Publications by authors named "Josephine Pui-Hing Wong"

23 Publications

  • Page 1 of 1

Factors Associated with Condom Knowledge, Attitude, and Use among Black Heterosexual Men in Ontario, Canada.

ScientificWorldJournal 2021 3;2021:8862534. Epub 2021 May 3.

Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada.

African, Caribbean, and Black (ACB) men living in Canada share a heightened risk of HIV infection and the associated risk factors such as suboptimal use of family planning services such as condom use. In this study, we assessed the factors associated with knowledge, attitude, and condom use among ACB men in Ontario. . This was a cross-sectional study that surveyed heterosexual ACB men regardless of their residency status living in Ontario ( = 430). This is a part of a larger mixed methods study informed by critical race theory, intersectionality, and community-based participatory research (CBPR). Outcome variables were knowledge of condom use, attitude towards condom use, and actual use of condom during the last 12 months. . Of 430 participants, 77.70% has good knowledge of condom use as a protection against HIV transmission, 31.77% had positive attitude towards condom use, and 62.43% reported using condom regularly with casual partners during the last 12 months. Men who were currently married had more positive attitude towards condom use compared with their unmarried counterparts (odds ratio = 1.46, 95% CI = 1.20, 1.78). Canadian residents were found to have higher odds of having correct knowledge of condom (odds ratio = 1.31, 95% CI = 1.11, 1.55), and positive attitude towards condom use (odds ratio = 1.44, 95%CI = 1.09, 1.92). Men who visited sexual health clinics showed a positive association with having correct knowledge of condom (odds ratio = 1.78, 95% CI = 1.30, 2.44) and reported experiences of difficulty in accessing sexual health. This showed a negative association towards condom use (odds ratio = 0.45, 95% CI = 0.21, 0.97]. . A considerable percentage of heterosexual ACB men did not have correct knowledge regarding the protective effect of condom use against HIV and positive attitude towards the use of condom. Several sociodemographic and healthcare-related factors were significantly associated with knowledge, attitude, and use of condom.
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http://dx.doi.org/10.1155/2021/8862534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463252PMC
May 2021

Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol.

JMIR Res Protoc 2021 Sep 13;10(9):e31211. Epub 2021 Sep 13.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.

Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status.

Objective: The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants' satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined.

Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale - Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program.

Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021.

Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations.

International Registered Report Identifier (irrid): DERR1-10.2196/31211.
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http://dx.doi.org/10.2196/31211DOI Listing
September 2021

Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study.

JMIR Res Protoc 2021 Aug 26;10(8):e25592. Epub 2021 Aug 26.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.

Background: Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources.

Objective: Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment - Linking Youth and 'Xin' (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China.

Methods: We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance.

Results: Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students.

Conclusions: This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention.

International Registered Report Identifier (irrid): PRR1-10.2196/25592.
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http://dx.doi.org/10.2196/25592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430866PMC
August 2021

Exploring Mechanisms of Mental Illness Stigma Reduction in Asian Canadian Men: Exploration Des Mécanismes de la Réduction des Stigmates de la Maladie Mentale Chez les Hommes Canadiens d'origine Asiatique.

Can J Psychiatry 2021 May 24:7067437211018674. Epub 2021 May 24.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.

Objective: Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada.

Method: Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; = 133), contact-based empowerment education (CEE; = 149), combination of ACT and CEE ( = 152), or psychoeducation ( = 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed.

Results: Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups ( = 3.67 to 3.78 for CEE groups, and = 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process.

Conclusions: Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma.
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http://dx.doi.org/10.1177/07067437211018674DOI Listing
May 2021

Promoting the Mental Health of University Students in China: Protocol for Contextual Assessment to Inform Intervention Design and Adaptation.

JMIR Res Protoc 2021 May 11;10(5):e25009. Epub 2021 May 11.

Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Chinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health.

Objective: The Linking Hearts-Linking Youth and 'Xin' (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China.

Methods: Six local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students' health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet.

Results: Linking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021.

Conclusions: Findings from this contextual assessment and analysis will generate new knowledge on university students' mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N' Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan.

International Registered Report Identifier (irrid): RR1-10.2196/25009.
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http://dx.doi.org/10.2196/25009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150405PMC
May 2021

Association between Mental Health Knowledge Level and Depressive Symptoms among Chinese College Students.

Int J Environ Res Public Health 2021 02 14;18(4). Epub 2021 Feb 14.

School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

This study aimed to explore the association between mental health knowledge level and the prevalence of depressive symptoms among Chinese college students. A cross-sectional study was conducted in six universities in Jinan, Shandong Province, China, and a total of 600 college students were recruited to self-complete a series of questionnaires. The Mental Health Knowledge Questionnaire (MHKQ) was used to investigate the level of mental health knowledge. Depressive symptoms were investigated with the depression subscale of the Depression Anxiety Stress Scale (DASS-21). The prevalence rate of depressive symptoms among college students was 31.2%. Compared with MHKQ scoring in the 1st quartile, college students with MHKQ scoring in the 3rd quartile and in the 4th quartile reported lower levels of depressive symptoms after adjusting for potential confounding factors. Since mental health knowledge level was related to depressive symptoms among college students, increased efforts to promote the level of mental health knowledge in Chinese college students are critical.
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http://dx.doi.org/10.3390/ijerph18041850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918134PMC
February 2021

Transnational contexts and local embeddedness of HIV/STI vulnerabilities among Thai and Filipino agricultural temporary foreign workers in Canada.

Cult Health Sex 2021 06 7;23(6):723-739. Epub 2020 Feb 7.

Department of Health Sciences, Brock University, ON, Canada.

Each year Canada approves about 70,000 agricultural temporary foreign worker positions. However, few studies have examined temporary foreign workers' sexual health. In this mixed-methods study, we used surveys and focus groups to explore the knowledge of HIV and sexually transmitted infections (STI), sexual behaviours and the perspectives of sexual health of 100 Thai and Filipino temporary foreign workers in southwestern Ontario, Canada. The findings revealed that transnational migration had opened up social space that workers were not familiar with. Social isolation, stress and prolonged separation from spouses and partners resulted in the formation of new intimate relationships. Close to two-thirds of the 100 participants were sexually active in the twelve months prior to the study and over three-quarters did not use condoms. Many participants had misconceptions about HIV risks and safer sex practices. Few temporary workers accessed sexual health services due to language barriers, time constraints, stigma and lack of transport. As a result, many obtained medical advice and medicine through their families back home and relied on self-treatment in dealing with symptoms of genital infections. Effective sexual health promotion for temporary foreign workers must consider the complex interactive sociocultural and political processes that involve institutional practices in the local and transnational contexts.
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http://dx.doi.org/10.1080/13691058.2020.1725643DOI Listing
June 2021

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada.

Cancer Med 2019 11 30;8(16):7108-7122. Epub 2019 Sep 30.

Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.

Background: Colorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population-based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants.

Methods: We conducted a population-based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50-74 who were eligible for FOBT from 1 April 2013 to 31 March 2015.

Results: We found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim-majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90-0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim-majority countries.

Conclusions: These findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.
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http://dx.doi.org/10.1002/cam4.2541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853827PMC
November 2019

Exploring mental illness stigma among Asian men mobilized to become Community Mental Health Ambassadors in Toronto Canada.

Ethn Health 2019 Jul 24:1-19. Epub 2019 Jul 24.

c Daphne Cockwell School of Nursing, Ryerson University , Toronto , ON , Canada.

Background: Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts.

Purpose: The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma.

Results: A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma.

Conclusion: Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma.
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http://dx.doi.org/10.1080/13557858.2019.1640350DOI Listing
July 2019

Exploring the use of fact-based and story-based learning materials for HIV/STI prevention and sexual health promotion with South Asian women in Toronto, Canada.

Health Educ Res 2019 02;34(1):27-37

Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, ON, Canada.

Story-based learning is well recognized as an effective strategy for adult health education. However, there is a scarcity of research on story-based health education among women in South Asian diasporic communities. To address this gap, we undertook a pilot study in Toronto to explore how South Asian women respond to the use of fact-based and story-based materials for HIV/STI prevention. A total of 78 women were recruited from across the city. We engaged nearly half of the women (n=40) using fact sheets on HIV/STIs, and the remainder (n=38) using stories written by South Asian women on HIV/STIs. Surveys and focus groups were used to explore participants' responses in terms of knowledge, attitudes and perspectives. Results indicated that both approaches were effective in increasing participants' knowledge of HIV/STIs. Participants in the fact-based sessions tended to distance themselves from the idea of personal HIV/STI risks. Participants in the story-based groups were emotionally engaged, expressing personal commitments to take a stand against HIV stigma. In summary, within-culture stories are potentially effective tools that enable women to make sense of their own life situations and contextual vulnerabilities. Story-based materials are useful for breaking the silence of taboo topics, addressing stigma and discrimination and raising awareness about collective empowerment.
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http://dx.doi.org/10.1093/her/cyy042DOI Listing
February 2019

Study protocol: Mobilizing Asian men in Canada to reduce stigma of mental illness.

Contemp Clin Trials 2018 08 19;71:133-139. Epub 2018 Jun 19.

Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada. Electronic address:

Background: The available evidence on interventions addressing the stigma of mental illness is limited because of small samples, lack of diversity in study samples, and exclusion of people living with mental illness. To date, no published studies have evaluated anti-stigma interventions for Asian men in Canada. Aim This paper describes the protocol of a study to evaluate psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing self-stigma and social stigma in Asian communities in three urban settings in Canada: Toronto, Calgary and Vancouver. The study targets Asian men living with or affected by mental illness, and community leaders interested in stigma reduction and advocacy.

Methods: Guided by a population health promotion framework and an ecological approach to health, the study will use a repeated measure design with mixed methods for data collection. In total, 2160 participants will be enrolled to detect moderate-to-large effect sizes, while accounting for possible attrition. Participants will be randomly assigned to one of three interventions or a control group, using a randomization matrix. Established measures will be used to collect outcome data at pretest, post-test, and 3 and 6 months follow-up, along with focus group discussions and monthly activity logs. Mixed linear models will compare participants' stigma, psychological flexibility, valued life domains, mindfulness, and empowerment readiness within and between groups.

Discussion: The project will generate new knowledge on the applicability and effectiveness of evidence-based psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing stigma of mental illness and mobilizing community leadership.
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http://dx.doi.org/10.1016/j.cct.2018.06.009DOI Listing
August 2018

Migrant Live-in Caregivers Mental Health in Canada.

Community Ment Health J 2018 07 12;54(5):590-599. Epub 2018 Jan 12.

Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Empirical evidence suggests rapid health decline among temporary migrant workers but there is limited knowledge about their mental health. This study explored live-in care givers' (LCs) mental health and its determinants. Using a mixed methods design, a purposeful sample of 30 LCs was recruited. Data were collected through a selfcompleted questionnaire. A third of participants reported their mental health as poor or fair. Almost half experienced major depression. The poor mental health was associated with the average working hours and living accommodation. The average resiliency scores was moderately high and appeared to function as a protective factor against mental illness. Our findings suggest LCs are at risk of compromised mental health associated to their substandard working and living conditions. These conditions originates from violation of employment contracts, unfair employment practices, and the lack of enforcement of LCs' legal and human rights.
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http://dx.doi.org/10.1007/s10597-017-0225-5DOI Listing
July 2018

Effects Of HIV stigma reduction interventions in diasporic communities: insights from the CHAMP study.

AIDS Care 2018 06 24;30(6):739-745. Epub 2017 Oct 24.

e Daphne Cockwell School of Nursing , Ryerson University , Toronto , ON , Canada.

Racialized diasporic communities in Canada experience disproportionate burden of HIV infection. Their increased vulnerabilities are associated with interlocking challenges, including barriers in accessing resources, migration and settlement stress, and systemic exclusion. Further, people living with HIV (PLHIV) in these diasporic communities face stigma and discrimination in both mainstream Canadian society as well as their own ethno-racial communities. HIV stigma negatively impacts all aspects of HIV care, from testing to disclosure to treatment and ongoing care. In response to these challenges, a Toronto based community organization developed and implemented the CHAMP project to engage people living with HIV/AIDS (PLHIV) and leaders from different service sectors from the African/Caribbean, Asian and Latino communities to explore challenges and strategies to reduce HIV stigma and build community resilience. The study engaged 66 PLHIV and ethno-racial leaders from faith, media and social justice sectors in two stigma-reduction training programs: Acceptance Commitment Therapy Training (ACT) and Social Justice Capacity Building (SJCB). Data collection included pre-and post- intervention surveys, focus groups and monthly activity logs. Participants were followed for a year and data on changes in the participants' attitudes and behaviors as well as their actual engagement in HIV prevention, PLHIV support and stigma reduction activities were collected. CHAMP results showed that the interventions were effective in reducing HIV stigma and increasing participants' readiness to take action towards positive social change. Participants' activity logs over a period of 9 months after completing the training showed they had engaged in 1090 championship activities to advocate for HIV related health equity and social justice issues affecting racialized and newcomer PLHIV and communities.
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http://dx.doi.org/10.1080/09540121.2017.1391982DOI Listing
June 2018

Breast cancer screening utilization among women from Muslim majority countries in Ontario, Canada.

Prev Med 2017 Dec 13;105:176-183. Epub 2017 Sep 13.

Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada; Department of Family and Community Medicine, St. Michael Hospital, Canada; Institute for Clinical Evaluative Sciences, Canada; Dalla Lana School of Public Health, University of Toronto, Canada. Electronic address:

Breast cancer screening disparities continue to prevail with immigrant women being at the forefront of the under screened population. There is a paucity of knowledge about the role of religious affiliation or cultural orientation on immigrant women's cancer screening uptake. This study examined differences in uptake of breast cancer screening among women from Muslim and non- Muslim majority countries in Ontario, Canada. A cohort of 1,851,834 screening-eligible women living in Ontario during April 1, 2013 to March 31, 2015 was created using linked health and social administrative databases. The study found that being born in a Muslim majority country was associated with lower breast cancer screening uptake after adjusting for region of origin, neighbourhood income, and primary care-related factors. However, screening uptake in Muslim majority countries varied by world region with the greatest differences found in Sub-Saharan Africa and South Asia. Screening uptake was lower for women who had no primary care provider, were in a traditional fee-for service model of primary care, had a male physician, had an internationally trained physician, resided in a low income neighbourhood, and entered Canada under the family class of immigration. Religion may play a role in screening uptake, however, the variation in rates by regions of origin, immigration class, and access to primary care providers alludes to confluence of socio-demographic, cultural beliefs and practices, immigration trajectories and system level factors. Facilitating access for immigrant women to regular primary care providers, particularly female providers and enrollment in primary care models could enhance screening uptake.
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http://dx.doi.org/10.1016/j.ypmed.2017.09.008DOI Listing
December 2017

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada.

BMC Public Health 2017 05 23;17(1):498. Epub 2017 May 23.

Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Canada.

Background: Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services.

Method: In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis.

Results: A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants' narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women.

Conclusion: A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.
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http://dx.doi.org/10.1186/s12889-017-4431-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442647PMC
May 2017

Taking action on violence through research, policy, and practice.

Glob Health Res Policy 2016 15;1. Epub 2016 Jul 15.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada.

Background: Violence is a critical public health problem associated with compromised health and social suffering that are preventable. The Centre for Global Health and Health Equity organized a forum in 2014 to identify: (1) priority issues related to violence affecting different population groups in Canada, and (2) strategies to take action on priority issues to reduce violence-related health inequities in Canada. In this paper, we present findings from the roundtable discussions held at the Forum, offer insights on the socio-political implications of these findings, and provide recommendations for action to reduce violence through research, policy and practice.

Methods: Over 60 academic researchers, health and social service agency staff, community advocates and graduate students attended the daylong Forum, which included presentations on structural violence, community violence, gender-based violence, and violence against marginalized groups. Detailed notes taken at the roundtables were analyzed by the first author using a thematic analysis technique.

Findings: The thematic analysis identified four thematic areas: 1) structural violence perpetuates interpersonal violence - the historical, social, political and economic marginalization that contributes to personal and community violence. 2) social norms of gender-based violence-the role of dominant social norms in perpetuating the practice of violence, especially towards women, children and older adults; 3) violence prevention and mitigation programs-the need for policy and programming to address violence at the individual/interpersonal, community, and societal levels; and 4) research gaps-the need for comprehensive research evidence made up of systematic reviews, community-based intervention and evaluation of implementation research to identify effective programming to address violence.

Conclusions: The proceedings from the Global Health and Health Equity Forum underscored the importance of recognizing violence as a public health issue that requires immediate and meaningful communal and structural investment to break its historic cycles. Based on our thematic analysis and literature review, four recommendations are offered: (1) Support and adopt policies to prevent or reduce structural violence; (2) Adopt multi-pronged strategies to transform dominant social norms associated with violence; (3) Establish standards and ensure adequate funding for violence prevention programs and services; and (4) Fund higher level ecological research on violence prevention and mitigation.
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http://dx.doi.org/10.1186/s41256-016-0006-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675061PMC
July 2016

Migration and young people's mental health in Canada: A scoping review.

J Ment Health 2015 Dec;24(6):414-22

c Faculty of Health Sciences, Simon Fraser University , Burnaby , British Columbia , Canada.

Background: Young people's mental health is a public health priority. Given the influences of migration and resettlement on mental health, synthesis of current research with young people from migrant backgrounds can help inform mental health promotion initiatives that account for and are responsive to their needs.

Aims: This article distils the results of a review of published literature on the mental health of adolescent immigrants (ages 10-19) living in Canada.

Method: Scoping review methods were used to define inclusion and exclusion criteria; inform the search strategies; and extract and synthesize key findings.

Results: Fourteen articles met criteria for inclusion. Analysis of the studies indicate diversity in mental health indicators, e.g., mental distress, emotional problems and behavioral problems, as well as a wide range of influences on mental health from age at migration and length of stay to place of residence, income and discrimination.

Conclusions: Findings support the need to account for the array of influences on young people's mental health in relation to migration and to augment initiatives beyond the level of individual intervention.
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http://dx.doi.org/10.3109/09638237.2015.1078881DOI Listing
December 2015

Changing access to mental health care and social support when people living with HIV/AIDS become service providers.

AIDS Care 2015 28;27(2):176-81. Epub 2014 Jul 28.

a Regent Park Community Health Centre , Toronto , ON , Canada.

As people living with HIV/AIDS (PHAs) achieve more stable health, many have taken on active peer support and professional roles within AIDS service organizations. Although the increased engagement has been associated with many improved health outcomes, emerging program and research evidence have identified new challenges associated with such transition. This paper reports on the results of a qualitative interpretive study that explored the effect of this role transition on PHA service providers' access to mental health support and self care. A total of 27 PHA service providers of diverse ethno-racial backgrounds took part in the study. Results show that while role transition often improves access to financial and health-care benefits, it also leads to new stress from workload demands, emotional triggers from client's narratives, feeling of burnout from over-immersion in HIV at both personal and professional levels, and diminished self care. Barriers to seeking support included: concerns regarding confidentiality; self-imposed and enacted stigma associated with accessing mental health services; and boundary issues resulting from changes in relationships with peers and other service providers. Evolving support mechanisms included: new formal and informal peer support networks amongst colleagues or other PHA service providers to address both personal and professional challenges, and having access to professional support offered through the workplace. The findings suggest the need for increased organizational recognition of HIV support work as a form of emotional labor that places complex demands on PHA service providers. Increased access to employer-provided mental health services, supportive workplace policies, and adequate job-specific training will contribute to reduced work-related stress. Community level strategies that support expansion of social networks amongst PHA service providers would reduce isolation. Systemic policies to increase access to insurance benefits and enhance sector-wide job preparedness and post-employment support will sustain long-term and meaningful involvement of PHAs in service provision.
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http://dx.doi.org/10.1080/09540121.2014.940269DOI Listing
April 2015

Sustainable capacity building among immigrant communities: the raising sexually healthy children program in Canada.

Health Promot Int 2014 Mar 5;29(1):26-37. Epub 2013 Jun 5.

*Corresponding author. E-mail:

The Raising Sexually Healthy Children (RSHC) program is a peer-to-peer leadership training program for immigrant parents in Toronto, Canada. It was established in 1998 with the goal of promoting family sex education and parent-child communication. This evaluative study examined the developmental processes and outcomes of the RSHC program to identify the strengths, challenges and insights that can be used to improve the program. It employed a multi-case study approach to compare the RSHC programs delivered in the Chinese, Portuguese and Tamil communities. Data collection methods included focus groups, individual interviews and document analysis. The cross-case analysis identified both common and unique capacity building processes and outcomes in the three communities. In this paper, we report factors that have enhanced and hindered sustainable capacity building at the individual, group/organizational and community levels, and the strategies used by these communities to address challenges common to immigrant families. We will discuss the ecological and synergetic, but time-consuming processes of capacity building, which contributed to the sustainability of RSHC as an empowering health promotion program for immigrant communities. We conclude the paper by noting the implications of using a capacity building approach to promote family health in ethno-racial-linguistic minority communities.
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http://dx.doi.org/10.1093/heapro/dat035DOI Listing
March 2014

Challenging homophobia and heterosexism through storytelling and critical dialogue among Hong Kong Chinese immigrant parents in Toronto.

Cult Health Sex 2013 12;15(1):15-28. Epub 2012 Nov 12.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada.

Homophobia and heterosexism are ubiquitous in Canadian society. They contribute to significant health and mental health disparities for lesbian, gay and bisexual youth and their families. Anti-homophobia efforts tend to focus on students and teachers at school. While these efforts are important, they do not reach parents, who play an important role in shaping young people's attitudes towards gender and sexuality. To eliminate bullying and victimisation associated with homophobia at school and in the community, concerted efforts are urgently needed to mobilise parents to become champions against homophobia and heterosexism. In this paper, we report on our use of storytelling and critical dialogue to engage a group of Hong Kong Chinese immigrant parents in Toronto to interrogate their values and assumptions about homosexuality. In particular, we illustrate how we use storytelling to create a liminal space whereby the narrators and listeners collaborate to create counter-discourses that challenge social domination and exclusion. We then discuss the implications of using a critical dialogical approach to integrate anti-homophobia efforts in community parenting programmes.
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http://dx.doi.org/10.1080/13691058.2012.738310DOI Listing
May 2013

Bringing translation out of the shadows: translation as an issue of methodological significance in cross-cultural qualitative research.

J Transcult Nurs 2010 Apr;21(2):151-8

Ryerson University, Toronto, Ontario, Canada.

Translation is an integral component of cross-cultural research that has remained invisible. It is commonly assumed that translation is an objective and neutral process, in which the translators are "technicians" in producing texts in different languages. Drawing from the field of translation studies and the findings of a translation exercise conducted with three bilingual Cantonese-English translators, the authors highlight some of the methodological issues about translation in cross-cultural qualitative research. They argue that only by making translation visible and through open dialogue can researchers uncover the richness embedded in the research data and facilitate multiple ways of knowing.
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http://dx.doi.org/10.1177/1043659609357637DOI Listing
April 2010

Psychosocial Experiences of East and Southeast Asian men who use gay Internet chatrooms in Toronto: an implication for HIV/AIDS prevention.

Ethn Health 2005 May;10(2):145-67

Asian Community AIDS Services, Toronto, Ontario, Canada.

Objectives: In recent years we have witnessed an increase in Asian men who use gay Internet chatrooms in Toronto. Previous research has shown that many men who had sex with men (MSM) sought sex partners through the Internet and that meeting sex partners via the Internet increases sexually transmitted infection (STI) and HIV risk. This study aims to (1) explore psychosocial issues relating to Asian men who use gay chatrooms and (2) identify culturally appropriate HIV prevention strategies for this population.

Design: In-depth interviews were conducted with a total of 21 East and Southeast Asian men who used Internet gay chatrooms. Unstructured, open-ended questions were used to obtain narrative data to help understand their lived, psychosocial experiences of gay chatrooms. Transcripts of the interviews were read to highlight themes and concepts.

Results: Analysis revealed complex lived, psychosocial experiences of Asian men who use gay chatrooms in Toronto. They tended to be socially isolated and highly marginalized, which had led to intense needs for social connections and thus left some Asian men vulnerable to sexual exploitation. Although they were fully aware that they should use condoms in anal intercourse with a casual partner, they had some misconceptions about HIV. Moreover, they rarely, if ever, used condoms in oral sex with a casual partner, which might leave them vulnerable to STI.

Conclusions: It is important for service providers to continually provide accurate information about STIs and HIV/AIDS including how they can be contracted. However, HIV prevention strategies for this population must also address issues relating to social isolation and marginalization in order to combat the spread of HIV/AIDS effectively. This can be accomplished by an online peer support program.
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http://dx.doi.org/10.1080/13557850500071202DOI Listing
May 2005
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