Patricia O'Campo

Implementing successful intimate partner violence screening programs in health care settings: Evidence generated from a realist-informed systematic review

We undertook a synthesis of existing studies to re-evaluate the evidence on program mechanisms of intimate partner violence (IPV) universal screening and disclosure within a health care context by addressing how, for whom, and in what circumstances these programs work. Our review is informed by a realist review approach, which focuses on program mechanisms. Systematic, realist reviews can help reveal why and how interventions work and can yield information to inform policies and programs. A review of the scholarly literature from January 1990 to July 2010 identified 5046 articles, 23 of which were included in our study. We identified studies on 17 programs that evaluated IPV screening. We found that programs that took a comprehensive approach (i.e., incorporated multiple program components, including institutional support) were successful in increasing IPV screening and disclosure/identification rates. Four program components appeared to increase provider self-efficacy for screening, including institutional support, effective screening protocols, thorough initial and ongoing training, and immediate access/referrals to onsite and/or offsite support services. These findings support a multi-component comprehensive IPV screening program approach that seeks to build provider self-efficacy for screening. Further implications for IPV screening intervention planning and implementation in health care settings are discussed.

Pathways connecting neighborhood influences and mental well-being: Socioeconomic position and gender differences ☆

Few studies have explored how participant socioeconomic position (SEP) and gender is related to perceptions of the pathways connecting neighborhood influences and mental well-being. This research used the concept mapping method, an intensive structured conceptualization process that produces pictorial views of how concepts are connected and interrelated. Thirty-six low and non-low SEP men and women from Toronto, Canada participated in the concept mapping sessions. One hundred and twenty unique neighborhood characteristics were felt to be related to mental well-being and those items were grouped into six distinct clusters. Notable differences in cluster importance by participant SEP status were found. While no overall differences were observed for males verses females, further stratification by both participant SEP and gender suggested that gendered perceptions are not uniform. Participant-created diagrams illustrated how the cluster domains are related to each other and to good mental well-being. These findings are important for uncovering the mechanisms by which neighborhoods differentially affect the mental health of residents from different SEPs and genders.

Are We Asking the Right Questions? A Review of Canadian REB Practices in Relation to Community-Based Participatory Research:

Access barriers to effective ethics review continue to be a significant challenge for researchers and community-based organizations undertaking community-based participatory research (CBPR). This article reports on findings from a content analysis of select (Behavioural, Biomedical, Social Sciences, Humanities) research ethics boards (REBs) in the Canadian research context (n = 86). Existing ethics review documentation was evaluated using 30 CBPR related criteria for their sensitivity to relevant approaches, processes, and outcomes. A linear regression was conducted to determine whether specific organizational characteristics have an impact on the CBPR sensitivity: (1) region of Canada, (2) type of institution (university or a healthcare organization), (3) primary institutional language (English or French) and (4) national ranking with respect to research intensiveness. While only research intensiveness proved statistically significant (p = .001), we recognize REB protocol forms may not actually reflect how CBPR is reviewed. Despite using a single guiding ethical framework, REBs across Canada employ a variety of techniques to review research studies. We report on these differences and varying levels of sensitivity to CBPR. Finally, we highlight best practices and make recommendations for integrating CBPR principles into existing ethics review.

Risk factors for postpartum depression among abused and nonabused women

OBJECTIVE The objective of the study was to compare risk factors for postpartum depression among women exposed vs not exposed to intimate partner violence and to assess the timing of abuse in relation to postpartum depression. STUDY DESIGN This was a retrospective cohort study utilizing data from the Canadian Maternity Experiences Survey, a telephone survey at 5-10 months postpartum. Survey questions were adapted from the Canadian Violence Against Women Survey and the Edinburgh Post-Natal Depression Scale. RESULTS Among abused women, younger (15-19 years), and older (35 years old and older), age was associated with postpartum depression, adjusted odds ratio (aOR, 2.29; 95% confidence interval [CI], 1.17-4.51) and (aOR, 2.33; 95% CI, 1.02-5.34) as was unemployment (aOR, 1.41; 95% CI, 1.06-1.84), foreign birth (aOR, 2.04; 95% CI, 1.35-3.09], and low income (aOR, 1.68; 95% CI, 1.25-2.25) among nonabused women. Postpartum depression was significantly associated with abuse occurring only prior to pregnancy (aOR, 3.28; 95% CI, 1.86-5.81), starting postpartum (aOR, 4.76; 95% CI, 1.41-16.02), and resuming postpartum (aOR, 3.81; 95% CI, 1.22-11.88). CONCLUSION Among pregnant women, subgroups defined by abuse exposure differ in their risk profile for postpartum depression.

Yearly incidence of mental disorders in economically inactive young adults

Increasing rates of mental health problems in youth and an extended period of school-to-work transition is a major concern in Sweden and many other European countries. In this study, being out of the workforce and not in education was associated with severe mental disorders. The risk of being admitted in hospital due to depression was more than doubled in economically inactive young adults. Similarly, the risk of being admitted to hospital due to self-harm and alcohol-related disorder was tripled. Drug abuse was seven times more prevalent among inactive young adults. Processes leading to economic inactivity and to deteriorating mental health are inextricably intertwined. Even if it is not possible to clarify if the association is caused by selection or if it is being outside of labour force that causes mental disorders, it is still urgent to prevent young persons from ending up in long-term economic inactivity.

Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): Toward a conceptual framework

ABSTRACT We used grounded theory to understand pathways and trajectories to housing instability (HI) and poor health among low-income women with experiences of intimate partner violence (IPV). We conducted in-depth interviews during 2010–11 with forty-one women (ages 18–45 years) living in Ontario, Canada. All women reported depressive symptoms in combination with other health problems. In addition to the direct pathway of IPV to poor health, thematic analysis revealed an indirect multi-tiered pathway with complex trajectories among IPV, HI, and poor health. These trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding, and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control), and social trajectories (financial problems, loss of employment, income, or social networks, and leaving school). These trajectories elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance) and exacerbated poor health already compromised by IPV. Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women’s experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. Finally, we found that for these women, achieving stable housing was crucial for stabilizing their health.

Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review

PURPOSE Striking disparities in Indigenous maternal-child health outcomes persist in relatively affluent nations such as Canada, despite significant health promotion investments. The aims of this review were two-fold: 1. To identify Indigenous prenatal and infant-toddler health promotion programs in Canada that demonstrate positive impacts on prenatal or child health outcomes. 2. To understand how, why, for which outcomes, and in what contexts Indigenous prenatal and infant-toddler health promotion programs in Canada positively impact Indigenous health and wellbeing. METHODS We systematically searched computerized databases and identified non-indexed reports using key informants. Included literature evaluated a prenatal or child health promoting program intervention in an Indigenous population in Canada. We used realist methods to investigate how, for whom, and in what circumstances programs worked. We developed and appraised the evidence for a middle range theory of Indigenous community investment-ownership-activation as an explanation for program success. FINDINGS Seventeen articles and six reports describing twenty programs met final inclusion criteria. Program evidence of local Indigenous community investment, community perception of the program as intrinsic (mechanism of community ownership) and high levels of sustained community participation and leadership (community activation) was linked to positive program change across a diverse range of outcomes including: birth outcomes; access to pre- and postnatal care; prenatal street drug use; breast-feeding; dental health; infant nutrition; child development; and child exposure to Indigenous languages and culture. CONCLUSIONS These findings demonstrate Indigenous community investment-ownership-activation as an important pathway for success in Indigenous prenatal and infant-toddler health programs.

Unmasking health determinants and health outcomes for urban First Nations using respondent-driven sampling

Objective Population-based health information on urban Aboriginal populations in Canada is limited due to challenges with the identification of Aboriginal persons in existing health data sets. The main objective of the Our Health Counts (OHC) project was to work in partnership with Aboriginal stakeholders to generate a culturally relevant, representative baseline health data set for three urban Aboriginal communities in Ontario, Canada. Design Respondent-driven sampling (RDS). Setting Hamilton, Ontario, Canada. Participants The OHC study, in partnership with the De dwa da dehs ney >s Aboriginal Health Access Centre (DAHC), recruited 554 First Nations adults living in Hamilton using RDS. Results Among First Nations adults living in Hamilton, 78% earned less than

Hospital admissions of young persons for illicit drug use or abuse: does neighborhood of residence matter?

20 000 per year and 70% lived in the lowest income quartile neighbourhoods. Mobility and crowded living conditions were also highly prevalent. Common chronic diseases included arthritis, hypertension, diabetes and chronic obstructive pulmonary disease and rates of emergency room access were elevated. Conclusions RDS is an effective sampling method in urban Aboriginal contexts as it builds on existing social networks and successfully identified a population-based cohort. The findings illustrate striking disparities in health determinants and health outcomes between urban First Nations individuals and the general population which have important implications for health services delivery, programming and policy development.

Polygamy and poor mental health among Arab Bedouin women: do socioeconomic position and social support matter?

Adolescence constitutes a period of risk for drug use and drug use disorders. Previous research, largely focused on individual risk factors, has failed to include neighborhood structure in the study of determinants of youth drug use or abuse. A cohort of 76,693 adolescents ages 13-15 from 586 urban neighborhoods in Sweden were followed up for 12 years, from age 16 to age 28. Multilevel modeling was used to analyze neighborhood variations in hospital admissions due to illicit drug use or abuse. We found a variation of 8% by neighborhood economic status and the risk of being admitted to hospital increased 73% in low-compared to high-income neighborhoods. Our results suggest that neighborhood of residence in adolescence plays a significant role in predicting future health-related behaviors and that the need for drug abuse interventions at a neighborhood level is compelling.