Health Sciences Capstone Projects

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Intervals of 12 Months and 36-96 Months Are Non-Inferior to 6 Months in hpv16/18 Antibody Response: Findings of a Systematic Review and Meta-Analysis of Two-Dose HPV Vaccine Schedules With Intervals of Six Months or Longer

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-06-09
Abstract: 

Human Papillomaviruses can cause cancer of multiple human anatomical sites, with essentially all cervical cancer cases worldwide being attributable to persistent HPV infections. HPV vaccination provides effective protection against HPV infections. An estimated 90% of cervical cancer cases occur in low and middle incomes, but only 20% of these countries have implemented HPV vaccination. In contrast, 82% of high income countries have included HPVV in their national vaccination programs. Current HPV vaccination schedules which recommend administering multiple doses within six months can be logistically challenging for both low- and middle-income as well as high-income countries. The ongoing global shortage of HPV vaccines that is expected to last until 2024 is an additional challenge. There are suggestions to extend the two dose 0,6 months schedule for the primary target population (females 9-14 years) to longer intervals, even up to 3-5 years, to ease logistics and relieve demand in the short-term. Interval extension however, requires evidence to support whether it will be beneficial. This paper reports findings of a systematic review of available studies, that compares the immunogenicity, efficacy and effectiveness of two-dose schedules of 7 or more months between doses with schedules of 6 months between doses. We found, similar to a previous systematic review, that increasing the two-dose interval from 6 months to 12 months resulted in non-inferior immunogenicity. Also an increase of the dose-interval from 6 months to 36-96 months, results in non-inferior antibody response to HPV6 and high risk HPV types 16 and 18, but not HPV11, based on data from an observational study. The effect of an interval of 8 or more months compared to an interval of 4-7 months on AGW incidence was inconclusive and no studies were available to assess efficacy or effectiveness against HPV infections or cancers. This highlights the acute scarcity of evidence necessary to evaluate two-dose schedules with intervals longer than 6 months. Nevertheless, our Page 4 of 64 non-inferiority findings indicate that a schedule with a 12 month interval can be adopted in lieu of one with a 6 month interval. However, even though the 36-96 month interval is indicated to be no worse than a 6 month interval in antibody response to HPV 16 and 18, the low certainty of the estimates derived from it, requires that it be studied further to confirm its effect on immunogenicity.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Bohdan Nosyk
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Delivering on Digital: A Review of Virtual Health Literature in Perinatal Care

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-04-08
Abstract: 

Virtual health aims to transform the delivery of healthcare and improve overall patient experiences and health outcomes. Women of reproductive age are frequent users of digital technologies, and the perinatal period presents an opportunity to improve both child and maternal health outcomes. Healthcare professionals recognize the importance of leveraging digital technologies to strengthen the delivery of patient-centred care during the perinatal period. This report reviews the current literature on digital health technologies targeted at pregnancy to assess the success factors, limitations and considerations necessary for implementation. Identified success factors include convenience, extended interactions between patient and provider and anonymity. Identified limitations include the digital divide, provider pushback and privacy concerns. The decision to implement digital health interventions also requires consideration of the potential for victim blaming, increases in social equity and complexity in health behaviour change.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Tania Bubela
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

The Effects of Settlement Location on the Mental Health of Immigrant Women in Canada: A Literature Review

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-04-30
Abstract: 

Background: With rates of immigration rising in Canada and worldwide, it is becoming increasingly important to understand the unique challenges faced by immigrant populations. A host of interpersonal, systemic and institutional barriers faced by both women and those settling in rural communities exacerbate mental health issues among immigrant populations. Canada’s vast geography, climate and community characteristics vary greatly, creating unique circumstances for individuals immigrating to this country. Immigrant women face additional barriers as a result of the systemic and institutionalized discrimination faced by women globally with political and economic practices and laws at all levels, cultural norms and societal expectations exacerbate inequitable health outcomes.

Methods: This literature review's search strategy and synthesis of relevant articles followed a scoping review protocol outlined by Levac, Colquhoun & O'Brian (2010). The databases used to conduct this literature review were: CINHAL and Scopus. In total, 2836 studies were identified and screened; full-text articles were assessed for 39 studies; 19 studies that met all inclusion criteria were then selected for final review.

Results: A review of the literature revealed that settlement location indeed impacts the mental wellbeing of immigrant women. Residing in a rural community was positively correlated with the mental health of immigrant women, regardless of ethnicity, age, age of immigration or family structure. The presence or absence of six main factors resulted in adverse mental health outcomes for immigrant women in rural communities.

Discussion: Through a review of the literature, six key factors associated with living in a rural community were found to impact the mental wellbeing of immigrant women accessing to medical services, connection to culture and gender norms, employment and financial security, managing multiple roles, racism, discrimination and stigma, social support networks and social isolation. Each factor is found to have implications on the other, potentially compounding inequities faced by this population if adequate resources are not provided. In order to understand the mechanisms in which these factors affect the mental health of immigrant women and address the associated structural barriers related to rurality and gender, implications and interventions at the policy, practise and research levels must also be considered.

Conclusion: As rates of immigration rise and the demography of immigrant populations continue to change, it is becoming increasingly important to understand the unique needs of newcomers, as the health of this growing population will, in turn, influence the health of Canadian communities and the country. Moving forward, it will be necessary for public health professionals, researchers and governing bodies alike to better understand the intersection of these factors and their impact on the mental health of immigrant women in order to avoid perpetuating existing inequities.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Scott Lear
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Critical Evaluation of Radon Detector Library Lending Programs in Canada

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-04-30
Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Anne-Marie Nicol
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Integrating Reflexivity in Public Health Practice: A Proposed Framework for Autoethnographic Exploration to Strengthen Meaningful Engagement of People Who Use (d) Drugs

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-04-12
Abstract: 

People who use drugs (PWUD) face significant stigma and are often excluded from or afforded little decision-making power in the development of services and policies that affect their health. This lack of agency has been recognized in recent years and engagement of PWUD is increasingly becoming best practice approach in Canada (Greer, Amlani, Pauly, Burmeister, & Buxton, 2018). However, special consideration needs to be paid to the process of engaging peers which can be addressed by integrating reflexivity at both interpersonal and institutional levels of public health practice. I will use this capstone paper to explore how public health practitioners who are cultural outsiders can operationalize reflexivity in their practice to ensure meaningful engagement of PWUD. I argue that when applied in an appropriate framework, autoethnography is a valuable methodological approach to practice reflexivity. I propose a framework for autoethnographic exploration to guide myself and potentially interested others to examine how the positionality of cultural outsiders working with PWUD can impact power relations, methods of engagement, representation of voice and production of knowledge within public health institutions. I draw from literature on reflexive practices, autoethnography, and peer engagement as well as my own work experiences to inform the framework. I hope this framework can serve as a tool for those interested in reflexive practice and shed light on ways each one of us can reshape our practices of working in health and social institutions as we aim to create more equitable spaces for meaningful engagement of PWUD in public health.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Maya Gislason
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Understanding the Impact of Youth Engagement on Positive Youth Development

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-04-06
Abstract: 

Young people are increasingly becoming involved in developing services designed for them. While much has been researched about youth engagement best practices and organizational benefits, there has been little focus on how youth engagement initiatives benefit the well-being of involved youth. This Capstone research seeks to understand how youth engagement initiatives can promote youth well-being using the Positive Youth Development (PYD) framework within a Canadian context. This framework is composed of 6 constructs that promote positive developmental pathways for youth: 1) competence; 2) caring; 3) confidence; 4) connection; 5) character; and 6) contribution. A systematic search and review were conducted, and 35 articles were analyzed to assess the impact of youth engagement initiatives on these 6 constructs. Multiple elements of youth engagement initiatives were associated with positive short- and long-term outcomes for involved youth across various domains. Recommendations are made for how to integrate these practices into new or existing youth engagement initiatives to best promote youth well-being.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Malcolm Steinberg
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

We All Can Help: Evaluation of an Online Gender-Based Violence Learning Series

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020-04-06
Abstract: 

Gender-based violence (GBV) is a persistent and pervasive public health problem and requires a collaborative response, especially from the health system. Health-care professionals (HCPs) are uniquely positioned to address GBV because they are often the first trusted professional that survivors interact with. Therefore, it is critical that HCPs are trained and equipped to provide an effective response. This capstone evaluates the uptake of Gender-Based Violence: We All Can Help, an online GBV Learning Series for HCPs in British Columbia. Evaluation findings revealed a low uptake to the learning series and identified logistical and internal barriers that HCPs face. This capstone uses the Theory of Planned Behavior to structure and understand these barriers to series’ uptake. Finally, recommendations, informed by literature and evaluation data, are offered to improve uptake of the series to ultimately strengthen the health sector’s response to GBV.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Malcolm Steinberg
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Quality Improvement Initiatives to Strengthen Viral Suppression Among Adolescents Living with HIV in Institute of Human Virology (IHVN) Supported Facilities in Abuja Nigeria

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-04-01
Abstract: 

Adolescents living with HIV (ALHIV) in high ALHIV-burden, resource-limited settings like Nigeria have significantly inferior outcomes from antiretroviral therapy (ART). This study reports on analysis, innovations, processes and outcomes of several continuous quality improvement (CQI) initiatives by the Institute of Human Virology Nigerian (IHVN) to identify gaps in achieving adolescent viral suppression among Nigerian ALHIVs - including suboptimal or complete lack of HIV status disclosure, higher rates of loss to follow up, poor ART adherence and increased need for psychosocial support. These CQI initiatives referred to as "small tests of change" to improve poor performing areas help to bridge identified gaps and follow four major steps per CQI requirements including – problem statement; root cause analysis; developing solutions and making an aims statement; and implementation of improvement changes which involves a plan-do-studyact (PDSA) cycle. The PDSA cycle represents a series of tests that forms the basis of a monitoring cycle to track innovations, outcomes and document change. It involves developing a strategy to test the change (Plan), executing the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). Strengthening adolescent viral suppression within IHVN supported sites in Abuja Nigeria ensures that ALHIVs are not left behind in the UNAIDS 90-90-90 targets.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Malcolm Steinberg
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

An Exploratory Analysis of Associations Between Psycho-Social Factors and Systemic Inflammation among South African Youth

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-02-20
Abstract: 

Introduction: Psycho-social factors affect biological processes, including inflammation and immune response, yet their contribution to gender and socio-economic disparity of HIV is not well understood. In South Africa, 38% of new HIV infections occur in 15–24 year olds, with 3-times higher incidence among females. In this exploratory study, we examined associations between psycho-social factors and biomarkers of inflammation that may be linked to HIV acquisition in South African youth.

Methods: Baseline plasma and linked cross-sectional survey data were obtained from the AYAZAZI study, which enrolled 425 HIV uninfected or HIV status-unknown youth (16-24 years old; 60% female) in Durban and Soweto (2014-2016). Survey data captured social and clinical determinants of health (e.g., gender, income, food insecurity, body mass index [BMI]) and psycho-social characteristics (depression, anxiety, stress, substance use). A random, gender-stratified subset of 39 HIV-negative participants was selected. Luminex® assays were used to analyze 12 plasma biomarkers. Associations between biomarkers and social, clinical, and psycho-social factors were assessed using Spearman’s rank correlation.

Results: Median age was 18 (IQR: 17-20); 19/39 were female. Consistent with prior studies, high depression symptomology scores were associated with elevated pro-inflammatory (IFN-a2, IL-1a, IL-6, IL-12(p40), MIP-1ß) and anti-inflammatory (IL-4, IL-10) cytokines (all p<0.05). Low BMI correlated with elevated pro-inflammatory (IFN-a2, IFN-g, IL-1a, IL-1ß, IL-6, IL-12(p70), IP-10 and TNF-a) and anti-inflammatory (IL-10) biomarker levels (all p<0.05). Associations were also observed between some biomarkers and indicators of anxiety, food insecurity, low income, and financial responsibility for dependents, which varied between sites.

Conclusion: Results indicate that psycho-social, clinical, and socio-economic challenges are associated with inflammatory biomarker levels in South African youth. This suggests a link between social determinants of health and biological factors that modulate disease risk, possibly including inflammatory conditions associated with increased HIV transmission. Further analysis is required to confirm these results and investigate their implications for HIV prevention.

Document type: 
Graduating extended essay / Research project
File(s): 
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Integrating Reflexivity in Public Health Practice: A Proposed Framework for Autoethnographic Exploration to Strengthen Meaningful Engagement of People Who Use (d) Drugs

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-04-12
Abstract: 

People who use drugs (PWUD) face significant stigma and are often excluded from or afforded little decision-making power in the development of services and policies that affect their health. This lack of agency has been recognized in recent years and engagement of PWUD is increasingly becoming best practice approach in Canada (Greer, Amlani, Pauly, Burmeister, & Buxton, 2018). However, special consideration needs to be paid to the process of engaging peers which can be addressed by integrating reflexivity at both interpersonal and institutional levels of public health practice. I will use this capstone paper to explore how public health practitioners who are cultural outsiders can operationalize reflexivity in their practice to ensure meaningful engagement of PWUD. I argue that when applied in an appropriate framework, autoethnography is a valuable methodological approach to practice reflexivity. I propose a framework for autoethnographic exploration to guide myself and potentially interested others to examine how the positionality of cultural outsiders working with PWUD can impact power relations, methods of engagement, representation of voice and production of knowledge within public health institutions. I draw from literature on reflexive practices, autoethnography, and peer engagement as well as my own work experiences to inform the framework. I hope this framework can serve as a tool for those interested in reflexive practice and shed light on ways each one of us can reshape our practices of working in health and social institutions as we aim to create more equitable spaces for meaningful engagement of PWUD in public health.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Maya Gislason
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)