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Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. PLoS One 2024; 19:e0297532. [PMID: 38635804 PMCID: PMC11025903 DOI: 10.1371/journal.pone.0297532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/30/2023] [Indexed: 04/20/2024] Open
Abstract
Integrating the voices of service users and providers in the design and delivery of health services increases the acceptability, relevance, and effectiveness of services. Such efforts are particularly important for youth opioid use treatments and services, which have failed to consider the unique needs of youth and families. Applying community-based participatory research (CBPR) and co-design can facilitate this process by contextualizing service user experiences at individual and community levels and supporting the collaborative design of innovative solutions for improving care. However, few studies demonstrate how to effectively integrate these methods and engage underserved populations in co-design. As such, this manuscript describes how our team wove CBPR and co-design methods to develop solutions for improving youth opioid use treatments and services in Canada. As per CBPR methods, national, provincial, and community partnerships were established to inform and support the project's activities. These partnerships were integral for recruiting service users (i.e., youth and caregivers) and service providers to co-design prototypes and support local testing and implementation. Co-design methods enabled understanding of the needs and experiences of youth, caregivers, and service providers, resulting in meaningful community-specific innovations. We used several engagement methods during the co-design process, including regular working group meetings, small group discussions, individual interviews and consultations, and feedback grids. Challenges involved the time commitment and resources needed for co-design, which were exacerbated by the COVID-19 pandemic and limited our ability to engage a diverse sample of youth and caregivers in the process. Strengths of the study included youth and caregiver involvement in the co-design process, which centered around their lived experiences; the therapeutic aspect of the process for participants; and the development of innovations that were accepted by design partners.
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Affiliation(s)
- Roxanne Turuba
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | - Alayna Ewert
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Corinne Tallon
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Providence Research, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
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Ooms T, Klaser K, Ishkanian A. The role of academia practice partnerships in the well-being economy: Retracing synergies between health and social sciences using bibliometric analysis. Health Policy 2023; 138:104936. [PMID: 37922743 DOI: 10.1016/j.healthpol.2023.104936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
Well-being economies develop policies at the intersection of health and socio-economic inequalities. These policies are often informed by data-driven approaches, such as quality-of-life indicators. However, despite great efforts in measurement, it is known that the perspectives of underserved and unhealthy populations are not always fully captured. This raises the question to what extent well-being economy policies, informed by data alone, can adequately improve well-being for all. In this paper we investigate the potential of academia practice partnerships (AcPrac) in facilitating transfer and production of knowledge and skills between researchers and practitioners (including decision makers, governments, and communities) to create well-being policies informed by both data and people. We use bibliometric analysis to visualise the current state of knowledge on AcPrac. We find that 1) the health field has made the largest scientific contribution in this area, 2) cross-fertilization, which is at the heart of the well-being economy approach, is starting to take place between health and social sciences, and 3) concerns for equity are a shared value underlying transdisciplinary partnerships for well-being. Our findings contribute to understanding the role of AcPrac in advancing well-being economies and informing policy, but further research is needed to draw conclusions about its effectiveness.
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Affiliation(s)
| | - Klaudijo Klaser
- Department of Economics and Management, University of Trento.
| | - Armine Ishkanian
- LSE Department of Social Policy and Executive Director of the LSE Atlantic Fellows for Social and Economic Equity.
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Enich M, Flumo R, Campos S, Flores N, Sullivan N, Mellor J, O'Neill C, Nyaku AN. Overdose education and naloxone distribution program design informed by people who use drugs and naloxone distributors. Prev Med Rep 2023; 35:102374. [PMID: 37680861 PMCID: PMC10480625 DOI: 10.1016/j.pmedr.2023.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
People who use drugs (PWUD) are the most directly affected by the overdose epidemic. However, they are not often targets of overdose education and naloxone distribution (OEND) programs. Instead, these programs target friends or family members of people prescribed opioids or general community members. This study aimed to understand the perspectives of PWUD and community naloxone distributors on OEND program design. We used a community-based participatory research model to elucidate participant perspectives on what OEND programs should look like in the context of each individual's specific risk environment. We conducted semi-structured in-depth interviews with PWUD and naloxone distributors (n = 30) in New Brunswick and Newark, New Jersey between February and November of 2022. We analyzed interviews using thematic analysis and identified the following themes: increasing naloxone knowledge, peer-based naloxone access, increasing PWUD-informed OEND program design, and desired broader OEND program scope. All Participants knew what naloxone was and emphasized that naloxone needed to be ubiquitous in the community. Participants prioritized peer-based distribution, integrating distribution into community organizations, and addressing psychosocial issues related to naloxone administration and drug use. In summary, PWUD and community naloxone distributors emphasized peer-led community naloxone distribution that prioritized novel ways for PWUD to access naloxone. OEND program design should prioritize PWUD's perspectives and direct community naloxone distribution.
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Affiliation(s)
- Michael Enich
- Rutgers University School of Social Work, 120 Albany Street, New Brunswick, NJ 08901, USA
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Rachel Flumo
- Rutgers University School of Public Health, 163 Hoes Lane, Piscataway, NJ 08854, USA
| | - Stephanie Campos
- John Jay College of Criminal Justice, Department of Anthropology, 524 West 59th Street, New York, NY 10019. USA
| | - Netanya Flores
- Temple University School of Podiatric Medicine, 148 N 8 St, Philadelphia, PA 19107, USA
| | - Nora Sullivan
- Rutgers University School of Social Work, 120 Albany Street, New Brunswick, NJ 08901, USA
| | - Jenna Mellor
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Caitlin O'Neill
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
| | - Amesika N. Nyaku
- New Jersey Harm Reduction Coalition, 37 Easton Ave., Suite 200, New Brunswick, NJ 08901. USA
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, 185 South Orange Ave, MSB I689, Newark, NJ 07103, USA
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Beck McGreevy P, Wood S, Thomson E, Burmeister C, Spence H, Pelletier J, Giesinger W, McDougall J, McLeod R, Hutchison A, Lock K, Norton A, Barker B, Urbanoski K, Slaunwhite A, Nosyk B, Pauly B. Doing community-based research during dual public health emergencies (COVID and overdose). Harm Reduct J 2023; 20:135. [PMID: 37715202 PMCID: PMC10504762 DOI: 10.1186/s12954-023-00852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
Meaningful engagement and partnerships with people who use drugs are essential to conducting research that is relevant and impactful in supporting desired outcomes of drug consumption as well as reducing drug-related harms of overdose and COVID-19. Community-based participatory research is a key strategy for engaging communities in research that directly affects their lives. While there are growing descriptions of community-based participatory research with people who use drugs and identification of key principles for conducting research, there is a gap in relation to models and frameworks to guide research partnerships with people who use drugs. The purpose of this paper is to provide a framework for research partnerships between people who use drugs and academic researchers, collaboratively developed and implemented as part of an evaluation of a provincial prescribed safer supply initiative introduced during dual public health emergencies (overdose and COVID-19) in British Columbia, Canada. The framework shifts from having researchers choose among multiple models (advisory, partnership and employment) to incorporating multiple roles within an overall community-based participatory research approach. Advocacy by and for drug users was identified as a key role and reason for engaging in research. Overall, both academic researchers and Peer Research Associates benefited within this collaborative partnerships approach. Each offered their expertise, creating opportunities for omni-directional learning and enhancing the research. The shift from fixed models to flexible roles allows for a range of involvement that accommodates varying time, energy and resources. Facilitators of involvement include development of trust and partnering with networks of people who use drugs, equitable pay, a graduate-level research assistant dedicated to ongoing orientation and communication, technical supports as well as fluidity in roles and opportunities. Key challenges included working in geographically dispersed locations, maintaining contact and connection over the course of the project and ensuring ongoing sustainable but flexible employment.
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Affiliation(s)
- Phoenix Beck McGreevy
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Shawn Wood
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Erica Thomson
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Charlene Burmeister
- PWLLE Stakeholder Engagement Lead, Professionals for Ethical Engagement of Peers (PEEP), BC Centre for Disease Control, Provincial Health Services Authority, Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Heather Spence
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Josh Pelletier
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Willow Giesinger
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Jenny McDougall
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Rebecca McLeod
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Abby Hutchison
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Kurt Lock
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alexa Norton
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Barker
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- School of Public Health and Social Policy, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Amanda Slaunwhite
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Health Evaluation and Outcome Sciences, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
- School of Nursing, University of Victoria, Box 1700 Stn CSC, Victoria, BC, Canada.
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Thulien M, Anderson H, Douglas S, Dykeman R, Horne A, Howard B, Sedgemore K, Charlesworth R, Fast D. The generative potential of mess in community-based participatory research with young people who use(d) drugs in Vancouver. Harm Reduct J 2022; 19:30. [PMID: 35337350 DOI: 10.1186/s12954-022-00615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17–28) who have current or past experience with drug use and homelessness in Greater Vancouver. We focus on moments when our guiding principles of shared leadership, safety, and inclusion became fraught in practice, forcing us in some cases to re-imagine these principles, and in others to accept that certain ethical dilemmas in research can never be fully resolved. We argue that this messiness can be traced to the complex and diverse positionalities of each person on our team, including young people. As such, creating space for mess was ethically necessary and empirically valuable for our CBPR project.
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Kendall CE, Boucher LM, Donelle J, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Bayoumi AM. Cohort study of team-based care among marginalized people who use drugs in Ottawa. Can Fam Physician 2022; 68:117-127. [PMID: 35177504 PMCID: PMC9842166 DOI: 10.46747/cfp.6802117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe team-based care use among a cohort of people who use drugs (PWUD) and to determine factors associated with receipt of team-based care. DESIGN A cohort study using survey data collected between March and December 2013. These data were then linked to provincial-level health administrative databases to assess patterns of primary care among PWUD in the 2 years before survey completion. SETTING Ottawa, Ont. PARTICIPANTS Marginalized PWUD 16 years of age or older. MAIN OUTCOME MEASURES Patients were assigned to primary care models based on survey responses and then were categorized as attached to team-based medical homes, attached to non-team-based medical homes, not attached to a medical home, and no primary care. Descriptive statistics and multinomial logistic regression were used to determine associations between PWUD and medical home models. RESULTS Of 663 total participants, only 162 (24.4%) received team-based care, which was associated with high school level of education (adjusted odds ratio [AOR] = 2.18; 95% CI 1.13 to 4.20), receipt of disability benefits (AOR = 2.47; 95% CI 1.22 to 5.02), and HIV infection (AOR = 2.88; 95% CI 1.28 to 6.52), and was inversely associated with recent overdose (AOR = 0.49; 95% CI 0.25 to 0.94). In comparison, 125 (18.8%) received non-team-based medical care, which was associated with university or college education (AOR = 2.31; 95% CI 1.04 to 5.15) and mental health comorbidity (AOR = 4.18; 95% CI 2.33 to 7.50), and was inversely associated with being detained in jail in the previous 12 months (AOR = 0.51; 95% CI 0.28 to 0.90). CONCLUSION Although team-based, integrated models of care will benefit disadvantaged groups the most, few PWUD receive such care. Policy makers should mitigate barriers to physician care and improve integration across health and social services.
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Affiliation(s)
- Claire E. Kendall
- Associate Professor in the Department of Family Medicine and is cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa in Ontario; Senior Investigator at the Bruyère Research Institute in Ottawa; a practising family physician with the Bruyère Family Health Team; Adjunct Scientist at ICES in Toronto, Ont; Affiliate Investigator in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute; Affiliate Scientist in the Li Ka Shing Knowledge Institute at St Michael’s Hospital in Toronto; and Associate Dean of Social Accountability in the Faculty of Medicine at the University of Ottawa.,Correspondence Dr Claire E. Kendall; e-mail
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Fernando S, Hawkins J, Kniseley M, Sikora M, Robson J, Snyder D, Battle C, Salmon A. The Overdose Crisis and Using Alone: Perspectives of People Who Use Drugs in Rural and Semi-Urban Areas of British Columbia. Subst Use Misuse 2022; 57:1864-1872. [PMID: 36096482 DOI: 10.1080/10826084.2022.2120361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: A significant rise in the rate of overdose deaths in British Columbia (BC), driven by fentanyl contamination of the illicit drug supply, led to the declaration of a public health emergency in 2016. Those at greatest risk of death are people who use alone. This community-based participatory action research study based in the Fraser East region of BC study aimed to overview underlying factors that contribute to unwitnessed overdoses in semi-urban and rural settings. Methods: This descriptive study used a community-based participatory action research model with peer research associates (PRAs) involved at various research stages. In total, 22 interviews were conducted with participants aged 19 and over who used illicit drugs in the Fraser East since the start of the public health emergency in 2016. A collaborative data analysis approach was taken for data interpretation, and content analysis was performed to explore themes surrounding using alone. Results: Among people who use drugs (PWUD), using alone was found to be influenced by (a) the availability of drugs and personal funds, (b) personal safety, (c) stigma and shame, (d) protecting privacy, (e) mental health conditions and addiction, and (f) the lack of engagement with harm reduction services. At times, using alone was due to unforeseen, episode-specific situations. Conclusion: A multi-dimentional and context-specific approach is needed in overdose prevention and response for people who use drugs alone. There is need for enhanced approaches that address or include support services for families to reduce stigma and isolation of those at risk of an overdose.
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Affiliation(s)
| | - Jennifer Hawkins
- Centre for Health Evaluation and Outcome Sciences.,Fraser Health Authority
| | | | | | | | | | | | - Amy Salmon
- Centre for Health Evaluation and Outcome Sciences.,University of British Columbia
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Tan DHS, Rana J, Tengra Z, Hart TA, Wilton J, Bayoumi AM. Preferences regarding emerging HIV prevention technologies among Toronto men who have sex with men: a discrete choice experiment. Sci Rep 2021; 11:22252. [PMID: 34782691 DOI: 10.1038/s41598-021-01634-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
New forms of HIV pre-exposure prophylaxis (PrEP) include long-acting injectables and topical microbicides, each with unique attributes that may appeal to distinct users. We used a discrete choice experiment to characterize preferences for new PrEP formulations among Toronto men who have sex with men. MSM undergoing anonymous HIV testing completed a discrete choice experiment with 12 choice sets by selecting their preferred option within each set. Each set included “usual methods to prevent HIV” (excluding PrEP) as one alternative and two hypothetical PrEP alternatives, which differed according formulation/dosing, side effects (none/mild), risk of drug resistance (none/low/moderate), and HIV prevention efficacy (50%, 65%, 80% or 99% risk reduction). We used mixed logistic regression to infer preferences for PrEP attributes and calculate the marginal rate of substitution between efficacy and other PrEP attributes. 306 men with median (interquartile range) age = 29 (25, 36) years participated, and reported 6 (3, 10) partners and 0 (0, 2) condomless receptive anal sex acts in the preceding six months. An on-demand pill was the most preferred formulation, followed by a monthly injection, daily pill, and on-demand rectal gel. Drug resistance was an important determinant of preferences if the risk was moderate, but not if it was low. The minimum efficacy required for an on-demand pill to be preferred over no PrEP was 32.6% (95%CI = 21.2–43.9%); for a daily pill, injections, and rectal gel, minimum efficacy was 57.9% (95%CI = 44.1–71.7%), 40.1% (27.0–53.2%), and 71.3% (60.5–82.1%), respectively. Attitudes towards PrEP formulations vary among men who have sex with men, with on-demand pills and monthly injections having the highest average preference scores. Understanding these preferences may help to predict uptake.
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Barker S, Maguire N, Gearing R, Cheung M, Price D, Narendorf S, Buck D. Community-engaged healthcare model for currently under-served individuals involved in the healthcare system. SSM Popul Health 2021; 15:100905. [PMID: 34568536 PMCID: PMC8449048 DOI: 10.1016/j.ssmph.2021.100905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.
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Affiliation(s)
- S.L. Barker
- University of Southampton, School of Psychology, Building 44, University Road, Southampton, SO17 1BJ, United Kingdom
| | - N. Maguire
- University of Southampton, School of Psychology, Building 44, University Road, Southampton, SO17 1BJ, United Kingdom
| | - R.E. Gearing
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - M. Cheung
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - D. Price
- University of Houston, Honors College, Houston, TX, 77204, USA
| | - S.C. Narendorf
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - D.S. Buck
- University of Houston College of Medicine, Houston, TX, 77204, USA
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Rowlands Snyder EC, Boucher LM, Bayoumi AM, Martin A, Marshall Z, Boyd R, LeBlanc S, Tyndall M, Kendall CE. A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada. PLoS One 2021; 16:e0253923. [PMID: 34197552 PMCID: PMC8248707 DOI: 10.1371/journal.pone.0253923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
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Affiliation(s)
| | - Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, Ontario, Canada
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
- Drug Users Advocacy League, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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11
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Kaida A, Carter A, Nicholson V, Lemay J, O'Brien N, Greene S, Tharao W, Proulx-Boucher K, Gormley R, Benoit A, Bernier M, Thomas-Pavanel J, Lewis J, de Pokomandy A, Loutfy M. Hiring, training, and supporting Peer Research Associates: Operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV. Harm Reduct J 2019; 16:47. [PMID: 31319894 PMCID: PMC6637632 DOI: 10.1186/s12954-019-0309-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A community-based research (CBR) approach is critical to redressing the exclusion of women-particularly, traditionally marginalized women including those who use substances-from HIV research participation and benefit. However, few studies have articulated their process of involving and engaging peers, particularly within large-scale cohort studies of women living with HIV where gender, cultural and linguistic diversity, HIV stigma, substance use experience, and power inequities must be navigated. METHODS Through our work on the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), Canada's largest community-collaborative longitudinal cohort of women living with HIV (n = 1422), we developed a comprehensive, regionally tailored approach for hiring, training, and supporting women living with HIV as Peer Research Associates (PRAs). To reflect the diversity of women with HIV in Canada, we initially hired 37 PRAs from British Columbia, Ontario, and Quebec, prioritizing women historically under-represented in research, including women who use or have used illicit drugs, and women living with HIV of other social identities including Indigenous, racialized, LGBTQ2S, and sex work communities, noting important points of intersection between these groups. RESULTS Building on PRAs' lived experience, research capacity was supported through a comprehensive, multi-phase, and evidence-based experiential training curriculum, with mentorship and support opportunities provided at various stages of the study. Challenges included the following: being responsive to PRAs' diversity; ensuring PRAs' health, well-being, safety, and confidentiality; supporting PRAs to navigate shifting roles in their community; and ensuring sufficient time and resources for the translation of materials between English and French. Opportunities included the following: mutual capacity building of PRAs and researchers; community-informed approaches to study the processes and challenges; enhanced recruitment of harder-to-reach populations; and stronger community partnerships facilitating advocacy and action on findings. CONCLUSIONS Community-collaborative studies are key to increasing the relevance and impact potential of research. For women living with HIV to participate in and benefit from HIV research, studies must foster inclusive, flexible, safe, and reciprocal approaches to PRA engagement, employment, and training tailored to regional contexts and women's lives. Recommendations for best practice are offered.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Canadian Aboriginal AIDS Network, Vancouver, BC, Canada.,Positive Living British Columbia, Vancouver, BC, Canada
| | - Jo Lemay
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | | | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Anita Benoit
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mélina Bernier
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Jamie Thomas-Pavanel
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Johanna Lewis
- Department of History, York University, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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12
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Pettersen H, Brodahl M, Rundgren J, Davidson L, Havnes IA. Partnering with persons in long-term recovery from substance use disorder: experiences from a collaborative research project. Harm Reduct J 2019; 16:40. [PMID: 31234878 PMCID: PMC6591986 DOI: 10.1186/s12954-019-0310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/30/2019] [Indexed: 02/03/2023] Open
Abstract
Background Traditional research about substance use disorder (SUD) treatment is considered, among an increasing number of service users, to be disempowering and poorly reflective of their priorities. Thus, this methodological article sought to examine the experiences of a peer research group (PRG), whose four members were in long-term SUD recovery, and a principal investigator (PI), when collaborating on a study of SUD recovery. This article has also aspired to discern the influence of peer researcher participation on the research process. The purpose of the qualitative research project that formed the basis of this methodological study was to examine the reasons provided and strategies employed for abstaining from problematic substance use among persons with SUDs. Methods The project took place from 2015 to 2018, during which time individual interviews were conducted with 18 persons in recovery from SUDs. The PRG contributed to all parts of the project and worked alongside the PI in preparing the study, during early stages of data analysis, and while writing up the findings. In total, ten group discussions were held over the course of 3 years. Results The study showed that the PRG offered important contributions with respect to developing the interview guide, preunderstanding among the PRG members, and discussing alternative forms of data collection. Key findings about how this collaborative research process was experienced relate to three matters: the group aspect of participation, the value of predictable routines and clear expectations, and the open sharing of private matters. The PI experienced the research process as having been enriched by alternative ways of asking questions and interpreting findings and as an interactive arena for reciprocal social and professional support. Conclusions When establishing a PRG while studying recovery processes, it can be advantageous to include several peer researchers with diverse lived experiences concerning substance use, treatment, and recovery. If possible, at least one peer researcher with formal training or qualitative research experience might be included. The PI should be trained in collaborating with peer researchers or should be part of a research environment in which it is possible to discuss methodological challenges with other researchers.
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Affiliation(s)
- Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Mental Health Division, Innlandet Hospital Trust, P.O. Box 104, N-2381, Brumunddal, Norway. .,Inland Norway University of Applied Sciences, P.O. Box 400, 2418, Elverum, Norway.
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Mental Health Division, Innlandet Hospital Trust, P.O. Box 104, N-2381, Brumunddal, Norway
| | - Jeanette Rundgren
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Mental Health Division, Innlandet Hospital Trust, P.O. Box 104, N-2381, Brumunddal, Norway
| | - Larry Davidson
- Program for Recovery and Community Health, School of Medicine, Yale University, Erector Square 319 Peck Street, New Haven, CT, 06513, USA
| | - Ingrid Amalia Havnes
- Norwegian National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, P.O. Box 4959 Nydalen, 0424, Oslo, Norway
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Goldman JE, Krieger MS, Buxton JA, Lysyshyn M, Sherman SG, Green TC, Bernstein E, Hadland SE, Marshall BDL. Suspected involvement of fentanyl in prior overdoses and engagement in harm reduction practices among young adults who use drugs. Subst Abus 2019; 40:519-526. [PMID: 31206354 DOI: 10.1080/08897077.2019.1616245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: From 2011 to 2016, the United States has experienced a 55% increase in overall overdose deaths and a 260% increase in fatal fentanyl-related overdoses. Increasing engagement in harm reduction practices is essential to reducing the rate of fentanyl-related overdoses. This study sought to examine the uptake of harm reduction practices among young adults who reported recent drug use and who were recruited for a study to assess the utility and acceptability of rapid fentanyl test strips. Methods: Between May and October 2017, 93 young adults who reported drug use in the past 30 days were recruited through word of mouth, Internet advertising, and public canvasing. Participants completed an interviewer-administered survey that assessed participants' sociodemographic and behavioral characteristics, suspected fentanyl exposure, and overdose history. We assessed harm reduction practices and other correlates associated with experiencing a suspected fentanyl-related overdose. Results: Of 93 eligible participants, 36% (n = 34) reported ever having experienced an overdose, among whom 53% (n = 18) suspected having experienced a fentanyl-related overdose. Participants who had ever experienced a fentanyl-related overdose were more likely to keep naloxone nearby when using drugs compared with those who had never experienced an overdose and those who had experienced an overdose that they did not suspect was related to fentanyl (P < .001). Additionally, experiencing a suspected fentanyl-related overdose was associated with having previously administered naloxone to someone else experiencing an overdose (P < .001). Conclusion: Those who had experienced a suspected fentanyl-related overdose were more likely to carry and administer naloxone. Future overdose prevention interventions should involve persons who have experienced a suspected fentanyl overdose and/or responded to an overdose in order to develop harm reduction programs that meet the needs of those at risk of an overdose.
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Affiliation(s)
- Jacqueline E Goldman
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Maxwell S Krieger
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Traci C Green
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward Bernstein
- Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Scott E Hadland
- Department of Emergency Medicine, Grayken Center for Addiction, School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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14
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Brown G, Crawford S, Perry GE, Byrne J, Dunne J, Reeders D, Corry A, Dicka J, Morgan H, Jones S. Achieving meaningful participation of people who use drugs and their peer organizations in a strategic research partnership. Harm Reduct J 2019; 16:37. [PMID: 31182099 PMCID: PMC6558880 DOI: 10.1186/s12954-019-0306-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/15/2019] [Indexed: 01/03/2023] Open
Abstract
Background Peer-led programs with people who use drugs (PWUD) have been a key characteristic of the harm reduction in many countries, including their involvement in research. However, peer involvement in research is often limited to recruitment, consultation, and reporting back, rather than a genuine collaboration in the priority setting, design, and conduct of research. PWUD peer organizations face ongoing challenges to demonstrate the depth of their knowledge of current and emerging issues within drug-using networks and the value of their peer insights for effective research and policy. The identification of benefits, barriers, and enablers for meaningful participation of PWUD in research has often been limited to methodological rather than system level factors. Methods This paper draws on the experiences and findings of the What Works and Why (W3) Project, a 5-year collaborative study with peer organizations. The study drew on systems thinking methods to develop a framework to demonstrate the role of peer organizations within their community and policy systems. The study required peer staff and researchers to undertake the simultaneous role of drivers, participants, and analysts in the research. To identify the learnings in relation to meaningful participation of PWUD peer organizations in research, we drew together the insights and experiences of peer staff and researchers across the 5 years of the study Results The W3 Project provided insights into the nuances of community-engaged research practice and the ongoing benefits, barriers, and enablers to the meaningful participation of PWUD and their peer organizations. These included system-level barriers and enablers beyond individual research projects or methodology. The capacity of research and peer organizations to maintain meaningful peer participation in research can be restricted or enhanced by the systems in which they are embedded. Conclusions Recognizing peer organizations as active participants and drivers within community and policy systems can help clarify their unique and critical role in research. Achieving meaningful collaboration with PWUD peer organizations requires looking beyond good practice methods to the system-level factors with attention to the system-level benefits, barriers, and enablers.
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Affiliation(s)
- Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Sione Crawford
- Harm Reduction Victoria, PO Box 12720, A'Beckett Street, Melbourne, 8006, Australia
| | - Gari-Emma Perry
- Peer-Based Harm Reduction WA, PO Box 8003, Perth, WA, 6849, Australia
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League, GPO Box 1555, ACT, Canberra, 2601, Australia
| | - James Dunne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Daniel Reeders
- School of Regulation and Global Governance, Australian National University, ACT, Canberra, 2600, Australia
| | - Angela Corry
- Peer-Based Harm Reduction WA, PO Box 8003, Perth, WA, 6849, Australia
| | - Jane Dicka
- Harm Reduction Victoria, PO Box 12720, A'Beckett Street, Melbourne, 8006, Australia
| | - Hunter Morgan
- Harm Reduction Victoria, PO Box 12720, A'Beckett Street, Melbourne, 8006, Australia
| | - Sam Jones
- Harm Reduction Victoria, PO Box 12720, A'Beckett Street, Melbourne, 8006, Australia
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15
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Boucher LM, Bayoumi AM, Mark AE, Cooper C, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Lee OM, Kendall CE. Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study. Subst Use Misuse 2019; 54:18-30. [PMID: 29932800 DOI: 10.1080/10826084.2018.1485699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is common among people who inject drugs (PWID) and is associated with morbidity and premature death. Although HCV can be cured, treatment may be inaccessible. We studied HCV testing, status and treatment among marginalized people who use drugs in Ottawa, Canada, a setting with universal insurance coverage for physician services. METHODS We analyzed data from the Participatory Research in Ottawa: Understanding Drugs study, a cross-sectional, peer-administered survey of people who use drugs from 2012 to 2013. We linked responses to population-based health administrative databases and used multivariable Poisson regression to identify factors independently associated with self-reported HCV testing, self-reported positive HCV status, and database-determined engagement in HCV treatment. RESULTS Among 663 participants, 562 (84.8%) reported testing for HCV and 258 (45.9%) reported HCV-positive status. In multivariable analysis, HCV-positive status was associated with female gender (RR 1.27; 95%CI 1.04 to 1.55), advancing age (RR 1.03/year; 95%CI 1.02 to 1.04), receiving disability payments (RR 1.42; 95%CI 1.06 to 1.91), injecting drugs (RR 5.11; 95%CI 2.64 to 9.91), ever injecting with a used needle (RR 1.30; 95%CI 1.12 to 1.52), and ever having taken methadone (RR 1.26; 95%CI 1.05 to 1.52). Of HCV positive participants, 196 (76%) were engaged in primary care but only 23 (8.9%) had received HCV therapy. Conclusions/Importance: Although HCV testing and positive status rates are high among PWID in our study, few have received HCV treatment. Innovative initiatives to increase access to HCV treatment for PWID are urgently needed.
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Affiliation(s)
- Lisa M Boucher
- a Bruyere Research Institute , Ottawa , Ontario , Canada.,b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Ahmed M Bayoumi
- c Division of General Internal Medicine , St. Michael's Hospital , Ontario , Canada.,d Department of Medicine and Institute of Health Policy, Management, and Evaluation , University of Toronto , Toronto , Ontario , Canada
| | - Amy E Mark
- e Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Curtis Cooper
- f Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Alana Martin
- f Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Zack Marshall
- g School of Social Work , McGill University , Montreal , Quebec , Canada
| | - Rob Boyd
- h Sandy Hill Community Health Centre , Ottawa , Ontario , Canada
| | - Pam Oickle
- i Ottawa Public Health , Ottawa , Ontario , Canada
| | - Nicola Diliso
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Dave Pineau
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Brad Renaud
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Sean LeBlanc
- k Drug Users Advocacy League , Ottawa , Ontario , Canada
| | - Mark Tyndall
- l BC Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Olivia M Lee
- b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Claire E Kendall
- a Bruyere Research Institute , Ottawa , Ontario , Canada.,b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada.,m Li Ka Shing Knowledge Institute of St. Michael's Hospital , Ontario , Canada
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16
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Charron CB, Hudani A, Kaur T, Rose T, Florence K, Jama S, Pakhalé S. Assessing community (peer) researcher's experiences with conducting spirometry and being engaged in the 'Participatory Research in Ottawa: Management and Point-of-care for Tobacco-dependence' (PROMPT) project. Res Involv Engagem 2018; 4:43. [PMID: 30519486 PMCID: PMC6271567 DOI: 10.1186/s40900-018-0125-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/15/2018] [Indexed: 05/31/2023]
Abstract
PLAIN SUMMARY This article examines the overall experiences of community researchers in their involvement with the 'PROMPT' project for smoking cessation, which targeted community members who were homeless or at-risk for homelessness. More specifically, four community members, representing the study population were involved in the project as researchers. They were asked to complete surveys at both the beginning and end of each research training session to better understand their learning as it related to using a key instrument for this project, a spirometer, to measure project participants' lung function. Spirometry is typically performed by trained healthcare providers. Community researchers were also interviewed to explore what their experiences were like working as a researcher with their own at-risk community. Although the researchers felt that the training was sufficient, more research is needed to evaluate training effectiveness among community researchers in delivering acceptable quality lung function testing using a spirometer. Upon analyzing the small group discussion and survey results, we found that the community researchers had an overall positive experience with both the project, and the training that was provided to equip them with the knowledge, tools, and resources they needed to successfully work in a research project of this kind. They also faced challenges that are common in such community-based projects, such as the power differential between the researchers with a healthcare background and themselves who have lived experience with the issue at hand. ABSTRACT Background The Ottawa Citizen Engagement and Action Model (OCEAM) used a Community Based Participatory Action Research (CBPAR) approach by involving the most at-risk urban population. Community (peer) researchers participated in every step of the study despite the multiple challenges. Objective To assess the community researchers' training and experiences in a CBPAR project, PROMPT: Participatory Research in Ottawa: Management and Point-of-care for Tobacco Dependence. Method Four community researchers were recruited, representative of the PROMPT project's target population with current or past poly-substance use; smoking tobacco; and/or being homeless or at-risk for homelessness. The community researchers participated in all phases of PROMPT, including study design, development of questionnaires, participant recruitment, administering consent forms and questionnaires, as well as hand-held spirometry after rigorous training. To assess their knowledge and comfort level with spirometry testing after standardized training, questionnaires were administered pre- and post-training. In turn, to assess their overall experience, interviews were conducted at the end of study completion. Results All community researchers underwent small-group training sessions including presentations, discussions and hands-on practice adapted from standardized training material prepared for health care professionals. Spirometry training was included in all sessions. Self-perceived knowledge and confidence in administering spirometry, as well as skill-testing score averages improved between the pre- and post-training questionnaires. Overall, all the community researchers had a fulfilling experience participating in the project. Conclusion Despite challenges, involving community researchers with lived experience is feasible, satisfying and productive even in the most marginalized populations. Standardized spirometry training of community researchers' representative of the PROMPT target population, with no healthcare educational background, was feasible and effective in improving knowledge, confidence and readiness to administer spirometry.
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Affiliation(s)
| | | | - Tina Kaur
- University of Toronto, Toronto, Canada
| | | | | | - Sadia Jama
- The Bridge Engagement Centre, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Smita Pakhalé
- Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Respiratory Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, K1H 8L6 Canada
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Vaughn LM, Whetstone C, Boards A, Busch MD, Magnusson M, Määttä S. Partnering with insiders: A review of peer models across community-engaged research, education and social care. Health Soc Care Community 2018; 26:769-786. [PMID: 29512217 DOI: 10.1111/hsc.12562] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Within community-engaged research, education and social care, peer models that partner with local "insiders" are increasingly common. Peer models are composed of insider "lay" community members who often share similarities or background with a project's target population. Peers are not academically trained, but work alongside researchers and professionals to carry out specific tasks within a project, or in the truest sense of partnership, peers collaborate throughout the project from start to finish as an equal member of the team. Although peer models are used widely, the literature lacks consistency and clarity. This systematic review of literature used a qualitative thematic synthesis to examine and report how, where and why peer models have been used in research, education and social care. We examined the language and titles used to describe the peers, details of their involvement in community-engaged projects, the setting, content/topic of study, level of engagement and related benefits/outcomes of such models. Focusing on the last 10 years, we conducted a comprehensive literature search twice between September 2016 and June 2017. The search resulted in 814 articles which were assessed for eligibility. Overall, 251 articles met our inclusion criteria and were categorised into three categories: empirical (n = 115); process/descriptive (n = 93); and "about" peers (n = 43). Findings suggest that there is a wide variety of peers, titles and terminology associated with peer models. There is inconsistency in how these models are used and implemented in research studies and projects. The majority of articles used an employment peer model, while only a handful involved peers in all phases of the project. The results of this literature review contribute to understanding the use, development and evolution of peer models. We highlight potential benefits of peer models for peers, their communities and community-engaged work, and we offer recommendations for future implementation of peer models.
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Affiliation(s)
- Lisa M Vaughn
- Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Alicia Boards
- Educational and Community-Based Action Research, University of Cincinnati, Cincinnati, OH, USA
| | - Melida D Busch
- Edward L. Pratt Research Library, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sylvia Määttä
- Department of Healthcare Improvement, Western Region, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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18
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Greer AM, Pauly B, Scott A, Martin R, Burmeister C, Buxton J. Paying people who use illicit substances or ‘peers’ participating in community-based work: a narrative review of the literature. Drugs: Education, Prevention and Policy 2018. [DOI: 10.1080/09687637.2018.1494134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Alissa Merielle Greer
- BC Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Alex Scott
- Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Martin
- College of Health Disciplines, University of British Columbia, Vancouver, Canada
| | | | - Jane Buxton
- BC Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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19
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Greer AM, Amlani A, Pauly B, Burmeister C, Buxton JA. Participant, peer and PEEP: considerations and strategies for involving people who have used illicit substances as assistants and advisors in research. BMC Public Health 2018; 18:834. [PMID: 29976169 PMCID: PMC6034321 DOI: 10.1186/s12889-018-5765-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
Background The Peer Engagement and Evaluation Project (PEEP) aimed to engage, inspire, and learn from peer leaders who represented voices of people who use or have used illicit substances, through active membership on the ‘Peeps’ research team. Given the lack of critical reflection in the literature about the process of engaging people who have used illicit substances in participatory and community-based research processes, we provide a detailed description of how one project, PEEP, engaged peers in a province-wide research project. Methods By applying the Peer Engagement Process Evaluation Framework, we critically analyze the intentions, strategies employed, and outcomes of the process utilized in the PEEP project and discuss the implications for capacity building and empowerment among the peer researchers. This process included: the formation of the PEEP team; capacity building; peer-facilitated data collection; collaborative data analysis; and, strengths-based approach to outputs. Results Several lessons were learned from applying the Peer Engagement Process Evaluation Framework to the PEEP process. These lessons fall into themes of: recruiting and hiring; fair compensation; role and project expectations; communication; connection and collaboration; mentorship; and peer-facilitated research. Conclusion This project offers a unique approach to engaging people who use illicit substances and demonstrates how participation is an important endeavor that improves the relevance, capacity, and quality of research. Lessons learned in this project can be applied to future community-based research with people who use illicit substances or other marginalized groups and/or participatory settings.
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Affiliation(s)
- Alissa M Greer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada. .,BC Centre for Disease Control, University of British Columbia, Vancouver, Canada.
| | - Ashraf Amlani
- BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | - Bernadette Pauly
- School of Nursing, Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Charlene Burmeister
- BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
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Pakhale S, Kaur T, Charron C, Florence K, Rose T, Jama S, Boyd R, Haddad J, Alvarez G, Tyndall M. Management and Point-of-Care for Tobacco Dependence (PROMPT): a feasibility mixed methods community-based participatory action research project in Ottawa, Canada. BMJ Open 2018; 8:e018416. [PMID: 29371273 PMCID: PMC5786139 DOI: 10.1136/bmjopen-2017-018416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine the feasibility of a Community-Based Participatory Tobacco Dependence Strategy (PROMPT) in the inner city population of Ottawa (Canada). DESIGN A feasibility mixed methods prospective cohort study following principles of community-based participatory action research. INTERVENTION Recruited 80 people whouse drugs, followed them for 6 months while providing access to counselling, nicotine replacement therapy and peer-support in a community setting. SETTING Community research office in downtown Ottawa, adjacent to low-income housing, shelter services and street-based drug consumption. PRIMARY OUTCOME Retention rate at 6-month follow-up. SECONDARY OUTCOME Biochemically validated 7-day point prevalence smoking abstinence at 26 weeks, self-reported abstinence in the past 7 days with exhaled carbon monoxide ≤10 ppm. RESULTS The average age of participants was 43.8 years. The 6-month follow-up rate was 42.5%. The mean number of smoking years reported was 27.3 years. The participants were 70% male, 33.7% reported less than a high-school education, 21% identified as indigenous and 43.8% reported an income between US$1000 and US$1999 per month. The baseline mean daily cigarette use was 20.5 and 9.3 cigarettes at study end, with mean reduction of 11.2 cigarettes at 6 months (P=0.0001). There was a considerable reduction in self-reported illicit substance use (18.8%), including a reduction in the opioids heroin (6.3%), fentanyl (2.6%) and Oxycontin (3.8%). The study findings also reveal psycho-socioeconomic benefits such as improved health, return to work and greater community engagement. CONCLUSIONS The PROMPT project describes socioeconomic variables associated with tobacco and polysubstance use. A programme focused on tobacco dependence, easily accessible in the community and led by community peers with lived experience is feasible to implement and has the potential to support positive life changes. PROMPT's patient engagement model is an effective harm-reduction strategy for the growing opioid use crisis and can improve the health outcomes of marginalised at-risk populations worldwide.
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Affiliation(s)
- Smita Pakhale
- Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tina Kaur
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Charron
- Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tiffany Rose
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
| | - Sadia Jama
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Boyd
- Oasis, Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Joanne Haddad
- Canadian Mental Health Association, Ottawa, Ontario, Canada
| | - Gonzalo Alvarez
- Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Munro A, Allan J, Shakeshaft A, Breen C. "I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy 2017; 12:49. [PMID: 29208008 PMCID: PMC5718008 DOI: 10.1186/s13011-017-0135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. METHODS This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program. RESULTS A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. CONCLUSION This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
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Munro A, Shakeshaft A, Clifford A. The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach. Health Justice 2017; 5:12. [PMID: 29204895 PMCID: PMC5714938 DOI: 10.1186/s40352-017-0056-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Given the well-established evidence of disproportionately high rates of substance-related morbidity and mortality after release from incarceration for Indigenous Australians, access to comprehensive, effective and culturally safe residential rehabilitation treatment will likely assist in reducing recidivism to both prison and substance dependence for this population. In the absence of methodologically rigorous evidence, the delivery of Indigenous drug and alcohol residential rehabilitation services vary widely, and divergent views exist regarding the appropriateness and efficacy of different potential treatment components. One way to increase the methodological quality of evaluations of Indigenous residential rehabilitation services is to develop partnerships with researchers to better align models of care with the client's, and the community's, needs. An emerging research paradigm to guide the development of high quality evidence through a number of sequential steps that equitably involves services, stakeholders and researchers is community-based participatory research (CBPR). The purpose of this study is to articulate an Indigenous drug and alcohol residential rehabilitation service model of care, developed in collaboration between clients, service providers and researchers using a CBPR approach. METHODS/DESIGN This research adopted a mixed methods CBPR approach to triangulate collected data to inform the development of a model of care for a remote Indigenous drug and alcohol residential rehabilitation service. RESULTS Four iterative CBPR steps of research activity were recorded during the 3-year research partnership. As a direct outcome of the CBPR framework, the service and researchers co-designed a Healing Model of Care that comprises six core treatment components, three core organisational components and is articulated in two program logics. The program logics were designed to specifically align each component and outcome with the mechanism of change for the client or organisation to improve data collection and program evaluation. CONCLUSION The description of the CBPR process and the Healing Model of Care provides one possible solution about how to provide better care for the large and growing population of Indigenous people with substance misuse issues. [corrected].
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anton Clifford
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia
- University of Queensland, Brisbane, QLD, 4072, Australia
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Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, Rose T, LeBlanc S, Tyndall M, Lee OM, Bayoumi AM. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J 2017; 14:16. [PMID: 28494791 PMCID: PMC5427560 DOI: 10.1186/s12954-017-0143-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study was to evaluate emergency department (ED) visits and hospital admissions among a cohort of PWUD. Methods We used a retrospective observational design between 2012 and 2013. The population was a marginalized cohort of PWUD (the PROUD study) for whom survey data was linked (n = 663) to provincial health administrative data housed at the Institute for Clinical Evaluative Sciences. We constructed a 5:1 comparison group matched by age, sex, income quintile, and region. The main outcomes were defined as having two or more ED visits, or one or more hospital admissions, in the year prior to survey completion. We used multivariable logistic regression analyses to identify factors associated with these outcomes. Results Compared to the matched cohort, PWUD had higher rates of ED visits (rate ratio [RR] 7.0; 95% confidence interval [95% CI] 6.5–7.6) and hospitalization (RR 7.7; 95% CI 5.9–10.0). After adjustment, factors predicting more ED visits were receiving disability (adjusted odds ratio [AOR] 3.0; 95% CI 1.7–5.5) or income assistance (AOR 2.7; 95% CI 1.5–5.0), injection drug use (AOR 2.1; 95% CI 1.3–3.4), incarceration within 12 months (AOR 1.6; 95% CI 1.1–2.4), mental health comorbidity (AOR 2.1; 95% CI 1.4–3.1), and a suicide attempt within 12 months (AOR 2.1; 95% CI 1.1–3.4). Receiving methadone (AOR 0.5; 95% CI 0.3–0.9) and having a regular family physician (AOR 0.5; 95% CI 0.2–0.9) were associated with lower odds of having more ED visits. Factors associated with more hospital admissions included Aboriginal identity (AOR 2.4; 95% CI 1.4–4.1), receiving disability (AOR 2.4; 95% CI 1.1–5.4), non-injection drug use (opioids and non-opioids) (AOR 2.2; 95% CI 1.1–4.4), comorbid HIV (AOR 2.4; 95% CI 1.2–5.6), mental health comorbidity (AOR 2.4; 95% CI 1.3–4.2), and unstable housing (AOR 1.9; 95% CI 1.0–3.4); there were no protective factors for hospitalization. Conclusions Improved post-incarceration support, housing services, and access to integrated primary care services including opioid replacement therapy may be effective interventions to decrease acute care use among PWUD, including targeted approaches for people receiving social assistance or with mental health concerns.
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Affiliation(s)
- Claire E Kendall
- Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada.
| | - Lisa M Boucher
- Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada
| | - Amy E Mark
- Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada
| | - Alana Martin
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Zack Marshall
- Social Development Studies and School of Social Work, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, ON, N2L 3G4, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, ON, K1N 1C7, Canada
| | - Pam Oickle
- Ottawa Public Health, 179 Clarence St, Ottawa, ON, K1N 5P7, Canada
| | - Nicola Diliso
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Dave Pineau
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Brad Renaud
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Tiffany Rose
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, ON, Canada.,Drug Users Advocacy League, Ottawa, ON, Canada
| | - Mark Tyndall
- BC Centre for Disease Control, 655W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Olivia M Lee
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto ON 30 Bond St, Toronto, ON, M5B 1 W8, Canada
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Boucher LM, Marshall Z, Martin A, Larose-Hébert K, Flynn JV, Lalonde C, Pineau D, Bigelow J, Rose T, Chase R, Boyd R, Tyndall M, Kendall C. Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs. Harm Reduct J 2017; 14:18. [PMID: 28494774 PMCID: PMC5427533 DOI: 10.1186/s12954-017-0145-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/30/2017] [Indexed: 12/04/2022] Open
Abstract
Background The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reduction, and which environmental factors interfere with or support the use of harm reduction strategies. This study explores how people who inject drugs (PWID) think about harm reduction and considers the critical imperative of equity in health and social services delivery for this community. Methods This community-based participatory research study was conducted in a Canadian urban centre. Using a peer-based recruitment and interviewing strategy, semi-structured qualitative interviews were conducted by and with PWID. The Vidaview Life Story Board, an innovative tool where interviewers and participant co-construct a visual “life-scape” using a board, markers, and customized picture magnets, was used to facilitate the interviews. The topics explored included injection drug use and harm reduction histories, facilitators and barriers to using harm reduction strategies, and suggestions for improving services and supports. Results Twenty-three interviews with PWID (14 men and 9 women) were analysed, with a median age of 50. Results highlighted an expanded conceptualization of harm reduction from the perspectives of PWID, including motivations for adopting harm reduction strategies and a description of harm reduction practices that went beyond conventional health-focused concerns. The most common personal practices that PWID used included working toward moderation, employing various cognitive strategies, and engaging in community activities. The importance of social or peer support and improving self-efficacy was also evident. Further, there was a call for less rigid eligibility criteria and procedures in health and social services, and the need to more adequately address the stigmatization of drug users. Conclusions These findings demonstrated that PWID incorporate many personal harm reduction practices in their daily lives to improve their well-being, and these practices highlight the importance of agency, self-care, and community building. Health and social services are needed to better support these practices because the many socio-structural barriers this community faces often interfere with harm reduction efforts. Finally, “one size does not fit all” when it comes to harm reduction, and more personalized or de-medicalized conceptualizations are recommended.
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Affiliation(s)
- L M Boucher
- Élisabeth Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.
| | - Z Marshall
- Social Development Studies & School of Social Work, Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario, N2L 3G4, Canada
| | - A Martin
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - K Larose-Hébert
- School of Social Work, Faculty of Social Sciences, Laval University, Charles de Koninck Hall, 1030, avenue des Sciences-Humaines, Quebec, G1V 0A6, Canada
| | - J V Flynn
- Department of Social Work, University of Gothenburg, Sprängkullsgatan 23, 405 30, Gothenburg, Sweden
| | - C Lalonde
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - D Pineau
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - J Bigelow
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - T Rose
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - R Chase
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, Manitoba, R3E 0W2, Canada
| | - R Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - M Tyndall
- BC Centre for Disease Control, 655 W 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| | - C Kendall
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, 43 Bruyère Street, (375) Floor 3JB, Ottawa, Ontario, K1N 5C8, Canada
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Lazarus L, Patel S, Shaw A, Leblanc S, Lalonde C, Hladio M, Mandryk K, Horvath C, Petrcich W, Kendall C, Tyndall MW; Proud Community Advisory Committee. Uptake of Community-Based Peer Administered HIV Point-of-Care Testing: Findings from the PROUD Study. PLoS One 2016; 11:e0166942. [PMID: 27911908 DOI: 10.1371/journal.pone.0166942] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/06/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives HIV prevalence among people who inject drugs (PWID) in Ottawa is estimated at about 10%. The successful integration of peers into outreach efforts and wider access to HIV point-of-care testing (POCT) create opportunities to explore the role of peers in providing HIV testing. The PROUD study, in partnership with Ottawa Public Health (OPH), sought to develop a model for community-based peer-administered HIV POCT. Methods PROUD draws on community-based participatory research methods to better understand the HIV risk environment of people who use drugs in Ottawa. From March-October 2013, 593 people who reported injecting drugs or smoking crack cocaine were enrolled through street-based recruitment. Trained peer or medical student researchers administered a quantitative survey and offered an HIV POCT (bioLytical INSTI test) to participants who did not self-report as HIV positive. Results 550 (92.7%) of the 593 participants were offered a POCT, of which 458 (83.3%) consented to testing. Of those participants, 74 (16.2%) had never been tested for HIV. There was no difference in uptake between testing offered by a peer versus a non-peer interviewer (OR = 1.05; 95% CI = 0.67–1.66). Despite testing those at high risk for HIV, only one new reactive test was identified. Conclusion The findings from PROUD demonstrate high uptake of community-based HIV POCT. Peers were able to successfully provide HIV POCT and reach participants who had not previously been tested for HIV. Community-based and peer testing models provide important insights on ways to scale-up HIV prevention and testing among people who use drugs.
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Closson K, McNeil R, McDougall P, Fernando S, Collins AB, Baltzer Turje R, Howard T, Parashar S. Meaningful engagement of people living with HIV who use drugs: methodology for the design of a Peer Research Associate (PRA) hiring model. Harm Reduct J 2016; 13:26. [PMID: 27717364 PMCID: PMC5054577 DOI: 10.1186/s12954-016-0116-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Community-based HIV, harm reduction, and addiction research increasingly involve members of affected communities as Peer Research Associates (PRAs)—individuals with common experiences to the participant population (e.g. people who use drugs, people living with HIV [PLHIV]). However, there is a paucity of literature detailing the operationalization of PRA hiring and thus limited understanding regarding how affected communities can be meaningfully involved through low-barrier engagement in paid positions within community-based participatory research (CBPR) projects. We aim to address this gap by describing a low-threshold PRA hiring process. Results In 2012, the BC Centre for Excellence in HIV/AIDS and the Dr. Peter AIDS Foundation collaborated to develop a mixed-method CBPR project evaluating the effectiveness of the Dr. Peter Centre (DPC)—an integrative HIV care facility in Vancouver, Canada. A primary objective of the study was to assess the impact of DPC services among clients who have a history of illicit drug use. In keeping with CBPR principles, affected populations, community-based organizations, and key stakeholders guided the development and dissemination of a low-barrier PRA hiring process to meaningfully engage affected communities (e.g. PLHIV who have a history of illicit drug use) in all aspects of the research project. The hiring model was implemented in a number of stages, including (1) the establishment of a hiring team; (2) the development and dissemination of the job posting; (3) interviewing applicants; and (4) the selection of participants. The hiring model presented in this paper demonstrates the benefits of hiring vulnerable PLHIV who use drugs as PRAs in community-based research. Conclusions The provision of low-barrier access to meaningful research employment described herein attempts to engage affected communities beyond tokenistic involvement in research. Our hiring model was successful at engaging five PRAs over a 2-year period and fostered opportunities for future paid employment or volunteer opportunities through ongoing collaboration between PRAs and a diverse range of stakeholders working in HIV/AIDS and addictions. Additionally, this model has the potential to be used across a range of studies and community-based settings interested in meaningfully engaging communities in all stages of the research process. Electronic supplementary material The online version of this article (doi:10.1186/s12954-016-0116-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - R McNeil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - P McDougall
- Dr. Peter AIDS Foundation, Vancouver, Canada
| | - S Fernando
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - A B Collins
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - T Howard
- Positive living society and the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - S Parashar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,BC Centre for Excellence in HID/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Pakhale S, Kaur T, Florence K, Rose T, Boyd R, Haddad J, Pettey D, Muckle W, Tyndall M. The Ottawa Citizen Engagement and Action Model (OCEAM): A Citizen engagement Strategy Operationalized Through The Participatory Research in Ottawa, Management and Point-of-care of Tobacco (PROMPT) Study: A Community Based Participatory Action Research Project in Inner City Ottawa. Res Involv Engagem 2016; 2:20. [PMID: 29507759 PMCID: PMC5831885 DOI: 10.1186/s40900-016-0034-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/11/2016] [Indexed: 06/01/2023]
Abstract
PLAIN LANGUAGE SUMMARY The PROMPT study is a community-based research project designed to understand the factors which affect smoking as well as ways to manage, reduce and quit smoking among people who use drugs in Ottawa. There is strong medical evidence that smoking tobacco is related to more than two dozen diseases and conditions. Smoking tobacco remains the leading cause of preventable death and has negative health impacts on people of all ages. Although Ottawa has one of the lowest smoking rates in Ontario (12 %), major differences exist, with approximately a 96 % smoking rate among those who use drugs in the city of Ottawa. To address this inequity, we recruited and trained four community research peers who were representative of the study target population (ex- or currently homeless, insecurely housed or multi-drug users). We designed the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. In this paper we have described this process in a step-by-step fashion, as used in the PROMPT study. The eighty PROMPT participants are being followed for six months and are being provided with free and off-label Nicotine Replacement Therapy (NRT). ABSTRACT Objectives The PROMPT study, Participatory Research in Ottawa, Management and Point-of-care of Tobacco, is a prospective cohort study which utilizes community-based participation and social network-based approaches to address tobacco dependence in inner city Ottawa. The project was designed to: facilitate retention of participants; to understand the barriers and facilitators of smoking; optimize ways to manage, reduce, and quit tobacco use among people who use drugs in Ottawa, Canada. The purpose of this paper is to describe the processes utilized in citizen or patient engagement in academic research, through our tobacco dependence management project in the inner city population in Ottawa, Canada.Background Tobacco smoking is inequitably distributed in Canada with rates at 12 % in Ottawa, as compared to 18 % in rest of Canada. However, the PROUD Study (Participatory Research in Ottawa: Understanding Drugs) demonstrated that 96 % of the inner city population, of Ottawa currently smoke tobacco. This distinct inequity in tobacco use translates into inequitable distribution of health outcomes, such morbidity and mortality in this population. Consequently, a community-based participatory, peer-led research project was conducted in the inner city population of Ottawa.Methods We recruited and trained four community research peers who were representative of the study target population. We conceived, designed and operationalized the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. The peers have co-led all aspects of the project from conceptualizing the study question to participating in knowledge translation. Each step of the project had defined objectives and outcome measures.Discussion The involvement of peers in recruitment ensured representation of tobacco and drug users-individuals truly representative of the intended target population. Peer, participant engagement and trust was established from the conception of the project. For historical and self-evident reasons, trust and engagement is rarely found in this population. Peers successfully participated in all ten steps of the Citizen Engagement and Action model. The PROMPT study utilized the CBPR (Community Based Participatory research) approach to encourage engagement and build trust in a difficult to reach and hard to treat, inner city population. The ten-step OCEAM model was conceived, designed and operationalized and the PROMPT study will continue to follow the eighty PROMPT participants for six months to understand the optimal ways to manage, reduce, and quit smoking within an inner city population.
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Affiliation(s)
- Smita Pakhale
- The Ottawa Hospital, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Tina Kaur
- The Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Canada
| | - Kelly Florence
- The Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Canada
- Community research peers, Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Tiffany Rose
- The Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Canada
- Community research peers, Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Robert Boyd
- Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Joanne Haddad
- Canadian Mental Health Association, Ottawa Branch, Ottawa, Canada
| | - Donna Pettey
- Canadian Mental Health Association, Ottawa Branch, Ottawa, Canada
| | | | - Mark Tyndall
- British Columbia CDC, University of British Columbia, Vancouver, BC Canada
- University of British Columbia, Vancouver, BC Canada
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Shaw A, Lazarus L, Pantalone T, LeBlanc S, Lin D, Stanley D, Chepesiuk C, Patel S, Tyndall M; PROUD Community Advisory Committee. Risk environments facing potential users of a supervised injection site in Ottawa, Canada. Harm Reduct J 2015; 12:49. [PMID: 26493319 DOI: 10.1186/s12954-015-0083-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/13/2015] [Indexed: 01/07/2023] Open
Abstract
Background Supervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm. Methods The PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service. Results Of those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19). Conclusion An SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.
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Stanley D, Marshall Z, Lazarus L, LeBlanc S, Heighton T, Preater B, Tyndall M. Harnessing the power of community-based participatory research: examining knowledge, action, and consciousness in the PROUD study. Soc Work Public Health 2015; 30:312-323. [PMID: 25774651 DOI: 10.1080/19371918.2014.1001935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Community-based participatory research (CBPR) is an approach to research that recognizes the specific knowledge and abilities that individuals from diverse backgrounds bring to the generation of new knowledge for the purpose of social action aimed at improving public health and health equity. In this article, the authors apply Gaventa and Cornwall's dimensions of participatory research to the analysis of 12 semistructured interviews with members of our Community Advisory Committee for the Participatory Research in Ottawa: Understanding Drugs (PROUD) study. This process-to-outcomes framework may help projects more systematically explore their experiences in relation to common CBPR principles and lead to greater conceptual clarity.
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Affiliation(s)
- Daina Stanley
- a Ottawa Hospital Research Institute , Ottawa , Canada
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