Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.

Studies have indicated that the prevalence of mental health disorders among refugees has increased. The social capital and socioeconomic status of the host country are believed to influence the development and maintenance of mental health. This study aims to generate knowledge about the factors that affect adult refugees’ mental illness in Sweden and inquires as to the activities in the labor market for preventing mental illness among adult refugees in Sweden. This study was conducted using a scoping review method. The author analyzed 14 articles, and the results revealed that refugees are more prone to experiencing mental health problems, such as depression and anxiety, than native-born Swedes. This study revealed that the social capital and socioeconomic status of the host country may influence the development and maintenance of adult refugees’ mental health.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

No description available.

The Community Nurse Networker (CNN) pilot project represents an innovative collaboration between primary care, public health and municipal stakeholders, including a local neighbourhood resident planning team in a priority neighbourhood in Hamilton, Ontario. This pilot linked primary care to ongoing community development work. The goal of the CNN pilot was to address issues beyond physical health, and to consider issues related to the social determinants of health, or where people, live, work, and play. This developmental evaluation study used a qualitative descriptive approach (Sandelowski, 2000, 2010). Multiple perspectives and sources were used to describe the implementation of the CNN pilot, the following were collected and analyzed: Interviews (N=5), a focus group (participants = 11), documents (N=90), and a survey (N=1). The implementation of the pilot was described by the following foci: (a) conceptualization of the CNN’s roles and activities, (b) perceived barriers and enablers in implementing the CNN pilot, (c) perceived impacts of the intervention, and (d) perceptions surrounding the value of a nurse in the CNN position. The CNN pilot is a unique intervention, demonstrating how primary care can be a leader within the community, engaging with health and social services organizations and hard to reach populations. The findings of this study supported the ongoing development of the CNN position. It provided an example of a nurse-led intervention, with an integrative approach to primary care, community development, social, and health services. This study illustrates the potential for strengthened partnerships between primary care and the community within priority neighbourhoods. / Thesis / Master of Science (MSc)

This systematic review examined literature spanning the last 10 years from Canada, the U.K., the U.S.A., Australia, and New Zealand. Findings highlight the significant gap in comparative literature examining (structural) racism as a determinant of South Asian healthcare access, utilization, and outcomes, and identifies areas of future research to address South Asian health equity concerns. / Background: Race, or specifically racism, has been well-established as a critical determinant of health, though current healthcare practices and policies in Western countries do not adequately address these issues. South Asians are the largest minority group in Canada, and they face disproportionate rates of chronic illnesses, mental health conditions, and barriers to care globally. However, their experiences in healthcare settings and the impact of race and racism on their health equity remain unexplored. This systematic review examined whether race affects healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. Methods: Embase, PsycInfo, Ageline, and CINAHL, were searched following PRISMA guidelines, as well as Google Scholar. Articles from 2013-2022 were included if they discussed racism, discrimination, or disparities/inequalities in South Asian physical and mental health, healthcare access, and utilization, outcomes compared to White populations in Canada, the U.K., the U.S.A., Australia, and New Zealand. The Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. Data was synthesized narratively. Results: The review included 89 studies from Canada (n=19), the U.K. (n=51), the U.S.A. (n=17), and Australia (n=2), with most studies (n=76) utilizing cross-sectional or cohort designs and examining physical health outcomes (n=50). Study samples predominantly included Indians, Pakistanis, and Bangladeshis over other subgroups. Notably, there was no overall increase in comparative studies over the last decade; however, the U.K. observed an 85% increase compared to an 82% and 64% decrease in Canada and the U.S.A., respectively. The review also identified limited research on experiences within healthcare settings and mental health outcomes, sexual/reproductive health, and all health outcomes for children/youth. Few studies directly discussed the impacts of structural or organizational racism or discrimination on outcomes, though some commented on individual racism as well. Instead, studies relied on the social determinants of health as proxies for structural racism, such as education and income. Conclusion: This review highlights the significant lack of comparative research on the impact of structural, organizational, and individual racism on the healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. The review emphasizes the need for more primary, comparative research that quantifies and contextualizes South Asian experiences in obtaining healthcare services. Future research must employ rigorous and representative sampling methods, diverse study designs, and quantitative and qualitative measures that capture implicit, covert, and overt racism in healthcare among South Asians. Additionally, studies should measure factors such as religion, housing, language, and racialized institutional policies, in addition to the typically examined social determinants of health. Finally, this review highlights the need to collect and report disaggregated race and ethnicity health data with input from community leaders, and stratify these data by South Asian subgroups to avoid homogenization of distinct cultures and differential experiences in healthcare systems. Overall, acknowledging racism in healthcare and institutional policies is essential to effectively dismantle these issues and ensure health equity for South Asians. / Thesis / Master of Public Health (MPH)

This systematic review aims to examine the relationship between the social determinants of health that significantly impact the prevalence and progression of chronic kidney disease (CKD) amongst Black Americans. The Black American population has the highest prevalence of CKD in the United States, while concurrently possessing prominent genetic risk factors for this chronic disease. The social determinants: healthcare quality and access (extended to account for health behaviors), social and community context, and economic stability were specifically assessed in this review. Key terms were utilized to search electronic databases PubMed and Web of Science, which yielded 470 unduplicated articles. Twenty-nine articles met the inclusion criteria for this systematic review, with three articles being applicable to the three selected social determinants, six being applicable to social and community context, six being applicable to economic stability, and fourteen being applicable to healthcare quality and access. Major contributors towards CKD incidence and progression amongst Black Americans were identified to be: exposure to discrimination, expectations of discrimination and prejudice, low routine medical care, limited health literacy, distrust of health providers, being of low socioeconomic status, and a lack of engagement in functional health behaviors (fruit/vegetable consumption and CKD screening). Each social determinant was seldom observed to be operating exclusively as a contributing factor towards CKD, exemplifying how the intersectionality of these factors contributes to increased CKD risk and progression. Findings from this systematic review highlight the need for targeted healthcare initiatives for Black Americans to remedy the CKD endemic.

Background: The first wave of Somali-Canadian refugees arrived in the 1990s following the civil war, with many settling in Toronto. First generation Somali-Canadians faced significant discrimination and settlement challenges. Previous research on Canada immigrants found that second generation youth tend to have a bright socioeconomic outlook. However, this outlook is not so certain for Somali-Canadian youth as they face unique long-term challenges with systemic barriers. Additionally, the pandemic has disproportionately impacted Black communities. Thus, it is important to explore how the pandemic has impacted the employment and health of Somali-Canadian youth living in Rexdale. Methods: Through an IPA approach, semi-structured interviews were conducted with 8 Somali-Canadian youth between the ages of 18-25 living in the Rexdale neighbourhood. The interviews were then analyzed through the IPA perspective to generate themes. Results: Somali-Canadian youth experience precarious employment, unsafe working conditions, lost income, faced financial difficulties and an increased risk of exposure to COVID-19. Furthermore, these impacts were exacerbated by living with large families and immunocompromised family members. Participants accessed government COVID-19 supports but some were ineligible due to precarious work or concerns associated with accessing governmental assistance. The pandemic negatively impacted the mental health of youth due to financial worries, educational and interpersonal challenges, and cultural stigma. Additionally, the intersectional identities of the participants resulted in limited choices and access to coping strategies. Conclusions: In order to improve the physical and mental wellbeing of Somali-Canadian youth, and those who share their experiences, there needs to be greater investments into the social determinants of health including employment, healthcare, housing, income, and education. / Thesis / Master of Science (MSc) / In the 1990s, Somali refugees arrived in Canada following a civil war, with many settling in Toronto. The first wave of Somali refugees faced discrimination and settlement challenges. Generally, children of immigrants have a bright socioeconomic outlook. However, second-generation Somali-Canadian youth face unique challenges and systemic barriers. This study explores how the pandemic impacts the health and employment of the Somali-Canadian youth living in Rexdale. Eight semi-structured interviews with youth aged 18-25. The findings illustrated impacts such as precarious employment, unsafe work, lost income, and increased risk of exposure to COVID-19. The mental health of the youth was negatively impacted due to financial worries, educational and interpersonal challenges, and cultural stigma. Sadly, the intersectional identities of the participants resulted in limited choices and access to coping strategies. To improve the health and wellbeing of Somali-Canadian youth, there needs to be greater investments into the social determinants of health including employment, healthcare, housing, income, and education.

Background: The COVID-19 pandemic disrupted access to healthcare services in Canada, but little is known about the magnitude of unmet healthcare needs and characteristics associated with increased risk of unmet needs in the adult population. Objectives: First, to describe unmet healthcare needs, including COVID-19 testing access, and to evaluate the association of the social determinants of health (SDOH) and chronic conditions with unmet healthcare needs. Secondly, to evaluate the association between symptoms of depression and anxiety with unmet healthcare needs, and test if the interaction was modified by sex. Methods: The data of 23,972 adults who completed the Canadian Longitudinal Study on Aging COVID-19 Questionnaire Study exit survey (Sept.–Dec. 2020) was analyzed. Three outcomes were evaluated: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. For objective 1, a prospective cohort study was conducted. For objective 2, a cross-sectional study was conducted. RESULTS: Overall, 25% of adults in Canada reported challenges accessing healthcare, 8% did not go to a hospital or see a doctor when needed, and 4% experienced barriers to COVID-19 testing. Several SDOH, including sex, immigrant status, racial background, education and income, were associated with unmet needs. The odds of reporting all three outcomes declined with age. Pre-pandemic unmet needs were strongly associated with higher odds of all three outcomes, while the presence of chronic conditions was associated with higher odds of the first two outcomes. Symptoms of depression and anxiety were strongly associated with all three outcomes. Interaction with sex was found for the first outcome, with stronger associations in females. Conclusions: This thesis identified groups that experienced difficulties accessing healthcare services during the pandemic. Future research may assess consequences of unmet needs, evaluate mechanisms that cause unmet needs and determine ideal interventions. / Thesis / Master of Public Health (MPH) / The COVID-19 pandemic in Canada affected how individuals were able to access healthcare services. To understand which groups experienced a greater level of difficulties, we examined the experience of unmet healthcare needs during the first year of the pandemic using a sample of 23,972 adults that had completed the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (Sept. – Dec. 2020). We found evidence that the experience of unmet healthcare needs varied by several sociodemographic characteristics, such as sex, immigrant status, racial background, education and income. Younger adults were more likely to report unmet needs. Individuals with chronic conditions and those had reported unmet healthcare needs prior to the pandemic were also more likely to report unmet needs during the pandemic. Individuals with symptoms of depression and anxiety were also more likely to report unmet healthcare needs. These results can be used to inform interventions that improve access to healthcare services for vulnerable groups.

No description available.