Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) an... more Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs') perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM. Design: We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines. Results: Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences). Conclusions: We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.
Introduction: Overdose education and naloxone distribution (OEND) programmes equip and train peop... more Introduction: Overdose education and naloxone distribution (OEND) programmes equip and train people who are likely to witness an opioid overdose to respond with effective first aid interventions. Despite OEND expansion across North America, overdose rates are increasing, raising questions about how to improve OEND programmes. We conducted an iterative series of codesign stakeholder workshops to develop a prototype for take-home naloxone (THN)-kit (i.e., two doses of intranasal naloxone and training on how to administer it). Methods: We recruited people who use opioids, frontline healthcare providers and public health representatives to participate in codesign workshops covering questions related to THN-kit prototypes, training on how to use it, and implementation, including refinement of design artefacts using personas and journey maps. Completed over 9 months, the workshops were audio-recorded and transcribed with visible results of the workshops (i.e., sticky notes, sketches) archived. We used thematic analyses of these materials to identify design requirements for THN-kits and training.
Studies evaluating predictors of operative outcome for lung resection have focused on physiologic... more Studies evaluating predictors of operative outcome for lung resection have focused on physiological measures of cardiorespiratory impairment, but these have proved inadequate. This study evaluated the predictive abilities of six preoperative variables: the global quality of life (QL), social function (SF), and emotional function (EF) scales of the European Organization for the Research and Treatment of Cancer's (EORTC) QLQ-C30 questionnaire, 6-min walk distance (6MWD), forced expiratory volume (FEVy), and diffusion capacity (DLco). Operative outcome was represented by the surrogate measure length of stay out of hospital within thefirst 30 days (LOSOH). A single-centre prospective cohort study evaluating 70 subjects was conducted using multiple regression. LOSOH was bimodally distributed, therefore analysis was undertaken for the entire sample and for two separate groups (A and B). Group B (n = 4) experienced severe complications (LOSOH = 0-5 days) and was too small for statistic...
IntroductionPlacenta accreta spectrum (PAS) disorder is a life-threatening condition that may res... more IntroductionPlacenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals at high risk of major haemorrhage during the third stage of labour. Current research reports on PAS disorder outcomes have highly variable levels of information, which is therefore difficult for investigators to aggregate to inform practice. There is an urgent need to harmonise data collection in prospective studies to identify and implement best practices for management. One approach to standardise outcomes across any health area via the use of core outcome sets (COSs), which are consensus-derived standardised sets of outcomes that all studies for a particular condition should measure and report. This protocol outlines the steps for developing a COS for PAS disorder (COPAS).Methods and analysisThis protocol outlines steps for the creation of C...
ObjectivesType 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic... more ObjectivesType 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic studies suggest concomitant symptomatic knee OA increases the risk of T2DM complications. We sought to explore the experiences and perspectives of individuals’ living with both symptomatic knee OA and T2DM, with a focus on the impact of OA on T2DM management and daily life.DesignWe conducted qualitative semistructured telephone interviews with persons living with T2DM and knee OA. We inductively coded and analysed interview transcripts, informed by interpretative description.SettingWe recruited participants from a community arthritis self-management programme and an academic hospital’s family medicine clinic in Ontario, Canada.ParticipantsWe included 18 participants who had a physician diagnosis of both T2DM and knee OA, with variation age, gender, and duration of T2DM and knee OA.ResultsParticipants with T2DM described how concomitant painful and disabling knee OA made it difficult to ...
Background: There is a growing body of evidence that where you live is important to your health. ... more Background: There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context. Methods: This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-income...
INTRODUCTION A common sequelae of brachial plexus birth injury (BPBI) is an elbow flexion contrac... more INTRODUCTION A common sequelae of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance-related goals. OBJECTIVE To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards (IPDAS) to help these youth and their families make treatment decisions. DESIGN Mixed-methods study SETTING: Brachial plexus clinic in a pediatric tertiary care centre PARTICIPANTS: Five young adults (21-24 years), 14 youth (8-19 years) and their parents, 15 families (children 2 - 16 years) and 19 clinicians from a Brachial Plexus Clinic participated in the PtDA development. Seventeen other youth (8-18 years) facing treatment decisions regarding their elbow contracture field-tested the PtDA prototype. INTERVENTIONS Non-applicable MAIN OUTCOME MEASURES: In-depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field-test the PtDA prototype. RESULTS Evidence from previously conducted knowledge synthesis and the youth-focused decisional needs assessment qualitative data informed the development of new PtDA prototype which included a questionnaire-based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field-tested the PtDA prototype understood its content, while only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. CONCLUSIONS This new PtDA can be used to help youth with BPBI and their families to make a personal value-based informed decision regarding treatment options for their elbow flexion contracture. This article is protected by copyright. All rights reserved.
Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years... more Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years), in which diabetes self-management is challenged as an individual learns to cope with diabetes and develop their independence. With the goal of helping providers individualize support as patients begin adult care, we conducted a qualitative study with 33 emerging adults with type 1 diabetes (51% female, age 20.6±0.3 years, diabetes duration 12±1 years). Individual semi-structured interviews allowed participants to depict their lived experiences with diabetes. We employed a narrative approach to the analysis of interview transcripts and constant comparison was used to identify similarities and differences in narrative typology and thematic content. We identified that participants’ accounts of living with diabetes could be grouped into three broad categories: Ingrained (n=14), Intrusive (n=12) and Inconspicuous (n=7). We interpreted these accounts as different “lenses” through which indi...
Comparison of postoperative outcomes among patients treated by male and female surgeons: a popula... more Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017; 359: j4366. 24 Greenwood B, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients.
International Journal of Qualitative Methods, 2021
While participant-created drawings in arts-based health research, used as a process of producing ... more While participant-created drawings in arts-based health research, used as a process of producing knowledge are well known, similar approaches with researcher-created drawings are less common. This article describes the journey of how researcher-created drawings as an arts-based analytical approach helped a novice researcher to draw deeper into the interpretive process. Emerging from a positivist paradigm, a proceduralist understanding of the qualitative methods was readily grasped by this researcher, but developing reflexivity and deep analytical insights required facilitation. An overarching interpretivist qualitative approach that aligns with Gadamerian philosophical hermeneutics was used to analyze participant observation data (field notes, researcher-created drawings) of decision-making encounters between families of youth with brachial plexus birth injuries and the health care team in the clinic setting. Drawing acted as an analytical catalyst such that the task of creating a v...
Background: Screening for lung cancer with low dose CT can facilitate the detection of early-stag... more Background: Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening, thus resulting in a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. Methods: This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning mo...
Background: There is a growing body of evidence that where you live is important to your health. ... more Background: There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context. Methods: This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-incom...
This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted P... more This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Standardized observation of neighbourhood disorder: does it work in Canada?
IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in th... more IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child’s diabetes ‘self’-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.Research design and methodsSemi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.ResultsAnalysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; ne...
Introduction The surviving opioid overdose with naloxone education and resuscitation (SOONER) pro... more Introduction The surviving opioid overdose with naloxone education and resuscitation (SOONER) project uses co-design and trial methods to develop and evaluate a point-of-care overdose education and naloxone distribution (OEND) tool. We plan to conduct a randomised controlled trial to assess the effectiveness of our OEND tool in comparison with best available standard of care by observing participants’ performance as a responder to a simulated overdose. Recruiting and retaining people at risk of or likely to witness opioid overdose raises scientific, logistical and bioethical challenges. A feasibility study is needed to establish the effectiveness of recruitment and retention strategies and acceptability of study procedures prior to launching the full trial. Methods and analysis Strategies to enhance recruitment include candidate-driven recruitment, verbal informed consent, and attractive, destigmatising materials. Adults at risk of or likely to witness opioid overdose will be recrui...
Background: Bystander cardiopulmonary resuscitation (CPR) improves the odds of survival from out-... more Background: Bystander cardiopulmonary resuscitation (CPR) improves the odds of survival from out-of-hospital cardiac arrest (OHCA). Despite this, bystander CPR rates are considerably lower in most ...
Background Opioid overdose epidemic is a public health crisis that is impacting communities aroun... more Background Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to design an open-access naloxone kit and ultra-brief education session for use in point-of-care settings. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for the kit and education session. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a one-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Col...
Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress a... more Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. Methods We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regr...
Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) an... more Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs') perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM. Design: We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines. Results: Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences). Conclusions: We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.
Introduction: Overdose education and naloxone distribution (OEND) programmes equip and train peop... more Introduction: Overdose education and naloxone distribution (OEND) programmes equip and train people who are likely to witness an opioid overdose to respond with effective first aid interventions. Despite OEND expansion across North America, overdose rates are increasing, raising questions about how to improve OEND programmes. We conducted an iterative series of codesign stakeholder workshops to develop a prototype for take-home naloxone (THN)-kit (i.e., two doses of intranasal naloxone and training on how to administer it). Methods: We recruited people who use opioids, frontline healthcare providers and public health representatives to participate in codesign workshops covering questions related to THN-kit prototypes, training on how to use it, and implementation, including refinement of design artefacts using personas and journey maps. Completed over 9 months, the workshops were audio-recorded and transcribed with visible results of the workshops (i.e., sticky notes, sketches) archived. We used thematic analyses of these materials to identify design requirements for THN-kits and training.
Studies evaluating predictors of operative outcome for lung resection have focused on physiologic... more Studies evaluating predictors of operative outcome for lung resection have focused on physiological measures of cardiorespiratory impairment, but these have proved inadequate. This study evaluated the predictive abilities of six preoperative variables: the global quality of life (QL), social function (SF), and emotional function (EF) scales of the European Organization for the Research and Treatment of Cancer's (EORTC) QLQ-C30 questionnaire, 6-min walk distance (6MWD), forced expiratory volume (FEVy), and diffusion capacity (DLco). Operative outcome was represented by the surrogate measure length of stay out of hospital within thefirst 30 days (LOSOH). A single-centre prospective cohort study evaluating 70 subjects was conducted using multiple regression. LOSOH was bimodally distributed, therefore analysis was undertaken for the entire sample and for two separate groups (A and B). Group B (n = 4) experienced severe complications (LOSOH = 0-5 days) and was too small for statistic...
IntroductionPlacenta accreta spectrum (PAS) disorder is a life-threatening condition that may res... more IntroductionPlacenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals at high risk of major haemorrhage during the third stage of labour. Current research reports on PAS disorder outcomes have highly variable levels of information, which is therefore difficult for investigators to aggregate to inform practice. There is an urgent need to harmonise data collection in prospective studies to identify and implement best practices for management. One approach to standardise outcomes across any health area via the use of core outcome sets (COSs), which are consensus-derived standardised sets of outcomes that all studies for a particular condition should measure and report. This protocol outlines the steps for developing a COS for PAS disorder (COPAS).Methods and analysisThis protocol outlines steps for the creation of C...
ObjectivesType 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic... more ObjectivesType 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic studies suggest concomitant symptomatic knee OA increases the risk of T2DM complications. We sought to explore the experiences and perspectives of individuals’ living with both symptomatic knee OA and T2DM, with a focus on the impact of OA on T2DM management and daily life.DesignWe conducted qualitative semistructured telephone interviews with persons living with T2DM and knee OA. We inductively coded and analysed interview transcripts, informed by interpretative description.SettingWe recruited participants from a community arthritis self-management programme and an academic hospital’s family medicine clinic in Ontario, Canada.ParticipantsWe included 18 participants who had a physician diagnosis of both T2DM and knee OA, with variation age, gender, and duration of T2DM and knee OA.ResultsParticipants with T2DM described how concomitant painful and disabling knee OA made it difficult to ...
Background: There is a growing body of evidence that where you live is important to your health. ... more Background: There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context. Methods: This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-income...
INTRODUCTION A common sequelae of brachial plexus birth injury (BPBI) is an elbow flexion contrac... more INTRODUCTION A common sequelae of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance-related goals. OBJECTIVE To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards (IPDAS) to help these youth and their families make treatment decisions. DESIGN Mixed-methods study SETTING: Brachial plexus clinic in a pediatric tertiary care centre PARTICIPANTS: Five young adults (21-24 years), 14 youth (8-19 years) and their parents, 15 families (children 2 - 16 years) and 19 clinicians from a Brachial Plexus Clinic participated in the PtDA development. Seventeen other youth (8-18 years) facing treatment decisions regarding their elbow contracture field-tested the PtDA prototype. INTERVENTIONS Non-applicable MAIN OUTCOME MEASURES: In-depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field-test the PtDA prototype. RESULTS Evidence from previously conducted knowledge synthesis and the youth-focused decisional needs assessment qualitative data informed the development of new PtDA prototype which included a questionnaire-based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field-tested the PtDA prototype understood its content, while only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. CONCLUSIONS This new PtDA can be used to help youth with BPBI and their families to make a personal value-based informed decision regarding treatment options for their elbow flexion contracture. This article is protected by copyright. All rights reserved.
Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years... more Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years), in which diabetes self-management is challenged as an individual learns to cope with diabetes and develop their independence. With the goal of helping providers individualize support as patients begin adult care, we conducted a qualitative study with 33 emerging adults with type 1 diabetes (51% female, age 20.6±0.3 years, diabetes duration 12±1 years). Individual semi-structured interviews allowed participants to depict their lived experiences with diabetes. We employed a narrative approach to the analysis of interview transcripts and constant comparison was used to identify similarities and differences in narrative typology and thematic content. We identified that participants’ accounts of living with diabetes could be grouped into three broad categories: Ingrained (n=14), Intrusive (n=12) and Inconspicuous (n=7). We interpreted these accounts as different “lenses” through which indi...
Comparison of postoperative outcomes among patients treated by male and female surgeons: a popula... more Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017; 359: j4366. 24 Greenwood B, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients.
International Journal of Qualitative Methods, 2021
While participant-created drawings in arts-based health research, used as a process of producing ... more While participant-created drawings in arts-based health research, used as a process of producing knowledge are well known, similar approaches with researcher-created drawings are less common. This article describes the journey of how researcher-created drawings as an arts-based analytical approach helped a novice researcher to draw deeper into the interpretive process. Emerging from a positivist paradigm, a proceduralist understanding of the qualitative methods was readily grasped by this researcher, but developing reflexivity and deep analytical insights required facilitation. An overarching interpretivist qualitative approach that aligns with Gadamerian philosophical hermeneutics was used to analyze participant observation data (field notes, researcher-created drawings) of decision-making encounters between families of youth with brachial plexus birth injuries and the health care team in the clinic setting. Drawing acted as an analytical catalyst such that the task of creating a v...
Background: Screening for lung cancer with low dose CT can facilitate the detection of early-stag... more Background: Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening, thus resulting in a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. Methods: This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning mo...
Background: There is a growing body of evidence that where you live is important to your health. ... more Background: There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context. Methods: This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-incom...
This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted P... more This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Standardized observation of neighbourhood disorder: does it work in Canada?
IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in th... more IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child’s diabetes ‘self’-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.Research design and methodsSemi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.ResultsAnalysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; ne...
Introduction The surviving opioid overdose with naloxone education and resuscitation (SOONER) pro... more Introduction The surviving opioid overdose with naloxone education and resuscitation (SOONER) project uses co-design and trial methods to develop and evaluate a point-of-care overdose education and naloxone distribution (OEND) tool. We plan to conduct a randomised controlled trial to assess the effectiveness of our OEND tool in comparison with best available standard of care by observing participants’ performance as a responder to a simulated overdose. Recruiting and retaining people at risk of or likely to witness opioid overdose raises scientific, logistical and bioethical challenges. A feasibility study is needed to establish the effectiveness of recruitment and retention strategies and acceptability of study procedures prior to launching the full trial. Methods and analysis Strategies to enhance recruitment include candidate-driven recruitment, verbal informed consent, and attractive, destigmatising materials. Adults at risk of or likely to witness opioid overdose will be recrui...
Background: Bystander cardiopulmonary resuscitation (CPR) improves the odds of survival from out-... more Background: Bystander cardiopulmonary resuscitation (CPR) improves the odds of survival from out-of-hospital cardiac arrest (OHCA). Despite this, bystander CPR rates are considerably lower in most ...
Background Opioid overdose epidemic is a public health crisis that is impacting communities aroun... more Background Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to design an open-access naloxone kit and ultra-brief education session for use in point-of-care settings. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for the kit and education session. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a one-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Col...
Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress a... more Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. Methods We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regr...
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Papers by Janet Parsons