities and increased IL-6 activity in PsA patients. By measuring inflammatory markers (IL-6) and lipid profiles early in the disease process, we can employ preventive strategies to better manage and improve survival and quality of life in patients with psoriasis.

Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review.

Introduction: Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. Methods: This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. Results: After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. Conclusion: From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.

Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study.

BACKGROUND: First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non-First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients' experiences with health care systems and identify solutions. METHODS: Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. RESULTS: Patients' (n = 10) and community health care providers' (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients' overall health. INTERPRETATION: Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.

Lessons learned from the chronic pain clinic: a qualitative study of the perspectives of healthcare providers.

Aim: The chronic pain clinic (CPC) was established to address chronic non-cancer pain and opioid-related harm. Materials & methods: Employing community participatory research design First Nation Metis representatives, clinicians and a researcher collectively agreed to document lessons learned from healthcare providers' perspective, 1 year post-clinic-implementation. 17 individual interviews were conducted. Results: Thematic analysis revealed that a multidisciplinary team offered client-centered care, education, counseling and multimodal treatment options. Medication reviews and case management ensured patient safety. Communication and education of community providers enhanced pain management capacity ensuring safe opioid prescribing. Evidence-based best practices were implemented through system-level monitoring. Access to Indigenous healing strategies provided culturally responsive spiritual care upon request. Conclusion: The multidisciplinary and multimodal CPC care model effectively manages chronic non-cancer pain.

Identifying Barriers to Healthcare Access for New Immigrants: A Qualitative Study in Regina, Saskatchewan, Canada.

Despite universal healthcare, immigrants often face unique challenges accessing healthcare. Employing an interpretative phenomenological analysis approach, four focus groups were conducted with 29 women and eight men from 15 different countries attending English language classes hosted at a non-governmental organization in Regina, Saskatchewan, Canada in 2016 and 2017. Personal factors such as language barrier, lack of transportation, childcare and others interacted with systemic factors such as lack of appointment, long wait times, etc. delaying access at each point of contact with the healthcare system. Participants expressed dissatisfaction with the potency of medications, time spent in appointments and the way healthcare professionals communicated health information. The referral process and wait times were viewed as barriers to accessing specialist, diagnostic and acute care services. Participants were concerned that appropriate healthcare will be unavailable when needed. Strategies addressing systemic and person-specific barriers are needed to provide equitable client-centered care.

Food insecurity among postsecondary international students: a scoping review protocol.

INTRODUCTION: International students make significant contributions to their host institutions and countries. Yet research shows that not all international students have the financial means to fend for themselves and meet their financial obligations for the entire study programme. Such students are at significant risk of food insecurity. The objective of this scoping review is to synthesise available information on the factors related to food insecurity among international students studying at postsecondary educational institutions and identify the types of food insecurity interventions that have been implemented to address this issue. METHODS AND ANALYSIS: The Joanna Briggs Institute scoping review methodology will be used to guide this scoping review, and we will search the following databases: MEDLINE (through Ovid), CINAHL (EBSCO), PubMed, ERIC (via Ovid), PROSPERO and ProQuest. The titles, abstracts, and subsequently full texts of the selected papers will then be screened against the inclusion criteria. Data from articles included in the review will be extracted using a data charting form and will be summarised in a tabular form. Thematic analysis will be used to identify common themes that thread through the selected studies and will be guided by the steps developed by Terry et al. ETHICS AND DISSEMINATION: Since this project entails a review of available literature, ethical approval is not required. The findings will be presented at academic conferences and published in a peer-reviewed journal. To make the findings more accessible, they will also be distributed via digital communication platforms.

Patient perspectives from the multi-disciplinary chronic pain clinic: a qualitative study.

Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.

Exploring family based immigrant youth substance use prevention programmes: a scoping review protocol.

INTRODUCTION: Canada has one of the highest rates of problematic opiate and alcohol use in the world. Globally, Canada was the second country that legalized marijuana for non-medical use. As Canada is an immigrant-receiving country, newcomers and immigrants contend with a substance use landscape that was likely absent in their countries of origin. Although immigrants have lower rates of substance use than the host population, the risk of substance use, especially among youth, increases with acculturation and peer pressure. While parents are best placed to mitigate the risks for substance use among their youth, immigrant parents often do not have the knowledge and skills to do so. Therefore, culturally adaptable family based interventions need be explored to build immigrant parents' capacities to mitigate substance use risks. AIM AND PURPOSE: The aim of this scoping review is to explore family based substance use prevention interventions for immigrant youth, which will be guided by two questions:What is known about family based interventions for preventing immigrant adolescents' substance use?What are the features and study results of these intervention protocols? METHODS AND ANALYSIS: We will apply Arksey and O'Malley's procedure for reporting scoping review and report study findings based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. DISCUSSION: We hope that the knowledge translation emanating from this review will increase immigrant parents' knowledge of substance use and enable them to effectively intervene to prevent substance use among their youth. We also hope that this work can inform policy development on best practices for substance use prevention and for the creation of culturally sensitive programmes and services for immigrant youth.