Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

As the concept of social prescribing gains momentum globally, including in Canada, questions have emerged about whether the term accurately reflects the model's intent. While the approach centers on connecting individuals to community-based resources to support health and well-being, the term prescribing may unintentionally evoke a medicalized or directive process. This article explores how language influences perception and engagement, particularly among diverse populations with varying relationships to healthcare systems. This piece advocates for reconsidering the leveraging of terminology within the social prescribing model to enhance clarity and inclusivity across diverse communities. By aligning language more closely with the model's foundational principles of empowerment, facilitation, and community connection, practitioners can better communicate its intent and value. Terms such as community connection referral or community connector may offer more accessible and culturally attuned alternatives, potentially improving public understanding, uptake, and implementation.

Intervention: The Attachment and Child Health (ATTACH™) program is a 10-12-week mentalization-based parenting intervention designed to increase parental reflective function (PRF), promote secure attachment, increase parent/child interaction quality, and improve child development outcomes in families at risk of poor health outcomes due to intergenerational stressors such as poverty, domestic violence, substance use and depression.

Research question: What is the effect of the ATTACH™ program on PRF, parent-child interaction quality, and child development in Indigenous participants who have experienced intergenerational stressors?

Methods: Secondary analysis was performed on data collected from participating Indigenous dyads (n = 17) who provided complete data on the primary outcome in one of seven pilot trials which consisted of both randomized controlled trial (RCT) and quasi-experimental (QE) studies. This study utilised two-tailed paired t-tests (alpha = 0.05) to compare baseline and post-assessment scores on the Reflective Function Scale (RFS) obtained from transcribed and coded Parent Development Interviews (PDI), Parent-Child Interaction Teaching Scale (PCITS), Ages and Stages Questionnaire (ASQ-3), and Ages and Stages Questionnaire - Social Emotional (ASQ-SE) for all Indigenous participants who received the ATTACH™ program in both the RCT and QE pilots.

Results: We found significant improvements in Parental-, Child-, and Total RF scores (p = 0.023, p = 0.024, p = 0.015 respectively). There was also significant improvement in the PCITS clarity of cues (p = 0.040).

Conclusion: The ATTACH™ program is a promising intervention that stands to counter the effect of intergenerational stressors on high-risk Indigenous parents' abilities to reflect on their own and their children's thoughts and feelings and may improve parent-child interaction quality.

Background: Access to provincial health-related data for multi-jurisdictional studies in Canada is restricted by privacy laws. Synthetic data (SD), which mimic real data, can facilitate privacy preservation. However, information on SD use in Canadian research is limited.

Objectives: To review characteristics, methods, and applications of published studies generating SD from Canadian health data (HD), including administrative, survey, public health, and clinical sources.

Methods: We conducted a scoping review following Arksey and O'Malley, Joanna Briggs Institute, and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines on studies (to September 2024) generating SD from provincial/national HD. We included English-language peer-reviewed articles and grey literature, identified through PubMed, Scopus, Web of Science, Google, and references. We extracted and descriptively analyzed data on HD types, research purposes, geographic sources, synthesis methods, and quality evaluation.

Synthesis: Of 232 identified articles, 31 were reviewed and nine met inclusion criteria; three additional articles were found through references and Google. Eleven articles were peer-reviewed. Topics included data replication, bias mitigation, and privacy-risk assessment. Survey data were most commonly synthesized. SD were generated from national/provincial datasets, including Canadian Community Health Survey and administrative/clinical data from Alberta, Manitoba, British Columbia, and Ontario. Synthesis methods included generative, sampling, and predictive models. Data quality evaluations assessed replicability, privacy risk, and predictive performance.

Conclusion: SD have mainly been used in single-province studies and national surveys. Broader use in clinical and public HD with methodological consistency could strengthen its role for privacy-protecting, multi-jurisdictional research and surveillance initiatives.

Background: Evaluability assessment (EA), conducted independently or as part of a broader evaluation process, is performed to determine whether a program, policy, or intervention is ready and suitable for evaluation. This study explores the innovative application of EA as a design-stage tool for guiding complex health interventions. It focuses on the VAX-TRUST - Addressing Vaccine Hesitancy in Europe project, where EA was employed to design and refine interventions addressing vaccine hesitancy across seven European regions.

Methods: EA was applied in a qualitative approach using an evaluability checklist. This tool facilitated iterative improvements in intervention design, implementation planning, and evaluation readiness, ensuring interventions were robust and contextually relevant. Additionally, efforts were made to qualitatively measure the impact of the evaluability assessment through an evaluability impact matrix.

Results and discussion: EA significantly influenced intervention design by identifying gaps and guiding real-time adjustments. Six of the seven interventions were successfully implemented with enhanced planning for unforeseen events, showcasing the iterative benefits of EA in the design phase. The iterative nature of EA allowed for real-time adjustments that enhanced program robustness and adaptability. Insights into the checklist's gaps, such as underdeveloped resource allocation metrics, are discussed to improve future applications.

Conclusions: This work advances EA literature by demonstrating its utility in the design stage and, by reinforcing the early alignment of different components and multiple contexts, provides a replicable framework for planning complex health interventions. Future evaluators are encouraged to adopt this proactive approach for more effective public health strategies.

Setting: The impacts of colonization have resulted in disruptions to food systems, land, language, and the overall health and well-being of Indigenous Peoples across Turtle Island. Food insecurity affects Indigenous People's health disproportionately due primarily to poverty and inequity, anti-Indigenous racism, and the ongoing effects of settler colonialism. Despite these challenges, Indigenous communities have used food as a tool for the resurgence of their cultures, identities, and self-determination.

Intervention: Understanding Our Food Systems (UOFS) is a participatory, community-engaged action project led by the Thunder Bay District Health Unit, a team of researchers and community development professionals, and a circle of Indigenous Elders and Knowledge Keepers working to build a deeper understanding of food security, Indigenous food sovereignty, and self-determination in Northwestern Ontario. The project takes leadership from and supports fourteen First Nations within the Thunder Bay District (Robinson Superior Treaty of 1850 and Treaty 9 areas) in their efforts to reclaim their traditional food systems.

Outcomes: Since 2018, the UOFS project has helped to establish and implement food sovereignty visions, priorities, and action plans for each of the First Nations communities; provided ongoing funding, workshops, training, and general assistance; hosted regular gatherings to learn, share, and plan collaboratively; and developed resources to support Indigenous food sovereignty across the region.

Implications: The UOFS project has contributed to enhancing Indigenous food sovereignty and self-determination across Northwestern Ontario. The project has also resulted in building a network of First Nations communities and reflective learning among the TBDHU and non-Indigenous participants about how to work in partnership and support First Nations to achieve their food sovereignty priorities.

Objectives: Land-based treatment programs for mental health and addictions challenges may counteract the negative effects of colonization on Indigenous peoples by centring First Nations cultures and approaches to healing that are tied to the land. The purpose of this mixed-methods study was to describe the experiences of participants in the Gwekwaadziwin Miikan land-based mental health and addictions treatment program.

Methods: This mixed-methods study was co-designed with treatment program participants and based on input from the United Chiefs of Mnidoo Mnising and the Elder Council and Knowledge Keepers. Semi-structured in-person one-on-one interviews were conducted during the 90-day land-based treatment program and 6 months after the end of the land-based treatment.

Results: We completed 39 in-person interviews during treatment and 20 6-month follow-up interviews by telephone in addition to attending circles and other group activities. Four overarching themes were identified: connection with Indigeneity, connection with the land, trauma, and peer relationships. All 20 participants completing the follow-up interview reported not using substances at 6 months. Five (25%) reported relapses at some point after leaving the program but had since stopped using.

Conclusion: The Gwekwaadziwin Miikan land-based treatment program provided connection with Indigeneity and with the land that might counteract processes that dispossess Indigenous people of their land. These findings can help support the wider implementation of land-based treatment programs and similar programs that centre Indigenous learnings and healing practices.

Objective: To investigate the seasonality of suicide mortality in Canada and explore differences across sex and age.

Methods: We analyzed monthly suicide deaths spanning January 2001 to December 2015 from the Canadian Vital Statistics Death Database. Data from 2016 onwards were not included in the main analysis as Ontario and Yukon data were unavailable due to data-sharing agreement limitations. However, data from 2016-2019 were included in the sensitivity analyses. Seasonal variations were assessed by evaluating the timing of peak and trough monthly suicide mortality rates, and amplitude (peak-to-trough risk ratio) overall and by sex and age groups. Statistical significance was tested using the Seasonal Autoregressive Integrated Moving Average procedure.

Results: With 40,405 recorded suicides, results indicated a peak in suicide rates in July (0.95 per 100,000 people), 6.74% higher than the monthly average, and a trough in February (0.78 per 100,000 people), 12.36% lower than the monthly average. The peak/trough relative risk (RR) was 1.22 (95% CI: 1.00, 1.47). Seasonality patterns were similar between sexes, but stronger and more stable among males. Seasonality patterns were similar across age groups, but the amplitude was larger among those aged 65+.

Conclusions: This study confirms seasonal patterns in suicide mortality in Canada, peaking during the summer months. Such patterns are more prominent and stable among males, and its amplitude was larger among older adults. Contrary to the common perception that suicide rates peak in January, our findings show a summer peak. Future research should explore the underlying mechanisms driving these seasonal variations and their demographic differences.

Incentives for participation can help enable more equitable public health research practices, particularly when working with people from structurally disadvantaged populations, such as people who use drugs or people experiencing homelessness. Administrative and perceived ethical advantages have solidified gift card incentives in research, even though participants tend to prefer cash incentives for their time, knowledge, and contribution of lived experiences. The use of cash instead of gift cards may merit fresh attention. Drawing from research with marginalized groups, we summarize concerns with gift cards and argue that cash incentives align better with public health ethical principles. Gift cards, while convenient for researchers, can constrain participants' economic autonomy, foster mistrust, and magnify inequities and power imbalances between researchers and participants. Cash can help to affirm participants' autonomy, reduce stigma, demonstrate solidarity and trustworthiness, and directly benefit health. Public health researchers and ethics boards can enable cash incentive practices that centre participant welfare over researcher and institutional convenience. In so doing, they uphold more equitable and respectful relationships with study participants, advancing both public health research and ethical standards.