Manuela Ferrari

A Controlled Evaluation of Web-Based Training for Teachers and Public Health Practitioners on the Prevention of Eating Disorders

The effectiveness of a web-based prevention program designed for elementary school teachers was examined in 78 elementary school teachers and 89 local public health practitioners (who provide support to schools). Participants were assigned to either the intervention (n = 95) or comparison (n = 72) study groups. All participants completed self-report online measures prior to, and following, the 60-day study period assessing knowledge about various factors that influence body image in children and efficacy to fight weight bias in the school. Information was also solicited on the feasibility of, and on the perceived benefit of the web-based program as a knowledge translation tool, in terms of layout and content. The Student Body program was found to be successful in improving knowledge concerning facts about dieting among the teacher participants, and in increasing efficacy to fight weight bias among the public health participants. Overall, the feedback was very positive concerning the layout and content of the Student Body. Participants reported an overall improvement in their awareness about how weight bias can be present in their teaching practices, and how this can trigger body image concerns among their students. Findings have implications for using the web to engage teachers in the prevention of disordered eating among school age children.

Project Re•Vision: disability at the edges of representation

The representational history of disabled people can largely be characterized as one of being put on display or hidden away. Self-representations have been a powerful part of the disability rights and culture movement, but recently scholars have analysed the ways in which these run the risk of creating a ‘single story’ that centres the experiences of white, western, physically disabled men. Here we introduce and theorize with Project Re•Vision, our arts-based research project that resists this singularity by creating and centring, without normalizing, representations that have previously been relegated to the margins. We draw from body becoming and new materialist theory to explore the dynamic ways in which positionality illuminates bodies of difference and open into a discussion about what is at stake when these stories are let loose into the world.

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). Methods: We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results: We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions: Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.

Health Materials and Strategies for the Prevention of Immigrants’ Weight-Related Problems

Existing health education materials dealing with healthy eating, active living, and body image were examined by immigrant parents of elementary school children to determine their relevance, cultural competence, and accessibility. A total of 13 immigrant mothers from Sri Lanka and China participated in a series of three focus groups. Study findings indicate that the present health education materials intended to help prevent weight-related problems could be improved to better meet the needs of new immigrant families. Immigrant mothers who participated in the study expressed their preferences for health education materials and prevention interventions undertaken in a culturally relevant/competent, knowledge-sharing, participatory manner. Acting on these suggestions could help practitioners and public health agencies develop more effective strategies that meet the requirements of ethno-cultural immigrant communities.

The African, Caribbean and European (ACE) Pathways to Care study: a qualitative exploration of similarities and differences between African-origin, Caribbean-origin and European-origin groups in pathways to care for psychosis

Objectives This paper reports on a qualitative exploration of the reasons for differences in pathways to care and duration of untreated psychosis (DUP) in the African, Caribbean and European (ACE) Pathways to Care study from the perspective of respondents to the study and their families. Setting Ontario, Canada. Participants Thirty-four participants in total. Twenty-five young people who had experienced a first episode of psychosis and nine family members. Participants were part of the ACE Pathways to Care study. Design We implemented six focus groups. Furthermore, we implemented four in-depth interviews with two African-origin young women, one Caribbean-origin woman, and one European-origin woman with lived experience of psychosis. Results Factors that influenced help-seeking delays across the three groups were: personal awareness of symptoms, family members’ knowledge of psychotic symptoms and knowledge of mental health services. Youth and their family members described how stigma played a key role in pathways to care by stopping them from asking for help. The way in which stigma operated on the three groups’ members, from feeling ashamed to feeling guilty for their mental illnesses, helped to explain differences in DUP between the groups. Guilt feelings emerged as a prominent theme among members from the African and Caribbean groups and it was not discussed in the European focus group. Delay in entering into first-episode psychosis programmes was also influenced by the stigma perceived by young people in healthcare settings. This had an impact on the therapeutic relationships, disclosure of symptoms and overall trust in the healthcare system. Conclusions The findings of this paper suggest that stigma, especially internalised stigma, may operate in different ways in European-origin, African-origin and Caribbean-origin groups. These findings could inform the development of more equitable services for people in early stages of psychosis.

Understanding the feasibility of integrating the eating disorders and obesity fields: the beyond obesity and disordered eating in youth (BODY) Study

BackgroundAttention has been devoted to exploring ways to integrate the eating disorders (ED) and obesity (OB) prevention fields. Although research has revealed considerable overlap between the risk factors for ED and those for OB, collaboration between the two fields remains strained. Existing position papers focus mainly on discussions about the lack of collaboration and whether or not the two fields should merge their prevention efforts. However, no empirical study has yet addressed these questions. The beyond obesity and disordered eating in youth (BODY) Study is a qualitative study that sheds light on the relationship between the ED and OB fields.AimUsing part of the BODY Study data and findings, this paper aims to further explore the costs and benefits of ED and OB collaboration/integration. Four models, or scenarios, proposed by Neumark-Sztainer to describe the interaction between the ED and OB prevention fields are used as a framework to guide the BODY Study findings’ discussion.MethodBased on grounded theory methodology, the BODY Study used in-depth interviews and focus groups as data collection methods. A total of 61 participants took part in the study: 35 researchers/practitioners who work in either ED or OB; and 26 youths (aged 16–26 who attended six focus groups and 12 in-depth interviews).AnalysisSelected BODY Study themes, relevant to better understanding the four scenarios proposed by Neumark-Sztainer, presented in this paper are: (a) Two camps: understanding the relationship between the ED and OB fields; (b) Consequences for professionals and youths of the existence of two camps; (c) Root causes of the perceived tension: ideology and philosophy, power and knowledge, and gender.ConclusionFindings from this study mirror existing theoretical papers that look at the relationship between the two fields—including Neumark-Sztainer’s scenarios. At the same time, this empirical work further discusses the costs of a possible integration that, even if desirable, does not take into account the root causes of the tension between the two fields (e.g., power imbalance, gender neutrality).

Gender differences in pathways to care for early psychosis

Gender is a critical demographic determinant in first‐episode psychosis research. We used data from the ACE Pathways to Care Project, which examined pathways to care in African‐origin, Caribbean‐origin and European‐origin participants, to investigate the role of gender in pathways to early intervention programmes.

Comparative analysis of pathways to early intervention services and duration of untreated psychosis in two Canadian cities.

Understanding pathways to early intervention services for psychosis in the local context is crucial, as the structure and organization of services need to be considered. This study compared pathways to early intervention services in two Canadian cities.

Symptom profiles and explanatory models of first-episode psychosis in African-, Caribbean- and European-origin groups in Ontario.

To assess variability in symptom presentation and explanatory models of psychosis for people from different ethnic groups.

Patients’ Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS)

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.