7th Annual McGill Family Medicine Research Symposium | May 12-13, 2022
Family Medicine Graduate Student Society (FMGSS)
Published online: 13 May 2022National Dementia Strategies in OECD Countries: A Focus on Inequities
Corresponding Author: Georgia Hacker, email georgia.hacker@mail.mcgill.ca
Abstract
Background: In response to global increases of dementia prevalence, several countries have developed national strategies to address dementia as a public health priority. These strategies aim to improve dementia care, supports, and resources for persons living with dementia, care partners, and communities. Inequities impact dementia care and health outcomes, however it is unclear whether dementia plans adequately address these inequities. Objectives: This review aims to (1) identify factors that may correlate with the development of dementia strategies, (2) describe if and how inequities are mentioned in these plans, and (3) assess whether specific objectives exist to mitigate these inequities. Methods: This review uses an environmental scan to identify, analyze, and evaluate the existing national dementia strategies of countries that are members of the Organization for Economic Cooperation and Development (OECD). Two national databases of grey literature were searched for national dementia strategies. After identifying where national dementia strategies have been developed, an analysis of the current health care context was conducted to identify trends and correlations between dementia strategy implementation and the demographic, political, and social environments of the countries in which they currently exist. Dementia strategies were analyzed for the presence of equity-focused targets of concern, and then evaluated based on the existence of specific objectives to mitigate inequity in dementia care. Results: As of 2021, 27 of 38 OECD countries had national dementia strategies, the development of which may have been impacted by economic factors like Gross Domestic Product and Health Spending. Of the 15 included dementia strategies, 13 mentioned one of the following inequities: Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Of the strategies that mentioned at least one inequity, 11 had general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage goals, deadlines, or allocated budgets for achieving the goals of their dementia strategies. Conclusion: This environmental scan contributes to a more comprehensive understanding of how healthcare inequities are being addressed in dementia care. To equitably care for all people, this scan suggests that there is a need to evaluate current national dementia strategies, determine if existing policy is adequately structured to mitigate inequities in healthcare, and if not, modify policy based on the current status of dementia globally.
Understanding and Managing the Impact of Mental Health Conditions on the Care Cascade Among Women Living with HIV
2Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
3Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
4Department of Psychiatry, McGill University, Montreal, QC, Canada.
5MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
6Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
7Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
8Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
9Department of Medicine, University of Toronto, Toronto, ON, Canada.
10Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
11Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
Corresponding Author: Seerat Chawla, email seerat.chawla@mail.mcgill.ca
Abstract
Background: The HIV care cascade model describes the steps required for people living with HIV to maintain health. Poor mental health can impact care at every step of this cascade, from delaying diagnosis to interfering with viral suppression. Women living with HIV (WLWH) are more likely to have mental health conditions than both men living with HIV and HIV-negative women. Nevertheless, WLWH remain undertreated for these comorbidities. Furthermore, not much is known about the impact of mental health on the engagement of women in the HIV care cascade over time. Objectives: We aim to (1) estimate the association between depressive symptoms and transitions between states of care among WLWH in Canada over three years and (2) describe the access to and use of mental health services among WLWH with mental health conditions, identifying factors associated with unmet needs for these services. Methods: This project will use data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, in which 1,422 WLWH were followed over three years. Depressive symptoms were assessed annually using the Center for Epidemiological Studies Depression Scale (CES-D). We will use multistate Markov models to determine the association between time-updated CES-D scores and the probabilities of transitioning between the states of care. The access and use of mental health services among WLWH will also be examined through descriptive statistics and sociodemographic and clinical characteristics associated with shortage of mental health support will be identified through regression analyses. Anticipated Results: Given the negative impact of poor mental health identified in cross-sectional analyses, we anticipate that depressive symptoms will be associated with transitions to less favorable states of care over time. Additionally, we hypothesize that more marginalized WLWH such as racial and sexual minorities will have greater unmet needs for mental health services. Implications: Understanding the impact of depressive symptoms on women’s trajectories across the care cascade will aid in the care and management of WLWH with mental health conditions. Surveying the current landscape and uptake of services will also inform policy regarding the integration of community mental health resources into primary or HIV care. These results will be discussed with WLWH, decision-makers, and clinicians to identify solutions to improve both HIV and mental health outcomes for this population.
Experiences with primary-gender affirming care for trans women: a quantitative analysis and mixed-methods review
2Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
3Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
4School of Social Work, University of Michigan, Ann Arbor, MI, USA
5MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
6Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
7Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
8Department of Medicine, University of Toronto, Toronto, ON, Canada
9Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
10Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
Corresponding Author: Bluma Kleiner, email bluma.kleiner@mail.mcgill.ca
Abstract
Background: Trans women are a vulnerable subset of women who face barriers in accessing primary care that is stigma-free, comprehensive, and respectful of their transgender identity. It is known that trans women experience barriers to gender-affirming care, such as health-related quality of life, transphobia, social and structural marginalization, and these barriers can be further increased for trans women living with HIV in the context of HIV-related stigma. Little is known about patient-and provider-related factors influencing care outcomes, and little synthesized evidence exists to attest to the current state of the provision of gender-affirming care for trans women. Objectives: We aim to (1) identify factors associated with higher patient satisfaction with primary health care for trans women in high-income countries through a mixed studies review of the literature, and (2) a) to measure the proportion of transgender women who reported feeling comfortable discussing trans-specific health care needs with their family doctor compared to with their HIV doctor; and b) to examine patient- and provider-related factors associated with this comfort. Methods: In addition to a mixed studies review of the literature with a protocol guided by the PRISMA checklist, this project will use data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), in which a subset of trans WLWH were followed over three years. Descriptive analyses, comparisons using chi-square, and multivariate logistic regressions will examine comfort with HIV providers as compared with family doctors and patient- and provider-related factors. Anticipated Results: We anticipate that the literature review will reveal that satisfaction with primary health care is contingent on providers’ knowledge of trans health care, ability to discuss and receive HRT, and creation stigma-free environments. We anticipate that trans WLWH will have reported higher comfort in discussing trans health-related issues with their HIV provider as compared to their family doctor due to HIV providers’ sensitivity to stigma and addressing sexual health. We anticipate that higher comfort will correlate with higher access to gender-affirming care. Implications: Transgender women should be receiving high-quality primary care that is comprehensive and stigma-free. It is essential to gather data on the current state of gender-affirming care for this population to guide health care improvements in our primary care milieu.
A convergent mixed methods study exploring and evaluating the feasibility of a volunteer patient navigation program
2St. Mary’s Research Center, Montreal, QC, Canada
Corresponding Author: Victoria Wicks, email victoria.wicks@mail.mcgill.ca
Abstract
Background: Health care systems are complex and difficult for persons with low health literacy to navigate, often resulting in forgone, fragmented or inappropriate care1,2,3,4,9,11. As lay peers close to the patient’s reality, patient navigators are well-positioned to communicate relevant information to low-literacy patients, leading to actionable change6,8, helping patients access appropriate health services and enhancing self-efficacy1,3,5,6. A pilot intervention trained community volunteers as patient navigators to reach out by telephone to help patients successfully access primary health care services7 . The pilot intervention is being spread to a new site, and the feasibility, acceptability, and impact on clinic staff, volunteers and patients is being evaluated. As part of that evaluation, this study will examine the feasibility and quality of trained volunteers to deliver the patient navigator service. Feasibility pertains to the quality of the program, the recruitment and retention of sufficient volunteers to meet the patient navigation demands, and to the training and support needed for competency in patient navigation. Additionally, capturing volunteers’ perceptions and the benefits it provides, will enable the identification of barriers and facilitators to feasibly train, recruit and retain volunteers for the development of a sustainable program. Objectives (1): To identify what aspects of patient navigator training and supervision are required to successful recruit and retain volunteers (2): To explore the impact and benefits that participation as a patient navigator has on volunteers (3): To explore the quality and reproducibility of volunteer patient navigator services Methods: This study will use a convergent mixed-methods design, where qualitative and quantitative data will be collected iteratively and in parallel. A questionnaire will be developed and piloted to evaluate the four domains of feasibility (recruitment, training, execution, and retention). All volunteer patient navigators will be surveyed at baseline, and once a month for 4 months after baseline to measure satisfaction, health self-efficacy10,13, health related-quality of life12 and intention-to-continue. Descriptive statistics will be used discern trends over time. Semi-structured individual interviews will be conducted to obtain complimentary data to that of the surveys by exploring volunteer experience with navigation and perceived benefits of participation. Data will be integrated during the “compare results” phase, where similarities and differences from data collection and analysis will be synthesized using a joint display to share the results from the quantitative and qualitative strands. Impact/Significance: Strengthening the capacity to understand, identify, and act on their health needs, will increase access to health services for patients with low health literacy, leading to a more streamlined primary care system. The fundamental aim of this project is to contribute transferable knowledge to sustain a volunteer patient navigation service at St. Mary’s Hospital Center. The findings of this project will inform how to train and supervise volunteers in a reproducible way that will enhance recruitment and retention. Additionally, this study will contribute to the knowledge of the health benefits of volunteering, demonstrating the potential for volunteer patient navigators to also be beneficiaries in a sustainable service.
Unpacking Northwestern Ontario’s sexual assault evidence kits: a mixed methods approach to understanding the barriers preventing justice and care for survivors
Corresponding Author: Sydney Timmermans, email sydney.timmermans@mail.mcgill.ca
Abstract
Background: Sexual assault evidence kits are used to gather forensic evidence from survivors following an assault. Justice is hindered without such evidence, resulting in dependence on survivors to recount traumatizing narratives. One third of Canadian women have experienced sexual assault, yet 41% of Canadian hospitals do not have sexual assault evidence kits available and/or staff trained to use them. Most of these deficits fall in remote Northern areas, forcing women to travel long distances to receive care. Research on availability is limited but it is known that a “justice gap” exists, whereby women in rural regions and socioeconomically marginalized communities have poor access; Northern and Indigenous communities are known to especially lack access to sexual assault evidence kits and related counselling. The lack of resources often results in poor survivor mental health, increased chronic health disorders, substance abuse, and violence perpetuation, placing further strain on health services. Objectives: I plan to gain the perspectives of Northwestern Ontario healthcare providers on access to sexual assault evidence kits in their communities, as well as any barriers they face in providing sexual assault care. Methods: I will employ a sequential explanatory mixed methods design. Phase 1 will involve survey questionnaires for ten small Northwestern Ontario healthcare centers, in order to grasp the scope of the problem. Results of these surveys will inform the guide for in-depth semi-structured interviews, which I will carry out with emergency healthcare providers at three large health hubs (i.e. Kenora, Thunder Bay and Sioux Lookout). Anticipated Results: This research may reveal oversights in sexual assault care, and additionally provide insight into rural healthcare challenges. Implications: Sexual assault stigma and trauma hinders many survivors from seeking care, especially when care has been inadequate in the past. It is essential that few barriers deter post-assault care. The results of this study will inform changes that can relieve over-burdened mental health, primary care and emergency services.
Perceived Racial Disparities in the Context of the Quebec Healthcare System: Preliminary results of a qualitative study within Montreal's Black communities
2St. Mary’s Research Centre, Montreal, Qc, Canada
Corresponding Author: Khandideh K. A. Williams, email khandideh.williams@mail.mcgill.ca
Abstract
Background: The Canadian healthcare system is known for being universally accessible, yet health and healthcare disparities still exist within racial minority communities. By studying these healthcare inequities, we might be able to better understand and address the higher rates of various chronic illnesses within Black communities, like diabetes, HIV, and cancer. Further, the COVID-19 pandemic has worsened healthcare inequities within Black communities, while also showing the limitations of Canada’s healthcare system to track these differences. For example, one survey showed that Black adults are 2.5 times likely to be infected by COVID-19 than the general Canadian population. Yet, even though 22.3% of the Canadian population identify as a visible minority, race is rarely considered in the Canadian healthcare literature. Objectives: Using a qualitative phenomenology design, this study is exploring the role of race in shaping experiences around accessibility and quality of healthcare in Black populations in Montreal. Insights emerging from analysis will inform the development of strategies to enhance healthcare accessibility. Methods: I am conducting in-depth, semi-structured interviews with diverse Black people in Montreal to understand their healthcare needs and experiences with accessing care. Sampling is being facilitated through my partnerships with community organizations that serve black groups, social media webpages, and recruitment within a local family medicine clinic. Deliberative dialogues with family physicians serving racially diverse communities in Montreal will solicit feedback about possible solutions. Anticipated results: Given evidence of stark racial inequities in healthcare experiences in the United States, I anticipate that Black communities in Montreal may experience additional barriers to accessing appropriate healthcare. Implications: Race-based analysis and the critical discourse it provokes are needed to avert disparities in morbidity and mortality that have already been observed within these populations and which have been amplified by the pandemic. Insights emerging from this study will inform the development of clinical strategies to enhance healthcare accessibility within racial minority groups in Montreal, with a particular focus on Black communities.
Illustrating Intergenerational Trauma (IGT) of Chinese Canadians Through Graphic Health Narratives
Corresponding Author: Rebecca Zhao, email rebecca.zhao@mail.mcgill.ca
Abstract
Background: Mental health of racialized communities is of great concern in Canada. Cultural, religious, and economic factors often limit access to care. For those who can access care, the lack of culturally sensitive approaches in primary is a further barrier. This project focuses on intergenerational trauma (IGT) and mental health among Chinese Little is known about IGT among Chinese Canadians despite being one of the largest visible minority groups, having the poorest self-rated mental health, and having a higher likelihood of reporting suicidal thoughts. Experiences of discrimination can exacerbate IGT, as demonstrated in Black and Indigenous communities. IGT could also result in symptoms of depression, anxiety, and posttraumatic stress disorder. While existing mental health services are categorically inadequate in Canada, Chinese Canadian communities are particularly poorly served. Graphic medicine (GM) is a promising therapeutic approach for communities where discrimination, cultural norms, and economic barriers limit access to mainstream therapies. Objectives: (1) Identify current uses of GM in mental health care and present gaps in knowledge. (2) Explore IGT and the use of GM as non-confrontational mental health support. (3) Evaluate effectiveness and utility of GM workshops for mental health support. Methods: Participatory visual methods are approaches that engage participants with the research process while using visual methods and create an accessible way of sharing knowledge between researchers and community. Specifically, GM—health narratives in the form of comics—juxtapose words and drawn images can convey illness, trauma, and healing especially for complex experiences that are difficult to describe verbally. To identify gaps in knowledge on use of visual methods for mental health support for marginalized populations, a scoping review will be conducted, and its findings will inform subsequent stages of this project. Self-identified second-generation Chinese Canadians will be recruited to create graphic narratives and invited to focus group discussions to analyze their own and each others’ graphic narratives. I will also analyze graphic narratives created by participants and discussion themes using a hermeneutical lens. Participants will be invited to complete a self-reported survey to determine the effectiveness of GM workshops. Anticipated Results/Implications: Previous work on GM for other populations demonstrated promising results on mental health support. This will be the first study that uses visual methods to explore IGT among Chinese Canadians. Additionally, this study will pilot the use of GM as a tool or a “graphic cure” as a potential culturally sensitive healing approach to IGT for an underrepresented population in mental health care.
Uses and Impacts of Chatbots in the Healthcare
2Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC, Canada
3Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
4Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
5Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada
Corresponding Author: Bertrand Lebouché, MD PhD, email bertrand.lebouche@mcgill.ca
Abstract
Background: In recent years, advances in digital health technology have fostered innovations in healthcare, resulting in less expensive, more efficient, and better-quality care. Chatbots are one of those promising solutions, given their broad spectrum of uses and their acceptability. The use of chatbots to access and deliver healthcare services appears to be on the rise, granting them multiple potential roles in preventing, diagnosing, and treating disease, impacting the whole healthcare system. To our knowledge, no study has discussed the uses and impacts of chatbots in healthcare. Objective: To explore the uses of chatbots with a health focus and their impacts on the healthcare system. Methods: We performed a systematic search using relevant databases (MEDLINE and EMBASE). We included all primary studies that met the inclusion and exclusion criteria and reported using a conversational agent (chatbot) either as the main intervention of the study or for delivering its intervention. We conducted a hybrid thematic analysis to identify the uses and impacts of chatbots in the healthcare system using an inductive and deductive approach. Anticipated Results: We identified four categories of uses of chatbots: 1. screening tools for risk assessment, initial provisional diagnosis, and triaging; 2. delivery of health education; 3. immediate assistance 24/7. 4. Behavior change. In addition, we recognized four reported benefits for the healthcare system: 1. enhanced patient engagement and patient-centered care; 2. reduced healthcare providers' workload and increased efficiency; 3. reduced financial or organizational burdens on the healthcare system; 4. data collection for further research. Conclusion: The wide range of uses and effects of health chatbots indicate the significance of chatbots as a key enabler for a more efficient quality of care. However, further research is needed to identify the limitations of chatbots.
Accelerometry for tracking physiological indicators of apathy: Preliminary results of a systematic review on the use of wearable sensor technology for detection and monitoring of neuropsychiatric symptoms of dementia
2Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada
3Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
4Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
5Faculty of Health Science, Queens University, Kingston, Ontario, Canada
6Ontario Shores Centre for Mental Health Sciences, University of Toronto, Toronto, Ontario, Canada
7Centre for Addiction & Mental Health, Toronto, Ontario, Canada
8Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
9Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research - Jewish General Hospital, Montreal, Quebec, Canada
10Division of Geriatric Medicine, McGill University, Canada
Corresponding Author: Elena Guseva, email elena.guseva@mail.mcgill.ca
Abstract
Background: Apathy is one of the most common neuropsychiatric symptoms (NPS) of dementia, affecting 50–70% of people with the condition. The presence of apathy is associated with less favorable outcomes including more rapid functional and cognitive decline, greater disease severity, and increased mortality. Accurate assessment and monitoring of apathy is of high importance to optimize NPS care management. Doing so, however, is challenging, due to the polymorphic nature of apathy that makes it difficult to define, and the fact that current clinical assessment scales are time consuming and somewhat subjective in nature. We investigated the evidence pertaining to the accuracy of using accelerometry to assess and monitor apathy in persons living with dementia (PLWD). Objectives: To present the evidence for the use of accelerometry in detecting and/or monitoring apathy in PLWD. Methods: This was part of a larger diagnostic test accuracy (DTA) systematic review assessing the use of wearable sensor technology for NPS detection and monitoring that was carried out from inception until December 2020 using medical and engineering library databases https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219917. Results: A systematic literature search among 7 library databases produced 12,928 articles from which 84 titles were retained for analysis. A total of 15 articles examined apathy as an NPS outcome using WST for detection and monitoring of apathy. There were 13 articles where DTA was the primary objective, among which 11 were retained for analyses that used accelerometry devices as their index test. Dementia participants predominantly had Alzheimer’s, frontotemporal or unidentified disease subtype (37%, 18%, and 18% respectively), and 54% had mild-moderate dementia. A wide range of reference standards were used, with the Neuropsychiatric Inventory and the Apathy inventory accounting for 46% and 18% respectively. Conclusion/implications: All included studies evaluating DTA of accelerometry for the detection and monitoring of apathy in PLWD reported significant correlations between motor activity and apathy scores. As such, it appears that PLWD who have apathy are less physically active than those who do not, and that it is possible to differentiate PLWD with and without apathy using accelerometry devices. Quantitative analyses in which estimates of effect will be pooled are planned.
"Too much pain, doctor!": Capturing clinical cues of gender-mediated presentations of psychosocial distress among culturally diverse patients in primary care encounters
2St. Mary's Research Centre, Montreal, QC, Canada.
3St. Mary’s Univerisity-affliated Family Medicine Group, Montreal, QC, Canada.
Corresponding Author: Madison Leggatt, email madison.leggatt@mail.mcgill.ca
Abstract
Background: In Canada, considerable inequities in mental health care exist. This is particularly evident in the mental health care of ethnoculturally diverse patients, who have higher rates of undiagnosed mental health conditions. Primary care clinicians play an important role in the diagnosis and management of psychosocial distress, but culturally and gender-mediated presentations of such distress may be one of the factors related to under-detection or misdiagnosis. The patient-centred clinical method is a widely applied approach for exploring and contextualizing the presentation of illness and disease in primary care. It has been linked to better symptom resolution and fewer diagnostic and specialist referrals. There has been seldom attention to ethnocultural expressions of mental health disease and illness within the patient-centered clinical method to give clinicians pragmatic strategies for accurately detecting psychosocial distress in the context of intercultural encounters. In collaboration with a larger research project focused on culturally mediated presentations of psychosocial distress, this study will focus on gender-based idioms in the presentation of psychosocial distress among ethnoculturally diverse patients, and gender-appropriate clinical strategies to ensure appropriate detection and treatment. Objectives 1. To explore gender-mediated presentations of psychosocial distress among patients of diverse cultural backgrounds observed by interpreters during clinical encounters. 2. To identify gender-based differences in the strategies or clues evoked by the expert clinicians in their use of the patient-centered method to recognize and elicit causes of psychosocial distress in their ethnoculturally diverse patients. Methods This exploratory qualitative study will be conducted in two ethnoculturally diverse boroughs of Montréal, Québec. A focus group with 2-3 primary care interpreters will be conducted and secondary analysis of semi-structured key informant interviews with 10-15 experienced primary care clinicians will be conducted. Anticipated Results The identified strategies will inform a training module to complement training in the patient-centred method for medical education. Implications The training will strengthen clinicians’ existing skills in the patient-centred method and heighten their clinical sensitivity to different expressions and presentations of psychosocial distress. This will help to improve the provision o
Barriers to Hypertension Detection and Management among Women in Bangladesh
2BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Corresponding Author: Amina Amin, email amina.amin@mail.mcgill.ca
Abstract
Background: In Bangladesh, the prevalence of hypertension is 20.3%, and 32.4% among men and women respectively. This gendered distribution of prevalence is in sharp contrast to global patterns. Rates of undiagnosed and uncontrolled hypertension are also higher among women. No known research has comprehensively explored the factors underlying women’s disproportionate risk of undiagnosed and uncontrolled hypertension in Bangladesh. Objectives: This study examines the perceptions and experiences of women in recognizing hypertension symptoms and seeking hypertensive care. Study objectives are to: 1) understand how hypertensive women in Bangladesh perceive and experience hypertension symptoms, diagnosis, hypertension treatment and management, 2) explore barriers to hypertensive care-seeking among women, and what adaptations are needed to improve equitable Non-communicable Disease (NCD) care services in Bangladesh. Methods: The study follows an exploratory qualitative approach and In-Depth Interviews (IDI) were used as the study method. A purposive sampling strategy was applied in rural and urban areas to select women diagnosed with hypertension through a national surveillance study. Interviews were conducted with 22 women using a semi-structured guideline. Thematic analysis was performed, assisted in part by the Framework Method. Results: Study findings showed that gender dynamics contribute to undiagnosed and uncontrolled hypertension in women. Most women reported being completely dependent on their male counterparts for accessing diagnosis and for disease management. In many cases, hypertension was diagnosed while being treated for another condition. Even though women share information and knowledge about hypertension amongst themselves, much of this information is gathered from their own social networks and is misleading and/or inaccurate. In the rural areas, the first point of care is informal providers whereas in urban areas women consult both informal and formal providers. Inadequacies of public sector services related to proximity and availability were noted in both rural and urban areas. Conclusion: In Bangladesh, women are at more risk of developing hypertension and NCD services provided at the community level are not designed to address the gender disparity. These research findings will support the journey of strengthening the primary health care system in Bangladesh by generating insights on how to make NCD health care services more gender appropriate and effective.
School-based interventions targeting substance use among young people in low- and middle-income countries: A systematic review and meta-analysis
Corresponding Author: Abdul Cadri, email abdul.cadri@mail.mcgill.ca
Abstract
Background: Globally, substance use is among the leading causes of preventable deaths, and most of these behaviours are initiated between the ages of 10 to 24. The burden attributable to substance use among young people is enormous. In 2016, about 2.8 million deaths were attributable to alcohol use and in 2019, tobacco smoking caused about 7.7 million deaths worldwide. Also, substance use exacerbates the risk of depression and anxiety, drug dependence, injuries and criminal behaviour, homelessness, as well as increasing the risk of non-communicable diseases. Delaying the onset or reducing the rate of substance use among young people is thus a global health priority. Schools have been noted to be a critical entry point for interventions because their structure aids intervention delivery to reach a larger audience and subsequent intervention success. Several reviews have presented the effectiveness of school-based interventions that target substance use among young people in Organisation for Economic Cooperation and Development (OECD) countries; however, an equivalent review is lacking in Low-and-Middle Income Countries (LMICs). The aim of this systematic review and meta-analysis is to synthesize available evidence on the impact of school-based interventions in delaying the onset or reducing the rate of substance use among young people compared to the usual school health education curriculum in LMICs. Methods: Online databases (MEDLINE (Ovid), EMBASE Classic+Embase (Ovid), African Index Medicus, CINAHL, PsycINFO (Ovid), Scopus, Web of Science Core Collection, Africa Wide Information, and ERIC) will be used to search for published articles from 1980 to 2022. Eligibility criteria: Randomised control trials, including cluster randomised controlled trials; staggered enrolment trials or stepped wedged trials; quasi-experimental trials; and time series/interrupted time-series trials that measures the impact of school-based interventions in delaying the onset or reducing the rate of substance use among young people, compared with the usual school health education curriculum. Study selection, appraisal, and synthesis: Studies will be independently identified, extract data, and assess the risk of bias, with Cochrane risk of bias tool. Authors of relevant studies will be contacted on unpublished data. Random-effects model will be used for the meta-analysis. Heterogeneity will be assessed through prediction intervals and explored using sub-group analysis. Expected Results: At the end of the study, we expect to see the effectiveness of school-based interventions in delaying the onset or reducing the rate of substance use among young people, compared to the usual school health education curriculum in LMICs. Impact: the study will contribute to knowledge advancement in the field of young people substance use prevention. Given the substantial proportion of young people that attend school in LMICs, population-level implementation of an effective intervention approach has the potential to provide significant gains by delaying the onset or reducing the rate of substance use; therefore, it will be of great interest to researchers, policy makers, and other key stakeholders.
Telemedicine in primary care for older adults: A systematic mixed methods review
2Rehabilitation Science, Université de Montréal, QC, Canada
Corresponding Author: Dr. Vladimir Khanassov, MD, MSc, email vladimir.khanassov@mcgill.ca
Abstract
Background: Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality alternative for primary care delivery. However, it poses unique challenges for older adults. Objectives: Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults. Methods: In this mixed-method systematic review using a result-based convergent design, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, ClinicalTrials.gov and WHO’s International Clinical Trials Registry Platform were searched for articles in English, French or Russian on community-dwelling older adults who used TM in primary care. Two reviewers performed study selection, data extraction and assessment of study quality independently. TM’s effects on experience of care, service use and health-related outcomes were reported through descriptive statistics. TM use determinants were described qualitatively via thematic analysis based on Chang’s framework. Quantitative and qualitative data were integrated using joint displays. Results: Out of 3,328 references identified, 21 studies were included. They used either phone (n=9), videoconference (n=9) or both (n=3). Experience of care was overall positive with a high level of satisfaction with TM. Studies exploring service use reported mixed outcomes on TM usability and on the number of clinical visits. Health-related outcomes reported a positive effect on self-efficacy and no effect on health status. Overall, most determinants of TM use were associated to patients and caregivers’ experiences. The most cited barrier pertained to ‘Technology skills and knowledge’. The most cited facilitator pertained to ‘Location/travel time’. Conclusions: TM in older adults’ primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.
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