Health Sciences Capstone Projects

Receive updates for this collection

The Social Inside: Critical Reflexivity, Autoethnography, and the NICYE Study

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

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. 

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Marina Morrow
Department: 
Health Sciences

Improving Barriers to Child and Adolescent Mental Health Outcomes in Ghana: A Narrative Review

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

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. 

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Kelley Lee
Department: 
Health Sciences

Application of Evidence- or Theory-Based Retention Strategies in Health-Related Research Involving "Hard-to-Reach" or "Vulnerable" Populations: A Systematic Review

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-08
Abstract: 

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. 

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Catherine, Nicole
Department: 
Health Sciences

Non-Profit or For-Profit Volunteer Tourism Organizations Contributing to the Cause of Increasing Global Health Inequities? A Review of Online Marketing Tools

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

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. 

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Malcolm Steinberg
Department: 
Health Sciences

Enhanced Homestead Food Production for Improved Household Food Security and Nutrition in Cambodia: A Critical Analysis of the Fish on Farms Program

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

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.  

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
John Calvert
Department: 
Health Sciences

Month of Birth & Childhood Asthma

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

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.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Tim Takaro
Department: 
Health Sciences

The Health of Racialized Sexual and Gender Minorities in Canada: A Literature Review

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

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.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Cari Miller
Department: 
Health Sciences

The Under-Representation of Women Living with Disabilities in the Literature on Sexual Health

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Using a critical literature review (with an emphasis on the Canadian context) I illustrate that the literature on the sexual health of women living with disabilities is sparse, fragmented and rarely addresses intersecting forms of oppression. Using the literature, I argue that the exclusion of women living with disabilities from the sexual health literature is itself a systemic health inequity. Additionally, I argue for the use of intersectionality as a framework for research that can best capture the complexities of women's experiences of disability and sexual health. 

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

Challenges to Oral Cancer Prevention in the South Asian Population: A Scoping Review

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07
Abstract: 

Oral cancer is a public health concern due to late diagnosis, which subsequently results in considerable morbidity and mortality. Globally, South Asian countries present with some of the highest rates of oral cancer. With migration, similar disparities have been observed in Canada where the South Asian community is the largest ethnic group. The underlying cause has been attributed to the common usage of smokeless tobacco amongst South Asians. However, oral cancer is amongst the few cancers that are preventable due to known modifiable risk factors, knowledge of clinical history, and early screenings at dental clinics. A scoping review was conducted to improve the understanding of knowledge, attitudes, and behaviours (KAB) related to oral cancer among South Asians. A total of 37 studies were included with culture being identified as a gap in research. This capstone utilizes a theoretical framework based on the Social Ecological Model (SEM) to facilitate current efforts for oral cancer prevention amongst South Asians.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Scott Venners
Department: 
Health Sciences

Colonial State of Mind: Examining the Culture of Healing and the Potential for Wholeness

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Prior to European contact, Indigenous peoples had complex and intricate medical systems that demonstrated high levels of efficacy in preventing and treating a plethora of historically specific health-related issues. Since contact, Indigenous groups in Canada have experienced severe and prolonged effects of colonization by European Settlers on their communities, lands and belief-systems. Consequently, European occupation of traditional Indigenous territories has had a dramatic impact on the lived realities of Indigenous peoples, including significant effects on their health and wellness. Multiple studies indicate that the health and wellness of Canada’s Indigenous population is lower than the general population in almost every health indicator. Various correlating factors have been advanced to help elucidate factors linking the multifarious aspects of colonialism to the maintenance of this health gap. Among these explanations, scholars have investigated how the introduction and imposition of foreign political and economic structures has resulted in the alienation and disconnection of Indigenous peoples from their own cultural practices and healing methods. In response, health care scholars and providers have begun designing unique strategies to meet the specific needs of Indigenous groups. The explicit recognition and incorporation of Indigenous healing systems within the biomedical model has been linked to improving the health and wellness of Indigenous peoples in Canada. This paper adapts the popular LEARN transcultural communication guide into a 5-part analytic framework investigating the emergence and maintenance of power imbalances vested in the dominant Western health care system. This paper deploys the LEARN analytic framework to examine how the colonial encounter has resulted in a severe disruption of traditional approaches to health and healing. As an analytic framework, LEARN has broad applications in assisting health care scholars in considering the various complexities of the Indigenous-Settler interface, including examining the implications of colonial contact for Indigenous health and wellness, a look at emergent recommendations to ameliorate poor health outcomes and strategies to resolve power disparities at an institutional and individual level.  

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Maya Gislason
Department: 
Health Sciences