Rural and Northern Health - Doctoral theses

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Another fork in the road: the experiences of retired teachers and nurses living in Northeastern Ontario.
(2023-08-08) Patrick, Elizabeth Ann
Canadian women born after the Second World War, between 1945 and 1964, were both credited and criticized for their roles in challenging traditions and forging life pathways that were different to those before them. In recent decades, this cohort has been entering their retirement paths. This qualitative study explored stories about how some women were living the transcendent stage of later life in rural and small towns in Northeastern Ontario. Using a feminist narrative approach, twenty-one primarily boomer women were interviewed by telephone, using semi- structured questions. The women had retired from teaching or nursing, accomplished professional designations in their jobs, and lived in the target areas. Braun & Clarke’s (2022) reflexive thematic analysis was followed to generate codes and themes. Ten themes emerged: 1) how do I feel at this stage of my life?, 2) it’s my life, my time., 3) where did my identity go?, 4) what do I do now?, 5) the impact of gender roles on participants’ stories., 6) options for retirement and feelings about this life event., 7) expectations for the next fork in the road., 8) connection and purpose., 9) the importance of health-financial, mental and physical., and 10) let go, take the plunge. The results of this study supported the literature regarding retirement pathways; however, this group mainly identified with transitional or continuity models. Freedom to make choices, unencumbered by the rules of a job, resonated throughout the results. Data highlighted the importance of community and family involvement for overall health and wellbeing. This resilient group determined that they would learn new things and adapt to ongoing physical and mental health issues through staying busy and maintaining relationships with family and friends. Key words: Women, Retirement, Baby Boomers, Professional, Northeastern Ontario, Retirement pathways.
Chronic obstructive pulmonary disease (COPD): the Impact of occupational hazards in the minerals industry
(2022-02-11) Mongeau, Sherry
This study aimed to explore the psychosocial, occupational, financial, and physical impact of chronic obstructive pulmonary disease on underground workers in the minerals industry in Northeastern Ontario, describe their experiences with the Ontario workers’ compensation claim process. This study also aimed to communicate experiences of physicians and union workers with underground mineral workers diagnosed with COPD as an occupational illness and the Ontario workers’ compensation claim process experience. Data were collected via semi-structured telephone interviews with 16 underground mineral workers with occupational COPD, four union compensation representatives and four physicians (two primary care and two specialists). Interviews were transcribed verbatim, and a thematic analysis was completed. Examples of themes that arose from the findings of the underground mineral workers’ COPD group included: 1) COPD affects quality of life, 2) I smoked; I did not think I could get compensation, 3) the compensation process is a joke, 4) doctors do not know anything, and 5) working in the mine is a dirty job – we did not know any better. Themes from the union compensation representatives and physicians included: 1) additional support resources required, 2) smoking cessation is essential, 3) the compensation claim process is challenging, 4) occupational diseases are challenging to prove, and 5) occupational COPD is costly. These results suggested that advocacy is critical to ensuring underground workers receive the support they need to obtain approval of a compensation claim. The results also illustrated the need for further education about the ability to document and support an occupational illness for physicians and worker’s compensation caseworkers involved in caring for an underground mineral worker diagnosed with occupational COPD. Continued research about occupational diseases and the compensation claim process for those with COPD is required to address the barriers and challenges experienced.
The effectiveness of a care transitions and rapid response nurse intervention at reducing readmissions and emergency department use for high risk patients: a mixed methods study
(2015-08-21) McNeil, David
The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Achieving seamless transitions between care settings is viewed as crucial to high-quality care for frail older persons. Care transitions interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse events associated with the transition of the patient from the hospital to the home. This mixed methods study evaluates the effectiveness of a care transitions and rapid response nurse intervention at lengthening the time to first readmission and reducing total readmissions, emergency department use and total hospital bed days during the 30-day, 60-day and 90-day post-discharge periods for patients at high risk of readmission. The intervening impact of social isolation and patient frailty is evaluated. A randomized control trial was undertaken to evaluate the effectiveness of the intervention. Analysis was completed using the intention-to-treat principle. The primary end-point - the time to first readmission - was analyzed using the Kaplan-Meier survival analysis. The Fisher’s exact test compared differences in the post-discharge period, on the number of readmissions and emergency department visits and the Mann-Whitney-U test for hospital bed-days used. The intervening impacts of frailty and social isolation were evaluated using the independent t-test, Pearson correlation and two-way analysis of variance. Patient satisfaction with transition was evaluated using the Care Transitions Measure. Factors associated with inpatient and emergency department use were analyzed using a linear mixed model approach. No statistically significant differences were found between the intervention and control groups on the time to first readmission or in the post-discharge emergency department or inpatient bed use. Social isolation and frailty were not shown to significantly influence these outcomes but frailty was shown to be significantly associated with death. Men living alone were found to be more socially isolated. Linear mixed model analysis demonstrated that gender and previous emergency department and inpatient bed use to be significant predictors of future emergency department, readmission and inpatient bed use. No differences in patient satisfaction with the transitions were found between the intervention and control groups. A qualitative analysis was undertaken using focus groups and individual interviews, involving providers, to identify the factors that facilitated or were barriers to the implementation of this care transitions intervention. Using thematic content analysis, it was found that the effectiveness of transitional coordination efforts was thwarted by ineffective communication which affected the quality of the underlying relationships between the two teams. Other barriers to achieving the desired outcomes included: issues of role clarity, role awareness and acceptance of the positions within the respective organizations, the adequacy and reinforcement of coordinating mechanisms, and the effectiveness of the information exchange protocols. The combination of these factors limited the ability of the professionals to work effectively together to achieve the patient outcomes desired. Several improvement opportunities were identified. The activities of the individual professionals delivering care were patient focused.
The engagement of the raising the Spirit’ Mental Wellness Team with First Nation communities in the Manitoulin, North Shore and Bemwijaang Tribal Council areas
(2021-08-31) Manitowabi, Susan Jane
The “Raising the Spirit” Mental Wellness Team (MWT) was funded as a pilot project in 2007. Funding for this project was made available by the federal government under the Mental Wellness Advisory Committee (MWAC) Strategy (see appendix 1). This pilot project partnered with ten First Nations communities from the Manitoulin Island, North Shore and Waabnoong Bemwijaang Tribal Council areas, in Northeastern Ontario. The goal of this pilot project was to work collaboratively with mental health and addiction workers and other service providers to improve access to specialized services; enhance knowledge, skills, and capacities of community workers; provide support, consultation, clinical supervision, coaching and mentoring; and, braid traditional and mainstream approaches to wellness. The focus of this research study was to evaluate how the MWT pilot project maintained the engagement and support of the participating First Nations communities. Areas explored included: the collaboration within and across Aboriginal communities; the integration of mainstream and traditional approaches; and, capacity building at the community level. Self -reflective journals, photovoice and narrative storytelling interviews were chosen because of their congruence with traditional ways of knowing and understanding which were also viewed as being culturally appropriate. These evaluation methods were extremely powerful means of telling the story of the relationship between the MWT and the First Nations communities involved in this project. One major contributing factor that enhanced the ability of the MWT pilot project to maintain the engagement with the First Nations communities was the strong commitment to the intent of the iv pilot project by all partners. Although there were many challenges that could have impacted the ability of the MWT to engage with the First Nations communities, there was good support from the First Nation leadership who recognized the benefits of enhanced mental health and addictions services in their communities. The pilot project offered an opportunity for the First Nations communities to access additional mental health and addiction services as well as increased access to traditional healing services. The Traditional Advisory Committee (TAC) was instrumental in creating opportunities through the Traditional Teaching Series for frontline workers to learn more about traditional healing practices and teachings. This had the added benefit of increasing their skills and abilities to utilize both traditional and mainstream approaches in their service provision to their clients, as well as themselves and their families.
Evaluating mental disorders and physician-based mental health services for patients enrolled in opioid agonists treatment across Ontario, Canada
(2020-06-15) Morin, Kristen A.
The overall purpose of this thesis was to explore the relationship between physician-based mental health services and all-cause mortality, emergency department visits and, hospitalizations among patients receiving opioid agonist treatment (OAT) in different regions of Ontario. I conducted a retrospective cohort study using secondary health administrative data from ICES. Specifically, I used the Ontario Health Insurance Plan (OHIP) and the Ontario Drug Benefit Plan (ODB) databases to identify patients. Eligible patients were 15 years of age and over and were receiving OAT from January 1, 2011, and December 31, 2015. I conducted quantitative analyses using logistic regression and propensity score matching methods to test the relationship between concurrent physician-based mental health services and OAT and health service outcomes. Five core findings were brought together in this thesis: (a) having a diagnosis of one or more mental disorders while in OAT was associated with a higher likelihood of mortality and a more complex profile of health service utilization when compared to patients in OAT who had not been diagnosed with mental disorders; (b) active engagement in OAT was associated with a reduced likelihood of all-cause mortality, emergency department visits, and hospitalizations compared to patients who had been but were not actively engaged in OAT; (c) receiving mental health services from physicians (i.e., psychiatrists, primary care or both) while actively enrolled in OAT was associated with a reduction in the likelihood of all-cause mortality compared to patients not receiving mental health services while in OAT; (d) physician-based mental health services (from psychiatrists, primary care or both) while enrolled in OAT was associated with frequent ED visits and hospitalizations; and (e) fewer patients accessed mental health services while enrolled in OAT in northern and rural Ontario compared to southern and urban regions of the province.
Evaluating the quality of work life of registered nurses in urban, rural and remote Northeastern Ontario
(2017-09-07) Horrigan, Judith Mary
The sustainability of our Canadian healthcare system to meet the demands of healthcare and healing for clients in urban, rural and remote hospital settings are dependent upon nurses’ health and the quality of nurses’ work life. The purpose of this research was to understand how Northeastern Ontario registered nurses’ (RNs’) in urban, rural and remote hospitals evaluated their quality of work life (QOWL), to examine similarities and differences of RNs’ evaluation related to their geographic locations, and to identify what QOWL and nursing practice environment factors were associated with nurses’ stress. A mixed methods sequential explanatory design was conducted that used an adapted version of the Nursing Work Life Model as the theoretical framework for Phase I. Quantitative data were collected from RNs working in urban, small urban, rural and remote Northeastern Ontario hospitals (n=4). The questionnaire consisted of demographic questions, the Brook’s Quality of Nursing Work Life, the Practice Environment Scale, the Nursing Stress scales (NSS), and a section for RNs to write comments. Multiple and logistic stepwise backward regressions were conducted to determine factors associated with nurses’ QOWL and stress scores. Phase II face-to-face interviews of RNs and nurse leaders (n=17) were conducted to explicate findings from Phase I results. Thematic analysis of participant comments (n=53), and semi-structured interviews were guided by Thorne’s (2008) Interpretative Description methods. A total of 319 packages were distributed and yielded a 54.23% response rate (n=173). The majority of RNs were female (93.1%) and ranged in age between 20 and 29 years (mean = 35.9, s.d. 11.0). Results from the QOWL multiple regression analysis indicated three key factors that explained 35% of the variance (R2 0.353) that included: general health, exhaustion, and factors in the staffing subscale of the Practice Environment Scale. Four key factors were associated with nurses’ stress scores that explained 42% of the variance (R2 0.423) and included: workload, work-home life balance, adequate support services, and factors of the nursing ability subscale of the Practice Environment Scale. Nurses who reported decreased presence of factors associated in the Nursing Quality subscale were 12.39 (95% CI: 2.58- 59.64) times as likely to have lower QOWL scores (≤163). Nurses who did not have adequate support services that allowed nurses to spend time with patients were 3.56 (95% CI: 1.78, 7.10) times as likely to report higher stress scores (≥ 78). The overarching theme summarizing the findings was revealed to be Supporting Holistic Client Healing and Nurse Healers that described nurses’ and nurse leaders’ evaluation of Northeastern Ontario nurses’ QOWL and stress. This was supported by five key themes: 1) Holistic Healing of Clients: Dueling Ideologies, 2) Facilitating Healing at the Bedside: Supporting Nurses’ Work Life, 3) Geographical Hindrances to Healing: Healthcare System Inequalities, 4) Supporting Healing Beyond the Hospital Bedside: Healthcare System Inequities in Policies, Funding and Decision-Making Processes, and 5) Nurses’ QOWL and Health Consequences. The findings of this research elucidated new knowledge related to factors impacting Northeastern Ontario nurses’ ability to provide quality holistic care to facilitate their clients healing processes, which affected nurses’ QOWL and stress. Supporting the holistic healing of clients and nurse healers requires nurses being able to access the supports and resources they need that maintains their legal and ethical standards of care. Inequitable healthcare system policies and decision-making processes that perpetuate healthcare system inequalities need to change. Improving nurses’ QOWL and stress requires a concerted effort by several stakeholders. Healthcare policies and decision-makers need to listen to the voices of nurses and healthcare providers who live and work in rural and remote settings across Northern Ontario. New and unique solutions and policies can be created that may eventually actualize the vision of the delivery of high quality healthcare services that are equitable for all Ontarians regardless of their geographic location.
An evaluation of the quality of care of diabetic patients with multimorbidity at nurse practitioner-Led clinics in the North East and North Simcoe Muskoka LHINs
(2018-06-05) Heale, Roberta
A multiple case study was undertaken with five Nurse Practitioner-Led Clinics (NPLCs) in in the North East and North Muskoka Simcoe Local Health Integration Networks in Ontario, Canada. The purpose was to evaluate the quality of care in NPLCs, specifically to address the following research questions: What is the relationship between organizational processes in the NPLC model and the care of diabetic patients with multimorbidity? To what extent are clinical practice guideline indicators for diabetes care being met for patients with multimorbidity in five NPLCs? How do nurse practitioners practicing at NPLCs evaluate the impact of the NPLC model on the quality of the care they provide to diabetic patients with multimorbidity? The research was guided by the Donabedian Quality Framework. The study included three types of data collection. First, documents related to NPLCs were collected and the impact of the nurse practitioner (NP) as primary care provider was analyzed. Then the Chronic Care Model was used to guide the development of a chart audit in each of the five NPLCs, conducted on 30 charts per clinic (n= 150) for non-pregnant, adult diabetic patients with multimorbidity. Analysis determined relationships between diabetes indicator scores and organizational and patient data. Next, 8 NPs from 4 of the 5 NPLCs participated in interviews, guided by semi-structured questions arising from the document review and chart audit analysis. Interpretive description methods were used to analyze the transcripts and identify themes. A cross-case analysis was conducted to compare the results of all analyses across NPLCs. Themes emerging from this multiple case analysis confirmed that the NP is the primary care provider and clinical leader at NPLCs, which has contributed positively to the quality of care in NPLCs. NPLCs have suffered from poor NP recruitment and retention. This, along with insufficient health care resources in the communities where NPLCs are located and high patient vulnerability, has had a negative influence on the quality of care. Strategies including mentoring and changes to funding offer possible solutions to improve the quality of care at NPLCs. (336 words)
Evidence-based strategies in occupational health: applying meta-analytic and qualitative methods to identify and understand sickness absence among nurses and health care aides with considerations for Northeastern Ontario
(2018-12-17) Gohar, Basem
Purpose: Compared to other employees, nurses and health care aides (HCAs) have the highest sickness absence rates in Canada yet the phenomenon remains insufficiently studied. Furthermore, the potential influence of geography on sickness absence has received scant attention. Guided by the Evidence-Based Practice in Occupational Health Psychology framework, this investigation aimed to identify factors associated with sickness absence, understand how they occur, and determine factors that may be specific to communities in northeastern Ontario. Methods: A systematic review identified relevant studies through structured search strategies, article screening, and quality testing. Pooled statistics in the form of odds ratios and confidence intervals were computed. Follow-up analyses examined heterogeneity (Q& I2). Qualitatively, focus group sessions were held with registered nurses (n= 6), registered practical nurses (n= 4), HCAs (n= 5), and key informants specialized in nursing, occupational health, disability management, and rehabilitation (n= 5). Nursing personnel were recruited from hospitals and long-term care facilities. Narrative data were analyzed using thematic analysis. Results: Meta-analytic searches yielded 812 studies, of which 27 met eligibility, and 11 variables that influenced the odds of sickness absence in a statistically significant manner (p< .05). Variables include: sex, occupation, health rating, previous sick leave, musculoskeletal pain, poor mental health, fatigue, night shifts, pediatric and psychiatric units, increased occupational demand, and work support. Poor health rating was highly heterogeneous (p< .05; I2= 82.77%). Thematic analysis revealed four primary themes: (1) Organizational factors including exposure to infectious diseases, shift work, safety climate, and work setting; (2) the jobs’ physical impact, mainly musculoskeletal pain; (3) psychological/mental impact including guilt, anxiety, and burnout; and (4) factors unique to northeastern Ontario including poor weather and road conditions, especially for HCAs providing home care, and the limited opportunity of interconnected health care networks where employers make staff available during worker shortages. Factors leading to sickness absence were described, with staff shortage serving as an important underlying contributor. Conclusion: This investigation points to the complexity and intricacy of factors influencing sickness absences. The qualitative results helped deepen the understanding of the quantitative findings, while considering northern-specific factors. Several concerns were attributed to staff shortages.
An exploration of interprofessional education in four Canadian undergraduate nursing programs
(2019-01-25) Donato, Emily
Formal inclusion of interprofessional education (IPE) curricula within Canadian undergraduate nursing programs has been occurring since 2012. While there is evidence that Canadian university nursing programs are working to achieve the integration of IPE throughout undergraduate curricula, a gap exists in what is known about IPE integration in Northern Ontario nursing programs, particularly from the perspectives of faculty members and program administrators. This multiple case study explored how four undergraduate university nursing programs in Northern Ontario integrated IPE into their curricula, including the opportunities and challenges of this work. Program experiences were explored within, and across, four undergraduate nursing programs located in Sudbury (including both English language and French language programs), Thunder Bay, and North Bay. Data acquisition strategies consisted of interviews with program directors (n=3), focus groups (n=10) and interviews (n=3) with faculty members, review of available program documentation and websites, and on-site program observations. Thematic analysis was undertaken for each case and during the cross-case analysis stage. The cross-case synthesis resulted in the following themes: 1) varied understandings of IPE, 2) diverse IPE learning activities within curricula, 3) the requirement for support and resources for IPE and research, 4) student participation and leadership in IPE, and 5) limited IPE evaluation. These results highlight IPE practices within these nursing programs and what supports them. Faculty development, IPE research, student involvement, and administrative support are required to maintain and sustain IPE. Dissemination of results may encourage further research and dialogue on current IPE practices among nursing programs in Northern Ontario and beyond.
Exploring how indigenous healing practices and a western treatment model “seeking safety” can co-exist in assisting indigenous peoples to heal from trauma and addiction
(2016-03-09) Marsh, Teresa Naseba
Background: Indigenous communities in Canada face significant challenges with trauma and substance use disorders (SUD). Most Elders, traditional healers and Indigenous scholars agree that connecting to culture, land, community, and spiritual practices is a pathway to healing trauma and SUD in Indigenous peoples. The purpose of this study was to explore whether the blending of Indigenous healing practices (IHP) and a mainstream treatment model, Seeking Safety (SS), resulted in a reduction of intergenerational trauma (IGT) symptoms and SUD. The SS model has been studied in other populations but there was no evidence of its effectiveness with Indigenous peoples. Some studies have shown the positive impact of Indigenous healing practices on SUD. Methods: A mixed-methods design was used to evaluate the impact of a 13-week Indigenous healing practices and Seeking Safety (IHPSS) implementation project. This was a pilot study with one group of 12 Indigenous women and one group of 12 Indigenous men (n = 24) in Northern Ontario. Semi-structured interviews and focus groups were conducted at the end of treatment. The transcripts underwent qualitative thematic analysis to depict themes and understand the ways in which the program promoted healing. Data was collected pre- and post-implementation using the following assessment tools: the Trauma Symptom Checklist-40 (TSC-40), the Addiction Severity Index-Lite (ASI-Lite), the Historical Loss Scale (HLS), and the Historical Loss Associated Symptom Scale (HLASS). The effectiveness of the new program was assessed using paired t-tests, with the TSC-40 as the main outcome. Results: A total of 17 participants completed the study. Four core themes emerged from the qualitative data that showed a positive impact on the symptoms and behaviors related to IGT and addiction in the participants. The benefits from both Indigenous healing practices and SS were clearly depicted through the voices and viewpoints of all 17 participants. Participants demonstrated improvement in the trauma symptoms, as measured by the TSC-40, with a mean decrease of 23.9 (SD=6.4, p=0.001) points, represented a 55% improvement from baseline. Furthermore, all six TSC-40 subscales demonstrated a significant decrease: anxiety (p = 0.001); depression (p=0.000); sexual abuse trauma index (p=0.0011); sleep disturbance (p=0.003); dissociation (p=0.027); and sexual problems (p=0.037). Substance use did not increase as measured by the ASI-Lite alcohol composite score (mean difference = -0.011) and drug composite score (mean difference = 0.032). Conclusion: Evidence from this mixed-methods pilot study indicates that blending IHP with the SS model was beneficial in reducing trauma symptoms. The combination of IHP and mainstream healing methods has the potential to enhance the health and well-being of Indigenous peoples.
Exploring the influence of language concordance and the active offer of French language physician services on patient satisfaction through a Northern Ontario continuing professional development initiative
(2023-01-16) Timony, Patrick
Francophone minority populations across Canada experience poorer health outcomes. A lack of French language health services may be a contributing factor. Interpersonal communication between patient and physician is essential to providing quality health care and the legislative landscape in Ontario is evolving to become more responsive to Francophone communication needs. For instance, the passing of Bill 74 and the modernisation of the French Language Services Act (that was first passed in 1989) have created an expectation that health service providers will proactively offer services in French. The purpose of the present thesis was to develop and evaluate the effectiveness of a continuing professional development (CPD) program that teaches patient-centered communication through the active offer of French language services; to investigate the presence of the active offer in Northeastern Ontario; and to explore the influence of language concordance and the active offer on patient satisfaction.
Food insecurity, poverty and lived experience of homelessness: a study of women in Northeastern and Southwestern Ontario
(2019-03-21) Al-Hamad, Areej
Understanding the connections between geographical location (Northern vs Southern Ontario) and gender inequalities and food insecurity, poverty, homelessness and health is vital within the current social and political context characterized by restraints in public funding. First, this study describes the experiences of poor and/or homeless women with or without dependents in two mid-size urban communities in Northeastern Ontario (City of Greater Sudbury) and Southwestern Ontario (City of London Ontario) with regard to food insecurity, homelessness, poverty and the perceived impacts on physical and mental health. Second, it identifies the profile of food-insecure women in Northeastern and Southwestern Ontario, as well as the factors associated with their general and mental health perceptions. The study employed a sequential descriptive multi-methods approach to address the objectives. A descriptive, qualitative exploration of food insecurity experiences among poor and/or homeless women in the two regions was conducted. Data were collected through a semi-structured interview with twenty poor and/or homeless women, 10 from each of the two communities. The participants were near homeless or absolutely homeless and all had prior histories of homelessness. The interview data were thematically analyzed. Subsequently, a quantitative secondary data analysis of extracted variables including sociodemographic, health and food insecurity from the Canadian Community Health Survey (CCHS, 2014) was conducted to describe the profile and factors associated with general and mental health perceptions for 408 women in the northeast and southwest of Ontario. The main themes were food and financial hardship, motherhood, resourcefulness and health perceptions. The quantitative findings did not capture the association between health perceptions and place of residency among food-insecure women. The general and mental health perceptions of these women were significantly related to household size, employment, worries about running out of food, inability to afford balanced meals and cutting or skipping meals regardless of where they lived. This study’s findings highlight the intersection of geography, health, gender and vulnerability to food insecurity and show that Northeastern and Southwestern women merit greater attention and support in accessing nutritious food. Such findings are important in shaping gendered public and social policies.
Giishpin Nonagzwaat Binoojiinyik Kanim Na Majiishkaami: determinants of obesity among indigenous children in six First Nations Communities in Northeastern Ontario
(2018-05-16) McGregor, Lorrilee E.M.
Background: Worldwide, childhood obesity rates are high and even higher among Indigenous children. Childhood obesity is of concern as it can result in metabolic conditions. Much has been written about the causes of obesity, usually focusing on individual behaviours, but a gap exists in understanding the social determinants of obesity in Indigenous populations. Methods: Survey data was collected from First Nations students in grades 6 to 8 through a diet and health behavior survey. Measurements including height, weight and waist circumference were taken. Focus groups with 33 caregivers were conducted to explore the determinants of physical activity and nutrition. Results: The prevalence of overweight/obesity in children was 65.8%. The prevalence central obesity was 37.7%. There was a strong positive correlation between waist circumference (cm) and BMI z scores (rs = 0.84, p>0). Daily physical activity (DPA) of 60 minutes per day was associated with a BMI ≤85th percentile and a waist circumference ≤90th percentile. Girls consumed 3.5 servings of fruits and vegetables and boys consumed 2.5 servings. Consuming fruit juice was directly associated with central obesity. Normal weight was associated with participation in at least four types of cultural activities. Caregivers identified impediments to physical activity as financial, recreational technology, safety concerns, and community activation. Changes in lifestyles, influenced by the consequences of colonization, have resulted in reduced physical activity. Colonial policies result in funding challenges for children’s recreation programs and a reliance on government develops. Safety concerns stem from intergenerational trauma created by colonial policies. Dietary decisions were influenced by the availability of fish and game, hunting and fishing regulations, food insecurity and the proliferation of processed foods. Dietary decisions are influenced by the contamination of traditional territories, the marginalization of culture, participation in the economy and issues of poverty. Conclusions: Waist circumference is an effective indicator of obesity along with BMI and should be used in public health screening of Indigenous children. Low fruit and vegetable consumption is of concern as is the consumption of fruit juice. Protective factors against obesity are 60 minutes of DPA and participation in at least four types of cultural activities. Colonialism is a determinant of physical activity, nutrition, and obesity in this population.
Health equity and rurality in Northern Ontario
(2021-07-28) Scott (Spiro), Grace M.
Background: The current climate in Ontario, Canada is one where access to health and social services, healthcare experience and health/social outcomes vary widely across the province. The existing health disparities in Ontario disproportionately affect those living in rural and northern areas. Current indicators used to measure this variability have been developed in the context of health systems in more densely populated areas and may not be relevant for more rural and remote geographic areas. As such, the objectives of this thesis were: (1) to develop a health equity measurement approach specific to Northern Ontario based on input from Northern Ontario health decision-makers, and (2) to operationalize a rurality measurement approach for Northern Ontario. Methods: This two-phase exploratory sequential mixed methods study included a qualitative inquiry followed by a descriptive rurality measurement. The first phase explored health equity measurement in the context of Northern Ontario through in-depth interviews with Northern Ontario health equity key informants. The resulting thematic analysis informed a proposed Northern Ontario health equity measurement approach and the rurality stratifier exploration in phase-two. The second phase included a descriptive analysis using secondary data. The two rurality measurement approaches included were Statistical Area Classification Type and the Remoteness Index. Chi -squared tests for independence were used to assess the level of association between all classification methods including alternate categorization approaches within the Remoteness Index measure. Results: The thematic analysis in phase-one revealed four health equity indicators of relevance to Northern Ontario: infant mortality, overall mortality, perceived health status, and satisfaction of health care received. Furthermore, two stratifiers were identified as uniquely important to measuring health equity in Northern Ontario contexts. These two stratifiers included geographic position (rurality), as well as material welfare (income). The descriptive analysis of the rurality stratifier in phase-two recommended two methods of categorization using the Remoteness Index to consider as a complement or replacement to the Statistical Area Classification Type approach. Conclusion: This exploration of health equity measurement in the context of Northern Ontario proved to be a feasible and productive way to engage key informants in health equity indicator/stratifier selection and recommendation. Certain health equity stratifiers – including rurality – are elusive to define and measure; however, the Statistical Area Classification Type and Remoteness Index should both be considered as rurality measures in Northern Ontario.
"If we have the knowledge, then that is power to help our expectant moms": Northern Ontario health care students' knowledge and attitudes addressing alcohol consumption during pregnancy.
(2017-09-28) Coons, Kelly D.
The current document is a paper-based dissertation investigating health care professionals’ knowledge, attitudes, and self-efficacy regarding fetal alcohol spectrum disorder (FASD) and alcohol consumption during pregnancy. This dissertation incorporates findings from a secondary data analysis of health care professionals in Ontario, as well as original data from health care students training in Northern Ontario. While previous research has demonstrated that health care professionals remain under-educated concerning FASD and alcohol use during pregnancy, limited research has investigated the knowledge and experiences of health care students. The first paper included is a secondary data analysis of the 2001-2002 Fetal Alcohol Syndrome Survey for Health Professionals. Ontario-specific data (N=834) were used to examine the awareness of FASD held by various provider groups in both rural and urban settings. Results from this study indicate that many physicians, midwives, and other health care professionals may have inconsistent knowledge regarding the impact of prenatal alcohol exposure, resulting in mixed messages for women of childbearing age about the safety of alcohol use during pregnancy. The second paper included is a qualitative analysis of scenario-based vignettes regarding alcohol use during pregnancy. Although almost all students (N=21) recognized that no alcohol consumption during pregnancy is the safest recommendation, many students noted that this advice is not always conveyed to pregnant women. Finally, the third paper included is also a qualitative analysis based on a thematic analysis of scenario-based vignettes and semistructured interviews. The third paper explores health care students’ (N=21) attitudes and beliefs about women who may continue to consume alcohol throughout their pregnancy and presents the often stereotypical and stigmatic perceptions of FASD and alcohol use during pregnancy held by health care professionals. Recommendations and implications for increasing students’ and professionals’ knowledge and self-efficacy regarding FASD management and prevention are discussed.
The impact of childhood obesity discourses on domestic and reproductive labour for single mothers in Northeastern Ontario : an institutional ethnographic study
(2018-08-24) O’Gorman, Laurel
Rationale: The term “healthy children” is often used to describe children whose weights are within a socially acceptable range which conflates health with thinness, often completely overlooking other aspects of health and employing body-stigmatizing language about children. Research Questions: 1. How do single mothers who live in poverty in Northeastern Ontario define good health for their children? What role do considerations of obesity play in their definition of good health? 2. What are the implications of participants understanding of health on their domestic and reproductive labour? 3. How are these experiences mediated by the families’ social location? Theory: Institutional ethnography (IE) is a theory and a method. IE investigates the coordination of ideologies that shape people’s experiences. Institutions made up primarily of government bodies and medical experts shape how childhood obesity is discussed in schools, the media, and in everyday life, impacting how we understand and speak about children’s bodies. This includes the amount and types of work expected of parents (primarily mothers) as well as the implications for bodies that do not meet the standard deemed acceptable in a particular time and place. Method: The research participants were twenty women residing in Northeastern Ontario who self-identify as a single mother living in poverty. I used two methods of data collection: interviews and guided tours of key areas impacting children’s health, such as grocery stores or places children play. Analysis: I analysed the interviews and the interactions between participants and their environment using an institutional ethnographic approach to coding. The aim of the analysis is to link the everyday lived experiences of research participants to the ruling relations in which they are shaped. Results: Participants talked about children’s health in ways that were consistent with obesity discourses. When I asked what the term healthy child meant to them, the first response was usually ‘food’ followed by ‘physical activity’. Mothers described a great deal of work that went into trying to make decisions that they felt were healthy. However, they also described many barriers to providing the types of healthy foods and activities they would like to provide for their children.
An interpretive description of health equity in chronic obstructive pulmonary disease (COPD) clinical practice guidelines
(2023-06-21) McMillan Boyles, Christina
Health equity is an increasing global phenomenon of interest among health care professionals (HCPs), researchers, and decision-makers. Clinical practice guidelines (CPGs) serve to promote standardized care and may have implications relative to health equity. Health care professionals rely on evidence including CPGs to be accountable, provide optimal care, and to advance advocacy efforts for people with chronic lung disease. However, CPGs for COPD may unintentionally exacerbate health inequities and health disparities experienced by those living in northern or rural areas where there may be decreased access to supports such as spirometry, pulmonary rehabilitation, and specialist care. The purpose of this study was to conduct an interdisciplinary analysis of COPD CPGs to understand the contribution and implications of these guidelines to health equity for individuals living with COPD. Different perspectives and representations of health equity across the guidelines may have problematic implications and challenges for patients, HCPs and decision-makers. The research question guiding this study is how do CPGs for COPD explicitly or implicitly address health equity? The study design, interpretive description, was guided by critical social theory. Using purposive sampling, publicly available international, national, and provincial English language CPGs for COPD were selected. Concurrent data collection and analysis was informed by five items of The Equity Lens instrument and the four items of Domain 5, outlined in the Applicability of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. The four stages of content analysis are decontextualization, recontextualization, categorization, and compilation. The results offer opportunities to engage multiple interdisciplinary knowledge users in dialogue about the implications of CPG adoption to move toward health equity and to best service individuals with COPD in Northeastern Ontario.
« Je ne me reconnais plus » : rupture biographique de l’identité sexuelle de femmes aux prises avec un cancer gynécologique – une recherche narrative appuyée par la création artistique
(2021-12-16) Rivard, Sylvie
Cette recherche narrative, ancrée dans des valeurs féministes et une démarche de réflexivité, aborde l’expérience de femmes aux prises avec un cancer gynécologique. Les concepts abordés ciblent les expériences de femmes francophones vivant en contexte linguistique minoritaire dont le corps est marqué par la maladie et les traitements médicaux, leur fonctionnement sexuel, l’expression de leur sexualité et de leur identité. L’identité narrative (Bamberg, 2011; Reissman, 2008), l’identité corporelle (Le Breton, 2016) et l’identité sexuelle (Dillon et coll., 2011; Worthington et coll., 2002) sont mises en lien avec divers éléments – notamment l’hégémonie hétérosexuelle et l’hétérosexualité obligatoire (Rich, 1980) – afin de dégager comment ces femmes s’identifient lorsque la maladie et les traitements altèrent leur corps, son fonctionnement, et en conséquence, leur identité familière et préférée. La méthodologie de recherche narrative (Clandinin, 2007; Reissman, 2008), dont le récit de vie (Atkinson, 2007; Bertaux, 2005) appuyée par l’art (Cole et Knowles, 2008) utilisée dans cette thèse de doctorat permet d’explorer, raconter et représenter une multiplicité d’expériences vécues. L’histoire individuelle des quatre participantes est accompagnée des autoportraits qu’elles ont créés à l’aide de médiums artistiques : le moulage du corps et le collage. Par la suite, une analyse narrative thématique dégage les thèmes suivants : prendre conscience de la possibilité de sa mort; vivre dans le moment présent; reconfigurer ses attentes du futur; composer avec des défis dans la langue de communication avec le personnel médical et l’expérience de la dilatation vaginale. Une analyse narrative structurelle présente comment, à la suite de traitements médicaux, ces femmes ne se reconnaissent plus dans leur corps et leur identité sexuelle de femme hétérosexuelle. L’invisibilité des effets de la maladie, des traitements et du stigmate social qu’elles y associent, la menace à leur vie, les multiples pertes et la pression des normes sociétales hétérosexuelles où la pénétration du pénis dans le vagin est le mode d’expression privilégié et perçu comme essentiel dans leurs relations de couple, sont des facteurs vécus comme une rupture biographique qui les contraignent à une transformation de leur identité. Enfin, une analyse narrative dialogique/en action réflexive explore mon engagement en tant que chercheure et mes interactions avec les participantes.
Kijiikwewin aji: sweetgrass stories
(2017-01-01) Wabie, Joey-Lynn
Kijiikwewin-aji means ‘to become a woman now’ in Algonquin and describes the heart of the research. Sweetgrass stories shares the title of this thesis as it is part of the research methodology used with traditional Indigenous women. Through grounding myself with Indigenous Grassroots Theory, the creation of an Algonquin Indigenist paradigm and my relationship with knowledge, I formed an Indigenous research methodology called sweetgrass story weaving which focuses on traditional Indigenous women as they share their moontime stories. Within this thesis, I also share information relating to the historical roots and present state of rites of passage with traditional Indigenous women and discuss the research journey using the concept of ethical space. Using an international, national and grassroots level focus on strength, resilience and power, you will read traditional Indigenous women’s voices as they look back through lived experiences; hope and determination when looking forward to the future, and the shared theme of wanting their cultural traditions and ceremonies to live on through future generations of Indigenous girls and women, including young men. What is the current state of the Berry Fast, understanding the assimilative nature of colonization and the effects it has had on Indigenous women? How can we continue to honour these rites of passage while living in a world both with traditional Indigenous worldviews and colonial constructs? I propose the introduction of a sweetgrass knowledge transfer model for the Berry Fast using the transferrable characteristics harvested from my research methodology. This knowledge transfer model has the capacity to increase accessibility and decrease the difficulty in completing the Berry Fast in order for traditional Indigenous women to complete it in the present day. Furthermore, the introduction of the sweetgrass knowledge transfer model for the Berry Fast can assist with framing the perspective of Indigenous women as powerful beings who elicit respect and an equal place in contemporary society. Over time, the collective strength and wisdom of traditional Indigenous women will increase which is a step in the decolonized direction of preventative health care which promotes mino bimaadiziwin.
The lived experience of Anishinaabe people with cancer: a focus on Indigenous healing, Western medicine and Minobimaadiziwin
(2015-05-26) Peltier, Cindy M.
Cancer is a leading cause of death in Anishinaabe people and the incidence is increasing. Despite reported successes of integrating Indigenous healing and Western medicine in the treatment of addictions, domestic violence, mental health, palliative care and chronic illness, there is a paucity of such information for cancer. A number of studies highlighted the need for awareness for policy makers and physicians of the contribution of Indigenous healing to cancer care, as well as the need for cultural safety. This Indigenous inquiry examined potential benefits and challenges of including Indigenous healing in cancer care. Using a participatory approach, I investigated how the cancer experience was affected when Anishinaabe people included both Indigenous and Western medicine in treatment and when they did not. This inquiry also examined how Indigenous healing assisted in achieving Minobimaadiziwin, an Anishinaabe understanding of health. Interviews were conducted with thirteen adults diagnosed with cancer from five Manitoulin First Nation communities. Seventeen key informant interviews were conducted with those working from Indigenous and Western health perspectives. A conversational method was employed in this Indigenous research as it honoured the oral tradition of the Anishinaabe and was concerned with co-creating knowledge in a relational context. Understanding stories involved Indigenous knowledge and Western theory, framed as two-eyed seeing. Participants recognized that Minobimaadiziwin could not be realized with Western medicine alone. With the inclusion of IH/TM and recognition of the spiritual component of life, a person can approach Minobimaadiziwin despite the obstacle of cancer along their path. This is best iv facilitated by braiding the two types of healing. Dissemination of results took two forms: a collective, teaching story for the Anishinaabe people concerning cancer and Minobimaadiziwin and publications concerning potential benefits of and challenges with pluralistic medicine for Anishinaabe cancer care.

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