Research and publications

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https://hdl.handle.net/10315/32385

This collection consists of journal articles, pre-prints, conference papers and other research and scholarship by graduate students and faculty associated with the School of Health Policy and Management, which includes the Graduate Program in Critical Disability Studies and the Graduate Program in Health.

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Now showing 1 - 20 of 58

Open Access
Are physicians ready for patients with Internet-based health information?
(Journal of Medical Internet Research, 2006-09-29) Ahmad, F; Hudak, PL; Bercovitz, K; Hollenberg, E; Levinson, W
Background: An increasing number of patients bring Internet-based health information to medical consultations. However, little is known about how physicians experience, manage, and view these patients. Objective: This study aimed to advance the understanding of the effects of incorporating Internet-based health information into routine medical consultations from physicians’ perspectives, using a qualitative approach. Methods: Six focus groups were conducted with 48 family physicians practising in Toronto. The data were analyzed using qualitative methods of content analysis and constant comparison, derived from grounded theory approach. Results: Three overarching themes were identified: (1) perceived reactions of patients, (2) physician burden, and (3) physician interpretation and contextualization of information. Physicians in our study generally perceived Internet-based health information as problematic when introduced by patients during medical consultations. They believed that Internet information often generated patient misinformation, leading to confusion, distress, or an inclination towards detrimental self-diagnosis and/or self-treatment. Physicians felt these influences added a new interpretive role to their clinical responsibilities. Although most of the physicians felt obliged to carry out this new responsibility, the additional role was often unwelcome. Despite identifying various reactions of patients to Internet-based health information, physicians in our study were unprepared to handle these patients. Conclusion: Effective initiatives at the level of the health care system are needed. The potential of Internet-based health information to lead to better physician-patient communication and patient outcomes could be facilitated by promoting physician acknowledgment of increasing use of the Internet among patients and by developing patient management guidelines and incentives for physicians.
Open Access
Assessing patient attitudes to computerized screening in primary care: psychometric properties of the computerized lifestyle assessment scale
(Journal of Medical Internet Research, 2008-04-18) Ahmad, F; Hogg-Johnson, Sheilah; Skinner, HA
Background: Computer-based health-risk assessments are electronic surveys which can be completed by patients privately, for example during their waiting time in a clinic, generating a risk report for the clinician and a recommendation sheet for the patient at the point of care. Despite increasing popularity of such computer-based health-risk assessments, patient attitudes toward such tools are rarely evaluated by reliable and valid scales. The lack of psychometric appraisal of appropriate scales is an obstacle to advancing the field. Objective: This study evaluated the psychometric properties of a 14-item Computerized Lifestyle Assessment Scale (CLAS). Methods: Out of 212 female patients receiving the study information at a family practice clinic, 202 completed a paper questionnaire, for a response rate of 97.6%. After 2 weeks, 52 patients completed the scale a second time. Results: Principal component analysis revealed that CLAS is a multidimensional scale consisting of four subscales (factors): (1) Benefits: patient-perceived benefits toward the quality of medical consultation and means of achieving them, (2) Privacy-Barrier: concerns about information privacy, (3) Interaction-Barrier: concerns about potential interference in their interaction with the physician, and (4) Interest: patient interest in computer-assisted health assessments. Each subscale had good internal consistency reliability ranging from .50 (2-item scale) to .85 (6-item scale). The study also provided evidence of scale stability over time with intraclass correlation coefficients of .91, .82, .86, and .67 for the four subscales, respectively. Construct validity was supported by concurrent hypotheses testing. Conclusions: The CLAS is a promising approach for evaluating patients’ attitudes toward computer-based health-risk assessments.
Open Access
Beyond barriers in studying disparities in women's access to health services in Ontario, Canada: a qualitative metasynthesis
(SAGE, 2013-04) Angus, JE; Lombardo, AP; Lowndes, RH; Cechetto, N; Ahmad, F; Bierman, AS
Women live within complex and differing social, economic, and environmental circumstances that influence options to seek health care. In this article we report on a metasynthesis of qualitative research concerning access disparities for women in the Canadian province of Ontario, where there is a publicly funded health care system. We took a metastudy approach to analysis of results from 35 relevant qualitative articles to understand the conditions and conceptualizations of women’s inequitable access to health care. The articles’ authors attributed access disparities to myriad barriers. We focused our analysis on these barriers to understand the contributing social and political forces. We found that four major, sometimes countervailing, forces shaped access to health care: (a) contextual conditions, (b) constraints, (c) barriers, and (d) deterrents. Complex convergences of these forces acted to push, pull, obstruct, and/or repel women as they sought health care, resulting in different patterns of inequitable access.
Open Access
Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht
(2023-06-21) MacGregor, William; Horn, Martin; Raphael, Dennis
Bertolt Brecht’s poem “A Worker’s Speech to a Doctor” is frequently cited as a means of raising awareness among health workers of the effects of living and working conditions upon health. Less cited is his trilogy of poems entitled Call to Arms which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article we show how “A Worker’s Speech”, with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Calls to Arms Trilogy: “Call to a Sick Communist”, “The Sick Communist’s Answer to the Comrades”, and “Call to the Doctors and Nurses”. We also show that while “A Worker’s Speech” has been applied in the training of health workers, its accusatorial tone towards health workers’ complicity in the system the poem is critiquing risks alienating them. In contrast, the Call to Arms Trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a “communist” risks estranging these health workers, our analysis of the Call toAction poems nevertheless indicates their use can contribute to move health workers’ educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.
Open Access
Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model
(Elsevier, 2002-05) Austin, LT; Ahmad, F; McNally, MJ; Stewart, Donna Eileen
The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.
Open Access
The burden of cancer in Austria
(Wolters Kluwer, 1999-02) Vutuc, C; Waldhoer, T; Haidinger, G; Ahmad, F; Micksche, M
The aim of this study was to assess the overall progress against cancer in Austria by analysing changes in age-adjusted mortality rates from 1970 to 1996. For the years 1970 to 1996, age-adjusted rates for all malignant neoplasms and for selected sites were calculated for men and women, according to year, age and sex. The number of cancer deaths were obtained from the Austrian Central Statistical Office--age-adjusted mortality rates of all malignant neoplasms decreased in men between 1971 and 1996 by 13% (from 289.1 to 251.4 deaths per 100,000), and in women between 1970 and 1996 by 19.1% (from 276.6 to 223.7 deaths per 100,000). Among older people (> or = 55 years) the mortality decreased by 13% in men and by 17% in women; among younger people (< 55 years) by 12% and 30%, respectively. The decrease in total cancer mortality is promoted by three tumour sites (the leading causes of cancer deaths in 1970). In both sexes, the decrease of stomach cancer mortality had the major impact, followed by colorectal cancer in women and by lung cancer in men. The observed changes in mortality are primarily related to changing incidence and early detection, rather than improvements in treatment. Unfortunately, there is evidence that prevention is losing ground in Austria. The implementation of the well-established knowledge of cancer prevention and the strengthening of preventative research is urgently needed.
Open Access
Cancer screening behaviours among South Asian immigrants in the UK, US and Canada: a scoping study
(Wiley, 2015-02) Crawford, J; Ahmad, F; Beaton, D; Bierman, AS
South Asian (SA) immigrants settled in the United Kingdom (UK) and North America [United States (US) and Canada] have low screening rates for breast, cervical and colorectal cancers. Incidence rates of these cancers increase among SA immigrants after migration, becoming similar to rates in non-Asian native populations. However, there are disparities in cancer screening, with low cancer screening uptake in this population. We conducted a scoping study using Arksey & O’Malley’s framework to examine cancer screening literature on SA immigrants residing in the UK, US and Canada. Eight electronic databases, key journals and reference lists were searched for English language studies and reports. Of 1465 identified references, 70 studies from 1994 to November 2014 were included: 63% on breast or cervical cancer screening or both; 10% examined colorectal cancer screening only; 16% explored health promotion/service provision; 8% studied breast, cervical and colorectal cancer screening; and 3% examined breast and colorectal cancer screening. A thematic analysis uncovered four dominant themes: (i) beliefs and attitudes towards cancer and screening included centrality of family, holistic healthcare, fatalism, screening as unnecessary and emotion-laden perceptions; (ii) lack of knowledge of cancer and screening related to not having heard about cancer and its causes, or lack of awareness of screening, its rationale and/or how to access services; (iii) barriers to access including individual and structural barriers; and (iv) gender differences in screening uptake and their associated factors. Findings offer insights that can be used to develop culturally sensitive interventions to minimise barriers and increase cancer screening uptake in these communities, while recognising the diversity within the SA culture. Further research is required to address the gap in colorectal cancer screening literature to more fully understand SA immigrants’ perspectives, as well as research to better understand gender-specific factors that influence screening uptake.
Open Access
Colorectal cancer screening behaviors among South Asian immigrants in Canada: a qualitative study
(Emerald, 2015-06) Crawford, J; Ahmad, F; Beaton, DE; Bierman, AS
Purpose: The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants. Design/methodology/approach: Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques. Findings: Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access. Originality/value: Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.
Open Access
Community-based participatory research: development of an emergency department-based youth violence intervention using concept mapping
(Wiley, 2010-08) Snider, CE; Kirst, M; Abubakar, S; Ahmad, F; Nathens, AB
Objectives: Emergency departments (EDs) see a high number of youths injured by violence. In Ontario, the most common cause of injury for youths visiting EDs is assault. Secondary prevention strategies using the teachable moment (i.e., events that can lead individuals to make positive changes in their lives) are ideal for use by clinicians. An opportunity exists to take advantage of the teachable moment in the ED in an effort to prevent future occurrences of injury in at-risk youths. However, little is known about perceptions of youths, parents, and community organizations about such interventions in EDs. The aims of this study were to engage youths, parents, and frontline community workers in conceptualizing a hospitalbased violence prevention intervention and to identify outcomes relevant to the community. Methods: Concept mapping is an innovative, mixed-method research approach. It combines structured qualitative processes such as brainstorming and group sorting, with various statistical analyses such as multidimensional scaling and hierarchical clustering, to develop a conceptual framework, and allows for an objective presentation of qualitative data. Concept mapping involves multiple structured steps: 1) brainstorming, 2) sorting, 3) rating, and 4) interpretation. For this study, the first three steps occurred online, and the fourth step occurred during a community meeting. Results: Over 90 participants were involved, including youths, parents, and community youth workers. A two-dimensional point map was created and clusters formed to create a visual display of participant ideas on an ED-based youth violence prevention intervention. Issues related to youth violence prevention that were rated of highest importance and most realistic for hospital involvement included mentorship, the development of youth support groups in the hospital, training doctors and nurses to ask questions about the violent event, and treating youth with respect. Small-group discussions on the various clusters developed job descriptions, a list of essential services, and suggestions on ways to create a more youth-friendly environment in the hospital. A large-group discussion revealed outcomes that participants felt should be measured to determine the success of an intervention program. Conclusions: This study has been the springboard for the development of an ED-based youth violence intervention that is supported by the community and affected youth. Using information generated by youth that is grounded in their experience through participatory research methods is feasible for the development of successful and meaningful youth violence prevention interventions.
Open Access
Computer-assisted screening for intimate partner violence and control: a randomized trial
(American College of Physicians, 2009-07) Ahmad, F; Hogg-Johnson, Sheilah; Stewart, Donna Eileen; Skinner, HA; Glazier, Richard; Levinson, W
Background: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women. Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting. Design: Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention. Setting: An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada. Participants: Adult women in a current or recent relationship. Intervention: Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (nÂ = 144). Control participants received standard medical care (nÂ = 149). Measurements: Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits. Results: The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (nÂ = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions. Limitation: The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used. Conclusion: Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients. Primary Funding Source: Canadian Institutes of Health Research and Ontario Women's Health Council.
Open Access
Concept mapping with South Asian immigrant women: barriers to mammography and solutions
(Springer, 2012-04) Ahmad, F; Mahmood, S; Pietkiewicz, Igor; McDonald, L; Ginsburg, O
Despite benefits of screening mammography, many South Asian (SA) immigrant women in Canada remain under screened. We aimed to elicit their experiences and beliefs about barriers to mammography and possible solutions. SA immigrant women aged 50 years or over were eligible if they never had a mammogram or had one more than 3 years ago. We employed the participatory mixed-method approach of Concept Mapping. Sixty women participated with a mean age of 58 years. Participants brainstormed 150 items which were consolidated into 67 items. After sorting and rating, cluster analysis revealed eight clusters of barriers on knowledge, fear, language and transportation, access to mammogram center, access to doctor, beliefs and practices, self-care, and family dependence. Participants discussed possible solutions, and emphasized out-reach models to address knowledge gaps and issues of language and transportation. One example was a community-based shuttle bus to screening centres, hosted by trained co-ethnic workers. The results are discussed to enhance the socio-cultural sensitivity of breast screening programs.
Open Access
Cross-cultural perspectives on research participation and informed consent
(Elsevier, 2006-01) Barata, PC; Gucciardi, Enza; Ahmad, F; Stewart, Donna Eileen
This study examined Portuguese Canadian and Caribbean Canadian immigrants' perceptions of health research and informed consent procedures. Six focus groups (three in each cultural group) involving 42 participants and two individual interviews were conducted. The focus groups began with a general question about health research. This was followed by three short role-plays between the moderator and the assistant. The role-plays involved a fictional health research study in which a patient is approached for recruitment, is read a consent form, and is asked to sign. The role-plays stopped at key moments at which time focus group participants were asked questions about their understanding and their perceptions. Focus group transcripts were coded in QSR NUDIST software using open coding and then compared across cultural groups. Six overriding themes emerged: two were common in both the Portuguese and Caribbean transcripts, one emphasized the importance of trust and mistrust, and the other highlighted the need and desire for more information about health research. However, these themes were expressed somewhat differently in the two groups. In addition, there were four overriding themes that were specific to only one cultural group. In the Portuguese groups, there was an overwhelming positive regard for the research process and an emphasis on verbal as opposed to written information. The Caribbean participants qualified their participation in research studies and repeatedly raised images of invasive research.
Open Access
Diet, Physical Activity, and Emotional Health: What Works, What Doesn’t, and Why We Need Integrated Solutions for Total Worker Health
(BMC, 2019) Syed, Iffath
Background Current research advocates lifestyle factors to manage workers’ health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees’ lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector. Methods Drawing on qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker’s mechanisms for maintaining physical, emotional, and social wellbeing. Results The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important. Conclusions Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers’ health and wellbeing.
Open Access
Eating Disorders
(BioMed Central, 2004-08-25) Gucciardi, Enza; Celasun, N; Ahmad, F; Stewart, Donna Eileen
Health Issue: Eating disorders are an increasing public health problem among young women. Anorexia and bulimia may give rise to serious physical conditions such as hypothermia, hypotension, electrolyte imbalance, endocrine disorders, and kidney failure. Key Issues: Eating disorders are primarily a problem among women. In Ontario in 1995, over 90% of reported hospitalized cases of anorexia and bulimia were women. In addition to eating disorders, preoccupation with weight, body image and self-concept disturbances, are more prevalent among women than men. Women with eating disorders are also at risk for long-term psychological and social problems, including depression, anxiety, substance abuse and suicide. For instance, in 2000, the prevalence of depression among women who were hospitalized with a diagnosis of anorexia (11.5%) or bulimia (15.4 %) was more than twice the rate of depression (5.7 %) among the general population of Canadian women. The highest incidence of depression was found in women aged 25 to 39 years for both anorexia and bulimia. Data Gaps and Recommendations: Hospitalization data are the most recent and accessible information available. However, this data captures only the more severe cases. It does not include the individuals with eating disorders who may visit clinics or family doctors, or use hospital outpatient services or no services at all. Currently, there is no process for collecting this information systematically across Canada; consequently, the number of cases obtained from hospitalization data is underestimated. Other limitations noted during the literature review include the overuse of clinical samples, lack of longitudinal data, appropriate comparison groups, large samples, and ethnic group analysis.
Open Access
Exploring ways to overcome barriers to mammography uptake and retention among South Asian immigrant women
(Wiley, 2013-01) Ahmad, F; Jandu, B; Albagli, A; Angus, JE; Ginsburg, O
South Asians comprise one of the fastest growing immigrant groups in North America. Evidence indicates that South Asian (SA) immigrant women are vulnerable to low rates of breast cancer screening. Yet, there is a dearth of knowledge pertaining to socio-culturally tailored strategies to guide the uptake of screening mammography in the SA community. In 2010, the authors conducted semi-structured focus groups to elicit perspectives of health and social service professionals on possible solutions to barriers identified by SA immigrant women in a recent study conducted in the Greater Toronto Area. Thirty-five health and social services staff members participated in five focus groups. The discussions were audio taped and detailed field notes were taken. All collected data was transcribed verbatim and thematic analysis was conducted using techniques of constant comparison within and across the group discussions. Three dominant themes were identified: 1) “Target and Tailor” focused on awareness-raising through multiple direct and indirect modes or approaches with underlying shared processes of involving men and the whole family, use of first language, and learning from peers; 2) “Enhancing Access to Services” included a focus on ‘adding ancillary services’ and ‘reinforcement of existing services’ including expansion to a one-stop model; and 3) “Meta-Characteristics” centred on providing ‘multi-pronged’ approaches to reach the community, and ‘sustainability’ of initiatives by addressing structural barriers of adequate funding, healthcare provider mix, inter-sectoral collaboration, and community voice. The findings simultaneously shed light on the grass-roots practical strategies and the system level changes in order to develop efficient programmes for the uptake of mammography among SA immigrant women. The parallel focus on the “Target and Tailor” and “Enhancing Access to Services” calls for coordination at the policy level so that multiple sectors work jointly to streamline resources, or meta-characteristics.
Open Access
Follow-Up Visit Patterns in an Antiretroviral Therapy (ART) Programme in Zomba, Malawi
(Public Library of Science, 2014-07-17) Rachlis, Beth; Cole, Donald; van Lettow, Monique; Escobar, Michael; Muula, Adamson; Ahmad, F; Orbinski, J; Chan, Adrienne K.
Background: Identifying follow-up (FU) visit patterns, and exploring which factors influence them are likely to be useful in determining which patients on antiretroviral therapy (ART) may become Lost to Follow-Up (LTFU). Using an operation and implementation research approach, we sought 1) to describe the timing of FU visits amongst patients who have been on ART for shorter and longer periods of time; and 2) to determine the median time to late visits, and 3) to identify specific factors that may be associated with these patterns in Zomba, Malawi. Methods and Findings: Using routinely collected programme monitoring data from Zomba District, we performed descriptive analyses on all ART visits among patients who initiated ART between Jan. 1, 2007–June 30, 2010. Based on an expected FU date, each FU visit was classified as early (≥4 day before an expected FU date), on time (3 days before an expected FU date/up to 6 days after an expected FU date), or late (≥7 days after an expected FU date). In total, 7,815 patients with 76417 FU visits were included. Ninety-two percent of patients had ≥2 FU visits. At the majority of visits, patients were either on time or late. The median time to a first late visit among those with 2 or more visits was 216 days (IQR: 128–359). Various patient- and visit-level factors differed significantly across Early, On Time, and Late visit groups including ART adherence and frequency of, and type of side effects. Discussion: The majority of patients do not demonstrate consistent FU visit patterns. Individuals were generally on ART for at least 6 months before experiencing their first late visit. Our findings have implications for the development of effective interventions that meet patient needs when they present early and can reduce patient losses to follow-up when they are late. In particular, time-varying visit characteristics need further research.
Open Access
HLST 1011 Keynote Speaker Dr Naheed Dosani interviewed by Azeezah Jafry
(2021-10-22) Vorstermans, Jessica
Interview with Dr. Naheed Dosani on his work as a palliative care physical working with street involved folks. Dr. Dosani is a health equity and justice advocate. He is interviewed by Azeezah Jafry.
Open Access
ICT-Based Interventions for Women Experiencing Intimate Partner Violence: Research Needs in Usability and Mental Health
(BMC Public Health, 2020-09-07) El Morr, Christo; Layal, Manpreet
Intimate Partner Violence is a “global pandemic”. Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).
Open Access
Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review
(Elsevier, 2011-03) O'Campo, P; Kirst, M; Tsamis, C; Chambers, C; Ahmad, F
We undertook a synthesis of existing studies to re-evaluate the evidence on program mechanisms of intimate partner violence (IPV) universal screening and disclosure within a health care context by addressing how, for whom, and in what circumstances these programs work. Our review is informed by a realist review approach, which focuses on program mechanisms. Systematic, realist reviews can help reveal why and how interventions work and can yield information to inform policies and programs. A review of the scholarly literature from January 1990 to July 2010 identified 5046 articles, 23 of which were included in our study. We identified studies on 17 programs that evaluated IPV screening. We found that programs that took a comprehensive approach (i.e., incorporated multiple program components, including institutional support) were successful in increasing IPV screening and disclosure/identification rates. Four program components appeared to increase provider self-efficacy for screening, including institutional support, effective screening protocols, thorough initial and ongoing training, and immediate access/referrals to onsite and/or offsite support services. These findings support a multi-component comprehensive IPV screening program approach that seeks to build provider self-efficacy for screening. Further implications for IPV screening intervention planning and implementation in health care settings are discussed.
Open Access
Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety
(BMJ, 2018-11-28) Zaheer, Shahram; Ginsburg, Liane; Wong, Hannah; Thomson, Kelly; Bain, Lorna
Background: There is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain—for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety. Purpose: The impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario. Methods: Cross-sectional survey data were collected from nurses, allied health professionals and unit clerks working on intensive care, general medicine, mental health or emergency department. Results: Hierarchical regression analyses showed that perceptions of senior leadership (p<0.001) and teamwork (p<0.001) were significantly associated with overall perceptions of PS. A non-significant association was found between perceptions of supervisory leadership and the outcome variable. However, when staff perceived poorer senior leadership support for safety, the positive effect of supervisory leadership on overall perceptions of PS became significantly stronger (p<0.05). Practice implications: Our results suggest that leadership support at one level (ie, supervisory) can substitute for the absence of leadership support for safety at another level (ie, senior level). While healthcare organisations should recruit into leadership roles and retain individuals who prioritise safety and possess adequate relational competencies, the field would now benefit from evidence regarding how to build leadership support for PS. Also, it is important to provide on-site workshops on topics (eg, conflict management) that can strengthen working relationships across professional and unit boundaries.

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