Jim Frankish

Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students

Health literacy has come to play a critical role in health education and promotion, yet it is poorly understood in adolescents and few measurement tools exist. Standardized instruments to measure health literacy in adults assume it to be a derivative of general literacy. This paper reports on the development and the early-stage validation of a health literacy tool for high school students that measured skills to understand and evaluate health information. A systematic process was used to develop, score and validate items. Questionnaire data were collected from 275, primarily 10th grade students in three secondary schools in Vancouver, Canada that reflected variation in demographic profile. Forty-eight percent were male, and 69.1% spoke a language other than English. Bivariate correlations between background variables and the domain and overall health literacy scores were calculated. A regression model was developed using 15 explanatory variables. The R(2) value was 0.567. Key findings were that lower scores were achieved by males, students speaking a second language other than English, those who immigrated to Canada at a later age and those who skipped school more often. Unlike in general literacy where the family factors of mothers education and family affluence both played significant roles, these two factors failed to predict the health literacy of our school-aged sample. The most significant contributions of this work include the creation of an instrument for measuring adolescent health literacy and further emphasizing the distinction between health literacy and general literacy.

Out of our inner city backyards: re-scaling urban environmental health inequity assessment.

In this paper, we report the results of a three-year research project (2008-2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city.

Homeless and incarcerated: an epidemiological study from Canada

Background: Incarceration and homelessness are closely related yet studied rarely. This article aimed to study the incarcerated homeless and identify specific vulnerabilities, which rendered them different from the nonincarcerated homeless. It also aimed to describe the homeless population and its significant involvement with the criminal justice and enforcement system. Methods: Data were derived from the British Columbia Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada: the large urban center Vancouver (n = 250), Victoria (n = 150) and Prince George (n = 100). Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ) and the Mini International Neuropsychiatric Interview (MINI) Plus. Results: Incarcerated homeless were more often male (66.6%), were in foster care (56.4%) and had greater substance use especially of crack cocaine (69.6%) and crystal methamphetamine (78.7%). They also had greater scores on emotional and sexual abuse domains of CTQ, indicating greater abuse. A higher prevalence of depression (57%) and psychotic disorders (55.3%) was also observed. Risk factors identified which had a positive predictor value were male gender (p < .001; odds ratio (OR) = 2.8; 95% confidence interval (CI): 1.7–4.4), a diagnosis of depression (p = .02; 95% CI: 1.1–4.4) and severe emotional neglect (p = .02; 95% CI: 1.1–3.2) in the childhood. Conclusion: Homeless individuals may be traumatized at an early age, put into foster care, rendered homeless, initiated into substance use and re-traumatized on repeated occasions in adult life, rendering them vulnerable to incarceration and mental illness.

Recruitment and retention of homeless individuals with mental illness in a housing first intervention study

Background Homeless individuals with mental illness are challenging to recruit and retain in longitudinal research studies. The present study uses information from the Vancouver site of a Canadian multi-city longitudinal randomized controlled trial on housing first interventions for homeless individuals. We were able to recruit 500 participants and retain large number of homeless individuals with mental illness; 92% of the participants completed the 6-month follow up interview, 84% the 24-month follow up, while 80% completed all follow-up visits of the study. Purpose In this article, we describe the strategies and practices that we considered as critical for successful recruitment and retention or participants in the study. Methods We discuss issues pertaining to research staff hiring and training, involvement of peers, relationship building with research participants, and the use of technology and social media, and managing challenging situations in the context of recruitment and retention of marginalized individuals. Conclusions Recruitment and retention of homeless participant with mental illness in longitudinal studies is feasible. It requires flexible, unconventional and culturally competent strategies. Longitudinal research projects with vulnerable and hidden populations may benefit from extensive outreach work and collaborative approaches that are based on attitudes of mutual respect, contextual knowledge and trust.

A longitudinal study of suicidal ideation among homeless, mentally ill individuals.

PurposePrevious cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation, which are strongly associated with completed suicide. We conducted the first known longitudinal study of suicidal ideation in the homeless.MethodsWe used data collected over 24xa0months in the Vancouver At Home project (Nxa0=xa0497), comprised two randomized-controlled trials of housing interventions for homeless individuals with mental disorders. Presence of suicidal ideation was determined using the Colorado symptom index.ResultsSuicidal ideation significantly decreased over time [odds ratio (OR)xa0=xa00.31 at 24xa0months, 95xa0% confidence interval (CI) 0.21–0.46]. Baseline diagnoses of mood (ORxa0=xa02.18, 95xa0% CI 1.48–3.21) and anxiety disorders (ORxa0=xa02.05, 95xa0% CI 1.42–2.97), as well as depressive mood (ORxa0=xa02.52, 95xa0% CI 1.90–3.33), use of any substance (ORxa0=xa01.59, 95xa0% CI 1.09–2.32), and polysubstance use (ORxa0=xa01.90, 95xa0% CI 1.40–2.60) were significantly associated with suicidal ideation in the multivariate model. Baseline diagnosis of a psychotic disorder (protective effect), daily substance use, intravenous drug use, recent arrest, multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only.ConclusionsInterventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals. Mental health services need to be tailored to address the complex needs of socially marginalized individuals.Trial registrationCurrent controlled trials: ISRCTN57595077 (Vancouver At Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing first plus intensive case management versus treatment as usual). Assigned 9 Oct. 2012.

Understanding the development of narrative insight in early psychosis: A qualitative approach

The primary objective was to understand the process of insight development in early psychosis, using narrative analysis and grounded theory. Given the growing interest in “narrative insight”, the study’s use of a qualitative research design was deemed appropriate for shedding light on this emerging phenomenon. Twenty-four data-gathering sessions were conducted; 12 participants from a Vancouver, BC early psychosis clinic wrote a narrative of their pathway into care, and were then interviewed. The results of the analysis, which used qualitative research, consisted of four “doorways” to positive insight development: “becoming demoralized”, “finding a fit”, “experiencing an impact”, and “envisioning illness in the background” of life. The “core process” of narrative insight development in early psychosis thus involves “coming to an acceptable, adaptive explanation” of one’s problem. The implications are that interventions should seek to help people find an explanation that resonates with their psychosis experience, and which is appraised as relevant to restoring their envisioned life trajectory.

Low-Income Mothers’ Descriptions of Children’s Injury-Related Events A Discourse Analysis

The purpose of this study was to examine how mothers with young children who were living in low-income households used discursive strategies to explain their children’s injury and near-miss events. In-person interviews were conducted with 17 mothers and a discourse analytic approach was used to analyze the data. Mothers used a variety of discursive strategies to explain injury events including minimizing the nature of events and expressing tensions between responsibility and resistance. Mothers also described challenges related to predicting children’s behavior and dealing with competing demands. These discursive strategies reflected how societal expectations that mothers are held to in terms of keeping children safe conflicted at times with the constraints experienced by mothers living in economically challenging situations. The findings can be used to inform the design of injury prevention strategies that are sensitive to experiences of mothers of young children who are living with economic challenges.

Are Substance use and Mental Illness Associated to an Earlier Onset of Homelessness

Purpose: Substance use and complex concurrent mental disorders are highly common among the homeless, contributing to a higher burden of disease and mortality. Are they associated to an earlier loss of housing? nMethods: Participants of the Vancouver arm of the At Home/Chez Soi study suffering from at least one psychiatric illness (n=490) were included in this cross-sectional analysis. Alcohol and substance use patterns were assessed at baseline using the highly validated Mini questionnaire. Age of first homelessness was a self-reported measure. To investigate the independent association between these variables, a linear regression model was created. nResults: Sixty percent of the participants had a diagnosis of psychoactive substance use disorder. Thirty-two percent an alcohol abuse and dependence disorder at baseline. While all participants had one mental disorder, over ninety percent had from two to eight diagnoses. According to our model, each additional psychiatric diagnosis was associated to an earlier onset of homelessness by 0.86 years and each category of drug used by 0.51 years. nConclusions: The number of psychiatric comorbidities and abused substances were found to be associated to earlier onset of homelessness. These findings provide information on the path into homelessness, general health conditions and social marginalization, helping the researchers understand how to better face this challenge. The data suggest an increased need for proactive integration of homeless individuals suffering from psychiatric disorders.