The purpose of this study was to explain how public health renewal has shaped public health nursing practice, how public health nurses have managed these changes, and the perceived impact of such changes on health outcomes. I used the grounded theory method to develop a theoretical explanation of how public health nurses navigated the changing organizational milieu in British Columbia. I interviewed 29 public health nurses and three public health nursing managers in three health authorities to explicate the impact of healthcare reform initiatives on public health nurses and public health nursing practice. Over the last few decades, there have been several organizational and policy changes in British Columbia, intended to strengthen the health system and health service delivery. These changes have eroded the nature of the public health nurse role and negatively influenced public health nursing practice, undermining the ability of public health nurses to improve population health and health equity. Many participants were concerned about changes in their practice and reported that leaders restricted their role, particularly in their broad health promotion and community development efforts. Nurses in this study highlighted specific organizational and policy changes that have undermined their effectiveness. For example, nurses talked about cuts to the public health budget, the disbanding of health unit structures, the appointment of leaders who lacked public health or public health nursing knowledge and experience, and the increase in mandated targeted public health nursing programs with a corresponding decrease in universal programs. As a result, participants engaged in the process of managing the eroding of the public health nurse role, which comprises five strategies. In standing tall, a number of nurses in this study advocated for their practice and pushed back against decisions that jeopardized the quality of public health nursing programs and services with varying degrees of force. Public health nurse participants also worked within organizational expectations and constraints in the process of getting by. In going underground, several public health nurses engaged in various activities in secret by harnessing their community connections and attended to community issues they believed went unaddressed. A number of nurses, dissatisfied by the state of their role, were contemplating getting out and considered other employment possibilities. Throughout the process of navigating external changes affecting practice, many nurses restored their dedication to the public health nurse role in reaffirming commitment. Given the limited research exploring the impact of healthcare reform and public health renewal on public health nursing practice, this research helps to provide an initial glimpse into the effects of such change on public health nurses in British Columbia. / Graduate

Pregnant and postpartum women often face high levels of psychological stress that increase the risk of common mental disorders (CMDs), such as depression and anxiety. This stress is often not met with timely mental health care and, therefore, may create health inequities. Mobile technology-assisted interventions represent a new opportunity for pregnant and postpartum women that may address health equity, especially during and after the COVID-19 era. We conducted an equity-focused systematic review and included 18 randomized and non-randomized controlled trials for analysis. Our results suggest that mobile interventions can prevent and manage depression across ethnicities and carry the potential to reduce psychological distress. Evidence on anxiety and utilization of care was limited and more research is needed among pregnant adolescents. Our collaborative research approach highlights the potential of mobile technologies and the need for active involvement of patients and other stakeholders in the co-creation and evaluation of mobile interventions.

It has been said that those with the least are often the ones with the most to give. This proved to be true for a Syrian refugee turned cardiologist who provides care in communities that are poor and underserved including refugees, immigrants, minorities, those of low socioeconomic status, and other vulnerable populations. Dr. Heval Kelli is the epitome of a kind-hearted, humble, genuine hero, through his dedication to serving humanity. Between providing health care to those in need, educating future generations of doctors, mentoring high school students, and advocating for the less fortunate, his life is truly his message to the world.

Introduction: Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. Methods: Thus, the current study utilized responses from the Treatment Episodes Data Set–Discharges, 2015–2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. Results: Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. Conclusions: The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.

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The field of bioethics relies on the voices of nonexperts when finding solutions for bioethical issues. However, there are many factors that influence an individual’s capacity to participate in bioethics. These include one’s understanding of bioethics or the relevant jargon, one’s awareness of an issue, one’s ability to relate to an issue, and one’s desire to participate with an issue. Therefore, it is imperative that bioethicists communicate directly with nonexperts to minimize these barriers. After all, if discussions surrounding bioethical issues only include people with high ethical literacy, our solutions will be tainted by sampling bias.There are currently few strategies aimed at communicating bioethics directly to nonexperts. I propose that musical narratives might serve as a useful communication tool. Narratives are relatable, inspiring, and easier to understand than logical-scientific language. By adding music, it is possible that these narratives will evoke deeper emotions, and improve retention of the topic being discussed. Musical narratives could be a powerful tool for presenting bioethical issues in plain language, in a way that increases awareness, inspires reflection, and encourages productive discussions. / Urban Bioethics / Accompanied by two .mp3 audio files: 1) Compassionate Care Release.mp3 2) Harm Reduction.mp3

Diversifying the physician workforce is crucial for addressing healthcare disparities. Despite efforts to promote diversity, residency programs still have low representation of Black/African Americans. Our research, drawn from articles in the Temple University Libraries Database and Google Scholar Database up to March 2024, highlights differences in perceptions of program culture and racial diversity between URIM and non-URIM applicants. URIM applicants consider factors such as the authenticity of diversity, equity, and inclusion (DEI) efforts, as well as the racial climate when evaluating programs. Additionally, representation of URIM faculty and residents along with post-interview communication and events are important factors when assessing residency programs. There is limited literature on how Black/African American applicants' preferences influence diversity recruitment efforts. It is imperative for programs to incorporate feedback from URIM applicants to develop effective recruitment strategies and foster cultural shifts. By doing so, we can contribute to a more diverse and inclusive physician workforce capable of more effectively addressing health disparities that disproportionately affect Black/African Americans. / Urban Bioethics

Context: Data, primarily from the United States, indicates that Black women experience delays in breast cancer treatment, receive non-standard care, and have a lower survival rate. Canada is not immune to racial disparities, but race-based health data is not routinely collected. Objectives: To understand the lived experiences of Black women in Canada living with breast cancer. Methods: One-on-one semi-structured qualitative interviews were conducted with 20 women living in Toronto, Ontario who identified as Black/African/Caribbean and who were currently undergoing or had previously undergone treatment for breast cancer. Data was analyzed using an inductive, constant comparative method to derive themes. Results: Several themes were identified including 1) the importance of social support and community; 2) importance of faith and spirituality; 3) cultural considerations; 4) mental health and psychosocial support; 5) body image and intimacy challenges; 6) importance of fertility preservation; 7) financial burden; 8) lack of representation; and 9) mistrust of the healthcare system. The overarching theme was a sense of feeling alone, unseen, and unrepresented. Recommendations include the importance of advocacy, the need for race-based cancer and health data and the need for racially concordant care. Conclusion: Invisibility and anti-Black racism in healthcare settings are unique concerns for Black women with breast cancer in Toronto. Understanding their needs can help to dismantle medical racism and colourblind healthcare. Further research is needed to develop tools to address these inequities and work towards culturally appropriate and safe approaches. / Thesis / Master of Public Health (MPH) / Little is known about the breast cancer experiences of Black women in Canada. The purpose of this study is to explore the lived experiences of Black women in Toronto, Ontario with breast cancer, in order to understand their cancer journey. In the United States, Black women are more likely to develop aggressive breast cancer and to die from their disease compared to white women. The information learned from this study will begin to address a gap in the literature about Black women living with breast cancer in Canada.

BACKGROUND: During the COVID-19 pandemic, vaccines were developed in randomized controlled trials (RCTs). While RCT data informed decision-making, it may not apply to all populations. It is recommended that health equity stratifiers (HES) be used in RCT reporting, but their use in COVID-19 vaccine trials remains unclear. OBJECTIVES: To review the importance of HES reporting in primary research, examine the use of HES in COVID-19 vaccine trials, and discuss areas for improvements of health equity reporting. METHODS: This paper consists of three chapters. First, a literature review on social determinants of health, health equity during COVID-19, and research reporting practices was conducted. Second, COVID-19 vaccine trials consolidated in the COVID-NMA systematic review database from January 1, 2020, to February 8, 2023, were assessed for HES usage based on three criteria: 1) describing participants, 2) reporting equity-relevant results, and 3) discussing equity-relevant implications. Third, our findings are linked to literature on strategies to enhance health equity reporting. Results: Chapter One highlighted how reported data influenced vaccine prioritization with subsequent effects on health inequities. In Chapter Two, 144 RCTs were reviewed, where age (100%), place of residence (100%), and gender/sex (99%) were the most used HES to describe participants. Age was most often used to disaggregate or adjust results (67%), followed by gender or sex (35%). Discussions of equity implications typically described generalizability concerning age (40% of studies). Nearly half (47%) considered at least one HES for all three criteria. No trials reported on religion, socioeconomic status, sexual orientation, or features of relationships. Chapter Three identified ways authors, journals, and other groups can improve reporting. CONCLUSIONS: Effective reporting in primary research has an impact on health equity. Our review identified the state of health equity reporting in COVID-19 vaccine RCTs and proposed approaches to improve the reporting of HES. / Thesis / Master of Public Health (MPH) / During the COVID-19 pandemic, data from vaccine trials helped inform public health decisions. Some of these decisions were unfair towards different groups of people. This may have been due to poor data reporting in the vaccine trials. This data could include personal characteristics like sex, race, occupation, or where one lives. Thus, we examined data reporting in 144 COVID-19 vaccine trials. Most trials reported data on trial participants' age. There was much less reported use of other characteristics. Our results inform the discussion of how we can improve data reporting in research to reduce unfair health gaps.

Anthropological research conducted in a local Texas hospital provides data to analyze cultural competency. Increasing health equity is a key aspect of cultural competency literature, hospital, and national goals. Examining the local context allows for the analysis of how one hospital can affect public health in the area by using patient-centered care. Using observational and interview data to create the ideal of the patient journey shows how patient families experience cultural competency. Overall, the patient families felt they experienced culturally competent healthcare, however from the hospital structure perspective there could more goals to attain.