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The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress. Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis. Research Participants and Context: 88 healthcare providers, based in British Columbia Canada, participated virtually. Ethical Considerations: The study received ethical approval from Simon Fraser University. Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children's education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride. Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue. Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic. [ABSTRACT FROM AUTHOR]

This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing. [ABSTRACT FROM AUTHOR]

Since the onset of the COVID-19 pandemic, community-dwelling people living with dementia and their family caregivers have experienced many challenges. The unanticipated consequences of public health measures have impacted these families in a myriad of ways. In this interpretive policy analysis, which used a longitudinal, qualitative methodology, we purposively recruited 12 families in British Columbia, Canada, to explore the impacts of pandemic public health measures over time. Semi-structured interviews were conducted every 3 months and participants completed diary entries. Twenty-eight interviews and 34 diary entries were thematically analyzed. The findings explore ways that families adopted and adapted to public health measures, loss of supports, both formal and informal, and the subsequent consequences for their mental and physical well-being. Within the ongoing context of the pandemic, as well as potential future wide-spread emergencies, it is imperative that programs and supports are restarted and maintained to avoid further harm to these families. [ABSTRACT FROM AUTHOR]

The PrEP Cascade is a dominant framework for investigating barriers to HIV pre-exposure prophylaxis (PrEP), an HIV prevention tool. We interviewed 37 PrEP users and 8 non-PrEP users in Ontario and British Columbia, Canada, about their decision-making through the Cascade. Participants were HIV-negative gay, bisexual, and queer men (GBQM). The data were analyzed using thematic analysis. PrEP decision-making was based on pragmatic considerations (logistics, costs, and systemic barriers), biomedical considerations (efficacy, side-effects, and sexually transmitted infections), and subjective considerations (identity, politics, and changing sexual preferences). Affective attachments to established versions of "safer sex" (condoms and serosorting) made some GBQM less likely to try PrEP. Some GBQM expressed increased social expectations to use PrEP, have condomless sex, and serodifferent sex. These findings support offering PrEP at no-cost, offering individualized counseling and community-based opportunities to discuss PrEP use and changing sexual practices, and improving communication on the manageability of PrEP side-effects. [ABSTRACT FROM AUTHOR]

This study adopted a community-engaged approach to explore Korean parents' perceptions of barriers and facilitators to accessing autism services in British Columbia, Canada. Understanding the experiences of culturally and linguistically diverse families and their children may help facilitate the development of more inclusive, appropriate, and culturally sensitive services. Semi-structured interviews with 20 Korean parents of autistic children were analyzed using a thematic approach. Barriers and facilitators at the system, provider, and family/cultural level were identified. Barriers at the system level included delays and waitlists for services, and ineffective school policies to address child behavioral challenges. At the provider level, barriers included a lack of qualified professionals, negative attitudes, and lack of guidance navigating services. For family/cultural-related barriers, language and communication difficulties, out-of-pocket costs, and stigma impeded service access. Facilitators at the system level included family-centered care and prioritization of mental health supports. At the provider level, strengths included culturally competent and bilingual professionals. The family/cultural-related facilitators identified were informal support networks, characteristics of the parent, and connections to cultural community organizations. The findings emphasize the need to understand and consider diverse experiences, preferences, and values in the design and provision of autism services for families and their children. Perceptions and experiences of culturally and linguistically diverse groups in accessing autism services in Canada are extremely limited. Thus, this study partnered with a community member to explore Korean immigrant parents' perceptions of barriers and facilitators to accessing autism services in British Columbia, Canada. Interviews were conducted with 20 Korean parents of autistic children. Barriers and facilitators at the system, provider, and family/cultural level were identified. Barriers at the system level included delays and waitlists for services, and ineffective school policies to address child behavioral challenges. At the provider level, barriers included a lack of qualified professionals, negative attitudes, and lack of guidance navigating services. For family/cultural-related barriers, these included language and communication difficulties, out-of-pocket costs, and stigma impeded service access. Facilitators at the system level included family-centered care and prioritization of mental health supports. At the provider level, strengths included culturally competent and bilingual professionals. The family/cultural-related facilitators identified were informal support networks, characteristics of the parent, and connections to cultural community organizations. The findings emphasize the need to understand and consider diverse experiences, preferences, and values in the design and provision of autism services for families and their children. [ABSTRACT FROM AUTHOR]

Introduction: People experiencing homelessness are faced with complex challenges and are at high risk of illness due to inequities and disparities in access to health care services. Objective: To explore the health and foot care problems related to people experiencing homelessness in British Columbia. Methods: A community participatory research approach was used with a sample of 65 people experiencing homelessness. Data were collected using a survey questionnaire and face-to-face semistructured interviews. Results: Thematic findings shows risk of foot injuries, lack of foot care resources, and absence of family support. Barriers to equitable access to services for most participants experiencing homelessness were lack of housing (76.92%), inability to work (72.31%), and inability to afford the cost of living on their own (63.08%). Conclusions: There is a pressing need for early screening and detection by health care professionals and enhanced foot care services to reduce foot problems and improve foot care wellness of homeless people. Addressing foot-related care are necessary steps in promoting health, preventing illness, and improving access to health services among people experiencing homelessness. [ABSTRACT FROM AUTHOR]

Community-based participatory research (CBPR) has a long history within HIV research, yet little work has focused on facilitating team-based data analysis within CBPR. Our team adapted Thorne's interpretive description (ID) for CBPR analysis, using a color-coded "sticky notes" system to conduct data fragmentation and synthesis. Sticky notes were used to record, visualize, and communicate emerging insights over the course of 11 in-person participatory sessions. Data fragmentation strategies were employed in an iterative four-step process that was reached by consensus. During synthesis, the team created and recreated mind maps of the 969 sticky notes, from which we developed categories and themes through discussion. Flexibility, trust, and discussion were key components that facilitated the evolution of the final process. An interactive, team-based approach was central to data co-creation and capacity building, whereas the "sticky notes" system provided a framework for identifying and sorting data. [ABSTRACT FROM AUTHOR]

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, codeveloped with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support. [ABSTRACT FROM AUTHOR]

Effective rollout of HIV treatment-based prevention such as pre-exposure prophylaxis and treatment as prevention has been hampered by poor education, limited acceptability, and stigma among gay men. We undertook a thematic analysis regarding the education sources and acceptability of these New Prevention Technologies (NPTs) using 15 semistructured interviews with gay men in Vancouver, Canada, who were early adopters of NPTs. NPT education was derived from a variety of sources, including the Internet, health care providers, community organizations, sexual partners, and peers; participants also emphasized their own capacities as learners and educators. Acceptable forms of NPT education featured high-quality factual information, personal testimony, and easy access. Stigma was highlighted as a major barrier. For public health, policy makers, and gay communities to optimize the personal and population benefits of NPTs, there is a need for increased community support and dialogue, antistigma efforts, early NPT adopter testimony, and personalized implementation strategies. [ABSTRACT FROM AUTHOR]

Centering on practice within child welfare systems, this article focuses on four representative narratives derived from 32 in-depth qualitative interviews with women who experienced intimate partner violence and involvement with the child welfare system in Manitoba and British Columbia, Canada. Narrative analysis was used to explore the content of mothers’ stories to understand how they position themselves against their child welfare workers’ understanding of them as “failed” mothers. This article concludes with recommendations to enhance practice with mothers who are involved with child welfare systems [ABSTRACT FROM AUTHOR]

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional–Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC. [ABSTRACT FROM AUTHOR]

Diagnosing HIV-positive gay men through enhanced testing technologies that detect acute HIV infection (AHI) or recent HIV infection provides opportunities for individual and population health benefits. We recruited 25 men in British Columbia who received an acute (n = 13) or recent (n = 12) HIV diagnosis to engage in a longitudinal multiple-methods study over one year or longer. Our thematic analysis of baseline qualitative interviews revealed insights within men’s accounts of technologically mediated processes of HIV discovery and diagnosis. Our analysis illuminated the dialectic of new HIV technologies in practice by considering the relationship between advances in diagnostics (e.g., nucleic acid amplification tests) and the users of these medical technologies in clinical settings (e.g., clients and practitioners). Technological innovations and testing protocols have shifted experiences of learning of one’s HIV-positive status; these innovations have created new diagnostic categories that require successful interpretation and translation to be rendered meaningful, to alleviate uncertainty, and to support public health objectives. [ABSTRACT FROM AUTHOR]

The article focuses on a research on a therapy involving peer support and mental health workers for recovery of patients of mental illness. It presents the objectives of the research which includes comparison of therapies involving peer support and mental health workers and provide statistics for a larger study of the topic. It also presents the result of the research which states that there is no significant difference in the mentioned therapies.

• Summary: The purpose of this article is to explore the tensions that emerge when two very different discourses – the ‘democratic’, participatory discourse of FGC and the legalistic, bureaucratized discourse of conventional child welfare practice – attempt to integrate. We present the findings of a qualitative study, where we conducted 74 interviews, involving 26 adult family members/caregivers (three youth); six child protection workers; and three FGC coordinators. By listening to the voices of participants, we explore the complexities and tensions that exist at the nexus of (at least) two competing discourses, when the FGC process takes place within the child protection bureaucratic structure.• Findings: Our findings show how participants’ voices were co-opted by the more forceful child protection discourse, itself shaped by legal, bureaucratized, and neoliberal discourses. This research shows how in each case participants’ experience of power was subjugated, even though, in each instance, the case was perceived to have had a successful outcome by the social worker and FGC coordinator.• Applications: If those involved in administering and delivering family group conferencing continue to at least be aware of how power operates in this context, then the possibility exists to realize FGC's broader social justice and transformative goals. Further, a reflective practice (Schön, 1991) can mitigate the possibility of cooptation from particular bureaucratic, legal, and neoliberal discourses which dominate at different times, and which are incompatible with the inherent values and objectives of the FGC. [ABSTRACT FROM PUBLISHER]

In the study presented here, we examined factors that shape women’s employability and their impact on women’s subjective health and well-being in four British Columbian communities. Although the economic contexts of the urban, rural, remote, and reserve communities were diverse, they intersected with gender roles and cultural norms to provide a picture of women’s employability that was remarkably consistent. In all the communities, the women reported difficulties making ends meet; caregiving overload; chronic stress and worry; and, in many cases, violence and abuse. Our intersectional analysis allowed us to gain a deeper understanding of women’s lived experiences of being defined as employable. [ABSTRACT FROM PUBLISHER]

Healthy Opportunities for Preschoolers (HOP) is a physical activity and movement skill intervention that was developed to address the unique needs of home-based child care providers. The authors used a train-the-trainer approach to enhance local uptake and implementation of HOP and examined the impact on the trainers’ (workshop leaders’) perceived knowledge, confidence, and intention to implement community workshops and subsequently on the knowledge, confidence, and intentions of workshop participants. This study also assessed feasibility: reach, satisfaction, and facilitators and barriers to workshop implementation. Overall, 92% and 89.5% of the leaders were very or extremely satisfied with the workshop content and delivery, respectively. Training significantly increased their self-reported knowledge (p < .001) and confidence (p < .001). Subsequently, 73% of workshop participants (48 workshops, n = 321) took part in the evaluation; intention to use what they learned after the workshop was high (86%) and perceived knowledge, confidence, and attitude all increased significantly (p < .001). The HOP train-the-trainer approach was feasible and enhanced knowledge, confidence, and readiness to change among home-based child care providers. This approach should be considered as a component of an overall strategy to enhance the promotion of physical activity and movement skills in home-based child care settings. [ABSTRACT FROM PUBLISHER]

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Palliative care is delivered by a number of professional groups and informal providers across a range of settings. This arrangement works well in that it maximizes avenues for providing care, but may also bring about complicated ‘politics’ due to struggles over control and decision-making power. Thirty-one interviews conducted with formal and informal palliative care providers in a rural region of British Columbia, Canada, are drawn upon as a case study. Three types of politics impacting on palliative care provision are identified: inter-community, inter-site, and inter-professional. Three themes crosscut these politics: ownership, entitlement, and administration. The politics revealed by the interviews, and heretofore underexplored in the palliative literature, have implications for the delivery of palliative care. For example, the outcomes of the politics simultaneously facilitate (e.g. by promoting advocacy for local services) and serve as a barrier to (e.g. by privileging certain communities/care sites/provider) palliative care provision. [ABSTRACT FROM AUTHOR]

Although individuals who are diagnosed with smoking-related disorders are offered smoking cessation programs, little attention has been directed toward reducing tobacco use among healthy relatives who smoke. The purpose of this article is to report smoking relatives' responses to a family member's diagnosis of lung disease, their constructions of smoking in this context, and their interaction patterns with the patient. Interviews with 11 family members where there was a diagnosis of lung cancer and 3 family members where there was another serious smoking-related diagnosis were analyzed. Family members used two strategies to support their continued smoking: distancing themselves from the diagnosis and taking the position that smoking cessation needed to be internally motivated by the "right reason" and initiated at the "right time" to anticipate success. The few participants who chose to quit, did so in support of their ill family member. The findings provide direction for intervening with family members who smoke. [ABSTRACT FROM AUTHOR]