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This paper reports on how service providers and academic researchers partnered to support the journey of a primary prevention organization in western Canada as they reviewed their programming against an evidence-based practice (EBP) framework. The process allows the organization to increase their EBP culture by encouraging staff understanding and uptake of their nine family support programs. It also informs service users and other stakeholders of the evidentiary status of different kinds of support services. In this way, the families become more informed and engaged partners who might easily evaluate the respective risks and benefits of the various applications. As part of the process, an evidence-based framework used a common language to assess the efficacy of the respective nine programs. All nine programs are now mapped into the EBP framework. This review allows staff to become more intentional and informed about the EBPs they employ to support vulnerable families and to use this knowledge to better inform the families with whom they work. This paper and the process the agency followed can be a model for other organizations who serve families experiencing short-term housing crisis, provide infant nursery care, and other support services for families with young children. [ABSTRACT FROM AUTHOR]

This collaborative paper explores the interconnections between climate change and the mental health and well‐being of Indigenous women in Western Canada. As the impacts of climate change intensify globally, vulnerable populations, particularly Indigenous communities, face disproportionate and multifaceted challenges. Centering on Indigenous women in Western Canada, this study explores how the climate crisis magnifies Indigenous communities' mental health disparities. Drawing from the Indigenist feminist research approach, the investigation focuses on Indigenous women's lived experiences, perceptions, and land‐based coping strategies amidst climate challenges, while simultaneously addressing the unique social, cultural, and historical factors influencing their mental health vulnerabilities within the context of climate change. The findings shed light on the complex relationships between environmental degradation, ongoing colonial impacts on traditional practices, and the mental well‐being of Indigenous women. Concluding with implications for policy and community‐led interventions, this research contributes to the discourse on the intersectionality of climate change impacts and mental health, particularly focusing on Indigenous women in Western Canada. [ABSTRACT FROM AUTHOR]

This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met. Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper. Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students. Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce. Medical School Education Medical schools have the responsibility to train a diverse physician workforce including those with disabilities. The integration of students with disabilities is important and should be done in a structured and timely manner that maximizes the individual's abilities and incorporates reasonable accommodations in the clinical learning environment. Though the definition of disability traverses a wide variety of diagnoses, this review highlights sensory and physical disabilities and the various accommodations to facilitate access and successful completion of required objectives. [ABSTRACT FROM AUTHOR]

Objectives: In celebration of the journal's 50th anniversary, the aim of the study was to review the whole collection of Community Dentistry and Oral Epidemiology (CDOE) publications from 1973 to 2022 and provide a complete overview of the main publication characteristics. Methods: The study used bibliometric techniques such as performance and science mapping analysis of 3428 articles extracted from the Scopus database. The data were analysed using the 'Bibliometrix' package in R. The journal's scientific production was examined, along with the yearly citation count, the distribution of publications based on authors, the corresponding author's country and affiliation and citation count, citing source and keywords. Bibliometric network maps were constructed to determine the conceptual, intellectual and social collaborative structure over the past 50 years. The trending research topics and themes were identified. Results: The total number of articles and average citations has increased over the years. D Locker, AJ Spencer, A Sheiham and WM Thomson were the most frequently published authors, and PE Petersen, GD Slade and AI Ismail published papers with the highest citations. The most published countries were the United States, United Kingdom, Brazil and Canada, frequently engaging in collaborative efforts. The most common keywords used were 'dental caries', 'oral epidemiology' and 'oral health'. The trending topics were healthcare and health disparities, social determinants of health, systematic review and health inequalities. Epidemiology, oral health and disparities were highly researched areas. Conclusion: This bibliometric study reviews CDOE's significant contribution to dental public health by identifying key research trends, themes, influential authors and collaborations. The findings provide insights into the need to increase publications from developing countries, improve gender diversity in authorship and broaden the scope of research themes. [ABSTRACT FROM AUTHOR]

Purpose: Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods: The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results: Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions: The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. Methods: A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. Results: Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. Conclusion: The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic. Plain language summary: Access to sexual and reproductive health (SRH) services is a basic human right. All individuals require access to appropriate SRH services to maintain their optimal sexual and reproductive health. Adolescents require special guidance, support, and youth-friendly services in matters of SRH as they enter puberty and explore their sexual identity. However, during the COVID-19 pandemic, many health and SRH services were suspended. Access to SRH products and services became difficult due to public health restrictions, which has possible negative consequences for adolescents' SRH. The experiences of adolescents during the COVID-19 pandemic regarding their SRH are not reported in Alberta, Canada. Therefore, we explored the impacts of these public health restrictions on adolescents' SRH. We performed qualitative interviews with adolescents and SRH service providers to know their perspectives on how the pandemic influenced the SRH of adolescents. This paper provides insights into the barriers faced by adolescents while accessing SRH services during the pandemic, as well as their perceptions of digital strategies, such as mobile applications, and other recommendations for supporting SRH education and services. Based on the study findings, an adolescent-friendly mobile application will be developed to provide a virtual platform connecting adolescents to SRH educational resources, services, and support. [ABSTRACT FROM AUTHOR]

Globally, mental health systems have failed to adequately respond to the growing demands of mental health services resulting in a disparity between the need and provision of treatment. Paucity of mental health care providers contributes to the aforementioned disparity. This can be addressed by engaging Nurse Practitioners (NPs) in an integrated model within healthcare teams. This paper describes the implementation of NPs as Most Responsible Provider (MRP) care of model in a specialised mental health hospital in Ontario, Canada. Guided by the participatory, evidence‐based, patient‐focused process for advanced practise nursing (APN) role development, implementation, and evaluation (PEPPA) framework, authors developed a model of care and implemented the first seven steps of the PEPPA framework – (a) define the population and describe the current model of care, (b) identify stakeholders, (c) determine the need for a new model of care (d) identify priority areas and goals of improvement, (e) define the new model of care, and (f) plan and implement the NP as MRP model of care. Within these steps, different strategies were implemented: (a) revising policies and procedures (b) harmonising reporting structures, (c) developing and implementing a collaborative practise structure for NPs, (d) standardised and transparent compensation (e) performance standards and monitoring (f) Self‐Assessment Competency frameworks, education, and development opportunities. This paper contributes to the state of the knowledge by implementing NPs as MRP model of care in a specialised mental health care setting in Ontario, Canada; and advocates the need for incorporating mental health programmes within the Ontario nursing curriculum. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) is expanding rapidly and can potentially be a huge data source. This study aimed to close the knowledge gap about possible IoT applications in health care. English-language academic publications from the Web of Science (WoS) were used for the present study. Bibliometric networks were used to analyze pertinent publications to examine the connections between authors, nations, and affiliations. Papers on digital health care have been published in more than 1195 sources, among which the most popular was the Journal of Medical Internet Research. Six top institutions were from the Netherlands, making the Vrije Universiteit Amsterdam the most productive institution after Australia and England. This study provides an overview of IoT-related research conducted in digital health care, helping academic researchers, policymakers, and practitioners to better understand the development of digital health care research. [ABSTRACT FROM AUTHOR]

Introduction: East Toronto Health Partners (ETHP) is a network of organizations that serve residents of East Toronto, Ontario, Canada. ETHP is a newly formed integrated model of care in which hospital, primary care, community providers and patients/ families work together to improve population health. We describe and evaluate the evolution of this emerging integrated care system as it responded to a global health crisis. Description: This paper begins by describing ETHP’s pandemic response mapping out over two years of data. To evaluate the response, semi-structured interviews were conducted with 30 decision makers, clinicians, staff, and volunteers who were part of the response. The interviews were thematically analyzed, and emergent themes mapped onto the nine pillars of integrated care. Discussion: The ETHP pandemic response evolved rapidly. Early siloed responses gave way to collaborative efforts and equity emerged as a central priority. New alliances formed, resources were shared, leaders emerged, and community members stepped forward to contribute. Interviewees identified positives as well as many opportunities for improvement post-pandemic. Conclusion: The pandemic was a catalyst for change in East Toronto that accelerated existing initiatives to achieve integrated care. The East Toronto experience may serve as a useful guide for other emerging integrated care systems. [ABSTRACT FROM AUTHOR]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Modern academic libraries are hubs of technology, yet the gap between the library and IT is an issue at several small university libraries across Canada that can inhibit innovation and lead to diminished student experience. This paper outlines results of a survey of small (<5,000 FTE) universities in Canada, focusing on IT and the library when it comes to organizational structure, staffing, and location. It then discusses higher level as well as smaller scale solutions to this issue. [ABSTRACT FROM AUTHOR]

Background: Efforts have been made by health research granting agencies to bring research closer to patients' concerns. In Canada, such efforts were formalized in 2011 with the funding of the Strategy for Patient-Oriented Research (SPOR)'s research networks to address research priorities identified by patients and accelerate the translation of research findings into patient care and health care policy. Among these networks, SPOR Diabetes Action Canada (DAC) has created patient-partner circles to facilitate their integration within the network. The nature of the relationships within this atypical patient-oriented research network is systematically explored in this paper.Methods: A cross-sectional social network study was conducted among the SPOR DAC's network members to examine inter-individual interactions, and the topics discussed the most between members. Descriptive data analyses were conducted to explore which discussion topics were discussed most among members whose primary roles were research, administration, governance, and patient representation.Results: The response rate was 51.9%, providing data on 76.5% of the maximum number of connections in the network. The survey captured 2763 inter-individual relationships. Responses to a sub-question inserted in the survey show that 482 of these relationships (17,4%) existed before joining the network in collaboration on a research project. Most ties captured in the survey were yearly or quarterly, while few relationships were monthly, weekly, or daily. In measured relationships, members discussed several topics, the most frequent being scientific research, patient engagement, network coordination and governance, and operations and management. The topics associated with the most significant proportion of relationships captured in the survey were scientific research (45.4%) and patient engagement (40.7%). Management & operations and governance & coordination follow, corresponding to 24.3 and 23.9% of the captured relationships. All discussion topic subnetworks were either somewhat or highly centralized, meaning that relationships were not equally distributed among members involved in these discussions. Of the 1256 relationships involving exchanges about scientific research, 647 (51.5%) involved a researcher, 419 (33.3%) an administrator, 182 (14.5%) a patient partner, and 82 (6.5%) a member whose primary role is network governance.Conclusions: Scientific research and patient engagement were the most common topics discussed, consistent with the patient-centered research at the heart of the SPOR Diabetes Action Canada network. The study identified several relationships where a patient partner has discussed scientific research with a researcher. However, relationships involving research discussions were three times more common between a researcher and an administrator than between a researcher and a patient partner, although twice as many patient partners as administrators participated in the survey. The institutionalization of patient-partner involvement in large research networks is an evolving practice for which optimal engagement methods are still being explored. [ABSTRACT FROM AUTHOR]

Aim: This study aims to present a general bibliometric overview of the development status of global nursing research from 2000 to 2019. Design: A longitudinal bibliometric analysis of nursing research was conducted. Methods: Nursing research publications (N = 88,665) were obtained from Web of Science. Bibliometric method was used to map the output and citation impact trends of countries/regions, institutions, disciplines, and journals and analyse the research collaboration among countries/regions and institutions. Results: The global paper output in nursing research increased steadily over the past two decades and it varied in different countries/regions with the USA being far ahead of the others. The paper output and cross‐border collaboration are mainly distributed in several developed countries like the USA, the UK, Australia, and Canada. The University of Pennsylvania, Harvard University, University of Toronto, and University of North Carolina at Chapel Hill have high academic influence in the field of nursing. Increasing attention from academic fields has been paid to research on nursing. Journal of Advanced Nursing is the most prolific and most cited journal in nursing field. Conclusion: Nursing research has developed steadily over the last two decades. Both the scientific output and research collaboration are disproportionally distributed between high‐income countries/regions and low‐ and middle‐income countries/regions. Most research and collaboration have taken place in a few developed countries across North America, Europe, and Oceania. Impact: The study highlighted the need for policy makers and funding agencies, especially those from low‐ and middle‐income countries/regions, to allocate research funding that supports the nursing higher education and international cooperation so as to promote the development of high‐quality nursing research in those countries/regions. At the same time, researchers from non‐English‐speaking countries/regions should attach more importance to publishing papers in English, strengthening the academic exchanges with international nursing colleagues and better integrating into the international academic community. [ABSTRACT FROM AUTHOR]

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra‐professional and Inter‐professional and Inter‐sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter‐related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra‐ and inter‐professional and inter‐organisational contexts. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study. Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care. Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known?: Police and mental health services benefit from meaningful service user engagement.Partnerships with organizations that are representative of community members—such as service users—are the most empowering model of collaboration. What this paper adds?: Describes how a service user organization can effectively advocate for change in the policing and mental health systems through both mutual collaboration and external pressure. Implications for practice?: Methods of creating change that can save lives through partnerships with service user organizations can be applied by service user organizations, police and mental health services.The methods described have the potential to reduce deaths and injury as a result of police action or mental healthcare practices [ABSTRACT FROM AUTHOR]

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations. • Boundary work is part of professional socialization process. • Professional boundaries are ambiguous in midwifery but they are understudied. • This paper examines boundary work among 31 Canadian midwifery students. • The boundaries were clear with physicians but blurred in communication with nurses. • Learning about boundaries, students recreated them but also became agents of change. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore the collaborative nature of an international research project with other advanced practice nurse researchers and critically analyse the process. Background: Research within the nursing community is recognized internationally as important to ensure that nurses participate in cutting‐edge health care and promote evidence‐based practices, yet there is little detail found in literature on how a successful collaborative relationship is initiated and conducted in advanced practice research. Design: Discussion paper: The purpose of this paper is to discuss the process of collaboration on a research study among advanced practice nurses from four countries who are members of an international organization. Implications for Nursing: The collaborative process in international nursing research can be challenging and rewarding. It is important to remember that there is a relationship between the complexity of the study and the time required to complete it. Keys to success include following established guidelines. Conclusion: This project was a valuable experience in developing collaborative relationships as well as creating partnerships for future research to build on the knowledge gained. The authors' linkages to universities facilitated their participation in the research and completion of the ethical review processes. The use of social media and university resources was indispensable. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present an inter-agency practice integrated within a police intervention model which was developed for police officers and their partners in Montréal.Design/methodology/approach The Integrated Police Response for Abused Seniors (IPRAS) action research project (2013-2016) developed, tested, and implemented a police intervention model to counter elder abuse. Two linked phases of data collection were carried out: a diagnostic of police practices and needs (year 1) and an evaluation of the implementation of the intervention model and the resulting effects (years 2 and 3).Findings The facilitating elements to support police involvement in inter-agency practices include implementing a coordination structure regarding abuse cases as well as designating clear guidelines of the roles of both the police and their partners. The critical challenges involve staff turnover, time management and the exchange of information. It was recognised by all involved that it is crucial to collaborate while prioritising resource investment and governmental support, with regards to policy and financing, as well as adequate training.Practical implications The IPRAS model is transferable because its components can be adapted and implemented according to different police services. A guideline for implementing the model is available.Originality/value In the scientific literature, inter-agency collaboration is highly recommended but only a few models have been evaluated. This paper presents an inter-agency approach embedded in an evaluated police intervention model. [ABSTRACT FROM AUTHOR]

Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016–2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t‐tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community‐based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community‐based hoarding intervention model. [ABSTRACT FROM AUTHOR]

Objectives: Weather is a key source of marine risk, but relationships between fishing activity, safety, and weather remain poorly understood. Critically, the fit between available marine forecast products, fish harvesters' needs, and harvester's decision-making processes has not been rigorously assessed. This paper addresses these gaps by documenting a) weather-related decision-making by harvesters, and its relationship to forecasts across multiple regions and fisheries on Canada's East coast (Newfoundland) and b) the dynamics of forecast production priorities. Methods: A multi-disciplinary, community-engaged research approach, conducted in partnership with the Newfoundland and Labrador Fish Harvesting Safety Association (NL-FHSA). Data consist of semi-structured interviews with fish harvesters and weather forecasters, focused on marine forecast production and use. Results: Results emphasize that there is a subjective "art" to both production and use of marine forecasts. Forecasters and harvesters share several common values regarding forecasts, but different emphases: forecasters favor some combination of accuracy, consistency, and utility, while harvesters are largely concerned with utility. Finally, harvesters' decision-making is based on nuanced and contextual interpretations of a few key hazards (winds and, to a lesser extent, waves). Conclusion: This community-engaged research has triggered experimentation with forecasts tailored to fisheries utility within Environment and Climate Change Canada (ECCC). It lays the groundwork for ongoing, mutually beneficial dialogue between forecasters and harvesters, engaging harvesters with the forecasting process while familiarizing forecasters with harvester's decision-making processes. Ongoing industry partnerships (NL-FHSA) continue to sustain momentum from this study towards further enhancing the utility of future marine forecasts for small-scale harvesters. [ABSTRACT FROM AUTHOR]

Introduction: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations.Objective: This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations.Methods: The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2).Results: Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces.Conclusions: If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions. [ABSTRACT FROM AUTHOR]

Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice—patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds—also play a role in how care is shaped. To date, how the human and non-human act together to exclude, invite, and regulate particular enactments of interprofessional collaboration has been subject to limited scrutiny. Our paper addresses this gap by attending specifically to the sociomaterial. Drawing on empirical data collected from an Academic Health Sciences Centre's inpatient medicine teaching unit setting in Ontario, Canada, we explore the influence of the sociomaterial on the achievement of progressive collaborative refinement, an ideal of how teams should work to support safe and effective patient care as patients move through the system. Foregrounding the sociomaterial, we were able to trace how assemblies of the human and the non-human are performed into existence to produce particular enactments of interprofessional collaboration that, in many instances, undermined the quality of care provided. Our research findings reveal the "messiness" of interprofessional collaboration, making visible how things presently assemble within the inpatient setting, albeit not always in the ways intended. These findings can be used to guide future innovation work in this and other similar settings. [ABSTRACT FROM AUTHOR]

This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs. [ABSTRACT FROM AUTHOR]

This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compare their treatment approaches. This report is a summary of their discussions, including empirical data from CR and Russia which have not previously been published in the English language. All participants agreed that continuing international collaboration would be very useful for the development of ethical international prescribing guidelines, as well as pooling data from studies on the efficacy and utility of pharmacological and other biological treatments for people who have committed sexual offences. [ABSTRACT FROM AUTHOR]

Abstract Local public health authorities often lack the capacity to adapt to climate change, despite being on the 'front lines' of climate impacts. Upper-level governments are well positioned to create an enabling environment for adaptation and build local public health authorities' capacity, yet adaptation literature has not specified how upper-level governments can build local-level adaptive capacity. In this paper we examine how federal and regional governments can contribute to enabling and supporting public health adaptation to climate change at the local level in federal systems. We outline the local level's self-assessed adaptive capacity for public health adaptation in Canadian and German comparative case studies, in terms of funding, knowledge and skills, organizations, and prioritization, drawing upon 30 semi-structured interviews. Based on interviewees' recommendations and complemented by scientific literature, we develop a set of practical measures that could enable or support local-level public health adaptation. We find that adaptive capacity varies widely between local public health authorities, but most report having insufficient funding and staff for adaptation activities. We propose 10 specific measures upper-level governments can take to build local public health authorities' capacity for adaptation, under the interrelated target areas of: building financial capital; developing and disseminating usable knowledge; collaborating and coordinating for shared knowledge; and claiming leadership. Federal and regional governments have an important role to play in enabling local-level public health adaptation, and have many instruments available to them to fulfill that role. Selecting and implementing measures to enable local public health authorities' adaptive capacity will require tailoring to, and consideration, of the local context and needs. Highlights • Local public health authorities often lack capacity to adapt to climate change. • National and regional governments can play supportive or enabling role. • We propose 10 concrete measures to enable local public health adaptation. [ABSTRACT FROM AUTHOR]

Purpose People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue.Design/methodology/approach The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia.Findings Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures.Research limitations/implications The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views.Practical implications Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms.Originality/value This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally. [ABSTRACT FROM AUTHOR]

Background: The recognition of medical professionalism as a complex social construct makes context, geographical location and culture important considerations in any discussion of professional behaviour. Medical students, medical educators and practitioners are now much more on the move globally, exposing them to cultural and social attitudes, values and beliefs that may differ from their own traditional perceptions of professionalism. Aims and Methods: This paper uses the model of the intercultural development continuum and the concept of 'cultural fit' to discuss what might transpire when a student, teacher or doctor is faced with a new cultural environment. Using our own experiences as medical educators working abroad and supported by evidence in the literature, we have developed four anecdotal scenarios to highlight some of the challenges that different cultural contexts bring to our current (Western) understanding of professionalism. Results and Conclusions: The scenarios highlight some of the potentially different regional and/or cultural perspectives and nuances of professional behaviours, attitudes or values that many of us either take for granted or find difficult, depending on our training and socio-cultural upbringing. With this paper, we hope to start a long overdue conversation about global professionalism amongst medical educators, identify potential areas for research and highlight a need for medical schools to embrace a 'global' approach to how professionalism is embedded in their curricula. [ABSTRACT FROM AUTHOR]

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants’ experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants’ expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants’ perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge. [ABSTRACT FROM AUTHOR]

Collaboration between child welfare and adult mental health service providers is important to address parental risk factors that may affect child wellbeing. The aim of this paper is to describe findings from a survey which identified barriers and facilitators to collaboration between these two sectors. A semi-structured instrument, adapted from Frederico et al. (2014), was used for data collection. A total of 339 service providers in Ontario, Canada, completed the survey. The collaborative strategies used most frequently were co-working with staff from other services and case conferences; yet, these strategies were only used by just over one half of all respondents. Several barriers and facilitators to collaboration were identified by respondents. To improve collaboration between child welfare and adult mental health services, respondents recommended better clarity of roles and goals, increased information sharing, capacity building across sectors and new models of integrated service delivery. [ABSTRACT FROM AUTHOR]

Recent work in Ontario (Canada) revealed that adults with intellectual and developmental disabilities experience higher rates of frailty and use of aging care services at earlier ages than the general population, and that the subset aged 65+ years is increasing. This paper describes the reaction of knowledge users to study findings and implications for policy and practice. A knowledge transfer webinar was held with nearly 200 people representing different regions of the province, participant types (family members, service providers, decision makers, researchers), and sectors (health and developmental services). Most participants viewed health and developmental services systems as not ready for the aging population with intellectual and developmental disabilities for two main reasons: insufficient cross-sector expertise and inadequate funding. The need for healthcare, challenged informal supports, lack of services, and the desire for independence were thought to drive higher use of home care among younger adults, while inadequacies within the developmental services sector, challenged informal supports, medical and care needs, lack of community supports, and the need for coordinated cross-sector services were noted as contributing to admissions to long-term care. There is a lack of evidence-based information on aging and intellectual and developmental disabilities. Ongoing access to quality, population-level data on the number and needs of persons with intellectual and developmental disabilities is needed to improve policies and practices to support aging in the community. Persons working in health and developmental services had a shared understanding of the need for system reform, better collaboration, and integration of resources. Both sectors also viewed admission to long-term care as particularly problematic. The province-wide webinar brought together persons with various levels of responsibility from different sectors. Future exchanges should focus on identifying and promoting best practices. [ABSTRACT FROM AUTHOR]

Background: The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes.Methods: As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis.Results: Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates.Conclusions: Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers.Trial Registration: Unique identifier- NCT00359593. [ABSTRACT FROM AUTHOR]

Rationale: Public health and preventive medicine (PHPM) has been recognized internationally as a physician specialty, but national parallels and differences exist between training contexts. This paper reviews PHPM training and employment in Canada, France, Italy, Japan, the United Kingdom, and the USA. Methods: Information gathered from relevant accreditation bodies and literature searches was used to create descriptive profiles of national training demographics and structure and a narrative outlining trends and challenges facing the specialty. Results: Notable similarities and differences exist between national contexts. Key themes were differences in training strategies and practice scope, specialty stakeholders, certification structure, and funding. Recognition challenges faced the specialty across all six countries. Other challenges included unclear competencies and training strategies and a need for PHPM specialists to highlight their role in combating population health threats. Additional differences existed between comparator countries on the structure of training, funding sources for training programs, availability of training posts, and linkages with other physician specialties. Conclusion: Highlighting these themes is a first step to fostering training collaborations between PHPM specialist physicians to augment transnational action on global public health challenges and also supports PHPM physician educators with innovative solutions from abroad that might address domestic specialty challenges. [ABSTRACT FROM AUTHOR]

Challenges and complexities associated with assessing dietary intakes are numerous, but not insurmountable. This opinion paper from Canadian researchers draws attention to the importance of building capacity and providing funding opportunities for research in dietary assessment methods in Canada and elsewhere. Such strategies would contribute to a better understanding of the roles played by diet in human health and better translation of this information into the most meaningful and effective dietary guidelines, policies, and interventions. [ABSTRACT FROM AUTHOR]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

This paper examines the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada. Analyzing data from qualitative interviews with 179 internationally educated physicians, nurses, and midwives and 70 federal, provincial and regional stakeholders involved in integration of IEHPs, we examine (1) which aspects of professional work are modified in transition to a new health care system; (2) which aspects of professional practice are learned by IEHPs in the new health environment, and (3) how IEHPs maintain their professional identity in transition to a new health care system. In doing so, we compare the accounts of IEHPs with the policy stakeholders' positions and analyze the similarities and the differences across three health care professions (medicine, nursing, and midwifery). This enables us to explore the issue of professional resocialization from the analytical intersection of gender, professional dominance, and institutional/organizational lenses. [ABSTRACT FROM AUTHOR]

Common ground is necessary for developing collaboration as part of building resilience for public health preparedness. While the importance of common ground as an essential component of collaboration has been well described, there is a need for studies to identify how common ground develops over time, across individual and group dimensions, and the contexts that influence its development. This paper studied common ground development in three Canadian communities between October 2010 and March 2011 through a project on capacity building for disaster management. Disaster management requires the integration of paid and volunteer participants across public and private sectors and is therefore a good domain to study common ground development. We used directed qualitative content analysis to develop a model of common ground development over time that describes its progression through coordinative, cooperative and collaborative common ground. We also identified how common ground develops at micro (individual) and macro (group) levels, as well as how agency, technology and geographical contexts influence its development. We then use the four phases of disaster management to illustrate how our model can support longitudinal common ground development. Our findings provide useful insight to enable proactive development of common ground in collaborative health communities. [ABSTRACT FROM AUTHOR]

This paper explores social scientists' and humanities (SSH) scholars' integration within the academic medical research environment. Three questions guided our investigation: Do SSH scholars adapt to the medical research environment? How do they navigate their career within a culture that may be inconsistent with their own? What strategies do they use to gain legitimacy? The study builds on three concepts: decoupling, doxa, and epistemic habitus. Twenty-nine semi-structured interviews were conducted with SSH scholars working in 11 faculties of medicine across Canada. Participants were selected through purposeful and snowball sampling. The data were analyzed by thematic content analysis. For most of our participants, moving into medicine has been a challenging experience, as their research practices and views of academic excellence collided with those of medicine. In order to achieve some level of legitimacy more than half of our participants altered their research practices. This resulted in a dissonance between their internalized appreciation of academic excellence and their new, altered, research practices. Only six participants experienced no form of challenge or dissonance after moving into medicine, while three decided to break with their social science and humanities past and make the medical research community their new home. We conclude that the work environment for SSH scholars in faculties of medicine does not deliver on the promise of inclusiveness made by calls for interdisciplinarity in Canadian health research. [ABSTRACT FROM AUTHOR]

The “general public” and specific “communities” are increasingly being integrated into scientific decision-making. This shift emphasizes “scientific citizenship” and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian “governmentality” the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of “scientific citizenship” to implicate both researchers and communities in a process of governance. [ABSTRACT FROM AUTHOR]

The author discusses the role of the Society of Rural Physicians of Canada (SRPC) as a catalyst that promotes excellent care close to home for Canada's rural population. Members of SRPC work at the coal face of rural health care. They have worked with several medical organizations since 1992 to promote and improve health care, including the College of Family Physicians of Canada. They produced the joint position paper on rural surgery and operative delivery.

Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results: The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects. [ABSTRACT FROM AUTHOR]