Health Sciences Capstone Projects

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Brain Drain into Brain Gain? A Review of Policies to address the Shortage of Human Resources for Health Indonesia

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

This capstone is a review of national policies and practices in Indonesia to address human resources for health shortages since 2010. A comprehensive search of peerreviewed and grey literature yielded 65 relevant studies/documents. These were evaluated to assess how well or poorly they align with the WHO Global of Practice on the International Recruitment of Health Personnel using an analytical framework developed specifically for the Code. The findings suggest that Indonesia’s policies have been adapted, to address the mobility of health workers, and mechanisms now exist to scale up the production of health workers. However, this review identifies key challenges remaining concerning equitable access, quality of healthcare, and regulation. Recommendations to policy-makers include the need for firmer negotiation of international agreements, stronger rural retention programs, modification of medical education curriculum and admissions criteria, and work with other stakeholders to ensure policy space for health priorities.

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

A Review of the Social Justice Concerns Related to the Integration of Palliative Care within the Kenyan Context

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

The World Health Organization (WHO) estimates that 40 million people are in need of palliative care worldwide, and of these, 37 million of them live in low- and middle-income countries (LMIC). Moreover, 98% of children who are in need of palliative care globally live in LMIC and almost half of them are living in Africa (WHO, 2015). Current palliative care needs are largely unmet and yet the need for palliative care is increasing due to the prevalence of HIV/AIDS, drugresistant tuberculosis, and increasing rates of cancer, chronic conditions and non-communicable diseases (Sternswärd & Clark, 2004; Blinderman, 2009). Kenya is a key region to examine because it is a lower middle-income country, the burden of disease is high, public funding of palliative care is very limited, and yet with the combined efforts of national associations, dedicated healthcare workers, Non-Governmental Organizations and charities, Kenya is one of only three African countries that is approaching full integration of palliative care – ranked alongside several high-income countries worldwide. Several international health and social justice agencies have highlighted that palliative care is a human right and should be recognized as a fundamental component of healthcare (Gwythner, Brennan & Harding, 2009); on the ground, the practice of this principal remains tenuous. In 2010 Human Rights Watch issued various hard-hitting reports on the state of palliative care in Kenya, highlighting a severe lack of governmental investments in palliative care service, particularly for children, and inadequate access or provision of essential palliative care medications such as morphine (Lohman & Amon, 2015). Since then, the 4 Kenyan Ministry of Health, in partnership with the Kenyan Hospices and Palliative Care Association (KEHPCA), has attempted to improve access to pain and palliative care services. Improvements such as including palliative care in the National Patients’ Rights Charter, issuing detailed plans to integrate palliative care into the Kenyan public health system, publishing National Palliative Care Guidelines, and recent purchases of publicly funded opioid analgesic in the form of oral morphine (Ali, 2016). Although there have been great strides in the establishment of palliative care services in Kenya, there are some overarching influential factors that complicate these efforts. There are also some key social justice concerns highlighted in the literature with regards to how inequity and stigma affect the facility of palliative care in Kenya. Through a comprehensive literature review in conjunction with my experiences from my internship with KEHPCA, I will discuss the hallmarks of palliative care in Kenya, the impacts of globalization, the increasing need for integrated services, the stigma and misconceptions that contribute to inequitable access, and finally explore the paradoxical relationship between social justice and this emerging public health issue.

Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Nicole S. Berry
Department: 
Health Sciences: Faculty of Health Sciences

Ethics of Task Shifting: Exploring the Role of Community Health Workers in HIV Care in Tanzania

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

In high HIV prevalence settings, the delivery of HIV prevention, treatment and care services has created an enormous strain on health systems currently struggling to cope with critical shortages of health personnel. In attempts to address this dilemma, task shifting has taken place across sub-Saharan Africa to improve access to testing and treatment, decrease service costs, improve outreach, and ultimately combat the spread of HIV. Within this, task shifting can take many forms. For example, nurses can provide treatments that were previously the responsibility of medical doctors; likewise, lay counsellors can offer voluntary HIV testing, which nurses and practitioners formerly conducted. Within the provision of HIV care delivery, Community Health Workers (CHWs) have played a critical role, as they are individuals who receive basic training to conduct specific services that overburdened staff would otherwise struggle to carry out. However, widespread usage of CHWs within HIV care has not been immune to ethical challenges. For instance, CHWs have often been expected to carry out emotionally- and physically-demanding tasks with inadequate training, supervision and even compensation. Moreover, CHWs have been poorly integrated into formal health systems, which has not only impacted the quality of their work, but has further perpetuated power asymmetries between them and other health worker cadres. By using Tanzania as a case study, the objective of this paper is to examine ethical challenges and propose strategies to potentially resolve them, which emerge within HIV care delivery programs that involve CHWs. In this study, I evaluate these challenges through the lens of Ethical Principlism and more specifically, by focusing on the following ethical principles: respect, justice, beneficence, critical reflection, and confidentiality. As discussed, prioritizing these principles can help to ensure that CHWs receive fair and standardized forms of remuneration, are provided with adequate resources to conduct their work, and have increased power and decision-making within HIV programs. These outcomes can ultimately enable CHWs to help combat the spread of HIV through a means that does not exploit or take their critical role within service delivery for granted.

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

An Impactful Youth-Adult Partnership: Evaluating the Youth Engagement Approach within an HIV intervention in Soweto, South Africa

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

Despite successful efforts made by the South African government to implement youthfriendly services in public clinics, none of these efforts have formally evaluated youth engagement as an integral framework to improve health service delivery to young adults (16-24 years). The youth engagement framework is a participatory research approach, where young people and adults merge their efforts to work towards a common goal while sharing knowledge and power. The objective of our study was to evaluate the effectiveness of the Youth Engagement (YE) approach as part of a larger adolescent HIV cohort study. AYAZAZI (‘knowing themselves’ in the Zulu language) is an interdisciplinary longitudinal cohort study at the Perinatal HIV Research Unit (PHRU) which aims to link HIV socio-behavioural patterns and clinical characteristics among youth age 16-24 years living in Soweto, South Africa. The AYAZAZI study adopted a youth engagement approach where youth (16-24 years) play an active role as research staff members and participants while receiving the guidance and support of adult allies. The AYAZAZI cohort study has a mixed age group on staff, consisting of Adolescents and Young Adults (AYA) (16-24 years) staff, and adult allies (older than 25 years). To evaluate the YE approach in AYAZAZI, we employed two data sources: anonymously written responses submitted via a suggestion box, as well as responses given during face-to-face interviews. The suggestion box was implemented in the youth lounge at the PHRU clinic to assess Adolescents and Young Adults (AYA) research participants’ satisfaction with the AYAZAZI research study. We also conducted face-to-face interviews with 5 (AYA) AYAZAZI research participants (18-24 years), 4 youth AYAZAZI research staff (16-24 years), and 4 AYAZAZI “adult allies” staff (older than 25). Key findings from the youth engagement evaluation included young people feeling valued by staff members, and youth staff having new career aspirations as a result of interacting with adult staff members. Adopting a youth engagement approach created an effective communication space between adults and young people. Taken together, our results suggest that, when given a supportive environment where young people can engage with those of the same age group along with supportive adults, youth are more likely to partake in programs and services intended to benefit them.

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

Connecting with Nature Program Guide

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Document type: 
Graduating extended essay / Research project
File(s): 
Department: 
Health Sciences: Faculty of Health Sciences

Using Quality Improvement To Implement Substance Use Disorders Services In Primary Health Care In Kenya: Impact And Experiences Of A Blended Course Among Health Workers Using The NextGenU Online Model

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

Background: Worldwide, mental and substance use disorders (SUD) account for over 183.9 million disability adjusted life years. While interventions do exist they are not readily implemented, especially in low- and middle-income countries, due to a lack of available human resources, monetary resources, stigma, and difficulties in changing practice patterns. Quality Improvement (QI) has been reported in literature to successfully improve health services and systems through small-scale, iterative change cycles. Objectives: This study assessed the impact of the NextGenU.org online blended course in terms of integrating, improving and sustaining mental health services using quality improvement methods in primary health care in Kenya. It also analyzed the experience of participants who completed the NextGenU.org online blended course. Method: A mixed-methods study was conducted, incorporating both qualitative focus groups (FGD) and key informant interviews (KII), and quantitative statistical measures. Data came from the Computer-Based and Alcohol Training Assessment in Kenya (eDATA K), which was implemented in collaboration with the University of British Columbia (UBC) and African Mental Health Foundation (AMHF). FGDs and KIIs were analyzed using NVivo through a constant-comparison method, to identify themes emerging from the data. A second coder analyzed the data to ensure reliability and validity. Quantitative analysis was conducted to analyze the course completion rates. Additionally, the researcher incorporated their own notes from observations made during fieldwork over the course of a 12-week practicum with AMHF to triangulate the results. Results: Overall, 27 screeners and clinicians completed the NextGenU.org online blended course. There were two FGDS and two KIIs conducted in Makueni county during July - September 2015. In terms of the staff’s experience in completing the online course many participants noted strong facilitators such as: the certificates, desire for knowledge, personal motivations, relevant material, and case studies. The limited amount of space, computers, and restrictions on Internet access acted as barriers. Participants perceived their knowledge of QI methods, leadership, and time management to have increased from completing the course. Perceived self-efficacy also increased, as staff believed their ability to be a leader, manage time and deal with errors and mistakes within the workplace improved. There was also a positive shift in stigma associated with SUD. Most importantly, the integration and improvement in mental health services was maintained even though staff discussed common challenges, such as heavy workload and limited time. Some participants reported that some people in management roles should have been more supportive, as their limited involvement acts as a barrier to greater integration of services, while other where thankful of the management support. Conclusion: This is one of the first studies of using QI methods to integrate, improve and sustain mental health services in the primary health care system in Kenya. Based upon the experiences described in the FGDs and KIIs, the blended online course was perceived to be acceptable, feasible and successful. The results indicate that quality improvement continues to be integrated in Makueni overall improving mental health services.

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

Mitigating Non-Point Source Pollution in the Abbotsford Sumas Aquifer: An Evidence Based Evaluation of the Effectiveness of the BC Action Plan to Tackle Non-Point Source Water Pollution

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

At the turn of the 20th century, BC completed its first public status report on the quality of water and found that 10% of the water sources monitored had poor water quality caused primarily by non-point source pollution. The Abbotsford-Sumas Aquifer (ASA) was mentioned in this report and it has had persistent and significant nitrate contamination, primarily from agriculture, for decades despite mitigation efforts. This poses significant public health, ecological and economic risks to the region. In 1999, the BC Action Plan to tackle non-point source (NPS) water pollution was released which focused on six key initiatives including (a) education and training (b) prevention at the site (c) land use, planning and coordination (d) assessment and reporting (e) economic incentives and (f) legislation and regulation. The following capstone evaluates to what extent the BC Action Plan was implemented to mitigate contamination of the ASA and how effective the key initiatives were at reducing NPS pollution. Evidence for this evaluation was collected through academic data base and targeted web based searches, and the capstone is informed by a range of resources, such as government documents, meeting minutes and scholarly journals. This evaluation allowed for the development of four key recommendations for actions moving forward to improve water quality in the aquifer and minimize negative public health impacts. These recommendations include strengthening the implementation of Beneficial Management Practises (BMPs) for agriculture, stricter legislation and tighter enforcement, increased coordination and commitment of local stakeholders and increased public awareness. As there will be increased focus on water quality in BC as the regulations under the Water Sustainability Act are implemented, and global pressure on water resources continues to build , there will be an increased urgency to prioritize collaborative efforts to protect our shared natural resource.

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

An Impactful Youth-Adult Partnership: Evaluating the Youth Engagement Approach within an HIV intervention in Soweto, South Africa

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-04
Abstract: 

Despite successful efforts made by the South African government to implement youthfriendly services in public clinics, none of these efforts have formally evaluated youth engagement as an integral framework to improve health service delivery to young adults (16-24 years). The youth engagement framework is a participatory research approach, where young people and adults merge their efforts to work towards a common goal while sharing knowledge and power. The objective of our study was to evaluate the effectiveness of the Youth Engagement (YE) approach as part of a larger adolescent HIV cohort study. AYAZAZI (‘knowing themselves’ in the Zulu language) is an interdisciplinary longitudinal cohort study at the Perinatal HIV Research Unit (PHRU) which aims to link HIV socio-behavioural patterns and clinical characteristics among youth age 16-24 years living in Soweto, South Africa. The AYAZAZI study adopted a youth engagement approach where youth (16-24 years) play an active role as research staff members and participants while receiving the guidance and support of adult allies. The AYAZAZI cohort study has a mixed age group on staff, consisting of Adolescents and Young Adults (AYA) (16-24 years) staff, and adult allies (older than 25 years). To evaluate the YE approach in AYAZAZI, we employed two data sources: anonymously written responses submitted via a suggestion box, as well as responses given during face-to-face interviews. The suggestion box was implemented in the youth lounge at the PHRU clinic to assess Adolescents and Young Adults (AYA) research participants’ satisfaction with the AYAZAZI research study. We also conducted face-to-face interviews with 5 (AYA) AYAZAZI research participants (18-24 years), 4 youth AYAZAZI research staff (16-24 years), and 4 AYAZAZI “adult allies” staff (older than 25). Key findings from the youth engagement evaluation included young people feeling valued by staff members, and youth staff having new career aspirations as a result of interacting with adult staff members. Adopting a youth engagement approach created an effective communication space between adults and young people. Taken together, our results suggest that, when given a supportive environment where young people can engage with those of the same age group along with supportive adults, youth are more likely to partake in programs and services intended to benefit them.

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

An Evaluation of the Impact of Charlie’s Food Bank – A Support Program for Pet Owners in the Downtown Eastside

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015
Abstract: 

This paper reports on an impact evaluation conducted amongst clients and volunteers of Charlie’s Food Bank. Charlie’s Food Bank has been a staple of the Vancouver Downtown Eastside for the past 15 years through the provision of pet food, veterinary services and other pet related supports provided to homeless and low-income pet owners. The evaluation sought to examine the impact and contribution of Charlie’s Food Bank services on the lives of clients. The findings of the evaluation suggest that pet services provided by Charlie’s Food Bank contribute not only to pet care but client wellbeing through emotional and mental health benefits, social connectedness and community building. The results also point to the importance of using strengths-based, trauma informed, and ecologically informed service delivery techniques in order to best serve the needs of the Downtown Eastside homeless pet owners.

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

Self-Management Education in Diabetes; How do We Measure the Effectiveness of Diabetes Expo in Improving Self-Management Skills of Individuals Affected by Diabetes?

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015
Abstract: 

The Canadian diabetes association is working to improve the quality of life of people living with diabetes through self-management education, research, and advocacy. Continued self-management education is the cornerstone in helping individuals living with diabetes. One of the important parameters in determining the effectiveness of any self-management education intervention is its ability to modify a risky health behavior. The Diabetes expo is one of the several projects implemented by Canadian Diabetes Association (CDA) that are aimed towards improvement of the self-management skills of people living with diabetes. The purpose of this study is to examine the effectiveness of a community diabetes self-management event and annual expo event hosted by CDA is discussed as a case study. First, review of previous documents and reports available with organization was done. Further, key informant interviews were conducted to identify the intended outcomes for evaluation of effectiveness of diabetes expo. To complete the task of the evaluation, logic model was used. In the next step indicators were identified which will measure the outcomes of the programme. In order to do that review of the Canadian Diabetes educator sections reference guide on best practices and critical literature review was also conducted. Review of the survey questionnaire used by CDA revealed the need for evaluation methods which will generate data for measuring the intended outcomes of diabetes expo. Constructs of health belief model (HBM) were employed in building the evaluation tool for the intended participants in a three parts survey questionnaire. The objective was to generate important data which will help project coordinators measure the change in perceptions along with other intended short term outcomes of the project. Finally, the data from the previous evaluation report was compared with the short term outcomes identified from the key informant interviews, critical literature review, and review of other documents. The data shows that diabetes expo is very popular amongst the intended participants. However its effectiveness is mainly determined by the achievement of the expected intended short term outcomes (changes in perception areas identified by HBM, empowerment) of a self-management education event.

 

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