Joy L. Johnson

Strengthening population health interventions: developing the CollaboraKTion Framework for Community-Based Knowledge Translation

BackgroundMuch of the research and theorising in the knowledge translation (KT) field has focused on clinical settings, providing little guidance to those working in community settings. In this study, we build on previous research in community-based KT by detailing the theory driven and empirically-informed CollaboraKTion framework.MethodsA case study design and ethnographic methods were utilised to gain an in-depth understanding of the processes for conducting a community-based KT study as a means to distilling the CollaboraKTion framework. Drawing on extensive field notes describing fieldwork observations and interactions as well as evidence from the participatory research and KT literature, we detail the processes and steps undertaken in this community-based KT study as well as their rationale and the challenges encountered. In an effort to build upon existing knowledge, Kitson and colleagues’ co-KT framework, which provides guidance for conducting KT aimed at addressing population-level health, was applied as a coding structure to inform the current analysis. This approach was selected because it (1) supported the application of an existing community-based KT framework to empirical data and (2) provided an opportunity to contribute to the theory and practice gaps in the community-based KT literature through an inductively derived empirical example.ResultsAnalysis revealed that community-based KT is an iterative process that can be viewed as comprising five overarching processes: (1) contacting and connecting; (2) deepening understandings; (3) adapting and applying the knowledge base; (4) supporting and evaluating continued action; and (5) transitioning and embedding as well as several key elements within each of these processes (e.g. building on existing knowledge, establishing partnerships). These empirically informed theory advancements in KT and participatory research traditions are summarised in the CollaboraKTion framework. We suggest that community-based KT researchers place less emphasis on enhancing uptake of specific interventions and focus on collaboratively identifying and creating changes to the contextual factors that influence health outcomes.ConclusionsThe CollaboraKTion framework can be used to guide the development, implementation and evaluation of contextually relevant, evidence-informed initiatives aimed at improving population health, amid providing a foundation to leverage future research and practice in this emergent KT area.

Migration and young people's mental health in Canada: A scoping review.

Abstract Background: Young people’s mental health is a public health priority. Given the influences of migration and resettlement on mental health, synthesis of current research with young people from migrant backgrounds can help inform mental health promotion initiatives that account for and are responsive to their needs. Aims: This article distils the results of a review of published literature on the mental health of adolescent immigrants (ages 10–19) living in Canada. Method: Scoping review methods were used to define inclusion and exclusion criteria; inform the search strategies; and extract and synthesize key findings. Results: Fourteen articles met criteria for inclusion. Analysis of the studies indicate diversity in mental health indicators, e.g., mental distress, emotional problems and behavioral problems, as well as a wide range of influences on mental health from age at migration and length of stay to place of residence, income and discrimination. Conclusions: Findings support the need to account for the array of influences on young people’s mental health in relation to migration and to augment initiatives beyond the level of individual intervention.

From didactic to dialogue: Assessing the use of an innovative classroom resource to support decision-making about cannabis use

Abstract Aims: In most countries, cannabis use rates are highest among young people. Efforts invested in cannabis prevention programmes have had limited success. In part, this may be attributed to a dearth of meaningful discussion in classroom settings on the topic and scarcity of credible resources. Although young people want opportunities to engage in dialogue focussed on cannabis, educators often feel unprepared to facilitate such discussions. Methods: In this knowledge translation study based on recent ethnographic findings, a film was created to explore decision-making and cannabis use among young people. Accompanying curricular materials were developed to support adult facilitators in leading group discussions. Findings: The film-based resource was used in 55 sites across Canada by 48 facilitators (school staff, public health professionals and youth workers); the film was viewed by more than 2500 students. Qualitative content analysis of facilitator evaluations along with telephone interviews revealed the impact of using the innovation. Facilitators adapted the resource in a variety of classes where in-depth discussions occurred, generating critical self-reflection. Conclusions: The diffusion of this drug education innovation underscores the importance of youth engagement in prevention programmes. Prevention approaches that accommodate inclusive and balanced discussion about cannabis use can support young people in their decision-making.

“Just as Canadian as Anyone Else”? Experiences of Second-Class Citizenship and the Mental Health of Young Immigrant and Refugee Men in Canada:

In recent years, the experiences of immigrant and refugee young men have drawn attention worldwide. Human-induced environmental disasters, local and global conflicts, and increasingly inequitable distributions of wealth have shaped transnational migration patterns. Canada is home to a large immigrant and refugee population, particularly in its urban areas, and supporting the mental health and well-being of these communities is of critical importance. The aim of this article is to report findings from a qualitative study on the social context of mental health among immigrant and refugee young men, with a focus on their migration and resettlement experiences. Informed by the conceptual lens of social context, a thematic narrative analysis approach was used to examine qualitative data from individual and group interviews with 33 young men (age 15 to 22 years) self-identified as immigrants or refugees and were living in Greater Vancouver, western Canada. Three thematic narratives were identified: a better life, living the (immigrant) dream, and starting again from way below. The narratives characterized the social context for immigrant and refugee young men and were connected by a central theme of negotiating second-class citizenship. Implications include the need for mental health frameworks that address marginalization and take into account the contexts and discourses that shape the mental health of immigrant and refugee populations in Canada and worldwide.

Assessing the impacts and outcomes of youth driven mental health promotion: A mixed-methods assessment of the Social Networking Action for Resilience study

Mental health challenges are the leading health issue facing youth globally. To better respond to this health challenge, experts advocate for a population health approach inclusive of mental health promotion; yet this area remains underdeveloped. Further, while there is growing emphasis on youth-engaged research and intervention design, evidence of the outcomes and impacts are lacking. The purpose of this paper is to contribute to addressing these gaps, presenting findings from the Social Networking Action for Resilience (SONAR) study, an exploration of youth-driven mental health promotion in a rural community in British Columbia, Canada. Mixed methods including pre- and post-intervention surveys (n = 175) and qualitative interviews (n = 10) captured the outcomes and impacts of the intervention on indicators of mental health, the relationship between level of engagement and benefit, and community perceptions of impact. Findings demonstrate the feasibility and benefits of youth engaged research and intervention at an individual and community-level.

“I tend to forget bad things”: Immigrant and refugee young men’s narratives of distress:

Distress among young immigrant and refugee men has drawn increasing research attention in recent years. Nuanced understandings of distress are needed to inform mental health and public health programming. The purpose of this research was to examine distress from the perspectives of young immigrant and refugee men living in Greater Vancouver, British Columbia, Canada. Thirty-three young men (aged 15–22 years) from diverse immigrant and refugee backgrounds participated in interviews, which were conducted between 2014 and 2015. Data were examined using narrative analysis and theories of masculinities. Three narratives were identified—norming distress, acknowledging distress as ongoing, and situating distress. The findings reveal that the narratives offer different frames through which distress was rendered a norm, or acknowledged and situated in relation to the participants’ relationships and to masculine discourses that shaped their expressions of distress. The findings can inform initiatives aimed at providing spaces for diverse young men to acknowledge their distress and to receive support for mental health challenges.

“I should have …”:A Photovoice Study With Women Who Have Lost a Man to Suicide:

While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women’s narratives drew upon feminine ideals of caring for men’s health, which in turn gave rise to feelings of guilt over the man’s suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women’s postsuicide bereavement support programs should integrate a critical gender approach.

The Connections Between Work, Prostate Cancer Screening, Diagnosis, and the Decision to Undergo Radical Prostatectomy

Prostate cancer diagnosis can occur at a time when men’s work and careers are central to their masculine identity, sense of purpose, and family life. In Canada, an aging male population, along with medical advances, has resulted in increasing numbers of working men being diagnosed with, and treated for, prostate cancer. Little is known about the linkages between men’s work and their experiences of prostate cancer. In this qualitative study, 24 Western Canadian men were interviewed to distil the connections between work, prostate cancer screening, diagnosis, and the decision to undergo radical prostatectomy. Data were analyzed using constant comparison in the context of masculinities theory. The findings demonstrated that work was central to men’s masculine identities and afforded financial security, social status, and a sense of personal growth. However, work-related strain and demands were also found to affect participants’ health and distance them from their families. A diagnosis of prostate cancer tended to diminish the importance of work, wherein participants focused on optimizing their health and strengthening family relations. In deciding on radical prostatectomy as a treatment to eradicate prostate cancer, few men considered the implications for returning to work. The current study findings indicate that clinicians and patients should explicitly explore and discuss how surgery side effects may affect work and career plans during treatment decision-making.

Developing Resilience: Gay Men’s Response to Systemic Discrimination

Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination.

Chapter 6 – “He’s More Typically Female Because He’s Not Afraid to Cry”: Connecting Heterosexual Gender Relations and Men’s Depression∗

Depression, a disorder often thought of as a women’s health issue, is underreported in men. Little is known about how heterosexual couples respond when the male partner is depressed; however, couples are often challenged to make life adjustments that impact their gender relations. The findings detailed in this chapter are drawn from an innovative qualitative study of 26 heterosexual couples (26 men and their 26 women partners) in which the man had a formal diagnosis and/or self-identified as depressed. Canadian-based participants completed individual, semistructured interviews that focused on exploring how masculinities and femininities intersect to forge particular heterosexual gender relations in the context of the male partner’s depression. A social constructionist gender analysis revealed three couple typologies: trading places, business as usual, and edgy tensions. Trading places refers to couples who embodied some atypical masculine and feminine roles to compensate for the men’s depression-induced losses (eg, men as homemakers and women as breadwinners). Women partners in these dyads broke with feminine ideals in how they provided partner support by employing tough love strategies to protect themselves and prompt the men’s self-management of their depression. Couples involved in business as usual co-constructed men’s alignment with masculine workman ideals and women’s emotional support to counter and conceal men’s depression-induced deficits. Among couples in the edgy tensions category, a mismatch of gender expectations fueled resentment and dysfunction that threatened the viability of some relationships. Overall, the limits of women’s resilience and caregiving were evident, yet the findings also reveal how women directly influenced the men’s management of their depression. Opportunities for couples to assess their relationship dynamics within a broad range of gender relations might support couples’ connectedness and life quality during the challenges that accompany men’s depression.