Health Sciences Capstone Projects

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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No, item is not peer reviewed.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): 
Senior supervisor: 
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No, item is not peer reviewed.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): 
Senior supervisor: 
Maya Gislason
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

The Impact of Indigenous Cultural-Safety Education Programs: A Literature Review

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-04-09
Abstract: 

Background: Indigenous-awareness education programs have been implemented in healthcare organizations to improve culturally-safe healthcare practices across Canada. Although many education programs have supported healthcare providers to understand cultural-safety, it is also important to evaluate these programs and ensure that cultural-safety knowledge is translated effectively into practice with Indigenous peoples.

Methods: Five systematic reviews were initially identified through a scoping review to understand the current body of evidence on cultural-safety education. Using systematic methods, a review was then conducted to identify evaluations of cultural-safety education programs that incorporated quantitative methods and were published in academic journals between 2009 and 2019. Medline, CINAHL, and PsycINFO databases were used. In total, 215 studies were identified and screened; full text articles were assessed for 27 studies; 14 studies that met all inclusion criteria were then selected for final review.

Results: Five systematic reviews found variability in evaluation methods, pedagogical approaches, and student experiences and outcomes across studies that evaluated cultural-safety education interventions. The overall quality of the 14 included studies was fair, encompassing pre-post, cross-sectional and longitudinal quantitative designs, as well as mixed methods using qualitative components in some cases. A number of evaluation tools were used to report on outcomes related to culturally-safe practices. Across the studies, outcomes were described in knowledge, attitudes, perceptions, confidence, communication, collaboration, empathy, cultural competency, cultural capability, “cultural desire” and student engagement with Indigenous health opportunities. Changes in participant behaviour and practice were also described through the educational outcomes summarized. This review contributes to the literature by comparing quantitative outcomes across the available studies, and by summarizing Indigenous methods atn teaching where these were available.

Discussion: Cultural-safety education evaluations have been previously criticized for their lack of rigour. As the studies included in this review did not use the most rigorous designs, more research using randomized controlled trials is needed to assess the impact of cultural-safety education, including how knowledge is applied in practice. Future studies could also make more use of qualitative techniques, as seen in the mixed-method studies summarized in this review, to examine how participants may reflect and critically examine their roles in creating culturally-safe environments for Indigenous people.

Conclusions: For all healthcare providers, learning how to provide culturally-safe care with Indigenous patients is a lifelong journey. Future research should explore and support Indigenous-led approaches in developing new interventions and evaluation measures. Academic and healthcare institutions also need to ensure that students and providers are not only equipped with knowledge about cultural-safety but also able to apply their knowledge to improve the healthcare experiences of Indigenous patients.

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

Conducting a Critical Interpretive Synthesis on Poppers Literature: The influence of the medical model of health on our understanding of alkyl nitrites

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

Poppers (alkyl nitrites) are vasodilators used by many gay men to relieve pain, enhance pleasure, and facilitate penetration during sex. Poppers have been studied by medical researchers since the 1980s, yet community-based and qualitative research remain uncommon. I conducted a critical interpretive synthesis examining the ways that the dominant medical model of health is influencing poppers literature. Analysis was performed using close coding of five papers, resulting in two constructs termed “responsible action” and “risk ratchetting”. Responsible action describes a bias in poppers research, resulting from researchers’ own senses of duty. Researcher duty is motivated not just by objective measures of risk, but by harmful stereotypes of gay men and people who use drugs. Risk ratcheting refers to aspects of academia that result in exaggeration of poppers-related risk over time. These constructs may provide a lens to more critically understand the poppers literature, and other bodies of marginal drug literature.

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

Police-Related Barriers to Harm Reduction and Poor Health Access Linked to Alarmingly High Rates of Non-Fatal Overdose among Sex Workers Who Use Drugs: Results of a Community-Based Cohort in Metro Vancouver, Canada

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-03-25
Document type: 
Graduating extended essay / Research project
File(s): 
Senior supervisor: 
Shira Goldenberg
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Health Systems Integration of Sexual and Reproductive Health Programmes for HIV Discordant Couples: The Case of Rwanda

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019-04-09
Abstract: 

A large proportion of new HIV transmissions on the African continent occur between long-term cohabiting HIV discordant couples. These couples have specific sexual and reproductive health (SRH) needs that often go unmet. In some contexts, SRH services are offered through vertical programmes that are not integrated with the primary health care (PHC) system. These vertical programmes, however, can lead to the undermining of health systems as a result of service fragmentation, and the preferential funding from external donors which can draw highly trained staff away from the public health care system. At the 1994 International Conference on Population and Development, there was a call for greater integration of SRH programmes into the PHC system to help ensure access and equity. Despite a history of conflict, Rwanda, through innovative service delivery mechanisms, such as performance-based financing and task shifting, has managed to integrate SRH services for HIV discordant couples into its PHC system. The purpose of this paper is to describe the steps the Rwandan government took to achieve SRH integration and distill the lessons that can be garnered from this achievement that may be valuable for other jurisdictions working towards integrated primary health care initiatives.

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

A Policy Analysis to Inform Options for Medical Device Regulation and Post-Market Surveillance in the Canadian Context

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018-04
Abstract: 

With ageing populations and rising rates of chronic diseases, medical devices are increasingly vital components of health care. From tongue depressors and stethoscopes to pacemakers and medical robotics, medical devices are numerous, diverse and constantly evolving, integrating medicine, biomechanics, materials, software, and electronics in their development and application (Chen et al., 2018). However, while innovation is generally beneficial for patients, the complexity and diversity of medical devices poses a challenge for regulatory systems across the globe, which are often slow to adapt to the increasing complexity of medical devices, unpredictable risks, and emerging threats to public health (Curfman and Redberg, 2011; Mishra, 2017; Chen et al., 2018). Consequently, with medical device failures and malfunctions appearing in media and academic journals there is a global push for stricter regulatory reform and harmonization of regulatory frameworks internationally (Curfman and Redberg, 2011; Altenstetter, 2012; Maak & Wylie, 2016; Chen et al., 2018). This capstone will review and compare the regulatory frameworks for three jurisdictions (Canada, the United States and the European Union) with an aim of identifying post-market strategies which could be applicable to the Canadian context. Additionally the current and proposed changes to the Canadian medical device regulations will be discussed and analysed across multiple dimensions (burdens on various actors, innovation vs regulatory oversight and health risk protection) and, the 3-I framework will be used to deepen the understanding behind the shift in regulatory approach that Health Canada is working to implement. Lastly, based on the regulatory approaches compared and analysed it will provide an informed opinion on the approach that Health Canada is taking.

Document type: 
Graduating extended essay / Research project
File(s): 
Department: 
Faculty of Health Sciences

Family Navigation as a Model of Care: Moving Beyond the Barriers

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

This capstone explores the disability landscape in British Columbia, Canada through a Fetal Alcohol Spectrum Disorder (FASD) lens mapping out why a Family Navigation model of care could facilitate access to and potential development of needed resources and services for families with children with FASD. A scoping literature review, critical analysis of literature gaps, and secondary data analysis of a quality improvement initiative at a single-site sub-speciality hospital were used to establish promising practises, limitations, and the resultant policy implications for British Columbia. This work was grounded in Critical Disability Theory and the Family Quality of Life theory to stress that within an ableist society we must continue to advocate for collaborative and concrete changes to improve outcomes for families and individuals with FASD throughout the lifespan.

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