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Batomen B, Cloutier MS, Carabali M, Hagel B, Howard A, Rothman L, Perreault S, Brown P, Di Ruggiero E, Bondy S. Traffic-Calming Measures and Road Traffic Collisions and Injuries: A Spatiotemporal Analysis. Am J Epidemiol 2024; 193:707-717. [PMID: 37288501 DOI: 10.1093/aje/kwad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 06/09/2023] Open
Abstract
Traffic-calming measures (TCMs) are physical modifications of the road network aimed at making the roads safer. Although researchers have reported reductions in numbers of road crashes and injuries tied to the presence of TCMs, such studies have been criticized for their pre-/post- designs. In this study, we aimed to complement our knowledge of TCMs' effectiveness by assessing their impact using a longitudinal design. The implementation of 8 TCMs, including curb extensions and speed humps, was evaluated at the intersection and census tract levels in Montreal, Quebec, Canada, from 2012 to 2019. The primary outcome was fatal or serious collisions among all road users. Inference was performed using a Bayesian implementation of conditional Poisson regression in which random effects were used to account for the spatiotemporal variation in collisions. TCMs were generally implemented on local roads, although most collisions occurred on arterial roads. Overall, there was weak evidence that TCMs were associated with study outcomes. However, subgroup analyses of intersections on local roads suggested a reduction in collision rates due to TCMs (median incidence rate ratio, 0.31; 95% credible interval: 0.12, 0.86). To improve road safety, effective counterparts of TCMs on arterial roads must be identified and implemented.
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Shephard R, Uy J, Otterman V, Betker C, Sandhu HS, Tjaden L, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Payne E, Fang L. The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization. J Public Health Manag Pract 2024; 30:432-441. [PMID: 38603751 DOI: 10.1097/phh.0000000000001884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.
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Affiliation(s)
- Rosemarie Shephard
- Author Affiliations: Public Health Agency of Canada, Ottawa, Ontario, Canada (Mss Shephard, Uy, Otterman, Payne, and Fang); National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Dr Betker, Mr Sandhu, and Ms Tjaden); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Mr Sandhu and Drs Di Ruggiero and Pawa); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Dr Apatu); Canadian Public Health Association, Ottawa, Ontario, Canada (Dr Musto); Division of Clinical Sciences, NOSM University, Sudbury, Ontario, Canada (Dr Pawa); and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (Dr Steinberg)
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Mac-Seing M, Di Ruggiero E. The Intersections of COVID-19 Global Health Governance and Population Health Priorities: Equity-Related Lessons Learned From Canada and Selected G20 Countries. Public Health Rev 2024; 45:1606052. [PMID: 38348131 PMCID: PMC10859516 DOI: 10.3389/phrs.2024.1606052] [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: 03/31/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background: COVID-19-related global health governance (GHG) processes and public health measures taken influenced population health priorities worldwide. We investigated the intersection between COVID-19-related GHG and how it redefined population health priorities in Canada and other G20 countries. We analysed a Canada-related multilevel qualitative study and a scoping review of selected G20 countries. Findings show the importance of linking equity considerations to funding and accountability when responding to COVID-19. Nationalism and limited coordination among governance actors contributed to fragmented COVID-19 public health responses. COVID-19-related consequences were not systematically negative, but when they were, they affected more population groups living and working in conditions of vulnerability and marginalisation. Policy options and recommendations: Six policy options are proposed addressing upstream determinants of health, such as providing sufficient funding for equitable and accountable global and public health outcomes and implementing gender-focused policies to reduce COVID-19 response-related inequities and negative consequences downstream. Specific programmatic (e.g., assessing the needs of the community early) and research recommendations are also suggested to redress identified gaps. Conclusion: Despite the consequences of the COVID-19 pandemic, programmatic and research opportunities along with concrete policy options must be mobilised and implemented without further delay. We collectively share the duty to act upon global health justice.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health & Centre de Recherche en Santé Publique, Université de Montréal, Montreal, QC, Canada
- Behavioural Health Sciences Division, Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Song MY, Blake-Hepburn D, Fadel S, Allin S, Ataullahjan A, Di Ruggiero E. Faith-based organisations and their role in supporting vaccine confidence and uptake: a scoping review protocol. BMJ Open 2023; 13:e070843. [PMID: 38135322 DOI: 10.1136/bmjopen-2022-070843] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Faith-based organisations (FBOs) and religious actors increase vaccine confidence and uptake among ethnoracially minoritised communities in low-income and middle-income countries. During the COVID-19 pandemic and the subsequent vaccine rollout, global organisations such as the WHO and UNICEF called for faith-based collaborations with public health agencies (PHAs). As PHA-FBO partnerships emerge to support vaccine uptake, the scoping review aims to: (1) outline intervention typologies and implementation frameworks guiding interventions; (2) describe the roles of PHAs and FBOs in the design, implementation and evaluation of strategies and (3) synthesise outcomes and evaluations of PHA-FBO vaccine uptake initiatives for ethnoracially minoritised communities. METHODS AND ANALYSIS We will perform six library database searches in PROQUEST-Public Health, OVID MEDLINE, Cochrane Library, CINAHL, SCOPUS- all, PROQUEST - Policy File index; three theses repositories, four website searches, five niche journals and 11 document repositories for public health. These databases will be searched for literature that describe partnerships for vaccine confidence and uptake for ethnoracially minoritised populations, involving at least one PHA and one FBO, published in English from January 2011 to October 2023. Two reviewers will pilot-test 20 articles to refine and finalise the inclusion/exclusion criteria and data extraction template. Four reviewers will independently screen and extract the included full-text articles. An implementation science process framework outlining the design, implementation and evaluation of the interventions will be used to capture the array of partnerships and effectiveness of PHA-FBO vaccine uptake initiatives. ETHICS AND DISSEMINATION This multiphase Canadian Institutes of Health Research (CIHR) project received ethics approval from the University of Toronto. Findings will be translated into a series of written materials for dissemination to CIHR, and collaborating knowledge users (ie, regional and provincial PHAs), and panel presentations at conferences to inform the development of a best-practices framework for increasing vaccine confidence and uptake.
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Affiliation(s)
- Melodie Yunju Song
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Shaza Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mac-Seing M, Gidey M, Di Ruggiero E. COVID-19-related global health governance and population health priorities for health equity in G20 countries: a scoping review. Int J Equity Health 2023; 22:232. [PMID: 37924074 PMCID: PMC10625304 DOI: 10.1186/s12939-023-02045-8] [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: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Since the declaration of the COVID-19 pandemic, the promotion of health equity including the health of various population sub-groups has been compromised, human rights jeopardised, and social inequities further exacerbated. Citizens worldwide, including in the Group of 20 (G20) countries, were affected by both global health governance (GHG) processes and decisions and public health measures taken by governments to respond to COVID-19. While it is critical to swiftly respond to COVID-19, little is known about how and to what extent the GHG is affecting population health priorities for health equity in global economies such as the G20 countries. This scoping review synthesised and identified knowledge gaps on how the COVID-19-related GHG is affecting population health priorities for policy, programme, and research in G20 countries. We followed the five-stage scoping review methodology promoted by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews guidelines. We searched four bibliographic databases for references conducted in G20 countries and regions and published in English and French, between January 2020 and April 2023. Out of 4,625 references and after two phases of screening, 14 studies met the inclusion criteria. G20 countries included in the review were Australia, Brazil, Canada, China, France, India, Italy, Japan, Russia, South Africa, the United Kingdom, the United States of America, and the European Union. We found insufficient collaboration and coordination and misalignment among governance actors at multiple levels. In most cases, equity considerations were not prioritised while unequal consequences of COVID-19 public health measures on population groups were widely reported. COVID-19-related population health priorities mainly focused on upstream and midstream determinants of health. Our scoping review showed the stark inequities of COVID-19 public health outcomes, coupled with a prevalent lack of coherent collaboration and coordination among governance actors. Moreover, governance as an object of empirical study is still emerging when examining its intersection with global health and population health policy, programme, and research. An urgent shift is required to effectively act upon structural health determinants that include transformative and comprehensive policies for prevention, equity, resilience, and sustainable health.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada.
- Social and Behavioural Health Sciences Division & Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
- Centre de recherche en santé publique, Université de Montréal, Montréal, Canada.
| | - Meron Gidey
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Social and Behavioural Health Sciences Division, Institute of Health Policy, Management and Evaluation & Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Sandhu HS, Otterman V, Tjaden L, Shephard R, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Betker C. The Governance of Core Competencies for Public Health: A Rapid Review of the Literature. Public Health Rev 2023; 44:1606110. [PMID: 37767458 PMCID: PMC10520247 DOI: 10.3389/phrs.2023.1606110] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.
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Affiliation(s)
- Harman Singh Sandhu
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Lynda Tjaden
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
| | | | - Emma Apatu
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Richard Musto
- Canadian Public Health Association, Ottawa, ON, Canada
| | - Jasmine Pawa
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Clinical Sciences, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Malcolm Steinberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Tarasuk V, Di Ruggiero E, Dennis CL, O’Connor DL, Sellen DW. Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto. Public Health Nutr 2023; 26:1468-1477. [PMID: 36919863 PMCID: PMC10346032 DOI: 10.1017/s1368980023000459] [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: 06/22/2022] [Revised: 11/18/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months. DESIGN Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding. SETTING Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women. PARTICIPANTS 316 birth mothers registered prenatally in the CPNP from 2017 to 2020. RESULTS Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site (P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses. CONCLUSIONS Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.
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Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | | | - Valerie Tarasuk
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence-Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Deborah L O’Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
- Pediatrics, Sinai Health, Toronto, ON, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
- Anthropology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
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Gautier L, Di Ruggiero E, Jackson C, Bentayeb N, Blain MJ, Chowdhury F, Gueye STM, Haydary M, Maillet L, Mahmoudi L, Mondal S, Ouffouet Bessiranthy A, Pluye P, Ziam S, Touati N. Learning from intersectoral initiatives to respond to the needs of refugees, asylum seekers, and migrants without status in the context of COVID-19 in Quebec and Ontario: a qualitative multiple case study protocol. Health Res Policy Syst 2023; 21:59. [PMID: 37340475 DOI: 10.1186/s12961-023-00991-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants. METHODS This theory-informed participatory research is co-created with socioculturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane's framework on health systems' responsiveness to guide the four phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include (1) building an inventory of intersectoral initiatives developed during the pandemic, (2) organizing a deliberative workshop with representatives of the study population, community, and public sector respondents to select and validate the intersectoral initiatives, (3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers, and employees of philanthropic foundations, and (4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers. DISCUSSION This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach-particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada.
- Centre de recherche en Santé Publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada.
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Naïma Bentayeb
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada
- École Nationale d'Administration Publique, Montreal, Canada
- McGill University, Montreal, Canada
| | - Marie-Jeanne Blain
- Centre de recherche et de partage des savoirs InterActions, Université de Montréal, Montreal, Canada
| | - Fariha Chowdhury
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | | | | | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Laila Mahmoudi
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | - Shinjini Mondal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Armel Ouffouet Bessiranthy
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Saliha Ziam
- École des Sciences de l'administration, Université TÉLUQ, Montreal, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Canada
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McLean RKD, Carden F, Aiken AB, Armstrong R, Bray J, Cassidy CE, Daub O, Di Ruggiero E, Fierro LA, Gagnon M, Hutchinson AM, Kislov R, Kothari A, Kreindler S, McCutcheon C, Reszel J, Scarrow G, Graham ID. Evaluating the quality of research co-production: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Health Res Policy Syst 2023; 21:51. [PMID: 37312190 DOI: 10.1186/s12961-023-00990-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Co-production is an umbrella term used to describe the process of generating knowledge through partnerships between researchers and those who will use or benefit from research. Multiple advantages of research co-production have been hypothesized, and in some cases documented, in both the academic and practice record. However, there are significant gaps in understanding how to evaluate the quality of co-production. This gap in rigorous evaluation undermines the potential of both co-production and co-producers. METHODS This research tests the relevance and utility of a novel evaluation framework: Research Quality Plus for Co-Production (RQ + 4 Co-Pro). Following a co-production approach ourselves, our team collaborated to develop study objectives, questions, analysis, and results sharing strategies. We used a dyadic field-test design to execute RQ + 4 Co-Pro evaluations amongst 18 independently recruited subject matter experts. We used standardized reporting templates and qualitative interviews to collect data from field-test participants, and thematic assessment and deliberative dialogue for analysis. Main limitations include that field-test participation included only health research projects and health researchers and this will limit perspective included in the study, and, that our own co-production team does not include all potential perspectives that may add value to this work. RESULTS The field test surfaced strong support for the relevance and utility of RQ + 4 Co-Pro as an evaluation approach and framework. Research participants shared opportunities for fine-tuning language and criteria within the prototype version, but also, for alternative uses and users of RQ + 4 Co-Pro. All research participants suggested RQ + 4 Co-Pro offered an opportunity for improving how co-production is evaluated and advanced. This facilitated our revision and publication herein of a field-tested RQ + 4 Co-Pro Framework and Assessment Instrument. CONCLUSION Evaluation is necessary for understanding and improving co-production, and, for ensuring co-production delivers on its promise of better health.. RQ + 4 Co-Pro provides a practical evaluation approach and framework that we invite co-producers and stewards of co-production-including the funders, publishers, and universities who increasingly encourage socially relevant research-to study, adapt, and apply.
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Affiliation(s)
- Robert K D McLean
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
- Policy and Evaluation Division, International Development Research Centre, Ottawa, Canada.
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada.
| | | | - Alice B Aiken
- Vice-President Research and Innovation, Dalhousie University, Halifax, Canada
| | - Rebecca Armstrong
- Research and Evaluation Branch, National Disability Insurance Agency, Melbourne, Australia
| | - Judy Bray
- Vice-President Research, Canadian Cancer Society, Toronto, Canada
| | | | - Olivia Daub
- School of Communication Sciences & Disorders, University of Western Ontario, London, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Leslie A Fierro
- Max Bell School of Public Policy, McGill University, Montreal, Canada
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University, Manchester, United Kingdom
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anita Kothari
- School of Health Studies, Western University, London, Canada
| | - Sara Kreindler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Chris McCutcheon
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Gayle Scarrow
- Michael Smith Health Research B.C, Vancouver, Canada
| | - Ian D Graham
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute & Schools of Epidemiology and Public Health & Nursing, University of Ottawa, Ottawa, Canada
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10
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Di Ruggiero E, Gherghel A. Tackling global challenges: a call for health promotion responses and perspectives. Glob Health Promot 2023:17579759231171259. [PMID: 37184271 DOI: 10.1177/17579759231171259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Canada
- Global Health Promotion
| | - Ana Gherghel
- Global Health Promotion
- International Union for Health Promotion and Education (IUHPE), Université de Montréal, Montréal, Canada
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Di Ruggiero E, Gherghel A. Un llamado para enfrentar los desafíos mundiales: respuestas y perspectivas de la promoción de la salud. Glob Health Promot 2023:17579759231171262. [PMID: 37165645 DOI: 10.1177/17579759231171262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Canada
- Global Health Promotion, Canada
| | - Ana Gherghel
- Global Health Promotion, Canada
- International Union for Health Promotion and Education (IUHPE), Université de Montréal, Montréal, Canada
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Di Ruggiero E, Gherghel A. Face aux défis mondiaux, un appel à la promotion de la santé pour apporter des réponses et des perspectives. Glob Health Promot 2023:17579759231172289. [PMID: 37161787 DOI: 10.1177/17579759231172289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Erica Di Ruggiero
- École de santé publique Dalla Lana, Université de Toronto, Canada
- Global Health Promotion
| | - Ana Gherghel
- Global Health Promotion
- International Union for Health Promotion and Education (IUHPE), Université de Montréal, Canda
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Yanful B, Kirubarajan A, Bhatia D, Mishra S, Allin S, Di Ruggiero E. Quality of care in the context of universal health coverage: a scoping review. Health Res Policy Syst 2023; 21:21. [PMID: 36959608 PMCID: PMC10035485 DOI: 10.1186/s12961-022-00957-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/28/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Universal health coverage (UHC) is an emerging priority of health systems worldwide and central to Sustainable Development Goal 3 (target 3.8). Critical to the achievement of UHC, is quality of care. However, current evidence suggests that quality of care is suboptimal, particularly in low- and middle-income countries. The primary objective of this scoping review was to summarize the existing conceptual and empirical literature on quality of care within the context of UHC and identify knowledge gaps. METHODS We conducted a scoping review using the Arksey and O'Malley framework and further elaborated by Levac et al. and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews reporting guidelines. We systematically searched MEDLINE, EMBASE, CINAHL-Plus, PAIS Index, ProQuest and PsycINFO for reviews published between 1 January 1995 and 27 September 2021. Reviews were eligible for inclusion if the article had a central focus on UHC and discussed quality of care. We did not apply any country-based restrictions. All screening, data extraction and analyses were completed by two reviewers. RESULTS Of the 4128 database results, we included 45 studies that met the eligibility criteria, spanning multiple geographic regions. We synthesized and analysed our findings according to Kruk et al.'s conceptual framework for high-quality systems, including foundations, processes of care and quality impacts. Discussions of governance in relation to quality of care were discussed in a high number of studies. Studies that explored the efficiency of health systems and services were also highly represented in the included reviews. In contrast, we found that limited information was reported on health outcomes in relation to quality of care within the context of UHC. In addition, there was a global lack of evidence on measures of quality of care related to UHC, particularly country-specific measures and measures related to equity. CONCLUSION There is growing evidence on the relationship between quality of care and UHC, especially related to the governance and efficiency of healthcare services and systems. However, several knowledge gaps remain, particularly related to monitoring and evaluation, including of equity. Further research, evaluation and monitoring frameworks are required to strengthen the existing evidence base to improve UHC.
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Affiliation(s)
- Bernice Yanful
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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MacLean TL, Qiang JR, Henderson L, Bowra A, Howard L, Pringle V, Butsang T, Rice E, Di Ruggiero E, Mashford-Pringle A. Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review. Int J Environ Res Public Health 2023; 20:ijerph20065217. [PMID: 36982126 PMCID: PMC10049537 DOI: 10.3390/ijerph20065217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 05/19/2023]
Abstract
Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought to broadly synthesize the academic literature on how CST programs are developed, implemented, and evaluated in the applied health, social work and education fields in Canada, United States, Australia, and New Zealand. MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA were searched for articles published between 1996 and 2020. The Joanna Briggs Institute's three-step search strategy and PRISMA extension for scoping reviews were adopted, with 134 articles included. CST programs have grown significantly in the health, social work, and education fields in the last three decades, and they vary significantly in their objectives, modalities, timelines, and how they are evaluated. The involvement of Indigenous peoples in CST programs is common, but their roles are rarely specified. Indigenous groups must be intentionally and meaningfully engaged throughout the entire duration of research and practice. Cultural safety and various related concepts should be careful considered and applied for the relevant context.
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Affiliation(s)
- Tammy L. MacLean
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence: ; Tel.: +1-647-778-2217
| | - Jinfan Rose Qiang
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Lynn Henderson
- Department of Clinical Studies, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Andrea Bowra
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lisa Howard
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Victoria Pringle
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Tenzin Butsang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Emma Rice
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Erica Di Ruggiero
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Angela Mashford-Pringle
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Thirugnanasampanthar SS, Embleton L, Di Ruggiero E, Braitstein P, Oduor C, Dibaba Wado Y. School attendance and sexual and reproductive health outcomes among adolescent girls in Kenya: a cross-sectional analysis. Reprod Health 2023; 20:29. [PMID: 36747291 PMCID: PMC9901832 DOI: 10.1186/s12978-023-01577-0] [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: 10/20/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Given the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties. METHODS This study uses baseline quantitative data from the mixed-methods evaluation of the In Their Hands (ITH) program which occurred between September to October 2018 in Homa Bay and Narok counties. In total, 1840 adolescent girls aged 15-19 years participated in the baseline survey, of which 1810 were included in the present analysis. Multivariable logistic regression models were used to assess the association between school attendance (in- versus out-of-school) and ever having sex, condom use during last sex, and ever pregnant, controlling for age, orphan status, income generation, religion, county, relationship status, and correct SRH knowledge. RESULTS Across the 1810 participants included in our study, 61.3% were in-school and 38.7% were out-of-school. Compared to adolescent girls who were in-school, those out-of-school were more likely (AOR 5.74 95% CI 3.94, 8.46) to report ever having sex, less likely (AOR: 0.21, 95% CI 0.16, 0.31) to have used a condom during their last sexual intercourse, and more likely (AOR: 6.98, 95% CI 5.04, 9.74) to have ever been pregnant. CONCLUSIONS School attendance plays an integral role in adolescent girls' SRH outcomes, and it is imperative that policy actors coordinate with the government and community to develop and implement initiatives that support adolescent girls' school attendance and education.
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Affiliation(s)
- Sai Surabi Thirugnanasampanthar
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Lonnie Embleton
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada ,grid.59734.3c0000 0001 0670 2351Present Address: Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Paula Braitstein
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, School of Public Health, Division of Epidemiology, Moi University, Eldoret, Kenya ,grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Clement Oduor
- grid.413355.50000 0001 2221 4219African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Yohannes Dibaba Wado
- grid.413355.50000 0001 2221 4219African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
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Bhatia D, Allin S, Di Ruggiero E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response. Humanit Soc Sci Commun 2023; 10:19. [PMID: 36687774 PMCID: PMC9844194 DOI: 10.1057/s41599-023-01501-8] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
The procurement and provision of expert-driven, evidence-informed, and independent science advice is integral to timely decision-making during public health emergencies. The 2019 coronavirus disease (COVID-19) pandemic has underscored the need for sound evidence in public health policy and exposed the challenges facing government science advisory mechanisms. This paper is a jurisdictional case study describing (i) the federal science advice bodies and mechanisms for public health in Canada (i.e., the federal science advice "ecosystem"); and (ii) how these bodies and mechanisms have mobilized and evolved to procure expertise and evidence to inform decisions during the first two years of the COVID-19 pandemic. We reviewed publicly accessible Government of Canada documents, technical reports, and peer-reviewed articles available up to December 2021. Canada's federal landscape of science advisory bodies for public health within the Health Portfolio was largely shaped by Canada's experiences with the 2003 severe acute respiratory syndrome and 2009 H1N1 outbreaks. In parallel, Canada has a designated science advisory apparatus that has seen frequent reforms since the early 2000s, with the current Office of the Chief Science Advisor created within the Science Portfolio in 2018. The COVID-19 pandemic has further complicated Canada's science advice ecosystem, with involvement from departments, expert advisory groups, and partnerships within both the federal Health and Science Portfolios. Although the engagement of federal departments outside the health sector is promising, the COVID-19 experience in Canada supports the need to institutionalize science advisory bodies for public health to improve pandemic preparedness and ensure rapid mobilization of well-coordinated and independent advice in future emergencies. This review also identified pressing areas for further inquiry to strengthen science advice for public health in Canada, including to assess the independence of science advisory actors and the interaction between federal and subnational authorities.
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Affiliation(s)
- Dominika Bhatia
- North American Observatory on Health Systems and Policies, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Sara Allin
- North American Observatory on Health Systems and Policies, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Erica Di Ruggiero
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Embleton L, Braitstein P, Di Ruggiero E, Oduor C, Wado YD. Sexual and reproductive health service utilization among adolescent girls in Kenya: A cross-sectional analysis. PLOS Glob Public Health 2023; 3:e0001508. [PMID: 36963079 PMCID: PMC10021741 DOI: 10.1371/journal.pgph.0001508] [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] [Received: 07/29/2022] [Accepted: 12/28/2022] [Indexed: 02/25/2023]
Abstract
We examined the association between adolescents' sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands intervention evaluation from September to October 2018. In total, 1840 adolescent girls aged 15 to 19 years were recruited to complete a baseline survey. We used unadjusted and adjusted logistic regression to model factors associated with SRH utilization across the social-ecological framework levels. Overall, 36% of participants reported visiting a health facility for SRH services in the past 12 months. At the structural level being out-of-school (AOR: 2.12 95% CI: 1.60-2.82) and not needing to get permission to go (AOR: 1.37 95%CI: 1.04-1.82) were associated with SRH service utilization. At the interpersonal level, participants who reported being able to ask adults for help when they needed it were more likely to report using SRH services in the past 12 months (AOR: 1.98, 95% CI: 1.09-3.78). At the individual level, having knowledge about where to obtain family planning (AOR = 2.48 95% CI: 1.74-3.57) and receiving information on SRH services in the past year (AOR: 1.44 95% CI:1.15-1.80) were associated with SRH service utilization. Our findings demonstrate the need for interventions, policies, and practices to be implemented across structural, health facility, community, interpersonal, and individual levels to comprehensively support adolescent girls to access and use SRH services.
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Affiliation(s)
- Lonnie Embleton
- Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Paula Braitstein
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Clement Oduor
- African Population and Health Research Center, Nairobi, Kenya
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Batomen B, Cloutier MS, Palm M, Widener M, Farber S, Bondy SJ, Ruggiero ED. Frequent public transit users views and attitudes toward cycling in CANADA in the context of the COVID-19 pandemic. Multimodal Transportation 2022. [PMCID: PMC9790877 DOI: 10.1016/j.multra.2022.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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O’Neill M, De Prophetis E, Allin S, Pinto AD, Smith RW, Di Ruggiero E, Schwartz R, Pawa J, Ammi M, Rosella LC. “We cobble together a storyline of system performance using a diversity of things”: a qualitative study of perspectives on public health performance measurement in Canada. Arch Public Health 2022; 80:177. [PMID: 35906667 PMCID: PMC9335461 DOI: 10.1186/s13690-022-00931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There have been longstanding calls for public health systems transformations in many countries, including Canada. Core to these calls has been strengthening performance measurement. While advancements have been made in performance measurement for certain sectors of the health care system (primarily focused on acute and primary health care), effective use of indicators for measuring public health systems performance are lacking. This study describes the current state, anticipated challenges, and future directions in the development and implementation of a public health performance measurement system for Canada.
Methods
We conducted a qualitative study using semi-structured interviews with public health leaders (n = 9) between July and August 2021. Public health leaders included researchers, government staff, and former medical officers of health who were purposively selected due to their expertise and experience with performance measurement with relevance to public health systems in Canada. Thematic analysis included both a deductive approach for themes consistent with the conceptual framework and an inductive approach to allow new themes to emerge from the data.
Results
Conceptual, methodological, contextual, and infrastructure challenges were highlighted by participants in designing a performance measurement system for public health. Specifically, six major themes evolved that encompass 1) the mission and purpose of public health systems, including challenges inherent in measuring the functions and services of public health; 2) the macro context, including the impacts of chronic underinvestment and one-time funding injections on the ability to sustain a measurement system; 3) the organizational structure/governance of public health systems including multiple forms across Canada and underdevelopment of information technology systems; 4) accountability approaches to performance measurement and management; and 5) timing and unobservability in public health indicators. These challenges require dedicated investment, strong leadership, and political will from the federal and provincial/territorial governments.
Conclusion
Unprecedented attention on public health due to the coronavirus disease 2019 pandemic has highlighted opportunities for system improvements, such as addressing the lack of a performance measurement system. This study provides actionable knowledge on conceptual, methodological, contextual, and infrastructure challenges needed to design and build a pan-Canadian performance measurement system for public health.
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Sandhu HS, Smith RW, Jarvis T, O'Neill M, Di Ruggiero E, Schwartz R, Rosella LC, Allin S, Pinto AD. Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study. J Public Health Manag Pract 2022; 28:702-711. [PMID: 36027605 PMCID: PMC9528938 DOI: 10.1097/phh.0000000000001596] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. OBJECTIVE To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. DESIGN A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis. SETTING This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. PARTICIPANTS Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). RESULTS We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. CONCLUSIONS The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.
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Affiliation(s)
- Harman S. Sandhu
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert W. Smith
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Tamika Jarvis
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Meghan O'Neill
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert Schwartz
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Laura C. Rosella
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Sara Allin
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Andrew D. Pinto
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
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Amri M, O’Campo P, Enright T, Siddiqi A, Di Ruggiero E, Bump JB. Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative. BMC Public Health 2022; 22:1989. [PMID: 36316679 PMCID: PMC9620663 DOI: 10.1186/s12889-022-14395-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.
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Affiliation(s)
- Michelle Amri
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Patricia O’Campo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, M5B 1T8 Toronto, ON Canada
| | - Theresa Enright
- grid.17063.330000 0001 2157 2938Department of Political Science, University of Toronto, 100 St George Street, M5S 3G3 Toronto, ON Canada
| | - Arjumand Siddiqi
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Jesse Boardman Bump
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.7914.b0000 0004 1936 7443Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Di Ruggiero E. Aborder la santé mentale à travers l’action intersectorielle dans le contexte de la COVID-19 et de l’agenda 2030 pour le développement durable. Glob Health Promot 2022. [DOI: 10.1177/17579759221122711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Di Ruggiero E. Addressing mental health through intersectoral action in the context of COVID-19 and the 2030 Agenda for Sustainable Development. Glob Health Promot 2022; 29:3-4. [DOI: 10.1177/17579759221122710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Di Ruggiero E. Abordar la salud mental a través de la acción intersectorial en el contexto de la COVID-19 y de la Agenda 2030 para el Desarrollo Sostenible. Glob Health Promot 2022. [DOI: 10.1177/17579759221122712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Recknor F, Di Ruggiero E, Jensen E. Addressing human trafficking as a public health issue. Can J Public Health 2022; 113:607-610. [PMID: 35534761 PMCID: PMC9262996 DOI: 10.17269/s41997-022-00642-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/06/2022] [Indexed: 05/11/2023]
Abstract
Human trafficking is increasingly recognized as a significant global public health issue. Human trafficking (HT) exists in all nations, including Canada, and is estimated to impact 25 million people globally. HT is a crime that is not always visible. It is associated with a myriad of deleterious health outcomes arising from adverse living and working conditions, and the physical, sexual, and/or psychological violence often accompanying it. Human trafficking also disproportionately affects people living under vulnerable circumstances, particularly those with intersecting vulnerabilities. Public health can advance health equity for trafficked persons and add value to existing anti-trafficking (AT) efforts. Among its many contributions, public health can bring its expertise in health promotion and surveillance. While efforts to incorporate a public health perspective are already underway in at least the United States and the United Kingdom, the nexus of public health and AT is still nascent and requires further development. A public health approach to trafficking focused on intervening on the upstream drivers of well-being can add value to the extant counter-trafficking paradigm. This commentary is intended to catalyze discussion in Canada and elsewhere as to what public health can contribute to this emergent field.
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Affiliation(s)
- Frances Recknor
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS 350, Houston, TX, 77030, USA.
- Global Migration & Health Initiative, Toronto, Ontario, Canada.
| | - Erica Di Ruggiero
- Social & Behavioural Health Sciences Division & Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elsabeth Jensen
- Division of Nursing, York University, Toronto, Ontario, Canada
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Baobeid A, Faghani-Hamadani T, Sauer S, Boum Y, Hedt-Gauthier BL, Neufeld N, Odhiambo J, Volmink J, Shuchman M, Di Ruggiero E, Condo JU. Gender equity in health research publishing in Africa. BMJ Glob Health 2022; 7:bmjgh-2022-008821. [PMID: 35820714 PMCID: PMC9277026 DOI: 10.1136/bmjgh-2022-008821] [Citation(s) in RCA: 7] [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: 02/16/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women’s careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or last author, or single author) during the time frame 2014–2016. We also examined policies and practices at journals publishing high rates of women scientists from sub-Saharan Africa, to identify potential structural enablers affecting these women in publishing. Methods The study used Namsor V.2, an application programming interface, to conduct a secondary analysis of a bibliometric database. We also analysed policies and practices of ten journals with the highest number of SSA women publishing in first authorship positions. Results Based on regional analyses, the greatest magnitude of authorship inequity is in papers from sub-Saharan Africa, where men comprised 61% of first authors, 65% of last authors and 66% of single authors. Women from South Africa and Nigeria had greater success in publishing than those from other SSA countries, though women represented at least 20% of last authors in 25 SSA countries. The journals that published the most SSA women as prominent authors are journals based in SSA. Journals with overwhelmingly male leadership are also among those publishing the highest number of SSA women. Conclusion Women scholars in SSA face substantial gender inequities in publishing in prestigious authorship positions in academic journals, though there is a cadre of women research leaders across the region. Journals in SSA are important for local women scholars and the inequities SSA women researchers face are not necessarily attributable to gender discrepancy in journals’ editorial leadership.
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Affiliation(s)
- Anwaar Baobeid
- Centre for Global Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Tara Faghani-Hamadani
- Centre for Global Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Sara Sauer
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Yap Boum
- Epicentre, Medecins Sans Frontieres, Yaoundé, Cameroon
| | | | - Nicholas Neufeld
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jackline Odhiambo
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
| | - Jimmy Volmink
- Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Miriam Shuchman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Centre for Global Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jeanine U Condo
- National University of Rwanda School of Public Health, Kigali, Rwanda.,Tulane University, New Orleans, Louisiana, USA
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Lee J, Di Ruggiero E. How does informal employment affect health and health equity? Emerging gaps in research from a scoping review and modified e-Delphi survey. Int J Equity Health 2022; 21:87. [PMID: 35725451 PMCID: PMC9208971 DOI: 10.1186/s12939-022-01684-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/26/2021] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction This article reports on the results from a scoping review and a modified e-Delphi survey with experts which aimed to synthesize existing knowledge and identify research gaps on the health and health equity implications of informal employment in both low- and middle-income countries (LMICs) and high-income countries (HICs). Methods The scoping review included peer-reviewed articles published online between January 2015 and December 2019 in English. Additionally, a modified e-Delphi survey with experts was conducted to validate our findings from the scoping review and receive feedback on additional research and policy gaps. We drew on micro- and macro-level frameworks on employment relations and health inequities developed by the Employment Conditions Knowledge Network to synthesize and analyze existing literature. Results A total of 540 articles were screened, and 57 met the eligibility criteria for this scoping review study, including 36 on micro-level research, 19 on macro-level research, and 13 on policy intervention research. Most of the included studies were conducted in LMICs while the research interest in informal work and health has increased globally. Findings from existing literature on the health and health equity implications of informal employment are mixed: informal employment does not necessarily lead to poorer health outcomes than formal employment. Although all informal workers share some fundamental vulnerabilities, including harmful working conditions and limited access to health and social protections, the related health implications vary according to the sub-groups of workers (e.g., gender) and the country context (e.g., types of welfare state or labour market). In the modified e-Delphi survey, participants showed a high level of agreement on a lack of consensus on the definition of informal employment, the usefulness of the concept of informal employment, the need for more comparative policy research, qualitative health research, and research on the intersection between gender and informal employment. Conclusions Our results clearly identify the need for more research to further understand the various mechanisms through which informal employment affects health in different countries and for different groups of informal workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01684-7.
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Affiliation(s)
- Juyeon Lee
- Dalla Lana School of Public Health, Division of Social and Behavioural Health Sciences, University of Toronto, 155 College Street, Room 408, M5T 3M7, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, Division of Social and Behavioural Health Sciences, University of Toronto, 155 College Street, Room 408, M5T 3M7, Toronto, ON, Canada.
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Di Ruggiero E, Dennis CL, Kiss A, O'Connor DL, Sellen DW. Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada. BMJ Open 2022; 12:e055830. [PMID: 35676013 PMCID: PMC9185489 DOI: 10.1136/bmjopen-2021-055830] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months. DESIGN Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada. PARTICIPANTS 337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. EXCLUSIONS pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Main exposure variable: any use of expressed human milk at 2 weeks postpartum. OUTCOMES cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum. RESULTS All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84). TRIAL REGISTRATION NUMBERS NCT03400605, NCT03589963.
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Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Pediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada
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Trowbridge J, Tan JY, Hussain S, Osman AEB, Di Ruggiero E. Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals. Int J Public Health 2022; 67:1604351. [PMID: 35652124 PMCID: PMC9149775 DOI: 10.3389/ijph.2022.1604351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/16/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically. Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research. Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors. Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.
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Affiliation(s)
- Joslyn Trowbridge
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Julia Y. Tan
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Sameera Hussain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Esawi Babiker Osman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Erica Di Ruggiero,
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McLean RKD, Carden F, Graham ID, Aiken AB, Armstrong R, Bray J, Cassidy CE, Daub O, Di Ruggiero E, Fierro LA, Gagnon M, Hutchinson AM, Kislov R, Kothari A, Kreindler S, McCutcheon C, Reszel J, Scarrow G. Evaluating research co-production: protocol for the Research Quality Plus for Co-Production (RQ+ 4 Co-Pro) framework. Implement Sci Commun 2022; 3:28. [PMID: 35287758 PMCID: PMC8919555 DOI: 10.1186/s43058-022-00265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and methods to assess the quality of co-production are limited. Here we describe a framework for assessing the quality of research co-production—Research Quality Plus for Co-Production (RQ+ 4 Co-Pro)—and outline our field test of this approach.
Methods
Using a co-production approach, we aim to field test the relevance and utility of the RQ+ 4 Co-Pro framework. To do so, we will recruit participants who have led research co-production projects from the international Integrated Knowledge Translation Research Network. We aim to sample 16 to 20 co-production project leads, assign these participants to dyadic groups (8 to 10 dyads), train each participant in the RQ+ 4 Co-Pro framework using deliberative workshops and oversee a simulation assessment exercise using RQ+ 4 Co-Pro within dyadic groups. To study this experience, we use a qualitative design to collect participant demographic information and project demographic information and will use in-depth semi-structured interviews to collect data related to the experience each participant has using the RQ+ 4 Co-Pro framework.
Discussion
This study will yield knowledge about a new way to assess research co-production. Specifically, it will address the relevance and utility of using RQ+ 4 Co-Pro, a framework that includes context as an inseparable component of research, identifies dimensions of quality matched to the aims of co-production, and applies a systematic and transferable evaluative method for reaching conclusions. This is a needed area of innovation for research co-production to reach its full potential. The findings may benefit co-producers interested in understanding the quality of their work, but also other stewards of research co-production. Accordingly, we undertake this study as a co-production team representing multiple perspectives from across the research enterprise, such as funders, journal editors, university administrators, and government and health organization leaders.
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Bhatia D, Mishra S, Kirubarajan A, Yanful B, Allin S, Di Ruggiero E. Identifying priorities for research on financial risk protection to achieve universal health coverage: a scoping overview of reviews. BMJ Open 2022; 12:e052041. [PMID: 35264342 PMCID: PMC8915291 DOI: 10.1136/bmjopen-2021-052041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/04/2022] Open
Abstract
OBJECTIVES Financial risk protection (FRP) is an indicator of the Sustainable Development Goal 3 universal health coverage (UHC) target. We sought to characterise what is known about FRP in the UHC context and to identify evidence gaps to prioritise in future research. DESIGN Scoping overview of reviews using the Arksey & O'Malley and Levac & Colquhoun framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. DATA SOURCES MEDLINE, PsycINFO, CINAHL-Plus and PAIS Index were systematically searched for studies published between 1 January 1995 and 20 July 2021. ELIGIBILITY CRITERIA Records were screened by two independent reviewers in duplicate using the following criteria: (1) literature review; (2) focus on UHC achievement through FRP; (3) English or French language; (4) published after 1995 and (5) peer-reviewed. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data using a standard form and descriptive content analysis was performed to synthesise findings. RESULTS 50 studies were included. Most studies were systematic reviews focusing on low-income and middle-income countries. Study periods spanned 1990 and 2020. While FRP was recognised as a dimension of UHC, it was rarely defined as a concept. Out-of-pocket, catastrophic and impoverishing health expenditures were most commonly used to measure FRP. Pooling arrangements, expansion of insurance coverage and financial incentives were the main interventions for achieving FRP. Evidence gaps pertained to the effectiveness, cost-effectiveness and equity implications of efforts aimed at increasing FRP. Methodological gaps related to trade-offs between single-country and multicountry analyses; lack of process evaluations; inadequate mixed-methods evidence, disaggregated by relevant characteristics; lack of comparable and standardised measurement and short follow-up periods. CONCLUSIONS This scoping overview of reviews characterised what is known about FRP as a UHC dimension and found evidence gaps related to the effectiveness, cost-effectiveness and equity implications of FRP interventions. Theory-informed mixed-methods research using high-quality, longitudinal and disaggregated data is needed to address these objectives.
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Affiliation(s)
- Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bernice Yanful
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mahmood S, Lobendino Flores JV, Di Ruggiero E, Ardiles P, Elhagehassan H, Purewal S. A comparative systematic scan of COVID-19 health literacy information sources for Canadian university students. Health Promot Chronic Dis Prev Can 2022; 42:188-198. [DOI: 10.24095/hpcdp.42.5.02] [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: 11/20/2022]
Abstract
Introduction
With the rapid spread of online coronavirus-related health information, it is important to ensure that this information is reliable and effectively communicated. This study observes the dissemination of COVID-19 health literacy information by Canadian postsecondary institutions aimed at university students as compared to provincial and federal government COVID-19 guidelines.
Methods
We conducted a systematic scan of web pages from Canadian provincial and federal governments and from selected Canadian universities to identify how health information is presented to university students. We used our previously implemented health literacy survey with Canadian postsecondary students as a sampling frame to determine which academic institutions to include. We then used specific search terms to identify relevant web pages using Google and integrated search functions on government websites, and compared the information available on pandemic measures categorized by university response strategies, sources of expertise and branding approaches.
Results
Our scan of Canadian government and university web pages found that universities similarly created one main page for COVID-19 updates and information and linked to public sector agencies as a main resource, and mainly differed in their provincial and local sources for obtaining information. They also differed in their strategies for communicating and displaying this information to their respective students.
Conclusion
The universities in our sample outlined similar policies for their students, aligning with Canadian government public health recommendations and their respective provincial or regional health authorities. Maintaining the accuracy of these information sources is important to ensure student health literacy and counter misinformation about COVID-19.
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Affiliation(s)
- Sana Mahmood
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paola Ardiles
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Hussein Elhagehassan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Simran Purewal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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I R Jenkinson J, Strike C, Hwang SW, Di Ruggiero E. Legal, geographic and organizational contexts that shape knowledge sharing in the hospital discharge process for people experiencing homelessness in Toronto, Canada. Health Soc Care Community 2022; 30:e377-e387. [PMID: 33105525 DOI: 10.1111/hsc.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness use acute healthcare at higher rates than the general population, yet hospitals frequently discharge them to the streets or emergency shelters. Available literature on the hospital discharge process for people experiencing homelessness identifies knowledge sharing as an important and challenging part of the discharge process; however, it does little to explain what generates these challenges or what might support knowledge sharing. In this study, we explain under which contexts certain mechanisms are triggered to facilitate knowledge sharing between hospitals and shelters during the discharge process. Between September 2018 and April 2019, we interviewed 33 participants: hospital workers on general medicine wards across three hospitals; shelter workers; researchers, policy advisors or advocates working at the intersection of homelessness and healthcare in Toronto. We find that within the legal context of health information protection, the concept of "circle of care" has created barriers to knowledge sharing between hospitals and shelters by excluding shelter workers from discharge planning. We note, however, that the degree to which hospital workers have navigated these barriers and brought shelter workers into the discharge process varies across hospitals. We explore this variation and find that certain geographic and organisational contexts have activated the development of institutional- and individual-level relationships between hospitals and shelters or their workers, respectively. We suggest that these relationships generate increased trust and communication and have led to knowledge sharing between hospitals and shelters. These findings are applicable in most urban centres with hospitals and where people experiencing homelessness live. Understanding the role of context is imperative for developing appropriate and effective interventions to improve hospital discharge processes. The development and implementation of more effective discharge processes can contribute to improved post-discharge care and recovery for this patient population and contribute to addressing health equity.
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Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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34
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Carducci B, Keats EC, Amri M, Plamondon KM, Shoveller J, Ako O, Osler FG, Henry C, Pant Pai N, Di Ruggiero E. Prioritizing gender equity and intersectionality in Canadian global health institutions and partnerships. PLOS Glob Public Health 2022; 2:e0001105. [PMID: 36962606 PMCID: PMC10021364 DOI: 10.1371/journal.pgph.0001105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite governmental efforts to close the gender gap and global calls including Sustainable Development Goal 5 to promote gender equality, the sobering reality is that gender inequities continue to persist in Canadian global health institutions. Moreover, from health to the economy, security to social protection, COVID-19 has exposed and heightened pre-existing inequities, with women, especially marginalized women, being disproportionately impacted. Women, particularly women who face bias along multiple identity dimensions, continue to be at risk of being excluded or delegitimized as participants in the global health workforce and continue to face barriers in career advancement to leadership, management and governance positions in Canada. These inequities have downstream effects on the policies and programmes, including global health efforts intended to support equitable partnerships with colleagues in low- and middle- income countries. We review current institutional gender inequities in Canadian global health research, policy and practice and by extension, our global partnerships. Informed by this review, we offer four priority actions for institutional leaders and managers to gender-transform Canadian global health institutions to accompany both the immediate response and longer-term recovery efforts of COVID-19. In particular, we call for the need for tracking indicators of gender parity within and across our institutions and in global health research (e.g., representation and participation, pay, promotions, training opportunities, unpaid care work), accountability and progressive action.
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Affiliation(s)
- Bianca Carducci
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, Ontario, Canada
| | - Michelle Amri
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Katrina M Plamondon
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jeannie Shoveller
- Faculty of Medicine, Community Health and Epidemiology Department, Dalhousie University, Halifax, Nova Scotia, Canada
- IWH Health Centre, Halifax, Nova Scotia, Canada
| | - Onome Ako
- Action Against Hunger, Toronto, Ontario, Canada
- Canadian Partnership for Women and Children's Health (CanWaCH), Peterborough, Canada
| | - F Gigi Osler
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Federation of Medical Women of Canada, Ottawa, Ontario, Canada
| | - Carol Henry
- Division of Nutrition, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Erica Di Ruggiero
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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35
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McAuliffe C, Upshur R, Sellen D, Di Ruggiero E. You can't report your feelings: The hidden labor of managing threats to safety by women in global public health fieldwork. PLOS Glob Public Health 2022; 2:e0000153. [PMID: 36962277 PMCID: PMC10022030 DOI: 10.1371/journal.pgph.0000153] [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] [Received: 09/10/2021] [Accepted: 04/21/2022] [Indexed: 11/19/2022]
Abstract
Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women students remain inadequately addressed during training, while more research to identify needs, expectations, gaps, and best practices would inform policy and practice to improve conditions for women working off-campus on global public health studies. One approach, reported here, is to document and better understand the lived experience of U.S. or Canadian women graduate students participating in global public health fieldwork. Participant in-depth phenomenological interviews and guided writing exercises aimed to capture lived experience descriptions for 25 women. A phenomenology of practice was applied throughout the research process, following Max van Manen's qualitative methodology approach. Loss of environmental familiarity, combined with graduate students' lack of power, created considerable hidden labor described by women in working to keep themselves safe from sexual and gender-based violence (SGBV) while participating in global public health fieldwork. Women shared specific experiences exemplifying how this can be both alleviated and/or intensified through a range of negotiated strategies, coping styles, and management techniques. Additionally, women recalled laboring as students to avoid or reduce instances of SGBV, that then, precluded them from having any material "of substance" to report once returned home. These findings offer new meaning structures, language for a foreign experience, or ways to describe, conceive of, and respond to global public health fieldwork that hold the potential to positively affect individuals' experiences, institutional understanding, and thus practice, of future women students in global public health.
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Affiliation(s)
- Corey McAuliffe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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36
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Di Ruggiero E, Dennis C, O'Connor DL, Sellen DW. High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada. Matern Child Nutr 2022; 18:e13260. [PMID: 34369075 PMCID: PMC8710126 DOI: 10.1111/mcn.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
Exclusive breastfeeding (EBF) for 6 months is a global public health goal, but measuring its achievement as a marker of population breastmilk feeding practices is insufficient. Additional measures are needed to understand variation in non-EBF practices and inform intervention priorities. We collected infant feeding data prospectively at seven time points to 6 months post-partum from a cohort of vulnerable women (n = 151) registered at two Canada Prenatal Nutrition Program sites in Toronto, Canada. Four categories of breastmilk feeding intensity were defined. Descriptive analyses included the (i) proportion of participants in each feeding category by time point, (ii) use of formula and non-formula supplements to breastmilk, (iii) proportion of participants practising EBF continuously for at least 3 months; and (iv) frequency of transitions between feeding categories. All participants initiated breastmilk feeding with 70% continuing for 6 months. Only 18% practised EBF for 6 months, but 48% did so for at least 3 continuous months. The proportion in the EBF category was highest from 2 to 4 months post-partum. Supplemental formula use was highest in the first 3 months; early introduction of solids and non-formula fluids further compromised EBF at 5 and 6 months post-partum. Most participants (75%) transitioned between categories of breastmilk feeding intensity, with 35% making two or more transitions. Our data show high levels of breastmilk provision despite a low rate of EBF for 6 months. Inclusion of similar analyses in future prospective studies is recommended to provide more nuanced reporting of breastmilk feeding practices and guide intervention designs.
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Affiliation(s)
- Alison Mildon
- Department of Nutritional Sciences, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Jane Francis
- Department of Nutritional Sciences, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Stacia Stewart
- Health Promotion and Community EngagementParkdale‐Queen West Community Health CentreTorontoOntarioCanada
| | - Bronwyn Underhill
- Health Promotion and Community EngagementParkdale‐Queen West Community Health CentreTorontoOntarioCanada
| | - Yi Man Ng
- Health Promotion and Community EngagementParkdale‐Queen West Community Health CentreTorontoOntarioCanada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Cindy‐Lee Dennis
- Lawrence‐Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Deborah L. O'Connor
- Department of Nutritional Sciences, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
- Joannah and Brian Lawson Centre for Child NutritionUniversity of TorontoTorontoOntarioCanada
- Pediatrics, Sinai HealthTorontoOntarioCanada
| | - Daniel W. Sellen
- Department of Nutritional Sciences, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Joannah and Brian Lawson Centre for Child NutritionUniversity of TorontoTorontoOntarioCanada
- Anthropology, Faculty of Arts and SciencesUniversity of TorontoTorontoOntarioCanada
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37
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Francis J, Ismail S, Mildon A, Stewart S, Underhill B, Tarasuk V, Di Ruggiero E, Kiss A, Sellen DW, O'Connor DL. Characteristics of vulnerable women and their association with participation in a Canada Prenatal Nutrition Program site in Toronto, Canada. Health Promot Chronic Dis Prev Can 2021; 41:413-422. [PMID: 34910898 DOI: 10.24095/hpcdp.41.12.02] [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] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Canada Prenatal Nutrition Program (CPNP) supports community organizations to provide maternal-infant health services for socially/economically vulnerable women. As part of our research program exploring opportunities to provide postnatal breastfeeding support through the CPNP, we investigated the sociodemographic and psychosocial characteristics of clients enrolled in a Toronto CPNP site and explored associations with participation. METHODS Data were collected retrospectively from the charts of 339 women registered in one southwest Toronto CPNP site from 2013 to 2016. Multivariable regression analyses were used to assess associations between 10 maternal characteristics and three dimensions of prenatal program participation: initiation (gestational age at enrolment in weeks), intensity (number of times one-on-one supports were received) and duration (number of visits). RESULTS The mean (SD) age of clients was 31 (5.7) years; 80% were born outside of Canada; 29% were single; and 65% had household incomes below the Statistics Canada family size-adjusted low-income cut-offs. Income was the only characteristic associated with all dimensions of participation. Compared to clients living above the low-income cut-off, those living below the low-income cut-off enrolled in the program 2.85 weeks earlier (95% CI: -5.55 to -0.16), had 1.29 times higher number of one-on-one supports (95% CI: 1.03 to 1.61) and had 1.29 times higher number of program visits (95% CI: 1.02 to 1.63). CONCLUSION Our findings show that this CPNP site serves vulnerable women, with few differences in participation based on maternal characteristics. This evidence can guide service provision and monitoring decisions at this program site. Further research is needed to explore new program delivery models to enhance perinatal services for vulnerable women.
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Affiliation(s)
- Jane Francis
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Ismail
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alison Mildon
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Valerie Tarasuk
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Ontario, Canada.,Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Ontario, Canada.,Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
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38
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Ogundele OJ, Fadel S, Braitstein P, Di Ruggiero E. Health actor approaches to financing universal coverage strategies for pneumococcal and rotavirus immunisation programmes in low-income and middle-income countries: a scoping review protocol. BMJ Open 2021; 11:e052381. [PMID: 34907060 PMCID: PMC8671985 DOI: 10.1136/bmjopen-2021-052381] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Sustainable financing of immunisation programmes is an important step towards universal coverage of life-saving vaccines. Yet, financing mechanisms for health programmes could have consequences on the design of universal approaches to immunisation coverage. Effective implementation of immunisation interventions necessitates investigating the roles of institutions and power on interventions. This review aims to understand how sustainable financing and equitable immunisation are conceptualised by health actors like Gavi, and government-related entities across low-income and middle-income countries (LMICs) and how financing mechanisms can affect universal coverage of vaccines. METHODS AND ANALYSIS This study protocol outline a scoping review of the peer-reviewed and the grey literature, using established methodological framework for scoping review. Literature will be identified through a comprehensive search of multiple databases and grey literature. All peer-reviewed implementation research studies from the year 2002 addressing financing and universal coverage of immunisation programmes for the pneumococcal conjugated vaccine and rotavirus vaccines immunisation interventions will be included and grey literature published in/after the year 2015. For the study scope, population, concept and context are defined: Population as international and national health stakeholders financing immunisation programmes; Concept as implementation research on pneumococcal conjugate and rotavirus vaccination interventions; and Context as LMICs. Findings will be quantitatively summarised to provide an overview and narratively synthesised and analysed. Studies that do not use implementation research approaches, frameworks or models will be excluded. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. Findings and recommendations will be presented to implementation researchers and health stakeholders.
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Affiliation(s)
- Oluwasegun Jko Ogundele
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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39
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Bleecker L, Sauveplane-Stirling V, Di Ruggiero E, Sellen D. Evaluating the integration of strategic priorities within a complex research-for-development funding program. Eval Program Plann 2021; 89:102009. [PMID: 34562669 DOI: 10.1016/j.evalprogplan.2021.102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
This paper examines the application of Complexity Theory constructs to a research-for-development program evaluation and presents an overview of the implications and promising approaches for evaluating complex programs. We discuss lessons learned from an evaluation completed for the International Development Research Centre's Food, Environment and Health (FEH) program, which investigated the integration and outcomes of five strategic program priorities: partnerships, southern leadership, gender and equity, scale, and environmental sustainability. We present interpretations from a secondary, thematic content analysis that categorized evaluation findings across four complexity constructs: emergence, unpredictability, contradiction and self-organization. Viewing the evaluation through these constructs surfaced some important features of the FEH program to date, specifically its evolving approach, adaptiveness to emergent issues, non-linear outcomes, and self-organizing agents, which had several implications for the evaluative process. We conclude that the most appropriate evaluation designs for complex funding programs are participatory (to explore all stakeholders' influence), adaptive (to capture the unexpected) and assess external contexts. The application of complexity constructs may be useful for evaluators to gain a deeper understanding of how program contexts change in the face of complexity and why some evaluation methods work more effectively than others.
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40
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Potvin L, Ferron C, Terral P, Di Ruggiero E, Cervenka I, Foucaud J. Research, partnership, intervention: the triptych of population health intervention research. Glob Health Promot 2021; 28:73-74. [PMID: 33843341 DOI: 10.1177/1757975920987112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christine Ferron
- Fédération nationale d'éducation et de promotion de la santé (Fnes), Saint-Denis, Île-de-France, France
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Iris Cervenka
- Institut national du cancer (INCa), Boulogne-Billancourt, France
| | - Jérôme Foucaud
- Institut national du cancer (INCa), Boulogne-Billancourt, France
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41
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Di Ruggiero E. Perspectives on the state of progress in population health intervention research: A diachronic reflection on the 2019 conference 'PHIR to tackle social and territorial inequalities in health'. Glob Health Promot 2021; 28:93-95. [PMID: 33843353 DOI: 10.1177/1757975920986778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Erica Di Ruggiero
- Associate Professor, Dalla Lana School of Public Health, Toronto, Canada
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42
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Jenkinson JIR, Strike C, Hwang SW, Di Ruggiero E. Nowhere to go: exploring the social and economic influences on discharging people experiencing homelessness to appropriate destinations in Toronto, Canada. Can J Public Health 2021; 112:992-1001. [PMID: 34448129 DOI: 10.17269/s41997-021-00561-0] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES A main component of discharging patients from hospital is identifying an appropriate destination to meet their post-hospitalization needs. In Canada, meeting this goal is challenged when discharging people experiencing homelessness, who are frequently discharged to the streets or shelters. This study aimed to understand why and how the ability of hospital workers to find appropriate discharge destinations for homeless patients is influenced by dynamic social and economic contexts. METHODS Guided by critical realism, we conducted semi-structured, in-depth interviews with 33 participants: hospital workers on general medicine wards at three urban hospitals; shelter workers; and researchers, policy advisors, and advocates working at the intersection of homelessness and healthcare. RESULTS Historical and contemporary social and economic contexts (e.g., shrinking financial resources) have triggered the adoption of efficiency and accountability measures in hospitals, and exclusion criteria and rules in shelters, both conceptualized as mechanisms in this article. Hospitals are pressured to move patients out as soon as they are medically stable, but they struggle to discharge patients to shelters: to prevent inappropriate discharges, shelters have adopted exclusion and eligibility rules and criteria. These mechanisms contribute to an explanation of why identifying an appropriate discharge destination for people experiencing homelessness is challenging. CONCLUSION Our results point to a systems gap in this discharge pathway where there is nowhere for people experiencing homelessness to go who no longer need acute care, but whose needs are too complex for shelters. Systemic changes are needed to better support hospital and shelter frontline workers to improve discharge processes.
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Affiliation(s)
- Jesse I R Jenkinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8, ON, Canada.
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8, ON, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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43
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Bradley Dexter S, Kavanagh Salmond K, Payne L, Chia MC, Di Ruggiero E, Mahato S. The art and science of a strategic grantmaker: the experience of the Public Health Agency of Canada's Innovation Strategy. Can J Public Health 2021; 112:186-203. [PMID: 34383264 PMCID: PMC8360247 DOI: 10.17269/s41997-021-00512-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/25/2021] [Indexed: 12/03/2022]
Abstract
SETTING The Public Health Agency of Canada's Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020. INTERVENTION During its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components. OUTCOMES PHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability. IMPLICATIONS Analysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.
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Affiliation(s)
- Shannon Bradley Dexter
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada.
- Public Health Agency of Canada, 301-351 Abbott Street, Vancouver, BC, V6B 0G6, Canada.
| | - Kelly Kavanagh Salmond
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
| | - Leslie Payne
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
- Public Health Agency of Canada, 301-351 Abbott Street, Vancouver, BC, V6B 0G6, Canada
| | - Marie C Chia
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Mahato
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
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44
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Richards E, Rousseau C, Di Ruggiero E, Dennis CL, O'Connor DL, Sellen DW. Correction to: Effect on breastfeeding practices of providing in-home lactation support to vulnerable women through the Canada Prenatal Nutrition Program: protocol for a pre/post intervention study. Int Breastfeed J 2021; 16:57. [PMID: 34325721 PMCID: PMC8320039 DOI: 10.1186/s13006-021-00404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Elle Richards
- The Stop Community Food Centre, Toronto, Ontario, Canada.,Tamarack Institute, Waterloo, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence-Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada.
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Pelletier H, Bleecker L, Sauveplane-Stirling V, Di Ruggiero E, Sellen D. Building the field of food systems research: commentary on a research funder's role. Health Res Policy Syst 2021; 19:101. [PMID: 34271926 PMCID: PMC8283388 DOI: 10.1186/s12961-021-00745-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/20/2020] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background The Food, Environment, and Health (FEH) program of the International Development Research Centre (IDRC) aims to improve the health of low- and middle-income country populations by generating evidence, innovations, and policies that reduce the health and economic burdens of preventable chronic and infectious diseases. A predominant focus of the FEH program is research related to consumer food environments that promote or enable healthy and sustainable shifts in consumption. An evaluation of the FEH program, led by the University of Toronto, provided an opportunity to analyse the approach and role of a development funder in building the field of food systems research. Discussion In this commentary, we provide an external evaluator’s perspective on the IDRC’s contributory role in building the field of food systems research, based on a secondary analysis of findings from a recent FEH program evaluation. We used the field-building framework outlined in Di Ruggiero et al. (Health Res Policy System, 2017) to highlight the strengths and challenges of the FEH’s approach to field-building and determined that the program aligns with six of the seven features of the framework. The FEH program has enhanced support and awareness for food systems research, provided organized funding and capacity-building opportunities, multilevel activity to support research and its use, and strong scientific leadership, and set significant standards and exemplars. However, we also found that not all sociopolitical environments have fully recognized or valued food systems research and its use for policy change. Conclusion The FEH program’s field-building approach can be situated within the field-building framework, and it has been successful in laying the groundwork for building the field of food systems, particularly consumer food environments research. However, supportive external environments and further investments may be needed to achieve a critical mass of capacity, continue building communities of practice, and influence policy. The FEH program approach may serve as an exemplar and comparator for other research funding agencies looking to develop strategic research programming in the field of food systems research.
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Richards E, Rousseau C, Di Ruggiero E, Dennis CL, O'Connor DL, Sellen DW. Effect on breastfeeding practices of providing in-home lactation support to vulnerable women through the Canada Prenatal Nutrition Program: protocol for a pre/post intervention study. Int Breastfeed J 2021; 16:49. [PMID: 34215288 PMCID: PMC8252273 DOI: 10.1186/s13006-021-00396-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Only one-third of Canadian infants are exclusively breastfed for the first 6 months of life as recommended. Skilled lactation support in the early postpartum period is one strategy for improving breastfeeding outcomes by building breastfeeding self-efficacy and resolving difficulties. Access to such support is limited among vulnerable women, including those who are new immigrants, low income, under-educated, young or single. The Canada Prenatal Nutrition Program (CPNP) aims to improve birth and breastfeeding outcomes among vulnerable women, but currently lacks a formal framework for providing postpartum lactation support. Methods This pre/post intervention study will examine the effect on breastfeeding outcomes of an evidence-based in-home lactation support intervention provided through the CPNP. We will enrol 210 pregnant women who intend to breastfeed and are registered CPNP clients at two sites in Toronto, Canada. During the intervention phase, postpartum home visits by International Board Certified Lactation Consultants (IBCLCs) will be pro-actively offered to registered clients of the two sites. Double-electric breast pumps will also be provided to those who meet specific criteria. Infant feeding data will be collected prospectively at seven time points from 2 weeks to 6 months postpartum. Descriptive and regression analyses will be conducted to measure intervention effects. The primary outcome is exclusive breastfeeding at 4 months postpartum. Secondary outcomes include the duration of any and exclusive breastfeeding, timing of introduction of breastmilk substitutes and timing of introduction of solid foods. Breastfeeding self-efficacy will be assessed prenatally and at 2 weeks and 2 months postpartum. Other measures include maternal socio-demographics, infant feeding intentions, maternal depression and anxiety, and household food insecurity. Monitoring data will be used to assess the reach, uptake and fidelity of intervention delivery. Discussion Increasing access to skilled lactation support through the CPNP may be an effective means of improving breastfeeding practices among vulnerable women and thereby enhancing health and development outcomes for their infants. This pre/post intervention study will contribute evidence on both the effectiveness and feasibility of this approach, in order to guide the development and further testing of appropriate models of integrating lactation support into the CPNP. Trial registration ClinicalTrials.gov (NCT03589963) registered July 18, 2018.
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Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale-Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Elle Richards
- The Stop Community Food Centre, Toronto, Ontario, Canada.,Tamarack Institute, Waterloo, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence-Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada.
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Ruggiero ED, Dennis CL, Kiss A, O'Connor D, Sellen D. Use of Expressed Breastmilk at Two Weeks Postpartum Is Associated With Early Cessation and Non-exclusive Breastmilk Feeding for Six Months in a Cohort of Vulnerable Women. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab046_083] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Pumping and feeding expressed breastmilk (EBM) in the early postpartum period are common but may not support longer-term breastfeeding outcomes. Our objectives were to examine in a cohort of vulnerable mothers of term-born infants: i) the prevalence of EBM feeding; and ii) associations between EBM use at two weeks and any and exclusive breastmilk feeding over the first six months postpartum.
Methods
We pooled data from two studies conducted with participants (n = 316) at three Toronto sites implementing the Canada Prenatal Nutrition Program, an initiative targeting vulnerable families. Socio-demographic data were collected prenatally or at two weeks postpartum. Household food insecurity was assessed at six months using the Canadian Community Health Survey module. A standardized questionnaire was administered prospectively at two weeks and two, four and six months postpartum to collect data on infant feeding practices in the previous two weeks. Descriptive statistics and logistic regression analyses were performed.
Results
The mean age of participants was 32 years, 91% were born outside Canada and 38% had lived in Canada less than three years. Nearly half (44%) reported household food insecurity. All participants initiated breastfeeding and 34% reported EBM use at two weeks postpartum. This declined to 24% at two months, 14% at four months and 8% at six months postpartum. Over the six-month follow-up period, 20% discontinued any breastmilk feeding and only 16% practiced exclusive breastmilk feeding. In adjusted models, EBM use at two weeks was associated with breastmilk feeding cessation (OR 2.75; 95% CI: 1.4–5.2) and non-exclusive breastmilk feeding for six months postpartum (OR 4.32; 95% CI 1.8–10.5).
Conclusions
EBM use in the first two weeks was a predictor of early cessation and non-exclusive breastmilk feeding for six months postpartum in our cohort of vulnerable women living in an urban Canadian context and accessing prenatal nutrition programs. Further research is needed to determine whether early EBM use is a marker for breastfeeding difficulties or undermines longer-term breastfeeding outcomes.
Funding Sources
Canadian Institutes of Health Research; The Sprott Foundation: Joannah and Brian Lawson Centre for Child Nutrition.
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Affiliation(s)
| | | | | | | | - Yi Man Ng
- Parkdale Queen West Community Health Centre
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Affiliation(s)
| | - Paola Ardiles
- Faculty Teaching Fellow & Lecturer, Social Innovation and Community Partnerships, Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Di Ruggiero E, Ardiles P. Perspectivas de la promoción de la salud frente a la COVID-19. Glob Health Promot 2021. [DOI: 10.1177/17579759211001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Paola Ardiles
- Simon Fraser University, Burnaby, British Columbia, Canada
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Potvin L, Ferron C, Terral P, Di Ruggiero E, Cervenka I, Foucaud J. Investigación, alianzas, intervención: el tríptico de la investigación de intervención en salud de la población. Glob Health Promot 2021. [DOI: 10.1177/1757975920987115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christine Ferron
- Fédération nationale d’éducation et de promotion de la santé (Fnes), Saint-Denis, Île-de-France, France
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Iris Cervenka
- Institut national du cancer (INCa), Boulogne-Billancourt, France
| | - Jérôme Foucaud
- Institut national du cancer (INCa), Boulogne-Billancourt, France
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