Health Sciences - Theses, Dissertations, and other Required Graduate Degree Essays

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Social and cultural aspects of living with type 2 diabetes for ethnic minorities in Canada

Date created: 
2020-04-30
Abstract: 

Diabetes is a chronic progressive disease that affects one in three Canadians and ethnicity is one of its risk factors in Canada. Type 2 diabetes (T2DM) which constitutes the vast majority of the cases, is highly impacted by social and cultural factors. However, we know very little about how social and cultural factors impact living with T2DM in for ethnic minorities in Canada. A systematic review of the existing literature and survey-based assessment of patient perceptions were conducted. The most important social and cultural determinants of health for patients were diabetes education, social support, cultural competency of institutions (e.g. healthcare system, the government), patient trust for institutions, perceptions of self, and the perception of financial barriers. The social and cultural factors of importance can be understood in three categories of (1) diabetes education, (2) perceptions of self and perceived relations with others, (3) perceived financial constraints.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Scott Lear
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

The knowledge and effect of a drug-related good samaritan law among people who use drugs in Vancouver, Canada

Author: 
Date created: 
2020-08-04
Abstract: 

In response to the drug poisoning crisis in Canada and the US, some jurisdictions have enacted drug-related Good Samaritan laws (GSLs) to encourage observers of acute poisoning events to call emergency medical services (EMS) during times of overdose. To date, the effectiveness of GSLs are indeterminate. This thesis undertook a literature review on the effectiveness of GSLs, evaluated the working knowledge of a GSL, and the impact of this law among participants of three large prospective cohort studies of community-recruited people who use illicit drugs (PWUD) in Vancouver, a full year after the enactment of a GSL in Canada. Overall, the literature review demonstrated mixed evidence with regard to the effectiveness of GSLs. Only about a third of our sample had accurate knowledge of the GSL and the GSL did not appear to have changed EMS-calling rates. Additional measures are urgently needed to support the aims of GSLs.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Kanna Hayashi
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Fairness under fire: Environmental justice, mental health, and natural disasters

Author: 
Date created: 
2020-08-10
Abstract: 

Natural disasters are increasing due to climate change, bringing with them substantial increases in disaster-associated mental illnesses, such as depression, PTSD, and anxiety. Previous evidence has shown that after a natural disaster, these mental heath outcomes are not distributed equally throughout the population, but tend to affect certain groups of people more than others. Yet, inequality does not necessarily constitute an inequity. Currently, there is no established way of determining the fairness of mental health outcomes post-disaster, which is a necessary component of determining whether policies or guidelines ought to change in order to remedy an injustice. In this project, I use an environmental justice framework to assess the justness of mental health outcomes after natural disasters, using the Fort McMurray fire of 2016, known as The Beast, as a case study. Environmental justice theories have not previously been used to determine justness of mental health outcomes after natural disasters, therefore I begin by determining whether this the correct type of theory to use for this endeavour by examining certain critical components of the theory against what would be required for its application in this particular context. I end this ethical analysis by suggesting particular elements for inclusion in an environmental justice theory, to accommodate its usage for mental health outcomes post-natural disaster. The Beast caused the largest mandatory evacuation and was the costliest disaster in Canadian history. It therefore serves as a highly relevant case study to examine the question of equity in mental health outcomes in a Canadian context. Using aggregated data from Alberta Health, academic articles, newspaper articles, and published reports, I attempt to determine what the mental health outcomes of the Beast were, and if they affected the members of the population equally. In my final chapter, I applied the findings from my ethical analysis to the case study. This iterative process highlighted gaps and strengths in the approach. I conclude this thesis by reflecting on the learnings from this application process and offer thoughts on how we can move forward.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Jeremy Snyder
Diego Silva
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

A study of mindfulness-informed group process: Towards burnout prevention and treatment

Author: 
Date created: 
2020-07-02
Abstract: 

Background: Chronic work-related stress, known as burnout, is damaging to patient’s recovery, healthcare professional’s health and the organization’s functioning. Burnout increases medical errors and healthcare costs through a cascade of effects, including a decrease in work quality, job satisfaction, and retention. Prevention and treatment strategies have focused on the improvement of the organizational environment or building individual resiliency. While important, these have not adequately addressed the vital role groups play in the management of stress. I posit the need for new approaches inclusive of innovative group strategies that bring about the co-regulation of stress in work groups. Mindfulness-informed group process is one such approach that appears to improve group functioning through a combination of safe group development infused with mindfulness. Methodology: To better understand the principles of mindfulness-informed group process, this research used a constructivist grounded theory methodology to develop a mindfulness-informed group theory. Data was collected using semi-structured interviews, relevant scholarly literature collated through systematic reviews, and additional related published materials. Interviews were conducted with mindfulness-informed group leaders, each with extensive training in a mindfulness-informed practice and group therapy. Results: Findings detailed an interlocking process whereby the leader’s mindfulness and the form of the group infuse the interpersonal mindfulness of the group. This creates an interpersonal field where mindfulness is practiced and trained as a skill. Mindfulness-informed group leaders play a vital role in the development of mindfulness-awareness in the group through their openness, genuineness and skillful communication. Interpersonal mindfulness allows for enhanced communication as member’s signal safety facilitated by the skillful articulation of feelings and thoughts in-the-moment within workplace constraints. Members create connections and social support, which appears to allow for increased self-regulation of stress through mindfulness and co-regulation through interpersonal mindfulness. Discussion: Mindfulness-informed group theory offers insights into the regulation of stress and burnout for healthcare leaders and professionals in small group environments. It does so by highlighting the development of safe group environments through the practice of interpersonal mindfulness in work interactions. Burnout is best addressed through improving individual resilience, the development of safe interpersonal environments and organizational efforts to support professionals in healthcare delivery.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Daniel Vigo
Heesoon Bai
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Embedded police officers in assertive community treatment: Impacts on service delivery and health-related outcomes

Author: 
Date created: 
2020-07-30
Abstract: 

Background: The deinstitutionalization of patients from psychiatric institutions and deficiencies in community treatment have been linked to a mental health “crisis” in Canadian cities. Municipal police departments have vocalized concerns that they have become 24-hour responders to this crisis, that it is taxing their resources beyond capacity, and that it is fostering a criminal justice response to mental illness. To address these concerns, some municipal police departments have advocated for the creation of Assertive Community Treatment (ACT) teams with embedded officers. Although the ACT model has been the focus of rigorous scientific scrutiny, modification with the presence of embedded officers remains largely unevaluated. This study seeks to address this knowledge gap through research focusing on the experiences of service providers and consumers. Methods: This research is informed by grounded theory ethnographic methods. Data collection included 47 in-depth qualitative interviews with both service providers (N = 23) and consumers (N = 24) as well as over 90 hours of focused observational fieldwork and informal interviews. Findings: Results reveal that embedding police officers in the ACT model shapes the experiences of service providers and consumers in multiple domains of their treatment interactions. Findings demonstrate the significance of relationships in the ACT model, the importance of secure housing as a component of treatment, service-provider struggles between identities as agents of social control and agents of change, and the impacts of systemic pressures for “flow” in and out of ACT teams. Conclusions: Police-embedded ACT offers a unique adaptation with the potential to address psychiatric, psychosocial, and criminogenic needs. However, findings of this study raise concerns, including coercion, lack of consumer autonomy, and potential blurring between treatment and social control. Police-embedded ACT and the potential power imbalances the model can create call for independent and transparent oversight as well as consumer involvement in future research and evaluation.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Will Small
Emily Jenkins
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Indigenous and gender informed approaches to understanding health, social, and mental wellness among indigenous people experiencing homelessness and mental illness in two Canadian cities

Author: 
Date created: 
2020-06-26
Abstract: 

Background: Indigenous people are overrepresented in urban homeless populations internationally, a consequence of racialized policies and structural violence. As a step toward reconciliation Canadian and international policies have recently affirmed Indigenous rights to self-determination. The objective of this dissertation was to identify distinct service needs, gender differences and trajectories to homelessness among Indigenous people in Canada, and to undertake an Indigenous-led process to develop recommendations for action. Methods: Data were drawn from the Vancouver and Winnipeg sites of Canada’s At Home/Chez Soi study. Retrospective analyses were conducted on baseline data from both study sites. Transcripts of interviews with Indigenous participants in Vancouver were thematically analyzed. A traditionally-inspired sharing circle was facilitated by an Indigenous elder and comprised of Indigenous people who had experienced homelessness as well as Indigenous service providers. The sharing circle dialogue employed imagery and symbols to express major themes related to the past and possible future of housing and inclusion among Indigenous peoples. Results: When compared to non-Indigenous participants, Indigenous peoples were more likely to have been homeless at a younger age, to experience ongoing symptoms of trauma, and to have young children. Among Indigenous participants, Indigenous women experienced significantly more symptoms of trauma, higher suicidality, and more experience as victims of violence. Indigenous narratives described situations of intense violence, family disconnection and the lasting harms of generational trauma. Recommendations for action affirmed that government action to promote self-determination is essential. Conclusions: This dissertation documents the distinct historical and current character of Indigenous homelessness, and the need to transform colonial practices that oppress Indigenous Canadians, particularly women and young people. Community developed recommendations for action emphasized the urgent need for practices that promote self-determination and strengthen the resurgence of Indigenous culture.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Julian Somers
John O'Neil
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Cannabidiol (CBD) marketing and decision-making: Examining 164 crowdfunding campaigns and 2,165 CBD products for sale online in Canada

Author: 
Date created: 
2020-07-14
Abstract: 

The popularity of cannabidiol (CBD) has increased dramatically due to medical perceptions of CBD as a “cure-all”, with over 1,000 products available. Limited research examines how consumers find and decide to purchase CBD for medical purposes. First, to understand motivations for CBD medical use, 164 GoFundMe.com campaigns incorporating CBD for a medical condition are thematically examined. Second, to understand how CBD is presented to potential consumers, 2,165 CBD products on Canadian websites are analyzed. The resulting findings suggest that among crowdfunders, CBD is identified as a treatment through self-directed research, a recommendation by a trusted care provider, or experiential insights from someone associated with or influencing the personal network. Product descriptions frame CBD as a treatment or cure for specific ailments, a natural health product, or a product used in specific ways to achieve particular results. These findings suggest the need for systematic auditing of CBD products for regulatory adherence.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Jeremy Snyder
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Privacy concerns, HIV care provider trust, and clinical care engagement among women living with HIV in response to the criminalization of HIV non-disclosure in Canada

Author: 
Date created: 
2020-01-13
Abstract: 

In 2012, the Supreme Court of Canada ruled that people with HIV have a legal obligation to disclose their serostatus to partners prior to sex that poses a “realistic possibility” of HIV transmission. This study used Wave 2 survey data from 1422 women living with HIV (WLWH) enrolled in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study to examine (1) the proportion and socio-demographic characteristics of WLWH who perceived privacy concerns due to the law; (2) the association between WLWH’s privacy concerns and trust of HIV care providers; and (3) the association between WLWH’s privacy concerns and HIV clinical care engagement. Results showed that a majority of participants reported privacy concerns, and that the socio-economically vulnerable women had significantly higher odds of privacy concerns. WLWH with lower provider trust had higher odds of privacy concerns. There was no significant association between privacy concerns and HIV care engagement.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Angela Kaida
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Evaluating and utilizing crowdsourced data and population surveys in bicycling safety research

Date created: 
2020-04-14
Abstract: 

Increased population level bicycling would benefit society by improving health outcomes and reducing fossil fuel emissions. A main factor preventing increased bicycling is concerns regarding safety. Traditional sources of bicycling safety data (police, hospital or insurance data) underreport incidents and are biased. Alternative sources of bicycling safety data, including crowdsourcing and population surveys, are untested and rarely utilized. Crowdsourced data will include incidents that go unreported to traditional sources, but the nature of any systematic biases in these data are poorly understood. Population surveys represent the only means of collecting detailed individual-level information regarding road users, but there is little consideration by researchers of how survey design choices may affect measured outcomes. When combined with spatial data, population surveys can contribute to understanding associations between rarely studied characteristics of road users and perceived or objective safety. In this thesis, I evaluate alternative sources of bicycling safety data, and contribute to different dimensions of bicycling safety knowledge, by evaluating bicycling safety data collection methods and identifying correlates of perceived and objective bicycling safety. Specifically, the chapters in this thesis address gaps in our understanding of (i) biases in crowdsourced bicycling safety data, (ii) the relationship between personal characteristics, infrastructure, and overall perceived bicycling safety, (iii) the impacts of survey design on measurements of bicycling behaviour, and (iv) bicycling crash risk for different sociodemographic characteristics, social environments (including attitudes and social norms), and neighbourhood-built environment features. In this thesis I provide two broad contributions: (i) showcasing the potential for crowdsourced data and population surveys to compliment traditional bicycling safety data and, provide answers to applied question in bicycling safety research; (ii) underscoring the value of linking a-spatial survey data to a geographic location to be able to assign measurements of a participants built environment and, be able to consider different scales of influence on the outcome. Future research in this area should focus on creating a linked crash database of self-report, crowdsourced, police, hospital and insurance data, as well as on the collection and integration of spatially resolved exposure estimates in travel surveys.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Meghan Winters
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Economic evaluation in the context of schizophrenia and related psychotic conditions: A systematic review and cost-consequence analysis

Author: 
Date created: 
2020-04-15
Abstract: 

Psychosis is a symptom that presents in mental health disorders including schizophrenia, major depression, and bipolar disorder. How best to capture the benefits of interventions in the broader context of mental health is an area of debate in health economics, particularly the suitability of generic quality of life measures. Specific to psychosis, these issues are explored through a systematic review and cost-consequence analysis. Findings from the review show the array of outcomes that have been used to quantify benefit in economic evaluations, with most studies using condition-specific (rather than generic) measures. Given this deviation from ‘standard’ approaches, cost-consequence analysis provides an appropriate way to assess the cost-effectiveness of interventions in this clinical context – the illustrative example in this thesis comprises an assessment of a supported employment model. Understanding the reasons for the infrequent use of widely-accepted economic evaluation techniques is an important area for further health economics and policy research.

Document type: 
Thesis
File(s): 
Supervisor(s): 
David Whitehurst
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.