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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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
Youth-Serving Organizations’ Inclusivity of LGBTQ Newcomers in Canada – A Content Analysis
(Journal of Gay & Lesbian Social Services, 2021-03-09) Flett, Joseph
For LGBTQ newcomer youth lacking support at home and in school, youth-serving organizations provide various services and socialization that can effectively address their challenges. In a two-stage content analysis, this study explored LGBTQ newcomer inclusivity in 39 youth-serving organizations in Toronto and Vancouver, as well as programs and services offered to this subpopulation specifically. Stage 1 findings demonstrate that few organizations displayed inclusion of, and supports for, LGBTQ newcomers. Stage 2 findings show that programs and services offered to this subpopulation can be categorized into four themes: cultural and linguistic sensitivity, skills development & education, socialization & community connections, and health & well-being. Recommendations for best practices are discussed.
Open Access
Tell me about Food Justice with Cheyenne Sundance. HLST 1011: Health on the Front Lines, School of Health Policy & Management, York University.
(2022-10-25) Vorstermans, Jessica
Tell me about food justice with Cheyenne Sundance. Video filmed for HLST 1011: Health on the Front Lines, School of Health Policy & Management, York University. Producer: Jessica Vorstermans. Filming: Regenesis.
Open Access
Tell me about immigration status & health with jade guthrie. HLST 1011: Health on the Front Lines. School of Health Policy & Management, York University.
(2021-11-12) Vorstermans, Jessica
Video with jade guthrie from Food Share. Produced for Health on the Front Lines (HLST1011), School of Health Policy & Management, York University. Producer: Dr. Jessica Vorstermans. Filming: Regenesis.
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
Ritualizing Madness: Case Files as Sites of Enforced Performativity, 1894-1950
(Canadian Journal of Disability Studies, 2021) Smith, Kira A.
In this article, I argue that case files kept by doctors, nurses, and attendants in Canadian Asylums, act as sites of performative madness enforced by the observer. In applying Foucauldian and performance theories, I look at the production of knowledge, and influence of power, which allow for the encoding of madness as a ritualized behaviour that is repeatable outside of the individual being recorded as mad. To illustrate this point, I use several case files from the Brockville Asylum to highlight how certain physical characteristics and behaviours were pathologized to support the medical argument that the inmate in question was in fact mad and belonged in the asylum. I suggest that one is not born mad, but they become mad through enforced ideas of madness, which enforced by the observer’s categorization of a physical characteristic or behaviour as mad.
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
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.
Open Access
Models of Concurrent Disorder Service: Policy, Coordination, and Access to Care
(Frontiers, 2019-02-19) Wiktorowicz, Mary; Abdulle, Aber; Di Pierdomenico, Kaitlin; Boamah, Sheila A.
Background: Societal capacity to address the service needs of persons with concurrent mental health and substance-use disorders has historically been challenging given a traditionally siloed approach to mental health and substance-use care. As different approaches to care for persons with concurrent disorders emerge, a limited understanding of current models prevails. The goal of this paper is to explore these challenges along with promising models of coordinated care across Canadian provinces. Materials and methods: A scoping review of policies, service coordination and access issues was undertaken involving a review of the formal and gray literature from 2000 to 2018. The scoping review was triangulated by an analysis of provincial auditor general reports. Results: Models of concurrent disorders service were found to have evolved unevenly. Challenges related to the implementation of models of collaborative care and local networks that foster service coordination and policy accountability were found to inhibit integrated care. Conclusion: Emergent models of coordinated care were found to include collaborative care, regional networks with centralized access to care, clinical information-sharing, cross-training, improved scope of care to include psychologists and alignment of physician incentives with patient needs to better support patient care.
Open Access
Women in clinical trials: a review of policy development and health equity in the Canadian context
(Biomed Central, 2019-04-15) Yakerson, Alla
Health equity in pharmaceutical research is concerned with creating equal opportunities for men and women to partake in clinical trials. Equitable representation is imperative for determining the safety, effectiveness, and tolerance of drugs for all consumers. Historically, women have been excluded from participating in clinical research leading to a lack of knowledge regarding drug effects and their consequences. This paper examines the changes made since the implementation of Canadian policies on the representation of women in clinical trials, the analysis of sex and gender, as well as the discourses that are prominent among researchers. A feminist ethics framework is used to examine the structures that endeavor to elucidate women’s involvement in trials, as experienced under extensive patriarchal history. Scholarly literature and Canadian government policy documents are used to explore the development of clinical trials as pertaining to sex and gender. Findings suggest that women continue to be underrepresented or excluded from important research, highlighting ongoing ethical and justice concerns. Improvement recommendations for policies are outlined. Keywords: Women, Clinical trials, Underrepresentation, Feminism, Sex, Gender, Policy
Open Access
Transnational pharmacogovernance: emergent patterns in the jazz of pharmaceutical policy convergence
(Biomed Central, 2018-08-22) Wiktorowicz, Mary; Moscou, Kathy; Lexchin, Joel
Background: As a transnational policy network, the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) aligns international regulatory standards to address the pressures of globalization on the pharmaceutical industry and increase access to new medicines. Founding ICH members include regulators and pharmaceutical industry trade associations in the European Union, the United States and Japan. In this paper we explore the manner in which state interdependence fosters the conditions for regulatory harmonization by tracing the underlying parallels between ICH and member state pharmacogovernance to clarify emergent patterns in regulatory policy convergence. Results: A shift to the life cycle approach to pharmaceutical regulation corresponded with international convergence in pre-market standards as emphasis shifted to post-market standards where convergence remains unresolved. Transnational pharmacogovernance was found to concentrate regulatory authority within a coregulatory model of bilateral negotiation with pharmaceutical trade associations in defining safety and efficacy standards. Given a context of state interdependence, parallels were found between transnational and ICH member pharmacogovernance modes that guide policy development. Divergent modes of state regulatory governance that re-calibrate perceptions of risk and risk mitigation were found to coincide with post-market policy dissonance. Conclusion: Although interdependence fostered harmonization in pre-market standards and aligned with increased focus on post-market approaches, the confluence of divergent state governance modes and perceptions of risk may inspire improvisation in post-market standards. As the ICH expands to an ensemble with a greater global reach, further research is needed to clarify the manner in which interdependence shapes transnational pharmacogovernance and the conditions that foster policy convergence in the public interest. Keywords: Pharmaceutical regulation, Medicines policy, Transnational governance, Transnational regulation, Pharmacogovernance, Policy network, Policy convergence, Drug safety, Pharmacovigilance
Open Access
Regulating the fast-food landscape: Canadian news media representation of the Healthy Menu Choices Act
(BMC, 2019) Moghimi, Elnaz; Wiktorowicz, Mary
With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choices
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
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
Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women
(Oxford University Press, 2002-04) Ahmad, F; Gupta, H; Rawlins, J; Stewart, Donna Eileen
Objective. The aim of this study was to investigate expressed preferences for family physician (FP) gender among Canadian European-descent (CED) and Canadian South-Asian (CSA) immigrant women. Method. An ‘on-site’ survey was conducted in community-based institutions in Toronto in order to determine preferences for the gender of FP under various health care scenarios: overall health care; gender-sensitive examinations; emotional problems; general ailments; and life-threatening conditions. Results. Ninety-four women responded to this survey (CED = 50, CSA = 44), response rate 77.3%. For all health care scenarios, CED and CSA women similarly expressed either a preference for a female FP or no preference. More than two-thirds of women preferred a female FP for gynaecological examinations (CED, 72.9%; CSA, 83.7%) or examinations with private body part exposure (CED, 72%; CSA, 81.8%). For ‘emotional problems', half of the women preferred a female FP and the other half had no preference. A similar pattern was observed for ‘overall health care', with some shift to female physician preference among CSA women (60.5%) compared with CED women (53.2%). For the ‘overall health care' scenario, CED and CSA women who preferred a female FP had a higher frequency of seeing female physicians within the last 5 years (CED, P ≤ 0.01; CSA, P ≤ 0.05), and attributed ‘positive' social skills more to female physicians (CED, P ≤ 0.01; CSA, P ≤ 0.01) compared with women with no preference for the gender of the FP. Yet, CED women with a female FP preference were more likely to have a concurrent female FP (P ≤ 0.01), and to rate past experiences with female physicians as high (P ≤ 0.01) and with male physicians as low (P ≤ 0.05) compared with CED women with no preference. In the CSA group, women with a preference for a female FP were more likely to be unemployed (P ≤ 0.01) and have low social support (P ≤ 0.01). Conclusions. Despite similar physician gender preference patterns, factors associated with these preferences show some differences between CED and CSA women.
Open Access
Women's hysterectomy experiences and decision-making
(Taylor & Francis, 2003) USKUL, AYSE K.; Ahmad, F; Leyland, NA; Stewart, Donna Eileen
The goal of the study was to examine women's experiences with gynaecologic symptoms and how they decided to undergo hysterectomy. For this purpose, twenty-nine women were interviewed in hospital within three days of undergoing hysterectomy. The interviews elicited information about the nature of the problem that caused the women to seek medical help, actions taken to solve their problem, their relationship with their gynaecologist, information seeking patterns and decision-making about hysterectomy. Although findings revealed that the symptoms women suffered had a negative impact on their lives, most women delayed seeking medical help and attributed their symptoms to factors other than a physical problem in their reproductive system. Most of the participants' information about the symptoms and possible treatments came from their consulting other women with similar problems. The women reported that their gynaecologist did not initiate a comprehensive discussion about other treatments and their advantages and dis-advantages. Only women who had informed themselves about other treatments actively discussed alternatives to hysterectomy with their physicians. The women's decision-making process about undergoing hysterectomy was difficult and depended primarily on the women's illness experiences, age, wish for future children, information they gathered from their gynaecologist and from other women. The findings are discussed in relation to the importance of information provision by gynaecologists and its effects on women's decision-making about hysterectomy.
Open Access
Voices of South Asian women: immigration and mental health
(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna Eileen
Purpose: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. Methods: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. Results: Mental health (MH) emerged as an overarching health concern with three major themes, i.e., appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed that MH did not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. Conclusion: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group.
Open Access
Popular health promotion strategies among Chinese and East Indian immigrant women
(Taylor & Francis, 2004) Ahmad, F; Shik, A; Vanza, R; Cheung, Angela M.; George, U; Stewart, Donna Eileen
Purpose: To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. Methods: Eight focus groups were conducted with 46 immigrant women, 22 from Mainland China and 24 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. Results: In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. Conclusion: Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An “outside the box” approach of non-institutional informal health promotion strategies needs to be tested for the studied groups.
Open Access
Physician–patient interaction: a gynecology clinic in Turkey
(Elsevier, 2003-07) USKUL, AYSE K.; Ahmad, F
Evidence for gender differences in physicians' communication with their patients comes primarily from Western countries. Little is known about whether these gender differences would also be observed in Turkey, where there are explicit rules about male-female conduct. The purpose of this study was to observe male and female gynecologists' communication with their patients in a gynecology clinic at a state hospital in Istanbul, Turkey. Four male and three female gynecologists were observed in their interaction with 70 patients over 10 days. The observations were conducted during both the history taking and the actual examination sessions by a woman researcher. The results reported in this paper are based on the extensive field notes taken during the observations. Important differences were revealed in interactions between male vs female gynecologists and their patients. Namely, interactions differed in terms of conversation initiation, communication style, use of technical and colloquial language, frequency of eye contact, patience, and provision of information. Communication characteristics specific to interactions between male gynecologists and their patients included a 'blaming the victim' approach, differential treatment of patients, and underestimation of patients' abilities. Environmental factors that affected physicians' interaction with their patients are reported in conjunction with physicians' use of these external factors to explain the problems they experienced in physician-patient interaction. The discussion focuses on alternative explanations for and future research implications of the observed differences between male and female gynecologists in this setting.
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.

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