Publications by authors named "Yogendra Shakya"

17 Publications

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Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto.

Community Ment Health J 2021 05 19;57(4):655-666. Epub 2020 Oct 19.

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

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.
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http://dx.doi.org/10.1007/s10597-020-00723-3DOI Listing
May 2021

The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal.

BMC Emerg Med 2020 05 26;20(1):43. Epub 2020 May 26.

Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Background: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has several variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis.

Methods: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among the patients age ≥ 16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method.

Results: RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I = 0.649-0.818; p-value = 0.000) as APACHE II (AUC of 0.728; 95% C. I = 0.637 to 0.819; p-value = 0.000) or SOFA (AUC of 0.680, 95% C. I = 0.591-0.770; p-value = 0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio = 1.81) and specificity of 54% (negative likelihood ratio = 0.32). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p = 0.555, 95% C. I = 0.231-2.194). Overall mortality was 27.02% (n = 40). RDW group analysis showed no mortality in RDW < 13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to > 15.6 RDW group and 45.9% mortality in > 15.6 RDW group. Significant mortality difference was seen in 14 to > 15.6 and > 15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively.

Conclusion: Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.
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http://dx.doi.org/10.1186/s12873-020-00337-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249690PMC
May 2020

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

Refugee mothers, migration pathways and HIV: a population-based cohort study.

AIDS Care 2020 01 6;32(1):30-36. Epub 2019 May 6.

Centre for Urban Health Solutions, St. Michaels Hospital, Toronto, Canada.

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/- 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.
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http://dx.doi.org/10.1080/09540121.2019.1612009DOI Listing
January 2020

Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study.

BMJ Open 2018 04 10;8(4):e018979. Epub 2018 Apr 10.

Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.

Objectives: Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.

Design: This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.

Setting And Participants: Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.

Primary Outcomes: Numerous adverse maternal and perinatal health outcomes.

Results: Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.

Conclusions: Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.
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http://dx.doi.org/10.1136/bmjopen-2017-018979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898303PMC
April 2018

Mental health of South Asian youth in Peel Region, Toronto, Canada: a qualitative study of determinants, coping strategies and service access.

BMJ Open 2017 Nov 3;7(11):e018265. Epub 2017 Nov 3.

Social Aetiology of Mental Illness Training Program, Health Systems and Health Equity Research Group, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.

Objectives: This qualitative study set out to understand the mental health challenges and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada.

Setting: In-depth semistructured interviews were carried out with South Asian youth living in Peel Region (Mississauga, Brampton and Caledon), a suburb of Toronto, Canada, home to over 50% of Ontario's South Asian population.

Participants: South Asian youth (n=10) engaged in thoughtful, candid dialogue about their mental health and service access barriers.

Primary And Secondary Outcome Measures: Qualitative interview themes related to mental health stressors and mental health service access barriers experienced by youth living in Peel Region were assessed using thematic analysis.

Results: South Asian youth face many mental health stressors, from intergenerational and cultural conflict, academic pressure, relationship stress, financial stress and family difficulties. These stressors can contribute to mental health challenges, such as depression and anxiety and drug use, with marijuana, alcohol and cigarettes cited as the most popular substances. South Asian youth were only able to identify about a third (36%) of the mental health resources presented to them and did not feel well informed about mental health resources available in their neighbourhood.

Conclusions: They offered recommendations for improved youth support directed at parents, education system, South Asian community and mental health system. Institutions and bodies at all levels of the society have a role to play in ensuring the mental health of South Asian youth.
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http://dx.doi.org/10.1136/bmjopen-2017-018265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695456PMC
November 2017

Patients' Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS).

J Immigr Minor Health 2018 Oct;20(5):1173-1181

School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON, M3J1P3, Canada.

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.
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http://dx.doi.org/10.1007/s10903-017-0643-zDOI Listing
October 2018

Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial.

CMAJ Open 2017 Jan-Mar;5(1):E190-E197. Epub 2017 Mar 1.

School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.

Background: Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments.

Methods: An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review.

Results: Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS ( = 75) and usual care ( = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group ( ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group ( > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1).

Interpretation: The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.
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http://dx.doi.org/10.9778/cmajo.20160118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378520PMC
March 2017

Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change.

Can Fam Physician 2017 Feb;63(2):e137-e144

Full Professor in the Faculty of Nursing at the University of Montreal in Quebec.

Objective: To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants.

Design: Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu.

Setting: Toronto, Ont.

Participants: A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less.

Main Outcome Measures: Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care).

Results: A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses ( = .0233), and the quality of the provider-patient relationship ( = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices.

Conclusion: Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395412PMC
February 2017

Burden of common mental disorders in a community health centre sample.

Can Fam Physician 2016 Dec;62(12):e758-e766

Psychiatrist and Medical Director of Underserved Populations at the Centre for Addiction and Mental Health in Toronto, Ont, and Chief Executive Officer of The Wellesley Institute.

Objective: To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings.

Design: English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS).

Setting: Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont.

Participants: Adult patients waiting to see a clinician.

Main Outcome Measures: The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators.

Results: A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire).

Conclusion: The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154667PMC
December 2016

Computer-assisted client assessment survey for mental health: patient and health provider perspectives.

BMC Health Serv Res 2016 Sep 23;16(1):516. Epub 2016 Sep 23.

Wellesley Institute, Centre for Addiction & Mental Health, 33 Russell Street, Toronto, ON, M5S2S1, Canada.

Background: The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial.

Methods: This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality.

Results: Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances.

Conclusions: Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area.

Trial Registration: ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.
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http://dx.doi.org/10.1186/s12913-016-1756-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035495PMC
September 2016

Severe Neonatal Morbidity Among Births to Refugee Women.

Matern Child Health J 2016 10;20(10):2189-98

Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5W 1W8, Canada.

Background Despite being considered high risk, little is known about the perinatal health of refugees in developed countries. Our objectives were to examine whether: (1) the healthy migrant effect applies to infants born to refugee women with respect to severe neonatal morbidity (SNM); (2) refugee status was a risk factor for SNM among immigrants; (3) refugee sponsorship status was a risk factor for SNM by comparing asylum-seekers to sponsored refugees; and (4) refugees were at greater risk of specific SNM subtypes. Methods Immigration records (1985-2010) linked to Ontario hospital data (2002-2010) were used to examine SNM. We calculated adjusted risk ratios (ARR) with 95 % confidence intervals (95 % CI) for SNM and unadjusted risk ratios with 99 % CI for SNM subtypes using log-binomial regression. Results There were borderline differences in SNM among refugees (N = 29,755) compared to both non-immigrants (N = 860,314) (ARR = 0.94, 95 % CI 0.89, 0.99) and other immigrants (N = 230,847) (ARR = 1.10, 95 % CI 1.04, 1.18) with a larger difference comparing other immigrants to non-immigrants (ARR = 0.83, 95 % CI 0.81, 0.85). Asylum-seekers did not differ from sponsored refugees (ARR = 1.07, 95 % CI 0.90, 1.27). Though rare, several SNM subtypes were significant with large effect sizes. Conclusion With respect to SNM risk, the healthy migrant effect clearly applies to non-refugee immigrants, but is weaker for refugees and may not apply. Among immigrants, refugee status was a weak risk factor for SNM and may not be clinically important. Sponsorship status was not associated with greater risk of SNM. Further investigation of several SNM subtypes is warranted.
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http://dx.doi.org/10.1007/s10995-016-2047-4DOI Listing
October 2016

Pathways between under/unemployment and health among racialized immigrant women in Toronto.

Ethn Health 2017 02 13;22(1):17-35. Epub 2016 May 13.

b Access Alliance Multicultural Health and Community Services, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.

Objective: We sought to document pathways between under/unemployment and health among racialized immigrant women in Toronto while exploring the ways in which gender, class, migration and racialization, as interlocking systems of social relations, structure these relationships.

Design: We conducted 30 interviews with racialized immigrant women who were struggling to get stable employment that matched their education and/or experience. Participants were recruited through flyers, partner agencies and peer researcher networks. Most interviews (21) were conducted in a language other than English. Interviews were transcribed, translated as appropriate and analyzed using NVivo software. The project followed a community-based participatory action research model.

Results: Under/unemployment negatively impacted the physical and mental health of participants and their families. It did so directly, for example through social isolation, as well as indirectly through representation in poor quality jobs. Under/unemployment additionally led to the intensification of job search strategies and of the household/caregiving workload which also negatively impacted health. Health problems, in turn, contributed to pushing participants into long-term substandard employment trajectories. Participants' experiences were heavily structured by their social location as low income racialized immigrant women.

Conclusions: Our study provides needed qualitative evidence on the gendered and racialized dimensions of under/unemployment, and adverse health impacts resulting from this. Drawing on intersectional analysis, we unpack the role that social location plays in creating highly uneven patterns of under/unemployment and negative health pathways for racialized immigrant women. We discuss equity informed strategies to help racialized immigrant women overcome barriers to stable work that match their education and/or experience.
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http://dx.doi.org/10.1080/13557858.2016.1180347DOI Listing
February 2017

Reflexivity: a methodological tool in the knowledge translation process?

Health Promot Pract 2015 May 28;16(3):426-31. Epub 2015 Jan 28.

University of Toronto, Toronto, Ontario, Canada Access Alliance Multicultural Health and Community Services, Toronto, Ontario, Canada.

Knowledge translation is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and application of knowledge. It is considered the bridge that closes the gap between research and practice. Yet it appears that in all areas of practice, a significant gap remains in translating research knowledge into practical application. Recently, researchers and practitioners in the field of health care have begun to recognize reflection and reflexive exercises as a fundamental component to the knowledge translation process. As a practical tool, reflexivity can go beyond simply looking at what practitioners are doing; when approached in a systematic manner, it has the potential to enable practitioners from a wide variety of backgrounds to identify, understand, and act in relation to the personal, professional, and political challenges they face in practice. This article focuses on how reflexive practice as a methodological tool can provide researchers and practitioners with new insights and increased self-awareness, as they are able to critically examine the nature of their work and acknowledge biases, which may affect the knowledge translation process. Through the use of structured journal entries, the nature of the relationship between reflexivity and knowledge translation was examined, specifically exploring if reflexivity can improve the knowledge translation process, leading to increased utilization and application of research findings into everyday practice.
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http://dx.doi.org/10.1177/1524839914568344DOI Listing
May 2015

Delayed presentation and diagnosis of Boerhaave's syndrome.

Emerg Med Australas 2014 Apr;26(2):201-2

Department of General Practice and Emergency Medicine, Institute of Medicine, Kathmandu, Nepal.

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http://dx.doi.org/10.1111/1742-6723.12175DOI Listing
April 2014

Self-management, health service use and information seeking for diabetes care among Black Caribbean immigrants in Toronto.

Can J Diabetes 2014 Feb;38(1):32-7

Ryerson University, Toronto, Ontario, Canada.

Objective: The objective of this research was to explore self-management practices and the use of diabetes information and care among Black-Caribbean immigrants with type 2 diabetes.

Method: The study population included Black-Caribbean immigrants and Canadian-born participants between the ages of 35 to 64 years with type 2 diabetes. Study participants were recruited from community health centres (CHCs), diabetes education centres, hospital-based diabetes clinics, the Canadian Diabetes Association and immigrant-serving organizations. A structured questionnaire was used to collect demographics and information related to diabetes status, self-management practices and the use of diabetes information and care.

Results: Interviews were conducted with 48 Black-Caribbean immigrants and 54 Canadian-born participants with type 2 diabetes. Black-Caribbean immigrants were significantly more likely than the Canadian-born group to engage in recommended diabetes self-management practices (i.e. reduced fat diet, reduced carbohydrate diet, non-smoking and regular physical activity) and receive regular A1C and eye screening by a health professional. Black-Caribbean immigrant participants were significantly more likely to report receiving diabetes information and care through a community health centre (CHC) and nurses and dieticians than their Canadian-born counterparts.

Conclusions: CHCs and allied health professionals play an important role in the management of diabetes in the Black-Caribbean immigrant community and may contribute to this group's favourable diabetes self-management profile and access to information and care. Additional research is necessary to confirm whether these findings are generalizable to the Black-Caribbean community in general (i.e. immigrant and non-immigrant) and to determine whether the use of CHCs and/or allied health professionals is associated with favourable outcomes in the Black-Caribbean immigrant community as well as others.
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http://dx.doi.org/10.1016/j.jcjd.2013.08.267DOI Listing
February 2014

A pilot with computer-assisted psychosocial risk-assessment for refugees.

BMC Med Inform Decis Mak 2012 Jul 16;12:71. Epub 2012 Jul 16.

School of Health Policy and Management, York University & Dalla Lana School of Public Health, University of Toronto, 4700 Keele Street, HNES Building, Room 414, Toronto, Ontario M3J 1P3, Canada.

Background: Refugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services.

Methods: A pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction.

Results: Out of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA=25; usual care=24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46% in usual care group [X2 (1)=3.47, p=0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean=4) and were 'unsure' about possible barriers to interact with the clinicians (mean=2.8) or to privacy of information (mean=2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean=4.3).

Conclusion: The studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool's potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.
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http://dx.doi.org/10.1186/1472-6947-12-71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461470PMC
July 2012
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