Vivian R. Ramsden

The development of participatory health research among incarcerated women in a Canadian prison

This paper describes the development of a unique prison participatory research project, in which incarcerated women formed a research team, the research activities and the lessons learned. The participatory action research project was conducted in the main short sentence minimum/medium security womens prison located in a Western Canadian province. An ethnographic multi-method approach was used for data collection and analysis. Quantitative data was collected by surveys and analysed using descriptive statistics. Qualitative data was collected from orientation package entries, audio recordings, and written archives of research team discussions, forums and debriefings, and presentations. These data and ethnographic observations were transcribed and analysed using iterative and interpretative qualitative methods and NVivo 7 software. Up to 15 women worked each day as prison research team members; a total of 190 women participated at some time in the project between November 2005 and August 2007. Incarcerated women peer researchers developed the research processes including opportunities for them to develop leadership and technical skills. Through these processes, including data collection and analysis, nine health goals emerged. Lessons learned from the research processes were confirmed by the common themes that emerged from thematic analysis of the research activity data. Incarceration provides a unique opportunity for engagement of women as expert partners alongside academic researchers and primary care workers in participatory research processes to improve their health.

Primary health care: applying the principles within a community-based participatory health research project that began in a Canadian women’s prison:

Objectives: the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. Design: the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative action research guided the overall design of this study. Participants: Incarcerated women, correctional centre staff and academic researchers participated collaboratively. Setting. The study was conducted in the main short sentence (two years or less) minimum/medium security women’s correctional centre in a Canadian province. Results: In-depth interviews were conducted with 16 incarcerated women; in-depth group interviews were facilitated with 16 correctional centre staff. Twenty-one themes, which emerged from participatory, inductive and content analysis of the data, were presented at a face-to-face meeting attended by 120 incarcerated women, 10 correctional centre staff and 5 academic researchers. Underlying values and principles for the project were identified prior to a discussion of the results. During the course of this meeting, the themes were converged into five major categories: addictions and mental health; HIV, hepatitis and infections; health care in prison; life skills and re-entry into society (including homelessness and housing); and children, family and relationships. Numerous suggestions for health interventions and participatory projects were generated, each relating to one of the five major categories. Conclusions: this study was unique in that, to our knowledge, no other studies have utilized community-based participatory research methods in which incarcerated women played a role in designing the research questions and tools, collecting the data, analyzing the data, interpreting the data and authoring the publications and presentations. This study demonstrated that it is feasible for incarcerated women to engage in developing and utilizing community-based participatory research methods and that these methods can be grounded in a settings approach to whole prison health promotion. (Global Health Promotion, 2009; 16 (4): pp. 43—53)

The pursuit of excellence: engaging the community in participatory health research.

Community-based participatory research approaches are designed to improve health and well-being in communities and to minimize health disparities in general. It is this partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research process and in which all partners contribute expertise, decision-making and ownership. Further to this, community-based participatory research is utilized to study and address community-identified issues through a collaborative and empowering action-oriented process that builds on the strengths of the community. The results of this research endeavour highlight the need for integrating community-based participatory research, primary health care and social accountability in the pursuit of excellence. The process and the results/findings provide ways that the community are able to enhance their health and wellness, increase capacity and be empowered to direct their education, research and service activities towards addressing and meeting the health priorities of the community.

How the Medical Culture Contributes to Coworker-Perpetrated Harassment and Abuse of Family Physicians

PURPOSE Harassment and abuse in the workplace of family physicians has been associated with higher levels of stress, increased consumption of alcohol, and higher risk for developing mental health problems. Few studies have examined issues contributing to abusive encounters in the workplace of family physicians. METHODS For the overall study we used a mixed methods design, which included a cross-sectional survey of a randomly selected sample of active family physicians from the database of the College of Family Physicians of Canada and telephone interviews with those who reported experiencing work related harassment and abuse in the last year. The data presented here arise from the qualitative interviews of the study, which were analyzed thematically. RESULTS The interview arm of the study included 23 female and 14 male participants. The major themes that emerged from the study were (1) modeling of abusive behaviors, (2) status hierarchy among various medical disciplines, (3) shortage of physicians, and (4) lack of transparent policies and follow-up procedures after abusive encounters. The results are discussed using the broken window theory. CONCLUSION Many family physicians experience harassing and abusive encounters during their training or in the workplace. The current medical culture appears to contribute to harassment and abuse in the workplace of family physicians in Canada. We described the components that intentionally or unintentionally facilitate abusive behavior in the medical culture.

A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations

BackgroundTo date, determinants of respiratory health in First Nations people living on reserves and means of addressing and redressing those determinants have not been well established. Hence the Saskatchewan First Nations Lung Health Project (FNLHP) is a new prospective cohort study of aboriginal people being conducted in two First Nations reserves to evaluate potential health determinants associated with respiratory outcomes. Using the population health framework (PHF) of Health Canada, instruments designed with the communities, joint ownership of data, and based on the 4-phase concept of the First Nations Regional Longitudinal Health Survey, the project aims to evaluate individual factors, contextual factors, and principal covariates on respiratory outcomes. The objective of this report is to clearly describe the methodology of (i) the baseline survey that consists of two components, an interviewer-administered questionnaire and clinical assessment; and (ii) potential intervention programs; and present descriptive results of the baseline data of longitudinal FNLHP.MethodsThe study is being conducted over 5 years (2012–2017) in two phases, baseline and longitudinal. Baseline survey has been completed and consisted of (i) an interviewer-administered questionnaire-based evaluation of individual and contextual factors of importance to respiratory health (with special focus on chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea), and (ii) clinical lung function and allergy tests with the consent of study participants. The address-redress phase consists of potential intervention programs and is currently being rolled out to address-at community level (via green light program and environmental study), and redress-at policy level (via obesity reduction and improved diagnosis and treatment of obstructive sleep apnea) the issues that have been identified by the baseline data.ResultsInterviewer-administered surveys were conducted in 2012–2013 and collected data on 874 individuals living in 406 households from two reserve communities located in Saskatchewan, Canada. Four hundred and forty six (51%) females and 428 (49%) males participated in the FNLHP.ConclusionsThe information from this project will assist in addressing and redressing many of the issues involved including the provision of adequate housing, health lifestyle practices, and in planning for health service delivery.

Monthly Incidence Rates of Abusive Encounters for Canadian Family Physicians by Patients and Their Families

Objective. The goal of this study was to examine the monthly incidence rates of abusive encounters for family physicians in Canada. Methods. A 7-page cross-sectional survey. Results. Of the entire study sample (N = 720), 29% of the physicians reported having experienced an abusive event in the last month by a patient or patient family member. Abusive incidents were classified as minor, major, or severe. Of the physician participants who reported having been abused, all reported having experienced a minor event, 26% a major, and 8% a severe event. Of the physicians who experienced an abusive event, 55% were not aware of any policies to protect them, 76% did not seek help, and 64% did not report the abusive event. Conclusion. Family physicians are subjected to significant amounts of abuse in their day-to-day practices. Few physicians are aware of workplace policies that could protect them, and fewer report abusive encounters. Physicians would benefit from increased awareness of institutional policies that can protect them against abusive patients and their families and from the development of a national policy.

Homelessness as viewed by incarcerated women: participatory research

PURPOSE The purpose of this paper is to describe the development, by incarcerated women who were members of a prison participatory health research team, of a survey tool regarding homelessness and housing, the survey findings and recommendations for policy. DESIGN/METHODOLOGY/APPROACH A survey was developed by incarcerated women in a minimum/medium security womens prison in Canada. Associations were examined between socio-demographic factors and reports of difficulty finding housing upon release, homelessness contributing to a return to crime, and a desire for relocation to another city upon release. Open-ended questions were examined to look for recurrent themes and to illuminate the survey findings. FINDINGS In total, 83 women completed the survey, a 72 per cent response rate. Of the 71 who were previously incarcerated, 56 per cent stated that homelessness contributed to their return to crime. Finding housing upon release was a problem for 63 per cent and 34 per cent desired relocation to another city upon release. Women indicated that a successful housing plan should incorporate flexible progressive staged housing. RESEARCH LIMITATIONS/IMPLICATIONS The present study focuses only on incarcerated women but could be expanded in future to include men. PRACTICAL IMPLICATIONS Incarcerated women used the findings to create a housing proposal for prison leavers and created a resource database of the limited housing resources for women prison leavers. SOCIAL IMPLICATIONS Lack of suitable housing is a major factor leading to recidivism. This study highlights the reality of the cycle of homelessness, poverty, crime for survival, street-life leading to drug use and barriers to health, education and employment that incarcerated women face. ORIGINALITY/VALUE Housing is a recognized basic determinant of health. No previous studies have used participatory research to address homelessness in a prison population.

Ear Infection and Its Associated Risk Factors in First Nations and Rural School-Aged Canadian Children.

Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6–17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts.

Participatory health research within a prison setting: a qualitative analysis of 'Paragraphs of passion'.

The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who became peer-researchers, correctional staff, and academic researchers facilitated the equitable contribution of expertise and decision-making by all partners. The study was conducted in a short sentence (two years or less), minimum/medium security Canadian women’s correctional centre. Of the approximately 200 women that joined the research team, 115 participated in writing a ‘paragraph of passion’ while incarcerated between November, 2005 and August, 2007. Participatory, inductive qualitative, narrative and content analysis were used to illuminate four themes: expertise, transformation, building self-esteem, as well as access and support. The women organized monthly health forums in the prison to share their new knowledge and life experience with other incarcerated women, correctional staff, academics, and community members, and in doing so have built bridges and relationships, some of which have lasted to the present day.

Is knowledge translation without patient or community engagement flawed

Background The engagement of patients/individuals and/or communities has become increasingly important in all aspects of the research process. Objective The aim of this manuscript is to begin the discussion about the use and implementation of authentic engagement in the development of presentations and manuscripts which evolve from research that has engaged patients/individuals and/or communities. Methods Community-Based Participatory Research; Transformative Action Research. Results and Discussion In Canada, the framework for engaging patients/individuals and/or communities is clearly outlined in Chapter 9 of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans which indicates that when research projects involving First Nations, Inuit and Métis peoples, the peoples in these communities are to have a role in shaping/co-creating the research that affects them. It is increasingly important that presentations and manuscripts that evolve from results/findings which have engaged patients/individuals and/or communities be co-presented/co-published. Presentations are often done without patients/individuals and/or communities and manuscripts published with only academic authors. Frequently, grants submitted and subsequently funded do not consider this aspect of the process in the budget which makes integrated and outcome knowledge translation, dissemination and distribution by and with patients/individuals and/or communities difficult to facilitate. Conclusions This manuscript was designed to begin the discussion at various levels related to authentic engagement in the development of presentations and manuscripts which evolve from research that has engaged patients/individuals and/or communities. How will you include patients/individuals and/or communities in your presentations and publications?