Canada, like other countries around the world, has health inequities. The literature on social accountability and responsibility urges medical schools to be grounded in the needs of communities to address health inequities. The Canadian professional and regulatory bodies promote the CanMEDS Competencies of which one, the Health Advocate Competency, speaks of addressing community issues. Yet medical schools face challenges actualizing social responsibility and teaching the Health Advocate Competency. Therefore it is important to understand how the teaching of health advocacy and social responsibility is incorporated into the undergraduate curricula of self-defined socially responsible medical schools in Canada. In this study, mixed methods were used beginning with a semi-structured questionnaire administered to undergraduate Course Directors at two medical schools in Canada with a response rate of 74% (n=60). This was followed by a series of open-ended interviews with eleven equity leaders to bring their perspective into the data collection and establish knowledge about frontline intersectional equity work. The major theoretical lens encircling this work was intersectionality which examines historical oppression and how the intersection of gender, race, and class compound health inequities. Questionnaire results made it clear that biomedical ideology and the CanMEDS Medical Expert Competency were privileged in the undergraduate curriculum at the expense of other knowledge such as health advocacy and social responsibility. The objective biomedical discourse ignores or marginalizes important social influences on health which are highlighted by using an intersectional lens. The semi-structured interviews provided rich data about working in an intersectional equity framework highlighting the impact of the intersections of race, gender, class and other identities on health inequities. These interviews also demonstrate the importance of health advocacy in improving health care outcomes and addressing social responsibility. Incorporating intersectionality into previously accepted assessment tools for physicians adds an important dimension to the health care encounter. Explicitly embedding social responsibility and health advocacy in the medical school mission and curriculum is essential to their acceptance. A series of supporting recommendations are offered.

Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.

Considering the increasing levels of unemployment and underemployment, and the limited evidence concerning the impact of underemployment on health, my study examines the relations between subjective, objective, and time-related underemployment and employees’ health-related quality of life, as manifested through self-rated health, activity limitations and work-related stress. The study compares an expanded model of work-health relations that, along with the factors addressed by control-demand, and social capital theories, includes characteristics of the physical work environment, and employees’ economic class. In addition to the commonly examined factors related to employment and health (control-demand and social capital), my study explores the impact of the work environment (hazards, discomfort and physical demands) and economic class to determine the specific effects of underemployment on an employee’s health-related quality of life. My main argument is that underemployment, in conjunction with lower economic class, higher exposure to a harmful work environment, lack of control over work, and lower social capital, contributes to increased work-related stress and diminishes health-related quality of life. The study applies a mixed methodological approach based on data from the Canadian Work and Lifelong Learning Survey and the US General Social Survey, and qualitative analysis of interviews from the Ontario Survey on Education-Job Requirements Matching. Evidence based on cross-sectional and qualitative data analysis provides consistent findings and confirms the main assumption that high levels of underemployment have a significant effect on employees’ health-related quality of life. The study shows that employees’ economic class, characteristics of work environment and control over work carry the highest associations with health-related quality of life, while underemployment has a significant additive association with health-related quality of life, most importantly with work-related stress.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Children who obtain insufficient physical activity (PA) have increased risk for chronic diseases. From childhood to adolescence, there is typically a decline in overall PA, with a more rapid decline in girls, at a younger age. The objective of this study was to determine the impact of two types of organized PA instructional conditions (structured no-choice, structured choice) on girls’ PA levels, as compared to free-play at a summer camp in Russia. We hypothesized that free-play would elicit the highest levels of PA. Methods: This study used a within-subjects cross-over trial design. Thirty-two girls (aged 10.7± 0.6yr; BMI percentile 47± 31%) at a Russian summer camp, attended daily 35-minute PA sessions for three weeks. Using the evidence-based Coordinated Approach to Child Health physical activity box, three PA instructional conditions (structured choice, structured no-choice, free-play) were implemented each day. Actical PA monitors collected step count and PA intensity data. Mixed model ANOVAs were used to assess differences in step counts and percentage of time in Moderate to Vigorous Physical Activity (MVPA) by instructional condition. Results: Twenty-five of the 32 participants attended all sessions, and 31 attended at least two of three sessions for each condition. Both structured conditions, no-choice steps/min (mean= 42.7 steps/min; 95%CI= 39.6–45.7; p= 0.0003) and choice condition steps/min (mean= 41.0 steps/min; 95%CI= 37.9–44.1; p= 0.004) were significantly higher than free-play steps/min (mean= 33.4 steps/min; 95%CI= 30.2–36.5). Percent time in MVPA was higher in the no-choice condition (mean= 30.9%; 95%CI= 28.1–33.8; p<0.0001) and choice condition (mean= 30.8%; 95%CI= 27.9–33.7; p< 0.0001) when compared to free-play (mean= 21.2 steps/min; 95%CI=18.2–24.1). There was no difference in steps/min or percentage time in MVPA between both structured conditions. Conclusion: Both types of instruction were superior to free-play with regard to PA level. Although contrary to our hypothesis, our results fit with previous literature that suggests evidence-based instructional interventions can promote higher PA levels in physical education sessions. Our results suggest that well-planned, stimulating PA sessions can increase short-term PA levels in girls compared to free-play opportunities in a Russian summer camp setting.

Master of Science / Department of Journalism and Mass Communications / Soontae An / African American women account for almost two thirds of all women living with HIV/AIDS in the United States. These epidemiological data highlight a critical need to develop intervention campaigns that communicate risk reduction strategies to this population. Using the framework of the Information-Motivation-Behavioral skills (IMB) model, the current study recruited African American women to view one of four brochures in which two experimental treatments were crossed: African American/individual prevention; Caucasian/individual prevention; African American/community prevention and Caucasian/community prevention. Attitude toward the message, risk perception, self-efficacy and community responsibility were measured through a survey questionnaire. Results showed that participants who viewed brochures featuring African American women displayed more favorable attitudes, increased self-efficacy, increased community responsibility and increased perceived risk for other African American women. The limitations of this study and implications for future research and development of HIV/AIDS prevention strategies are discussed.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / International college students are becoming a sizable part of the overall college student population in American universities. Studies show that these students come to the United States (U.S) with food habits that could be in variance with the U.S. food safety norms. While food safety in the U.S. is among the safest in the world, foodborne illness has remained a growing concern. Food experts are showing increasing concern about how food habits associated with cultural and ethnic norms are impacting basic food safety practices in the U.S. While minimal research regarding food safety has been conducted with college students in general, no studies have sought to understand food safety practices among international college students. This study investigated self-reported food safety practices of international college students. Specific objectives included: determine international college students’ knowledge regarding basic food safety principles, evaluate international college students’ belief towards food safety, and examine international students’ current food safety practices. The target population was international college students at Kansas State University. An online survey system was used to administer the questionnaires. The respondents were allowed two weeks to complete the questionnaires. To facilitate a higher response rate, two email reminders were sent, the first after one week and another two days prior to the expiration date. SPSS (version 17.0) was used for data analysis. Descriptive statistics were computed to understand the nature of data and provide characteristics of international college students in the study. Independent Samples t-tests were used to examine differences between demographic characteristics. A One-way ANOVA was used to identify differences in food safety knowledge and food handling practices among different ethnic groups regarding food safety. The Pearson correlation coefficient was used to measure association between variables. The majority of the respondents did not answer correctly questions related to cooking foods adequately and keeping foods at safe temperatures. The study suggests that most participants had beliefs that enhanced good safety practices. Respondents rarely practiced using a thermometer to determine correct temperatures of cooked foods or using separate cutting boards when preparing raw and ready-to-eat foods. They also reported using towels that were available to others to dry their hands. No significant differences were found between training and self-reported food safety handling practices.

Objectifs: Les patients hospitalisés aux soins intensifs (SI) sont souvent victimes d’erreurs médicales. La nature interprofessionnelle des équipes de SI les rend vulnérables aux erreurs de communication. L’objectif primaire du projet est d’améliorer la communication dans une équipe interprofessionnelle de soins intensifs par une formation en simulation à haute fidélité. Méthodologie Une étude prospective randomisée contrôlée à double insu a été réalisée. Dix équipes de six professionnels de SI ont complété trois scénarios de simulations de réanimation. Le groupe intervention était débreffé sur des aspects de communication alors que le groupe contrôle était débreffé sur des aspects techniques de réanimation. Trois mois plus tard, les équipes réalisaient une quatrième simulation sans débreffage. Les simulations étaient toutes évaluées pour la qualité, l’efficacité de la communication et le partage des informations critiques par quatre évaluateurs. Résultats Pour l’issue primaire, il n’y a pas eu d’amélioration plus grande de la communication dans le groupe intervention en comparaison avec le groupe contrôle. Une amélioration de 16% de l’efficacité des communications a été notée dans les équipes de soins intensifs indépendamment du groupe étudié. Les infirmiers et les inhalothérapeutes ont amélioré significativement l’efficacité de la communication après trois sessions. L’effet observé ne s’est pas maintenu à trois mois. Conclusion Une formation sur simulateur à haute fidélité couplée à un débreffage peut améliorer à court terme l’efficacité des communications dans une équipe interprofessionnelle de SI. / Objective: Patient hospitalized in intensive care units (ICU) are often victims of medical errors. The interprofessional nature of ICU teams makes them particularly vulnerable to communication errors. The primary objective of this project is to improve interprofessional communication in an ICU team using a high fidelity simulation-based training. Method A prospective, double-blind, randomized controlled trial was conducted. Ten teams of six ICU workers completed three simulated scenarios of resuscitation. The intervention group was debriefed on communication skills, whereas the control group was debriefed on technical resuscitation skills. Three months later, teams completed a fourth simulation without debriefing. All simulation sessions were coded for quality, efficacy of communication and team information-sharing by four blinded observers. Results For our primary end-point, improvement in communication in intervention group wasn’t greater than in control group. A 16% increase in communication effectiveness was noted in ICU teams independently of the studied group. Nurses and respiratory therapists significantly increased their communication effectiveness after three sessions. The effect did not last to three months. Conclusion The combination of high-fidelity simulation training and communication-oriented debriefing can produce short-term gains in communication effectiveness of an interprofessional ICU team.

This thesis evaluated the effects of two types of training on nurses’ ability to safely and efficiently administer IV medications using a smart infusion pump. A high fidelity simulated nursing unit was created in which nurses recruited from the University Health Network programmed a series of infusions after receiving training. A training script modeled after the pump vendor’s training sessions was created and tested first on 24 nurses. The results were analyzed for deficiencies in safety and efficiency from a human factors and education perspective and a new training script was created and tested on a group of 23 nurses. No significant differences were found between training groups on measures related to safety, but significant differences were found in nurse efficiency and behaviour in some aspects of pump programming. This study sets a precedent for human factors evaluation being used in tandem with existing training practices and lays the groundwork for further exploration on this topic.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.