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Background: Many trans people who seek medical transition, particularly youth, struggle to access care in a timely manner. Frequently, specialized clinics tend serve the majority of the trans population and the capacity of these clinics ends up being overburdened by demand. Yet, the provision of gender-affirming medical care is not beyond the skillset of general practitioners and if more took up prescribing it, access could be improved. Objectives: This study sought to understand physician perspectives on gender-affirming care for trans youth in the hopes that insights into how to encourage more practitioners to take up providing care could be gleaned. The study had two central research questions. 1) What are Canadian physicians’ perceptions, education, and knowledge base surrounding gender-affirming care for youth under the age of 18? 2)How does this differ between knowledgeable physicians who have experience with gender-affirming care and inexperienced physicians who do not? Methodology: An anti-oppressive queer theoretical lens was applied to this study. Individual, semi-structured, in-depth, interviews were conducted with 13 physicians who had a range of experiences providing care for trans patients. The interviews were transcribed and coded for similar themes which constructed the results. Results: Participants discussed a wide range of topics related to gender-affirming care for trans patients, both specific to youth and more general to trans healthcare broadly. Many participants argued, some with direct firsthand experience, that gender-affirming care does not need to be specialized care and can be prescribed, easily, by primary care providers. Many physicians receive little, or no education related to gender-affirming care in medical school. Despite this lack of education several participants became knowledgeable and willing to provide care to trans patients. Knowledgeable physicians frequently shared similar motivations, and accessed similar resources, in o

The presence of two or more chronic conditions in the same individual has increased over recent years among different population groups. Studies have indicated that multimorbidity affects many adults and youth and leads to the overuse of healthcare services. In Colombia, the available evidence shows that 19.5% of all patients suffered from several chronic conditions in 2012-2016. The Wayuu people are one of the approximately 115 Indigenous ethnic groups in Colombia, with an estimated population of 380,400 (20% of the Indigenous people in the country). Anas Wayuu (AW) is an Indigenous-led non-profit health insurance company that provides health coverage to Wayuu people and collects data to reimburse health care services. A retrospective cohort study was performed, including a cross-sectional multimorbidity descriptive analysis. Administrative health records from AW healthcare providers were used as the data source. The purpose of the study was to identify multimorbidity patterns amongst AW enrollees. The Agglomerative Hierarchical Cluster analysis was used. Generalized linear mixed models were fitted for model differences in the healthcare services use rates provided to enrollees. In total, 159,921 were enrolled in AW in 2014-2017. The descriptive results indicated greater multimorbidity prevalence in female and older populations. Multimorbidity patterns across subpopulations showed morbidity profiles with a higher prevalence of musculoskeletal conditions. Healthcare utilization assessment in 2018-2019 showed higher use among multimorbid patients suffering from circulatory illnesses, Indigenous females, and those living in urban areas. The evidence about multimorbidity may help identify chronic disease clusters requiring further epidemiological research on causes, prevention, and treatment. The evidence may also be helpful for healthcare services planning and delivery for AW. The study provides information about multimorbidity among the Wayuu people, contributing to

Women with pathogenic or likely pathogenic variants in BRCA1 or BRCA2 (“BRCA-positive”) have an increased risk of developing high grade serous ovarian cancer (HGSOC). The majority of HGSOC develops in the fallopian tubes and later spreads to the ovaries and peritoneal cavity. Therefore, BRCA-positive women may consider risk-reducing salpingo-oophorectomy (RRSO) to preventatively remove their ovaries and fallopian tubes. The Hereditary Gynecology Clinic (HGC) in Winnipeg specifically targets care to the unique needs of BRCA-positive women through an interdisciplinary team of gynecological oncologists, menopause specialists, and registered nurses. A mixed-methods study design was used to explore the decision-making processes of BRCA-positive women considering (or who completed) RRSO, and how this decision was influenced by experiences with healthcare providers at the HGC. BRCA-positive women without a previous diagnosis of HGSOC and who had previously received genetic counselling were recruited from the HGC and the Shared Health Program of Genetics & Metabolism. Forty-three women completed a survey and 15 completed an interview about their experiences and decisions surrounding RRSO. Surveys were analyzed to compare scores on validated scales related to decision-making and cancer-related worry. Interviews were transcribed, coded, and analyzed using a generic qualitative research approach called interpretive description, which is a commonly used to explore clinical phenomena. The results of this study demonstrated that BRCA-positive women face complex decisions that are intertwined with unique experiences. BRCA-positive women interpreted their HGSOC risk through a personalized “lens” of contextual factors that impacted perceptions about the practical and emotional implications of RRSO, and therefore the need for surgery. Mean scores on validated scales evaluating the HGC’s impact on decisional outcomes and preparedness for decision-making about RRSO were not significant

BACKGROUND: Despite the over-representation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, there is limited research on their HIV care needs and treatment outcomes. This study addressed this knowledge gap by describing how newcomers are linked into HIV care in Manitoba, challenges faced when accessing care and their treatment outcomes. METHODS: An environmental scan was performed to collect data from literature sources and from semi-structured interviews with key informants who provide services to newcomers. The scan data were examined using qualitative content analysis. Clinical data from 1986 to 2017 were obtained from a cohort of people who receive care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed to compare differences in socio-demographic and clinical characteristics and treatment outcomes between newcomers, Indigenous and Canadian-born non-Indigenous persons in HIV care. RESULTS: Newcomers are linked to the Manitoba HIV Program through pathways that involve the Surveillance Unit at Manitoba Health, Seniors and Active Living, Regional Health Authorities’ Public Health Departments, Settlement Coordinators and physicians. Effective linkage and engagement in care may be limited by language barriers, stigma, distrust of medical systems, trauma, financial insecurity and lack of holistic support. By the end of 2017, there were 86 newcomers, 259 Indigenous and 356 Canadian-born non-Indigenous persons enrolled in the cohort. Newcomers in the cohort were younger, with a mean age of 43 years compared to the Indigenous group (45 years) and Canadian-born non-Indigenous group (52 years) (p<0.05). Newcomers were more likely to be female (45%) compared to Indigenous (42%) and Canadian-born non-Indigenous (13%) cohort participants (p<0.05). A higher proportion of newcomers self-reported their HIV risk exposure as heterosexual contact (80%) compared to the Indigenous group (53%) and Canadian-born non-Indigen

There is an overrepresentation of Indigenous children and families receiving services in the Manitoba child and family services sector at this time. There are upwards of 11,000 children in the care of the system and the children by large majority are Indigenous children. There have been many factors that have been identified as leading contributors to the current representation, including Colonization, the 60's Scoop and the Indian Residential School system. Each of these historic tragedies has contributed to the ongoing social impacts to Indigenous families, children and communities, which have in turn, become some of the social indicators of children's consequential involvement with the child welfare system. These indicators and predictor are, but not limited to: cycles of abuse, poverty, addiction, systemic involvement (child welfare and judicial) and mental health instability. In 2003, the process of 'Devolution' ensued based on the Aboriginal Justice Inquiry child welfare initiative and was an attempt to address the number of persons involved in the child and family services sector that were of Indigenous ancestry who were accessing and receiving services. This qualitative research involved listening to the stories and experiences of 12 mothers of varying ages and socioeconomic status, all of whom identified as Indigenous women. Each mother shared her experience of involvement within the Manitoba child and family services sector. From the shared experiences came needed areas for change, such as supports provided to families as well as worker relationships with families. Additionally, suggestions for more efficient and family centred service provision were offered.

In current global health parlance, sustainability is a key concern of funders and implementers alike, tied to growing concerns with accountability and, relatedly, the demand for precise measurement. Concerns over sustainability relate to vertical programming, fragmented care and short funding cycles. Communities who participate in successive programs may become disillusioned by the continual turnover and shifting priorities. In this thesis, I analyze the central role of program discourses, evidence production regimes and knowledge practices in the everyday life of a global health project to illuminate power imbalances that emerge within international partnership formations. Furthermore, within the context of a multi-partner maternal, newborn and child health (MNCH) project in Kenya, I illustrate how local communities engage with global health projects to ensure sustainability on their own terms. Methods: I conducted a 13-month ethnographic study of a MNCH and nutrition project in Taita Taveta County, eastern Kenya, following a project ethnography. Data collection took place between July 2014 and August 2016. Because the social dynamics of the project unfolded in multiple locales, I conducted my ethnographic fieldwork in Winnipeg, Canada, and in Nairobi and Taita Taveta, Kenya. In addition to participant observation, I undertook primary and secondary archival research to gain a deeper understanding of the history of development in Taita Taveta. I also conducted key informant interviews with university scientists and analyzed secondary qualitative data from the MNCH project. Data analysis occurred through an iterative process that triangulated the findings from the various sources. Results and Conclusions. Evidence is a central preoccupation in global health practice, with respect to 1) how scientists and program implementers attempt to meet funders’ demand for standardized, quantitative metrics and 2) how local people and communities position themselves to benefit fr

Chronic kidney disease (CKD) and its care are not evenly distributed across Canada, and individuals living in rural and remote locations across the country do not receive the same quality of care that is available in larger urban centres. Increasingly, technology is being used to assist with provision of care for those with chronic conditions in remote regions of the country. This study describes a pilot project that used Telehealth and a nurse clinician to provide care for individuals living with CKD in Northern Manitoba. From March 2010 until March 2014, 117 individuals received care from a northern-based nurse clinician using Telehealth to link with specialty nephrology services in Winnipeg. This study looks at patient demographic variables, health status variables and clinical indicator variables. Adverse clinical outcomes and disease progression are also presented.

Youth health promotion activities should reflect the concerns and interests of the youth being served. A quantitative exploration of youth concern related to health risk behaviour (HRB) engagement was conducted among youth in Winnipeg, MB. This study involved descriptive and inferential analysis of HRB engagement and attitude data from a cross-sectional survey of 250 youth (14–24 years). Chi-squared tests, Fisher’s exact tests, logistic regression and cluster analyses were employed to explore relationships between sociodemographic traits, HRB engagement, and HRB-specific concern. Findings demonstrated that A) youth in Winnipeg, regardless of their sociodemographic characteristics, do express concern about HRBs that they engage in; B) the likelihood of concern varies depending on what HRB one is examining; and C) while youth display similar trends in their concern about HRBs, different groups of youth, characterized by different patterns of engagement and sociodemographic traits vary in their likelihood of being concerned about particular HRBs.

The biomedical conceptualisation of “depression” as a disease entity stems from biological science rooted in a 17th century paradigm, and is an inappropriately positivist idea which discounts individual agency, disregards social context underscored in the descriptive epidemiology, fails to accommodate inter-subjectivity and process, medicalizes suffering, and serves a managed care model of health administration. A qualitative study using in-depth interviews was undertaken to elicit perspectives from individuals who had lived experience of biomedical (pharmacological) treatment for affective distress and who self-reported having attained satisfactory recovery. Thematic analysis of interview data clustered around three main categories: (1) multifactorial conceptual understandings; (2) context pertinent to the experience of distress and recovery – including a variety of stressors – and (3) trajectories of recovery from acute distress to negotiation of ambivalence toward treatment, enlisting of supports, and reclaiming of agency. Relationships with service providers marked by trust, empathy, and hope were valued as primary difference-makers.

Statement of Problem: Aboriginal youth are at greater risk of Type 2 Diabetes (T2D) compared to non-Aboriginal youth. Diabetes prevention strategies need to consider cultural factors that are embedded within an ecological perspective. Methods: Photovoice was used to explore the meanings of T2D and the Aboriginal Youth Mentorship Program (AYMP). Also, a non-randomized crossover experimental trial was performed on children. Grade 4 students were offered a 5 month intervention led by high school mentors. The main outcome measures were WC and BMI z score. Results: Results indicate that youth were very hopeful that T2D can be prevented or managed through nutrition and physical activity. They believe that AYMP can help with T2D prevention, through learning positive health behaviors, but also by enhancing social determinants of health related to education, employment and social support networks. After the intervention, the change in WC was significantly lower in the intervention group compared to the control group (p <0.05). Conclusion: Findings from this research study show that AYMP may be a successful program in teaching positive lifestyle behaviors while supporting social determinants of health; the combined biological and social outcomes can benefit students in reducing their risk for T2D.

A qualitative exploratory study informed by a community-based research model was conducted, involving the non-governmental organization Karnataka Health Promotion Trust, and community-based organization Chaitanya Mahila Sangha led by women in sex work, in India at each stage of the study. In-depth interviews were conducted by community research investigators among a purposive sample of 21 female sex workers and male intimate partners in Bagalkot district, Karnataka, India to explore how they describe their experience and understandings of intimate partner violence (IPV). The results show the social significance of intimate relationships as well as the interplay of multi-leveled issues underlying the vulnerability to intimate partner violence among sex-workers. The findings support the need for structural interventions working not only on the individual and relationship levels to address relevant triggers of violence, but also the community and societal levels, with the integral involvement of community partners, to more effectively address vulnerability to IPV.