Tracey L. O'Sullivan

Interdisciplinary physical activity counseling in primary care A qualitative inquiry of the patient experience

The Physical Activity Counseling randomized controlled trial integrated a physical activity (PA) counselor into a primary care practice to provide intensive counseling to sedentary patients following brief counseling from their regular health care provider. This article presents the voices of 15 patients, who through a series of 3 interviews, described their experience with this 3-month combined provider PA counseling intervention. Patient satisfaction was a dominant emergent theme, and the patients were particularly positive about the quality of care and educational support for lifestyle change. They favored the tailored approach and felt the strategies for overcoming PA barriers were helpful.

In the Path of Disasters: Psychosocial Issues for Preparedness, Response, and Recovery

The psychosocial impacts of disasters are profound. In recent years, there have been too many reminders of these impacts and the dire needs of the people involved. The purpose of this article is to present the following themes from the psychosocial literature on disasters and emergency management: (1) differential impacts of disasters according to gender and age; (2) prevention efforts to reduce racial discrimination, rape, and other forms of abuse; (3) readiness for cultural change toward prevention and preparedness; and (4) the need to involve aid beneficiaries as active partners in relief strategies, particularly during reconstruction of communities and critical systems. Psychosocial needs change throughout the disaster cycle, particularly as social support deteriorates over time. It is important to anticipate what psychosocial needs of the public, emergency responders, support staff, and volunteers might emerge, before advancing to the next stage of the disaster. Particular consideration needs to be directed toward differential impacts of disasters based on gender, age, and other vulnerabilities.

The Cost of Integrating a Physical Activity Counselor in the Primary Health Care Team

Objective: This article assesses direct costs of integrating a physical activity counselor (PAC) into primary health care teams to improve physical activity levels of inactive patients. Methods: A monthly cost analysis was conducted using data from 120 inactive patients, aged 18 to 69 years, who were recruited from a community-based family medicine practice. Relevant cost items for the intensive counseling group included (1) office expenses; (2) equipment purchases; (3) operating costs; (4) costs of training the PAC; and (5) labor costs. Physical and human capital were amortized over a 5-year horizon at a discount rate of 5%. Results: Integrating a PAC into the primary health care team incurred an estimated one-time cost of CA

Support for families coping with stroke or dementia: special considerations for emergency management

91.43 per participant per month. Results were very sensitive to the number of patients counseled. Conclusions: The costs associated with the intervention are lower than many other intervention studies attempting to improve population physical activity levels. Demonstrating this competitive cost base should encourage additional research to assess the effectiveness of integrating a PAC into primary health care teams to promote active living among patients who do not meet recommended physical activity levels.

A model for common ground development to support collaborative health communities

Public resilience, an important determinant of effective disaster management, is dynamic, and families coping with debilitating illnesses, such as stroke or dementia, experience unique vulnerabilities as a result of their caregiving responsibilities. When social networks cannot sustain care, family caregivers turn to formal respite programmes for support. This has tremendous implications on demands for respite services in any disaster response. With an ageing population, the demands for family caregiving are increasing, and more people face the challenges of balancing work and family responsibilities. This includes members of the response community who have family members who need assistance with daily living. Without support, many responders may struggle to fulfil their professional roles, creating a threat to response capacity. Preparedness interventions should focus on building resilience and encourage families to explore possibilities for respite care as well as other standard strategies to ensure self-sufficiency in the early phases of a disaster.

The EnRiCH Community Resilience Framework for High-Risk Populations

Common ground is necessary for developing collaboration as part of building resilience for public health preparedness. While the importance of common ground as an essential component of collaboration has been well described, there is a need for studies to identify how common ground develops over time, across individual and group dimensions, and the contexts that influence its development. This paper studied common ground development in three Canadian communities between October 2010 and March 2011 through a project on capacity building for disaster management. Disaster management requires the integration of paid and volunteer participants across public and private sectors and is therefore a good domain to study common ground development. We used directed qualitative content analysis to develop a model of common ground development over time that describes its progression through coordinative, cooperative and collaborative common ground. We also identified how common ground develops at micro (individual) and macro (group) levels, as well as how agency, technology and geographical contexts influence its development. We then use the four phases of disaster management to illustrate how our model can support longitudinal common ground development. Our findings provide useful insight to enable proactive development of common ground in collaborative health communities.

“We Don't Have a Back-Up Plan”: An Exploration of Family Contingency Planning for Emergencies Following Stroke

Introduction: Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. Methods: The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. Results: Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. Discussion: We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.

The Promotion of ‘Grab Bags’ as a Disaster Risk Reduction Strategy

Little research has explored emergency preparedness among families coping with stroke. In this longitudinal qualitative study, we explored contingency caregiving planning by interviewing (N = 18) family caregivers providing care for a stroke survivor at home during the first 6 months post-discharge from the hospital. Emergent themes showed most families did not have a concrete “back-up plan” for a crisis or disaster situation involving the primary caregiver being unable to provide care. Furthermore, they assumed formal respite services or long-term care would be available should the need arise. Despite increased awareness over time, most caregivers had not devised contingency plans at 6 months.

Upstream Disaster Management to Support People Experiencing Homelessness

Introduction: An all-of-society approach to disaster risk reduction emphasizes inclusion and engagement in preparedness activities. A common recommendation is to promote household preparedness through the preparation of a ‘grab bag’ or ‘disaster kit’, that can be used to shelter-in-place or evacuate. However, there are knowledge gaps related to how this strategy is being used around the world as a disaster risk reduction strategy, and what evidence there is to support recommendations. Methods: In this paper, we present an exploratory study undertaken to provide insight into how grab bag guidelines are used to promote preparedness in Canada, China, England, Japan, and Scotland, and supplemented by a literature review to understand existing evidence for this strategy. Results: There are gaps in the literature regarding evidence on grab bag effectiveness. We also found variations in how grab bag guidelines are promoted across the five case studies. Discussion: While there are clearly common items recommended for household grab bags (such as water and first aid kits), there are gaps in the literature regarding: 1) the evidence base to inform guidelines; 2) uptake of guidelines; and 3) to what extent grab bags reduce demands on essential services and improve disaster resilience.

Support Needs for Canadian Health Providers Responding to Disaster: New Insights from a Grounded Theory Approach.

The unique context of day-to-day living for people who are chronically homeless or living with housing insecurity puts them at high risk during community disasters. The impacts of extreme events, such as flooding, storms, riots, and other sources of community disruption, underscore the importance of preparedness efforts and fostering community resilience. This study is part of larger initiative focused on enhancing resilience and preparedness among high risk populations. The purpose of this study was to explore critical issues and strategies to promote resilience and disaster preparedness among people who are homeless in Canada. A sample of interviews (n=21) from key informants across Canada was analyzed to explore existing programs and supports for homeless populations. The data was selected from a larger sample of (n=43) interviews focused on programs and supports for people who are at heightened risk for negative impacts during disasters. Qualitative content analysis was used to extract emergent themes and develop a model of multi-level collaboration to support disaster resilience among people who are homeless. The results indicate there is a need for more upstream continuity planning, collaboration and communication between the emergency management sector and community service organizations that support people who are homeless. Prioritization and investment in the social determinants of health and community supports is necessary to promote resilience among this high-risk population. The findings from this study highlight the importance of acknowledging community support organizations as assets in disaster preparedness. Day-to-day resilience is an ongoing theme for people who are chronically homeless or living with housing insecurity. Upstream investment to build adaptive capacity and collaborate with community organizations is an important strategy to enhance community resilience.