Health Sciences Capstone Projects

Healthiest Babies Possible (HBP) is a perinatal nutrition program that supports women facing challenging life circumstances in Vancouver and Richmond. The program has existed since 1976 and has undergone multiple changes to its service delivery model. HBP is now embarking on an evaluation that will be used for quality improvement and to identify best practices that can be shared with other service agencies. Stakeholder engagement and participatory methods have led to successful evaluation plans in similar programs. This document focuses on engaging with an Evaluation Stakeholder Workgroup (ESW) consisting of partners, HBP staff, patient advisors, leadership and funders, to create a program logic model. The program logic model is intended to form the basis of a future evaluation plan.

This study aimed to explore the use of quarterly monitoring reports by STOP HIV/AIDS representatives from all Health Authorities in British Columbia. The STOP HIV/AIDS project is a provincial initiative that aims to reduce the burden of HIV/AIDS in British Columbia. The study deployed in-depth interviews with twelve key informants and a ten survey questionnaire to deepen our understanding of the usefulness and the role the quarterly monitoring reports play in informing program planning. The findings found reports to be useful to end-users and provide many benefits including evaluating progress, informing decision-making and a tool to compare work across Health Authorities. Findings also suggest changing the format of the reports, adding more indicators and providing a high level summary page of the report. Overall, informants found the report to be useful for monitoring progress, a tool to compare across Health Authorities and a rich source of data to refer to.

Community-based participatory research (CBPR) is a transformative research methodology that seeks to develop equitable partnerships between academic researchers and community partners in the research process. CBPR has grown in prominence in inequities-focused health research, yet critics have noted that insider-outsider tensions and unequal power relations often become reproduced, despite research partners’ best intentions. CBPR researchers suggest that “critical reflexivity” can illuminate the processes by which insider-outsider tensions come to be reproduced. However, critical reflexivity is underexplored in the CBPR literature. In this paper, I use autoethnography to analyze how social identity and positionality come to impact the research process, representation of voice, and production of knowledge within CBPR. Drawing on my own experiences as a researcher in the Naloxone and Inner City Youth study, I demonstrate how autoethnography can be used as a critically reflexive methodology by which CBPR researchers can better understand how insider-outsider power relations come to reproduced. Following my analysis, I discuss implications for CBPR and for using critical reflexivity in research. 

There is increasing evidence that suggests that mental health problems affect 10-20 per cent of children and adolescents worldwide. Despite the increasing contribution of mental health to the total burden of disease and the impacts of mental disorders, policies, plans and programs to address mental health has been given less attention, particularly in low resource poor settings. Ghana is one such setting. Addressing the burden of poor mental health poses many challenges at the public health level in Ghana. This capstone presents a narrative review of the existing literature to identify barriers to improving mental health care services and, particularly, to discuss their relevance to child and adolescent mental health in Ghana. Key barriers identified include: the low priority attached to mental health service delivery as a public health issue, scarcity of resources for mental health, inequities in access to mental health care and the lack of collaboration formal and informal health providers. Recommendations for overcoming these barriers centered on the need to increase political will, the need for greater advocacy and clear policy and legislation to reduce the unmet needs to children and adolescents in Ghana. 

Background Strategies that increase participant retention are critical to success in health research to ensure the validity and generalizability of study findings. However, reports of strategies to increase retention within the published literature are typically brief, descriptive and inconsistent if they are mentioned at all. Researchers can and should be applying evidence-based and theoretically-informed approaches to developing comprehensive retention plans early on in the research design phase. The reporting of “retention protocols” presents an opportunity to enhance the field of retention methodology by increasing transparency around effective retention practices through systematic reporting. The BC Healthy Connections Project (BCHCP) is a large-scale, long-term trial examining the effectiveness of the Nurse-Family Partnership (NFP) compared to existing services (usual care) in improving child and maternal health within the province of British Columbia. The BCHCP’s Scientific Team is developing and implementing a detailed retention protocol. This process requires a literature review to support the implementation of a comprehensive, evidence-based, theoretical framework for retention. Objectives This systematic review is intended to determine whether evidence exists of the application of evidence-based, theoretical approaches to retaining “hard-to-reach”, “vulnerable” populations within the published health literature. If they do, they will then be evaluated to determine their applicability to the BCHCP research context and whether they can be incorporated into the BCHCP retention protocol. Methods Seven electronic databases were searched systemically using a detailed search term strategy that included retention, attrition, and population terms in addition to any relevant compact vocabulary terms. Selection criteria for objective one included the following retention-specific conditions: had to be retention within a research context specifically, could not involve post-hoc strategies only, had to be applied to at least one follow-up point beyond enrolment or randomization, and selection of strategies had to involve some rationale. Studies also had to refer to the involvement of “hard-to-reach”, “vulnerable” populations as described for the purposes of this review. Publication limits were set for health-related research involving humans, published in English between January 1, 1980 and May 1, 2016. Objective two restricted eligibility further to studies that more closely matched the BCHCP study context in terms of study design and population as well as their approach to retention. Data items were collected in Microsoft Excel and were grouped under three main categories that included general study characteristics, retention characteristics, and follow-up characteristics. They were then presented in three summary tables (one for each category of characteristics) by full-text article according to assigned study ID. Counts for individual data items from each table were used to assist in interpretation of results. Results Of 1,337 original articles, 49 articles met objective one eligibility criteria. Of those 49, two met the original eligibility two criteria. Restrictions for criteria two were retrospectively lowered so that articles meeting three of the four original criteria were included. Eight articles qualified with adjusted criteria and were assessed for comparison to the BCHCP. The articles presented a diversity of study contexts with disparate lengths of follow-up, number of follow-up points, numbers and types of strategies used, level of description provided, and analyses of retention. The ways in which strategies were reported and assessed also differed substantially. However, few made mention of cost, and less than half made an effort to garner feedback, either from participants or research staff, on the research (and retention) process. While the majority of the articles reported some form of evidence to rationalize which retention strategies were selected for a given study, there was a wide variety in type and quality of evidence provided. Furthermore, only five articles reported studies that were explicitly informed by a theoretical approach to retention. While the majority did iterate the importance of planning for retention from the outset, only seven employed the term protocol in the description of their retention approach. Conclusions While retention strategies may be appearing more frequently within the health-related scientific literature, efforts to adopt the practice of developing comprehensive approaches to retention during the research design phase and to include plans to systematically evaluate and report on their outcomes are still missing. Moreover, examples of the practice of employing evidence-based, theoretically-informed, comprehensive retention approaches remain lacking. Certain organizations have taken the approach of encouraging researchers to conduct methodological research within the trial process–terms trials within a trial–in order to enhance the trial methodology evidence-base. The BCHCP retention protocol, on the other hand, presents a more comprehensive and systematic means for researchers to share an entire approach to trial retention. The adoption of retention protocols should therefore be encouraged as a necessary part of the trial publication process, similar to the implementation of systematic review protocols and trial study protocols. 

Voluntourism is defined in this paper as organized short-term volunteer work completed in the Global South by a tourist from the Global North whose goal is to provide relief from or alleviate poverty in a society. Recently, this practice has been publicly critiqued for exacerbating global inequities, namely power and health. The marketing of voluntourism programs plays a significant role on the impacts of voluntourism (i.e., either reinforcing or stopping these critiques). Therefore, this paper seeks to examine volunteer tourism websites to better understand how medical voluntourism is marketed. It further seeks to compare for-profit and non-profit volunteer tourism organizations’ marketing practices. A qualitative analysis of online mission statements and related text of 21 volunteer tourism websites, offering a medical project, was completed. It was found that for-profit volunteer tourism organizations promoted responsible volunteer travel and sustainability more often than non-profit organizations. However, non-profit organizations were more empowering than for-profit organizations when describing host communities. Lastly, organizations often demonstrated a discrepancy between their mission statement and website text constituting their underlying values. 

Background: To rigorously assess the effectiveness of the Enhanced Homestead Food Production (EHFP) program, HKI has partnered with the University of British Columbia (UBC) to conduct a two-phase research and development. The aims of this research were to assess the impact of various EHFP models at improving food security, nutrition outcomes, livelihoods, and women’s empowerment in Cambodia (FOF Protocol, 2012). After the completion of the first phase, known as Fish on Farms (FOF), a Gap Analysis was commissioned to better understand key structural, socioeconomic, and behavioural differences between highly successful and highly unsuccessful women farmers that impacted the uptake and continuation of EHFP practices. Objectives: This study used the Gap Analysis from the FOF project as a case study to examine the tensions between locally focused agriculture development projects and the macroeconomic conditions in which they occur. The sustainability of this project in the long term in light of these tensions was then critically assessed using the Sustainable and Inclusive Agriculture Development (SIAD) analytical framework. Methods: A secondary data analysis of the Gap Analysis was conducted; a mixed methods study that utilized deviant case sampling to identify highly successful and unsuccessful farmers. Semi-structured interview data was analyzed using NVivo software. Line by line coding was used to examine textual data after which content analysis was undertaken to identify differences between positive and negative deviant farmers. Themes were identified by condensing and refining codes into categories in an iterative process. Quantitative data was analyzed using Microsoft Excel 2013 software and descriptive statistics were generated. Data was then organized into frequency tables and charts to better understand patterns and trends within the sample. Results: Several key factors were identified that contributed to respondents’ success or failure in increasing household (HH) food production and income including: access to primary inputs and irrigation; growing conditions and technical skills; HH demographic and socioeconomic indicators; EHFP harvest and utilization; and marketing and sale of products. Positive impacts of the FOF project were not uniformly distributed within the sample therefore, the intervention was moderately successful in improving access to micronutrient rich foods and improving HH incomes. Conclusions: While the FOF project contributed positively to HH food production andincomes for some, for others, this was not the case. Without continued financial support and safety nets, negative deviants were more likely to discontinue EHFP all together. In the context of contradictory development policies that prioritize neoliberal free market policies, the possibility for lasting impact is unlikely and threatens the positive gains made by the FOF project. Therefore, it is critical that donor agencies work with LMICs to revise national poverty reduction strategies and allow countries to exercise mercantilist practices where domestic agriculture policy is concerned.  

Background: Studies in the United States and Europe show that children born in fall-winter have higher risk of developing atopic status later in life. This study examines the relationship between month of birth and development of atopic status at 3 years of age across Canada. Method: The data were obtained from the Canadian Healthy Infant Longitudinal Development (CHILD) study. Data about month of birth, exposure to second hand smoking, mold, pet and cold were extracted from self reported questionnaire. Exposure to Nitrogen dioxide (NO2) was calculated by averaging the concentration of NO2 for the first six month of life for each participant. In total, 2367 children of approximately 3 years of old including 338 atopic individuals that had complete data on date of birth, atopic status and study location were included. The logistic regression run to do bivariate analysis and build the final model. Results: Results suggest that children born in June and December have higher risk of developing atopic status at three years old, though this result was not significant. Conclusion: Further research is needed to investigate seasonal pollen pattern and its association with atopic status. These results could be used to implement preventive measures for early management of childhood asthma.

This literature review is the first of its kind to examine the body of research on the health of racialized (i.e., Indigenous, Black, people of mixed ancestry/heritage, and people of colour) sexual and gender minorities in a Canadian context. The literature highlights how the particularities and intersections of racialization, gender, sexuality and other social determinants of health impact the health of racialized sexual and gender minorities in unique ways affecting access to health and social services, experiences of violence and discrimination, and sexual and mental health. Each racialized group discussed--Indigenous, Black and Asian--experience outcomes that differ from other racialized sexual and gender minorities, white sexual and gender minorities, and/or racialized heterosexual people. The implications of these findings suggest that racialized sexual and gender minorities have unique experiences and health outcomes that need to be addressed in specific and nuanced ways in sexual and gender minority research and public health practice.