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We encourage you to read the abstracts submitted by this year’s poster presenters. We were delighted by the number of submissions for research projects related to this year’s student-led conference theme!

Collaborative Application of Resilience Education (CARE); Fostering Resilience to Combat Depression and Anxiety in Graduate Students

Authors: Jocelyn Lee, Alexander Moore, Radhika Prabhune, Edyta Marcon, Richard Foty

Background: Graduate students are training to be the next generation of researchers, teachers, and innovators. However, they experience depression and anxiety at rates six times higher than the general population. A literature review of resilience education and an environmental scan of existing preventative resources has been conducted, displaying current university-provided mental health interventions as primarily reactive, short-term, and crisis oriented. There remains a need for preventative resources that prepare students to effectively face adversity and maintain wellbeing.

Purpose: Our team aims to implement a proactive, skill-based resource that teaches strategies to foster resilience in graduate school while emphasizing the importance of self-care, self-awareness, and help-seeking.

Methods: In collaboration with experts in mental health, psychology, pedagogy, resource development, and graduate students themselves, our team is co-creating a new preventative resource to be piloted at the University of Toronto, scheduled for 2023. Graduate students will be recruited conveniently, with the first 20 students responding to a Laboratory Medicine and Pathobiology department-wide email advertisement, to use the resource. Here, they will also undergo quantitative and qualitative assessment to test the resource’s effectiveness in building resiliency and the overall acceptance of the resource, respectively. Quantitative testing will occur pre- and post-intervention using scores from the Connor-Davidson Resilience Scale (CD-RISC). Semi-structured interviews with graduate students will be used to qualitatively evaluate perceived efficacy and gather feedback and suggestions for improvement.

Anticipated Results and Potential Implications: We anticipate that the group receiving the intervention will display improved CD-RISC scores following their participation in the resource compared to those who did not participate at all. Furthermore, prior studies have found that increased resilience is correlated with improved mental health, better life satisfaction, and less burnout – we expect that pilot participants will report similar outcomes. Overall, we expect this resource will reduce levels of depression and anxiety for students by preparing them for the stress they experience in graduate school. If successful, this resource may be adapted to address the needs of graduate students in different departments, universities, and institutions worldwide.

A Sociotechnical Systems Approach to Evaluating Healthcare Provider Readiness for Social Prescribing within an Integrated Care Model in one Ontario Health Team

Authors: Lavania Jeganathan, Katie Dainty, Kelly Smith

Social prescribing (SP) is the process by which healthcare providers (i.e., primary care physicians or nurse practitioners) leverage their position between patients/caregivers and social services, to provide a prescription addressing the social determinants of a patient’s condition. Social determinants of health (SDoH) consist of the interactions within and between life conditions, such as income and housing, and systems/policies which shape these conditions. They contribute to up to 80% of individual and population health.

Current literature promotes integrated teams-based care as the most effective to address these determinants. In 2019, Ontario’s Connecting Health Care Act formed 54 Ontario Health Teams (OHT) to address healthcare fragmentation and enhance integrated healthcare delivery. Presently, there is limited understanding of the provider’s ability to deliver SP within the integrated care system offered through OHTs.

This poster/oral presentation will describe a research proposal to evaluate healthcare providers’ readiness for SP within one OHT. The evaluation will use the sociotechnical systems theoretical approach and the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) conceptual framework to evaluate systems and individual factors impacting the implementation of SP.

A survey will be administered to healthcare providers (i.e., primary care physicians, nurse practitioners etc.) by healthcare team leaders (i.e., primary care clinics, community health centers etc.) found within one OHT. Sex- and gender-based analyses will be performed to examine the role of sex/gender in a healthcare provider’s readiness to implement SP. The survey will include open-ended questions to contextualize the data collected.

This research aims to identify facilitators and barriers to the implementation of social prescription in integrated care teams. This is the first step to successfully implementing social prescription into Ontario’s integrated care system, which will improve health outcomes for patients who are made vulnerable by social inequities.

Prescription cellular phones help healthcare providers support emergency department patients: Interim survey results from the PHONE-CONNECT initiative

Title: PHONE-CONNECT: Prescribing cellular phones to patients helps health care workers provide care in the emergency department

Authors: Galo F. Ginocchio, Jennifer Hulme, Evelyn Dell, Tali Fedorovsky, Kelli Janes, Brielle Bossin, Hannah Girdler, Andrea Somers

Background: Emergency Department (ED) patients experiencing disadvantage may have limited access to cellular phones, affecting their ability to receive correspondence, connect with community resources, and receive follow-up health care. Examples of experiencing disadvantage can include homelessness, addictions, mental health, and/or undocumented status. The ED-based intervention, PHONE-CONNECT (Phones for healthier Ontarians in the emergency department), provides cellular phones and/or prepaid phone plans to patients who do not have them. PHONE-CONNECT allows health care workers (HCW) to facilitate follow-up care following the transition from hospital to community. Here we present our first complete data set from the PHONE-CONNECT initiative.

Objective: To explore how PHONE-CONNECT affects health care workers in the emergency department, including those implementing it

Methods: We used a realist evaluation-informed approach to understand how, why, and for whom PHONE-CONNECT works best. Research assistants trained in data collection conducted an anonymous in-person and online survey amongst HCWs in three Toronto ED’s. Respondents included registered nurses, medical doctors, clerical staff, clinical assistants, social work staff, and peer-based staff with lived experience of disadvantage. This survey explored the feasibility, acceptability, and appropriateness of PHONE-CONNECT, including questions surrounding implementation of the program and its impact on the health care workers facilitating it.  Data was analyzed using descriptive statistics.

Results: 142 survey responses were collected between August and September 2022 using a 5-point Likert scale ranging from Completely disagree [1] to Completely Agree [5]. Aggregate scores from implementation science outcome measures (AIM-IAM-FIM) were calculated. Respondents agree that PHONE-CONNECT is acceptable, appropriate, and feasible. A subset of 46 respondents facilitating the program reported the following: PHONE-CONNECT improves HCW’s ability to: a) Meet the health needs of patients (92.9%); b) Meet the social needs of patients (91.4%); c) Facilitate disposition planning while in the ED (88.1%); d) Facilitate patient follow-up (91.9%). PHONE-CONNECT improves the quality of care provided (90.5%) and Distributing phones to ED patients experiencing disadvantage: a) Is worth the cumulative time & effort (91.7%) and b) reduced moral distress (82.4%) and burnout (69%)

Conclusion: PHONE-CONNECT is feasible, acceptable, and appropriate, showing promise in helping meet the health/social needs of patients, facilitating disposition planning/follow-up, improving the quality of care, and is perceived to be worth the cumulative time and effort. Despite having a low impact on reducing burnout, the intervention may provide HCW’s protection from it through reduction of moral distress.

Theory building for decision-making processes for the system-level translation of multidisciplinary health technologies: A case study of the Ontario Health Pharmacogenomics Working Group

Authors: Mary Schmitz, Samuel Neumark, Richard Foty, Joseph Ferenbok

Background: Translational Research in healthcare aims to move observations and discoveries from laboratory, clinical, and non-clinical settings into tangible interventions to improve patient care. While translational activities have occurred for decades, focused efforts to study translational research is a newer field. There is a need for high-quality efficient translation in the dynamic public health space. By understanding current translational processes, we can improve upon or replicate them as needed. Our project will use a current public health initiative, the Ontario Health Pharmacogenomics Working Group, as an observational case to analyze current translational practices. The field of pharmacogenomics (PGx) describes how genes affect individuals’ drug responses. Recommendations for the implementation of PGx testing technologies is the focus of the Ontario Health initiative. The purpose of our project is to understand the components involved in the decision-making steps of translating novel multidisciplinary health technologies, such as PGx, at a system-level.

Methods: We will use immersive ethnographic methods to study the activities of the Ontario Health PGx Working Group and their development of a recommendations report. We will observe and catalogue their activities from inception through adjournment over a 10-month period. The data will be analyzed to generate models, frameworks, or other products for knowledge translation.

Implications: The results of the study will be used to build theory about decision-making processes for the system-level translation of multidisciplinary health technologies. While adding to the literature of translational research, the knowledge products will be designed with flexibility to iterate and respond to a changing public health landscape. This research will establish a model of current practices for translational processes that other health jurisdictions can replicate.

Conclusions: This project will address the current gap in understanding around decision-making processes for the adoption, implementation, and dissemination of the novel health technologies transforming public healthcare in Canada.

HPV and Cervical Cancer Prevention in Immigrant Women: An Intersectional Approach

Authors: Abisha Yogaratnam

Background: HPV-related cervical cancer (CC) is the fourth most commonly diagnosed cancer among women aged 14 to 44 years in Canada. Refugee women who resettle in the Greater Toronto Area (GTA) dur to conflict, human rights violations, and climate disasters in their homelands are at increased risk for HPV-related cancer. One potential explanation for the increased risk in HPV-related CC among refugee women in the GTA is that refugee women face barriers to accessing routine sexual health and HPV preventative services in the GTA. In many cases, refugee women from developing nations resettling in the GTA have a higher incidence of HPV-related CC as a result of differing cultural norms and awareness of sexual and reproductive health. Upon resettling in their host countries, the existing services aimed at HPV prevention fail to reach this population because of growing gaps in intersectional care considering cultural, religious, and the historical trauma women may have. The knowledge gaps both in healthcare services about the intersectional needs of women, and the gaps in refugee women’s knowledge about the importance of HPV prevention perpetuates an increased burden among the population.

Objective: The objective of this scoping review was to understand the different barriers that refugee women who resettle in the GTA experience. Further, the review was also done to understand how an intersectional approach facilitating health promotion about sexual and reproductive healthcare can increase routine uptake of HPV screening preventative services in the GTA.

Methods: A search on PubMed, JSTOR, and MEDLINE was done using terms for HPV, cervical cancer, refugee women, screening, Pap tests, and HPV vaccines. Articles analyzing equitable and intersectional care to address knowledge gaps were included.

Results: 29 articles were included in this review. The results of the literature review highlighted that refugee women in the GTA experience a disproportionate rate of risk for HPV-related CC. This disease burden was correlated with the inadequacy of programs targeted specifically at refugee women who require an intersectional approach to address the knowledge gaps.

Conclusion: The barriers women face in accessing preventative measures to reduce HPV can be attributed to the lack of intersectional care which includes culturally appropriate and patient-centered care for refugee women. Arriving to Canada with various cultures, ethnicities, religions, and unique traumas, refugee women need CC prevention programs that focus on knowledge translation, community, and culturally centred care to improve outcomes. To reduce the disease burden of HPV-related CC among refugee populations, who make up a large proportion of the GTA population, the lack of accessible health literacy and information needs to be addressed. By bridging the knowledge gaps of both refugees and healthcare providers, and increasing awareness through intersectional, trauma-informed, and culturally appropriate care, public health initiatives in the GTA can reduce overall HPV-related CC rates.

Mental Health Risks Persist Over Time? Psychological Distress of Chinese Residents in Canada across Three Years of the Pandemic

Authors: Linke Yu and Lixia Yang

Introduction: The COVID-19 pandemic has been detrimental to mental health. Chinese abroad are highly susceptible to negative consequences from the COVID-19, including the unique challenges they face given the rise in anti-Chinese discrimination. It is important to assess how their mental health has changed over time with the unfold of the pandemic. The current study sought to assess psychological distress among Chinese Canadians across three years of the pandemic (2020, 2021, and 2022) and to identify consistent robust risk predictors of psychological distress.

Methods: Three groups of Chinese aged 18 or above were randomly recruited through social media platforms and internet to complete an online survey administered at three different time points (early 2020, 2021, and 2022) respectively. Psychological distress was assessed using self-reported ratings on the COVID-19 Peritraumatic Distress Index (CPDI), where higher scores indicating greater psychological distress. We conducted univariate analysis of variance (ANOVA) models, Pearson correlations, as well as hierarchical multiple regression models to identify the time point and sociodemographic and COVID-19 related predictors for psychological distress.

Results: The CPDI score peaked in 2021 (January – March), with an increased CPDI in 2021 and 2022 compared to 2020. Residence status and age were identified as significant predictors of CPDI. Those who were young adults (relative to older adults) and on business visas (relative to other types) showed heightened psychological distress (βs = 4.48-10.10 ps < 0.05). In addition, those who were in relatively poorer health status, with higher self- or family-infection worry, and higher perceived anti-Chinese discrimination reported higher psychological distress (βs = 1.45 – 7.44, ps <0.001).

Conclusion: The current study reported gradually increased psychological distress across three years, with a peak in 2021, among Chinese residents in Canada and found that poor health status, higher infection worry, and higher perceived anti-Chinese discrimination were associated with greater psychological distress.

Implications: The results urge timely and culturally appropriate mental health supports for Chinese Canadians during and following the pandemic.

The Increasing Vulnerability of South Asians in Canada during the COVID-19 Pandemic

Authors: Tijhiana Rose Thobani and Dr. Zahid Butt

Canadian South Asians are disproportionately being economically, socially, politically, and culturally impacted by the COVID-19 pandemic. There is currently a gap in the literature on the unique challenges faced by this specific group of individuals. This commentary included an in-depth search of the current peer-reviewed literature on Scopus and Medline, as well as a grey literature search on Google. This commentary aims to add a new perspective by specifically exploring factors that may contribute to the high rates of COVID-19 among South Asian communities in Canada. Another goal is to highlight the importance of providing tailored support at the provincial and federal level and the negative consequences if this is not correctly done. Factors such as overrepresentation in essential work and financial instability are discussed. Pre-existing health conditions among South Asians such as diabetes, hypertension, anxiety, and mood disorder are considered, as well as how the history of these conditions within this population elevates the risk of severe health complications. The commentary addresses several areas in relation to cultural, economic, and social gaps in current policies which neglect the contextual needs of this populations. Several structural barriers continue to present unique challenges to the Canadian South Asian community, which are directly and indirectly a result of the COVID-19 pandemic. There is still a pressing need to collect qualitative and quantitative data on the experiences and needs of South Asians living in Canada to provide them with the tools and resources required to promote health and well-being. This commentary also presents suggestions for addressing this gap in research, as well as directions for future public health initiatives and policies. By presenting these results, we aim to bring awareness and work toward future structural and political change for this community, as our society grows from the pandemic.

This commentary has been published in the International Journal of Environmental Research and Public Health.

Thobani, T. R., & Butt, Z. A. (2022). The Increasing Vulnerability of South Asians in Canada during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(5), 2786.

Contact us: slc.dlsph@utoronto.ca