Health Sciences Capstone Projects

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Addressing Depression among Women through Action on the Social Determinants of Health in Pakistan: A Literature Review

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No, item is not peer reviewed.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

Depressive disorders constitute a substantial proportion of the global disease burden. These disorders are a major public health concern for both developed and developing countries, with particularly high prevalence observed in Pakistan, especially among women. Despite recognition of the social determinants (SDH) of depression to address mental health globally, Pakistan is lagging behind with poorly implemented mental health policies. This literature review examines the association of the SDH and depression among women in Pakistan. This review confirms a high prevalence of depression among women linked to SDH including poverty, illiteracy, unemployment, lack of social support and housing, inadequate health care access and poor mental health facilities with stigma attached to mental disorders. The findings also reveal a need for a comprehensive mental health policy to integrate mental health services into primary health care and to target mental health care towards underprivileged and marginalised women.  A key component of an integrated approach to address the SDH associated with the growing burden of depression amongst women in Pakistan is a focus on mental health literacy among underprivileged and marginalized women.

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

Indoor Radon Exposure in British Columbia: A Primer for Health Promotion

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015
Document type: 
Graduating extended essay / Research project
File(s): 
Supervisor(s): 
Malcolm Steinberg
Department: 
Health Sciences: Faculty of Health Sciences

Enhancing the Performance of Knowledge Brokers: Implications for Public Health

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No, item is not peer reviewed.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

The use of scientific findings in the development of health policy is a critical element of disease prevention and health promotion. Nonetheless, a well-established body of public health research has determined that scientific knowledge continues to inadequately inform and guide health-impacting decisions. Due to a lack of organizational evidence-informed-decision-making (EIDM), policies and practices, on average, do not sufficiently protect the health of workers exposed to occupational health hazards, such as respirable crystalline silica (RCS). Workers are commonly overexposed to RCS and consequently experience unacceptably high health risk levels. While the concept of Knowledge Translation (KT) has made some progress transferring risk-mitigating knowledge into organizational practice, research use remains unsatisfactory. Poor organizational research implementation is associated with pervasive KT barriers that impede the flow of knowledge from knowledge producers to knowledge users. Within an occupational context, KT barriers create gaps in what has been identified as the Occupational Health and Safety Knowledge-to-Action Process. In an effort to bride knowledge-to action gaps, the use of Knowledge Brokers has recently gained much traction. Through the use of engaging, interactive strategies that meaningfully convey messages, Kbs can attenuate KT barriers and prompt behaviour change in the form of increased EIDM. Due to a lack of Kb educational and performance standards however, many Kbs are ill equip to conduct effective KT. Supporting the Promotion of Activated Research and Knowledge (SPARK) is an evidence-informed intervention aimed to improve Kb KT capacity through a KT skills training program. To assess KT knowledge and skill acquisition a process evaluation was conducted. Evaluation results revealed that Kb KT skills can be enhanced. While thorough program efficacy has yet to be tested, evaluation findings are believed to be the first step in understanding the illness prevention and health promoting potential of this intervention. Based on the need to mitigate occupational health risks, and prospects of promising evaluation results, it is believed that KT training should be applied to Kbs within the Occupational Health and Safety Knowledge-to-Action Process, specifically WorkSafe BC Prevention Officers. It is believed that the occupational public health implications of well-trained, KT-capable Kbs can significantly reduce health risks among workers exposed to occupational health hazards and pave the way for increased organizational EIDM.

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

Predictors of Virologic Suppression and Rebound Among HIV-Positive Men who have Sex With Men in a Large Multi-Site Canadian Cohort

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

Objectives: Men who have sex with men (MSM) represent the largest HIV transmission category in Canada, but there are limited pan-provincial data regarding combination antiretroviral therapy (cART) treatment outcomes. We sought to identify socio-demographic and clinical correlates of virologic suppression and rebound in this population.

Methods: Our analysis included MSM participants in the Canadian Observational Cohort (CANOC) collaboration ≥ 18 years old who initiated ART naïvely between 2000 and 2011. We used accelerated failure time models to identify factors predicting time to suppression and time to subsequent rebound.

Results: 3,180 participants were eligible for inclusion, of whom 2,616 (82.3%) achieved virologic suppression in a median time of 4 months. Our analysis identified more recent era of ART initiation, no history of injection drug use, older age, lower baseline viral load, higher viral load testing rate, and being on an initial regimen consisting of nonnucleoside reverse transcriptase inhibitors as significant predictors of virologic suppression. Subsequent virologic rebound was experienced by 298 participants (11.4%) in a median time of 22 months. Significant factors predicting rebound were more recent era of ART initiation, IDU history, younger age, higher baseline CD4 cell count, > 6 annual viral load tests, and living in British Columbia.

Conclusion: The majority of HIV-positive MSM on ART are successfully achieving virologic suppression, which marks significant improvements in the health of HIV-positive MSM in Canada since the emergence of ART. A minority of MSM experience an increased risk of virologic rebound. Priority target groups include younger MSM and those with a history of IDU. 

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

A Review of System-Level and Practitioner Relevant Factors That Improve Access to Primary Dental Care for Children Living in Vulnerable Contexts

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

The distribution of childhood caries and dental surgery in BC and Canada is inequitable and is a potential indicator of limited access to prevention and treatment through primary dental care. This paper focuses on different ways to improve access to primary dental care, specifically with an interest in better meeting the needs of children 0-18 years of age living in vulnerable contexts. Findings from this research indicate that policies and investment strategies that reduce the cost of primary dental care have significant impact on improving access, and that a combination of interventions that address economic, safety and health human resource related barriers to care can contribute. Innovative funding and staffing models, inter-disciplinary collaboration, the use of technology and transport, child centered and friendly care and targeted training, recruitment and retention strategies all contribute to increasing access. This paper recommends continued advocacy for policy changes to include primary dental care for children and youth as a part of the Canada Health Act as well as local planning that looks at innovative, creative, flexible and family-friendly ways of providing service, building staffing and maximizing the usage of existing infrastructure and resources. 

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

A Systematic Review of Measurement Instruments to Assess Cognition and Language Development at 24 Months of Age, for Use in Effectiveness Trials of Nurse-Home Visitation Programs

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

This systematic review evaluates cognitive and language measurement instruments for use at 24 months of age in effectiveness trials of nurse-home visitation programs. In particular, this review aims to identify and recommend potential instruments for the British Columbia Healthy Connections Project, a scientific evaluation of the Nurse Family Partnership, a nurse-home visitation program, in Canada. Although there is an overlap in child cognitive and language development in young children, the extent of the overlap is unclear, and hence it is recommended that instruments designed to separately assess cognition and language be used if feasible. A general search of potential instruments was completed, in addition to searches pertaining to instruments that have been used in home visitation interventions designed to improve language and cognition in young children. Detailed components are reported for 6 instruments: the Bayley Scales of Infant and Toddler Development –Third Edition (Bayley-III), the Battelle Developmental Inventory –Second Edition (BDI-2), the Preschool Language Scale –Fifth Edition (PLS-5), the MacArthur-Bates Communicative Development Inventory (CDI), the Language Development Survey (LDS), and the Language Use Inventory for Young Children (LUI). All 6 instruments were considered as acceptable for reliability and validity (r > 0.70). Although the Bayley-III is considered the gold standard, without adequate resources and planning, it presents challenges in training and administration. The BDI-2 is a suitable substitute for the Bayley-III in lower resource situations. More research is required to draw conclusions on the reliability and validity of the PLS-5. Selection between the CDI, LDS, and LUI depends on what aspect of language development is to be evaluated. Child cognitive and language instruments administered at 24 months of age have limitations in their predictive validity and use in populations speaking English as a second language. Further research and longitudinal studies in these areas are warranted.

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

Connections amidst Complications: An Evaluation of the Outreach Support Program at Positive Women’s Network

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

Outreach support programs are part of the continuum of care for people living with HIV. The outcomes of these programs can be classified into two types: healthcare and non-healthcare services. Outreach support programs can help to overcome barriers to both types of services for people living with HIV. An evaluation of the outreach support program at Positive Women’s Network was done to capture the components and outcomes of the program. Interviews were conducted with the outreach support worker and five program participants. Results found that despite complications, the outreach support program was able to create meaningful connections with members of Positive Women’s Network. Program activities included providing aid with food, transportation, and housing, helping participants to access healthcare, providing support at appointments, and undertaking outreach to women in the federal prison. The evaluation findings are consistent with and build upon existing literature. More studies examining outreach support programs in different contexts are needed to further the body of literature and support for outreach programs. 

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

A Scoping Review on the Impacts of the Extractive Resource Industry on Sexual and Reproductive Health Outcomes of Mineworkers and Communities in Southern Africa

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

This capstone is a scoping review on the impacts of the extractive resource industry on sexual and reproductive health outcomes of mineworkers and communities in southern Africa. After a comprehensive search, 17 articles from the relevant literature were reviewed to develop a synthesis of key findings and recommendations. The reviewed studies suggest that poor sexual and reproductive health outcomes are linked to structural determinants of health and wellbeing, such as circular migration patterns; rural poverty; limited education and income opportunities; family unification and migration policies; housing and healthcare access; economic conditions; gender dynamics; weak industry regulation; and regional history and policies. Recommendations call for broadening the scope of sexual health interventions, addressing the determinants of health and wellbeing within mining areas, and strengthening sectoral regulation and responsibility among mining companies.

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

Quantitative and Qualitative Evidence on Cuba's Primary Health Care

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

Many scholars have lauded the Cuban primary health care system because the country has demonstrated a remarkable success in providing access to and improving the health of its population under punishing economic circumstances. While much of the evidence supporting this view has relied on quantitative research, more recent research with ethnographic components offers alternative perspectives of the Cuban health experience. The purpose of this capstone is to determine the extent to which there may be dissonance between quantitative and qualitative research. A review of the published literature reveals challenges for both patients and health workers. Issues discussed include the informal economy for health, diminishing income for physicians, constraints for patients, and medical internationalism. This capstone concludes that Cuba‘s primary health care system has been largely successful in meeting the health care needs of its population.

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

Evolution of the MSM Blood Donation Policy in Canada

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

In order to ensure the safety of the blood supply, potential blood donors in Canada are screened for eligibility prior to making a donation. This process includes answering a series of questions intended to identify those at higher risk of carrying transfusion-transmissible pathogens. Prior to 2013, male donors who had had sex with another man, even once, since 1977 were banned for life from donating blood. From 2013 onward, men who have sex with men (MSM) could donate blood provided that they had not had sex with another man for five years. This policy has been criticized, both before and after the policy change in 2013, as being discriminatory and not based on current scientific knowledge and practices. This paper describes and analyzes the evolution of the MSM blood donation policy in Canada. The analysis shows that Canadian Blood Services, the organization in charge of the blood supply, prioritized blood safety and the perspectives of blood recipients above all others, which led them to take a particularly cautious approach in deciding when and how to change the policy. The analysis also reveals that the policy was finally able to change in 2013 because of the accumulation of research, the engagement of high-interest stakeholder groups, and shifts in the perceived costs and benefits of maintaining the status quo vs. changing the MSM blood donation policy. Examining the costs and benefits of a policy change for blood recipients and the MSM community suggests that what is needed for the policy to change in the future is more research into alternative screening criteria which can maintain the safety and adequacy of the blood supply.

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