Colleen Davison

Preliminary field-work: methodological reflections from northern Canadian research

In the Canadian North researchers of all disciplines are increasingly finding that local communities are neither uninterested nor ignorant of the potential for research to benefit their communities. We propose preliminary field-work as the early stages of research in the field that allow for exploration, reflexivity, creativity, mutual exchange and interaction through the establishment of research relationships with local people often prior to the development of research protocols and ethics applications. Based on a review of field research literature combined with our own personal research narratives from northern Canadian community research, we initiate a much needed discussion on the topic of preliminary field-work in order to understand more clearly its functions and contributions. We reflect on and examine our own experiences providing methodological guidance to other researchers who are contemplating community-based field research. Preliminary fieldwork acknowledges the increasingly intertwined standards of research quality, integrity and broader research ethics.

HPV vaccine acceptability in Africa: a systematic review.

OBJECTIVE The objective of this study was to provide a systematic review of peer-reviewed literature on the factors associated with HPV vaccine acceptability among adults in African countries. METHODS A systematic search was conducted across five electronic databases: EMBASE, PsychINFO, CINAHL, Global Health and Ovid MEDLINE, to identify studies related to HPV vaccination acceptability in African countries (August 2013). The Health Belief Model was used to guide data abstraction and synthesis. RESULTS Fourteen unique studies representing ten sub-Saharan African countries were identified, with more than half published within the last two years. Acceptability of the HPV vaccine for daughters was high (range 59-100%); however, vaccine-related awareness and knowledge were low. Perceived barriers including accessibility and cost concerns were important for acceptance, as were cues to action from healthcare providers and governments. CONCLUSIONS This review suggests that acceptability of the HPV vaccine in countries in this region will be high. Broad knowledge gaps were highlighted regarding HPV and cervical cancer and these should be addressed. Education on the vaccines effectiveness and reducing perceived barriers to vaccination would also be useful. Public endorsement by governments and healthcare providers will likely also increase acceptance.

Student Researchers Negotiating Consent in Northern Aboriginal Communities

In this article, the authors discuss what students are doing to reconcile the differences between institutional ethical review standards and the reality of community-based, qualitative research, particularly in northern Canada. They examine the experiences of 12 students who are currently undertaking or have recently completed qualitative research in the North. Students raised concerns about what informed consent really mean; the contentiousness of obtaining written consent, and modified consent forms and the flexibility of research ethics board (REB) standards. The authors demonstrate that significant judgment is required in the introduction of ethics procedures in northern Canadian research. More work is needed to guide novice researchers and help build their agency for making ethical judgments in the field.

Critical examination of knowledge to action models and implications for promoting health equity

IntroductionKnowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity.MethodsWe conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric.ResultsWe identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas.ConclusionsExisting knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory and integrative research. There is room to develop more robust equity supporting models.

The Development and Validation of Hand Motion Analysis to Evaluate Competency in Central Line Catheterization

OBJECTIVES Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire. METHODS Ten nonexperts (junior emergency medicine residents) and 10 experts (critical care fellows or attending physicians) were recruited. Electromagnetic sensor probes were used to capture hand motion during an US-guided internal jugular cannulation on a standardized manikin. Hand, US, and needle motion were analyzed for the following metrics: total path length, total time, translational movements, and rotational movements. Subjects were also videotaped and evaluated using a modified, validated global rating scale (GRS) by a blinded expert. RESULTS There was a significant difference in almost all examined motion parameters between experts and nonexperts. Experts took 66% less time (50.2 seconds vs. 148.7 seconds, p < 0.001) and had significantly less right-hand and US motion (total path length and translational and rotational movements). Left-hand total path length was the only parameter that was not significantly different between groups. Concurrent validity of motion parameters was established by strong correlations (r2 > 0.74) to a previously published, modified GRS. CONCLUSIONS Electromagnetic hand and instrument motion analysis is technically feasible for assessing competence in US-guided insertion of a CVC guidewire in a simulation setting. In showing that it discriminates between the performances of nonexperts and experts, this study has provided evidence for construct validity. It also shows excellent correlation with a modified version of a previously validated GRS, providing evidence of concurrent validity.

Drinking, Substance Use and the Operation of Motor Vehicles by Young Adolescents in Canada

Background Impaired driving is a recognized cause of major injury. Contemporary data are lacking on exposures to impaired driving behaviours and related injury among young adolescents, as well as inequities in these youth risk behaviours. Methods and Findings Cycle 6 (2009/10) of the Health Behaviour in School-Aged Children survey involved 26,078 students enrolled in 436 Canadian schools. We profiled cross-sectionally the reported use of alcohol, marijuana, or other illicit drugs by on-road and off-road vehicle operators when young adolescents (mean age 13.3 (±1.6) years) were either driving or riding as a passenger. Comparisons were made across vulnerable subgroups. Multi-level logistic regression analyses were used to quantify the effects of the driving behaviours on risks for motor vehicle-related injury. Attributable risk fractions were also estimated. A total of 10% (±3%) of participants reported recent operation of an on-road or off-road motor vehicle after consuming alcohol, marijuana, or other illicit drugs, while 21% (±3%) reported riding as a passenger with a driver under the same conditions. Larger proportions of youth reporting these risk behaviours were males, and from older age groups, rural communities, and socio-economically disadvantaged populations. The behaviours were consistently associated with increased risks for motor vehicle-related injury at the individual level (RR 2.35; 95% CI: 1.54 to 3.58 for frequent vs. no exposure as a driver; RR 1.68; 95% CI: 1.20 to 2.36 for frequent vs. no exposure as a passenger) and at the population level (Attributable Risk Fraction: 7.1% for drivers; 14.0% for passengers). The study was limited mainly by its reliance on self-reported data. Conclusion Impaired driving is an important health priority among young adolescents in Canada. Inequities in the involvement of younger adolescents in these risk behaviours suggest the need for targeted interventions for specific subgroups such as youth from rural communities, and among socially disadvantaged populations.

Insights into the School Environment that Surveys Alone Might Miss: An Exploratory Pilot Study Using Photovoice

The dynamics of how social connection is created or maintained through the physical structures of a school are not fully understood. An exploratory photovoice project was undertaken in a rural high school. Students took photos and spoke to what they felt the photos showed about the schools social environment. The findings showed that the school was segmented into clear territories, enshrining particular types of power, welcoming some students and alienating others. Being ‘in’ or ‘out’ was associated with cliques known to gather in particular places. Having a car maintained what the students called ‘a divide’. A confronting reality about school life was surfaced that standard school connection and social network questionnaires miss. A display of the photos at the school confirmed the findings and led to actions to address the issues raised. Thus the strategy offers unique insights and an opportunity to create tailored, place-focused ways to make the schools more welcoming.

Bicycle helmet use and bicycling-related injury among young Canadians: an equity analysis

IntroductionCycling is a major activity for adolescents in Canada and potential differences exist in bicycling-related risk and experience of injury by population subgroup. The overall aim of this study was to inform health equity interventions by profiling stratified analytic methods and identifying potential inequities associated with bicycle-related injury and the use of bicycle helmets among Canadian youth. The two objectives of this study were: (1) To examine national patterns in bicycle ridership and also bicycle helmet use among Canadian youth in a stratified analysis by potentially vulnerable population subgroups, and (2) To examine bicycling-related injury in the same population subgroups of Canadian youth in order to identify possible health inequities.MethodsData for this study were obtained from the 6th cycle (2009/10) of the Health Behaviour in School-aged Children (HBSC) study, which is a general health survey that was completed by 26,078 students in grades 6–10 from 436 Canadian schools. Based on survey responses, we determined point prevalence for bicycle ridership, bicycle helmet use and relative risks for bicycling-related injury.ResultsThree quarters of all respondents were bicycle riders (n=19,410). Independent factors associated with bicycle ridership among students include being male, being a younger student, being more affluent, and being a resident of a small town. Among bicycle riders, 43% (95%CI ± 0.6%) reported never wearing and 32% (± 0.6%) inconsistently wearing a helmet. Only 26% (± 0.5%) of students reported always wearing a bicycle helmet. Helmets were less frequently used among older students and there were also important patterns by sex, geographic location and socioeconomic status. Adjusting for all other demographic characteristics, boys reported 2.02-fold increase (95% CI: 1.61 to 1.90) and new immigrants a 1.35-fold increase (95%CI: 1.00 to1.82) in the relative risk of bicycling-related injury in the past 12 months, as compared to girls and students born in Canada. The relative risk of injury did not vary significantly by levels of socioeconomic status.ConclusionsTroubling disparities exist in bicycle use, bicycle helmet use and bicycling-related injuries across specific population subgroups. Bicycle safety and injury prevention initiatives should be informed by disaggregated analyses and the context of bicycle-related health differences should be further examined.

Community-driven alcohol policy in Canada's northern territories 1970-2008.

OBJECTIVE To describe community-driven alcohol policy for 78, primarily First Nations, Métis and Inuit, communities in Canadas three northern territories (Yukon, Northwest Territories and Nunavut) between 1970 and 2008. This is a first step to understanding the policy-oriented prevention system that has evolved in these areas over time. METHODS Regulatory data were compiled from Part II of the Territorial Gazette Indices and the Revised Statutes and Regulations of each territory. Regulations were categorized as open, restricted, prohibited or other. RESULTS The number of communities with some form of regulation has increased steadily over time with half of the sample communities adopting some form of regulation between 1970 and 2008. The use of prohibition as a policy choice peaked in 1980 but has remained relatively steady since that time. There has been a steady increase in the adoption of other kinds of restrictions. Communities with regulations tend to have smaller and younger populations, a greater percentage of people with First Nations, Métis or Inuit origin and are more geographically isolated than those with no regulation. CONCLUSIONS This is the first time alcohol control policies have been compiled and described for the Canadian north. The dataset records the collective energies being put into community problem solving and provides a means to interpret the prevalence of health and social problems linked to alcohol use in these communities over time.

Recreational use of prescription medications among Canadian young people: Identifying disparities

OBJECTIVES: While the recreational use of prescription medications is widely recognized as a growing public health issue, there are limited epidemiological studies on patterns of use in Canada, particularly studies identifying populations at highest risk. The objective of this study was to describe recreational prescription drug use among Canadian adolescents by age, sex, socio-economic, immigration and geographic status.METHODS: Data were obtained from grade 9 and 10 students participating in the 2009/2010 cycle of the nationally representative Canadian Health Behaviour in School-aged Children study (n=10,429). Students were asked about past-year recreational use of pain relievers, stimulants and sedative/tranquilizer medications. Cross-tabulations and multi-level Poisson regression were conducted to evaluate the prevalence of use and to explore disparities.RESULTS: Approximately 7% of students reported past-year recreational use of one or more prescription medication(s). Females reported 1.25 times the risk of recreational use of pain relievers as compared with males (95% confidence interval [CI]: 1.04–1.51). Students of lower socio-economic status (SES) were 2.41 times more likely to report recreational use of any type of medication (95% CI: 1.94–2.99). Recreational use of pain reliever medications was highest among rural youth living in close proximity to urban centres. Rates for all medications were similar between immigrant and non-immigrant students.CONCLUSIONS: Recreational prescription drug use disproportionately affects certain subgroups of youth, including females, those of lower SES and those in some rural settings more than others. These results provide foundational data to inform preventive efforts aimed at management of the non-medical use and divergence of prescription medications.RésuméOBJECTIFS: L’usage récréatif des médicaments sur ordonnance est largement reconnu comme étant un problème de santé publique en croissance, mais il y a peu d’études épidémiologiques sur les types de consommation au Canada, tout particulièrement d’études axées sur les populations les plus à risque. Nous avons cherché à décrire la consommation de médicaments sur ordonnance à des fins récréatives chez les adolescents canadiens selon l’âge, le sexe, le statut socioéconomique, le statut d’immigrant et l’emplacement géographique.MÉTHODE: Nos données sont celles des élèves de 9e et de 10e année ayant participé au cycle 2009–2010 de l’Étude sur les comportements de santé des jeunes d’âge scolaire au Canada (n=10 429). Ces élèves ont répondu à des questions sur leur usage récréatif d’analgésiques, de stimulants et de sédatifs ou de tranquillisants au cours de l’année antérieure. Des tabulations en croix et des régressions de Poisson à niveaux multiples ont permis d’évaluer la prévalence de la consommation et d’en explorer les disparités.RÉSULTATS: Environ 7 % des élèves ont déclaré avoir consommé un ou plusieurs médicaments sur ordonnance à des fins récréatives au cours de l’année antérieure. Les filles ont été 1,25 fois plus susceptibles que les garçons de déclarer avoir consommé des analgésiques à des fins récréatives (intervalle de confiance [IC] de 95 %: 1,04–1,51). Les élèves de faible statut socioéconomique (SSE) ont été 2,41 fois plus susceptibles de déclarer avoir consommé n’importe quel type de médicament à des fins récréatives (IC de 95 %: 1,94–2,99). L’usage récréatif des analgésiques était le plus élevé chez les jeunes des milieux ruraux vivant tout près de centres urbains. Les taux de consommation de tous les médicaments étaient semblables chez les élèves immigrants et non immigrants.CONCLUSIONS: La consommation de médicaments sur ordonnance à des fins récréatives touche démesurément certains sous-groupes de jeunes, dont les filles, les élèves de faible SSE et les jeunes vivant dans certains milieux ruraux. Ces résultats fournissent des données de base pour éclairer les efforts de prévention visant la prise en charge de l’usage non médical des médicaments sur ordonnance et la divergence de ces médicaments.