Lois A. Jackson

Does moving from a high-poverty to lower-poverty neighborhood improve mental health? A realist review of 'Moving to Opportunity'

Ray Pawsons realist review method was used to analyse 22 evaluations/reviews of the Moving to Opportunity (MTO) housing intervention. MTO was a randomized controlled trial that moved families from high-poverty to low-poverty neighborhoods in five US cities between 1994 and 2006. This realist review focussed on mental health outcomes of families who moved, as well as the mechanisms through which moving influenced mental health. It identified and assessed the effectiveness of the underlying theory driving MTO, and suggests revising the existing theory. This realist review suggests that, even when moves are voluntary, there are potentially negative mental health outcomes from these types of social interventions. Directing resources towards the improvement of existing communities is one way of improving health outcomes for all community residents.

Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs

Awareness of drug use in rural communities and small towns has been growing, but we know relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services. Semi-structured interviews were conducted with 115 IDUs in urban and non-urban areas of Atlantic Canada. In many instances, geographic distance to a needle exchange program (NEP) meant that individuals living outside of urban areas and who were not provided services through an NEPs outreach program were at a disadvantage in terms of an array of supports offered through many NEPs. These include access to free clean injecting equipment, and such ancillary services as clothing, food, referrals, information and social support. The integration of the services and approaches provided by NEPs into mainstream health services in non-urban places is one possible model for improving such access.

Intimate relationships and women involved in the sex trade: perceptions and experiences of inclusion and exclusion

This article reports on a qualitative study exploring the intimate (non-work) relationships of women involved in the sex trade. Women working in the sex industry and intimate partners of women in the industry were interviewed in order to understand how intimate relationships are perceived as influencing the womens general health and well-being. The research suggests that intimate relationships can, and do, provide a space for feelings of inclusion and safety that are perceived as positive forces in womens general health and well-being. At the same time, however, feelings and experiences of exclusion (fuelled by the dominant stigmatizing discourse related to prostitution) can enter into intimate relationships, and are perceived as having a negative impact on the womens well-being, particularly their emotional health. Although there are attempts to keep the womens work separate from the intimate relationship, cross-over between the two spheres does occur. The research suggests that health care and service providers need to look beyond the womens working lives, and understand the relationships between work and home, as well as the ways in which intimate relationships can influence womens lives and health through both positive and negative forces.

The power of relationships: implications for safer and unsafe practices among injection drug users.

Aims: To explore the influence of social relationships, at the interpersonal and community level, on safer and unsafe drug use practices among injection drug users (IDUs) in Nova Scotia, Canada. Method: Thirty-eight current injection drug users were recruited through two needle exchange programs. Fifteen women and 23 men participated in semi-structured interviews about their daily lives, relationships and safer/unsafe drug use and sexual practices. Findings: Most participants were well aware of the risks associated with injecting drugs and reported purposely engaging in numerous strategies to minimize those risks for themselves and others. However, several IDUs revealed that the dynamics of their relationships with other IDUs and with non-IDUs could and did lead to unsafe practices including needle sharing. Stigmatizing encounters with non-users and social exclusion from mainstream resources and structures appear to underlie and reproduce these unsafe practices. Conclusions: Within the current Canadian political context, there is a move to shift drug policies away from harm reduction toward a more enforcement-based approach. This shift will likely only exacerbate the current discourse of blame and stigma directed at injection drug users. In addition, it may serve to increase the interdependency among IDUs, and social and economic exclusion from non-IDUs.

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting

BackgroundThe implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care.MethodsUsing case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study.ResultsThe analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases.ConclusionsThe findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.

Expanding the PARiHS framework: thinking more broadly about context and facilitation

Background The movement of innovations (i.e., new knowledge and tools) into healthcare settings is a significant challenge. The Promoting Action on Research Implementation in Health Services (PARiHS) framework proposes that the successful implementation of research into practice is a function of the interaction between three elements: 1) evidence; 2) context; and 3) facilitation. The objective of this paper is to present data from a study of innovation implementation in Nova Scotia, Canada, which extends and refines our understanding of PARiHS.

Youth Views on Environmental Changes, the Future of the Environment, and Stewardship: The Case of a Canadian Coastal Community

This article discusses and provides insights concerning rural youths perceptions of their natural environment and the future role of rural youths in environmental stewardship. Insights are based on two focus groups with youths 17–24 years of age living in an isolated coastal Canadian community. The youths expressed a strong attachment to place, as well as a concern for local, natural resources. However, because of the economic instability of their local community, many youths are planning a future in places far away with more lucrative employment and education opportunities. We suggest that strategies need to be developed that allow youths to engage in environmental stewardship activities “from away.” Some suggestions for “virtual stewardship” are discussed.

Young people and injection drug use: Is there a need to expand harm reduction services and support?

A complex array of intersecting social contextual factors are known to influence safer and/or unsafe practices among people who inject drugs. However, less is known about the social contextual factors that may specifically influence injection practices for young people who inject drugs. In this qualitative study, we explored with young people, ages 18-29, living in an urban centre in Nova Scotia, Canada, their perceptions and experiences of the social contextual factors that influence their safer and/or unsafe injection practices. We found that many of the social contextual factors the young people reported as influencing unsafe practices are at the micro-environmental level, and a number of these factors also affect adults (as per the literature). Methadone maintenance treatment was identified by a number of the participants as an important factor influencing safer practices. An expansion of harm reduction services and supports may help to address many of the social contextual factors identified by young people who inject drugs and should be considered given their important role in reducing the harms associated with injection drug use.

Community HIV Prevention: What Can We Learn from the Perceptions and Experiences of HIV-Positive Women Living in Metropolitan Toronto, Canada?

Researchers and practitioners have pointed to a number of gender issues that influence womens ability to practice safer sex and protect themselves from HIV. Many of the studies, however, are based on research with HIV-negative women. This qualitative study sought to explore with forty HIV-positive women (for whom prevention was not effective) the types of issues that they believe need to be addressed to ensure effective prevention for other women. Participants also were asked to discuss the impact of HIV on their sexual lives as a means of exploring the types of issues that are needed to ensure effective secondary prevention efforts. Many of the women interviewed suggested that not only is there a need to challenge gender inequities as a means of ensuring womens protection against HIV, but that different “accommodation strategies” are necessary in the short-term to ensure womens health. In addition, many of the women pointed to the fact that womens identity—as wife or girlfriend—is often based on the belief that their sexual relationships are “safe” from HIV. The importance of addressing gender identity (rooted in gender inequities) when developing HIV prevention efforts is discussed.

Barriers to primary and emergency healthcare for trans adults

Abstract Trans individuals are less healthy than the general population in part because of their avoidance and underutilisation of healthcare. Using qualitative research methods, the objective of this study was to explore the barriers trans adults encounter when pursuing primary and emergency care in Nova Scotia, Canada. Findings reveal that trans adults often feel discriminated against and socially excluded in primary and emergency care settings. This marginalisation is manifested in relationships with healthcare providers and within both the physical care and social care environments. The findings suggest that there is a ‘discrimination continuum’ with experiences of discrimination ranging from subtle to overt. Findings indicate that subtle discriminatory experiences may be encountered most frequently. Both kinds of experiences are reported to have detrimental consequences. The findings also indicate that trans adults are often burdened by the expectation that they will take on a more active role in their care than cisgender patients, including educating their healthcare providers and remaining resilient in the face of discrimination.