Browsing by Author "Henderson, Rita"

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    A realist review of best practices and contextual factors enhancing treatment of opioid dependence in Indigenous contexts
    (2023-03-17) Henderson, Rita; McInnes, Ashley; Danyluk, Ava; Wadsworth, Iskotoah’ka; Healy, Bonnie; Crowshoe, Lindsay
    Abstract Objectives The objective of this study was to examine international literature to identify best practices for treatment of opioid dependence in Indigenous contexts. Methods We utilized a systematic search to identify relevant literature. The literature was analysed using a realist review methodology supported by a two-step knowledge contextualization process, including a Knowledge Holders Gathering to initiate the literature search and analysis, and five consensus-building meetings to focus and synthesize relevant findings. A realist review methodology incorporates an analysis of the complex contextual factors in treatment by identifying program mechanisms, namely how and why different programs are effective in different contexts. Results A total of 27 sources were identified that met inclusion criteria. Contextual factors contributing to opioid dependence described in the literature often included discussions of a complex interaction of social determinants of health in the sampled community. Twenty-four articles provided evidence of the importance of compassion in treatment. Compassion was evidenced primarily at the individual level, in interpersonal relationships based on nonjudgmental care and respect for the client, as well as in more holistic treatment programs beyond biophysical supports such as medically assisted treatment. Compassion was also shown to be important at the structural level in harm reduction policies. Twenty-five articles provided evidence of the importance of client self-determination in treatment programs. Client self-determination was evidenced primarily at the structural level, in community-based programs and collaborative partnerships based in trust and meaningful engagement but was also shown to be important at the individual level in client-directed care. Identified outcomes moved beyond a reduction in opioid use to include holistic health and wellness goals, such as improved life skills, self-esteem, feelings of safety, and healing at the individual level. Community-level outcomes were also identified, including more families kept intact, reduction in drug-related medical evacuations, criminal charges and child protection cases, and an increase in school attendance, cleanliness, and community spirit. Conclusions The findings from this realist review indicate compassion and self-determination as key program mechanisms that can support outcomes beyond reduced incidence of substance use to include mitigating systemic health inequities and addressing social determinants of health in Indigenous communities, ultimately healing the whole human being.
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    Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework
    (2024-04-29) Sehgal, Anika; Henderson, Rita; Murry, Adam; Crowshoe, Lynden (.; Barnabe, Cheryl
    Abstract Background Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. Methods A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. Results A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. Conclusions The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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    An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change
    (2020-12-05) Leslie, Myles; Khayatzadeh-Mahani, Akram; Birdsell, Judy; Forest, P. G; Henderson, Rita; Gray, Robin P; Schraeder, Kyleigh; Seidel, Judy; Zwicker, Jennifer; Green, Lee A
    Abstract Background Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementation history of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Methods Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n = 20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses. Results Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success. Conclusions Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.
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    Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol
    (2018-03-02) Mrklas, Kelly J; MacDonald, Shannon; Shea-Budgell, Melissa A; Bedingfield, Nancy; Ganshorn, Heather; Glaze, Sarah; Bill, Lea; Healy, Bonnie; Healy, Chyloe; Guichon, Juliet; Colquhoun, Amy; Bell, Christopher; Richardson, Ruth; Henderson, Rita; Kellner, James; Barnabe, Cheryl; Bednarczyk, Robert A; Letendre, Angeline; Nelson, Gregg S
    Abstract Background Despite the existence of human papilloma virus (HPV) vaccines with demonstrated safety and effectiveness and funded HPV vaccination programs, coverage rates are persistently lower and cervical cancer burden higher among Canadian Indigenous peoples. Barriers and supports to HPV vaccination in Indigenous peoples have not been systematically documented, nor have interventions to increase uptake in this population. This protocol aims to appraise the literature in Canadian and global Indigenous peoples, relating to documented barriers and supports to vaccination and interventions to increase acceptability/uptake or reduce hesitancy of vaccination. Although HPV vaccination is the primary focus, we anticipate only a small number of relevant studies to emerge from the search and will, therefore, employ a broad search strategy to capture literature related to both HPV vaccination and vaccination in general in global Indigenous peoples. Methods Eligible studies will include global Indigenous peoples and discuss barriers or supports and/or interventions to improve uptake or to reduce hesitancy, for the HPV vaccine and/or other vaccines. Primary outcomes are documented barriers or supports or interventions. All study designs meeting inclusion criteria will be considered, without restricting by language, location, or data type. We will use an a priori search strategy, comprised of key words and controlled vocabulary terms, developed in consultation with an academic librarian, and reviewed by a second academic librarian using the PRESS checklist. We will search several electronic databases from date of inception, without restrictions. A pre-defined group of global Indigenous websites will be reviewed for relevant gray literature. Bibliographic searches will be conducted for all included studies to identify relevant reviews. Data analysis will include an inductive, qualitative, thematic synthesis and a quantitative analysis of measured barriers and supports, as well as a descriptive synthesis and quantitative summary of measures for interventions. Discussion To our knowledge, this study will contribute the first systematic review of documented barriers, supports, and interventions for vaccination in general and for HPV vaccination. The results of this study are expected to inform future research, policies, programs, and community-driven initiatives to enhance acceptability and uptake of HPV vaccination among Indigenous peoples. Systematic review registration PROSPERO Registration Number: CRD42017048844
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    Caribou Conservation Guided, Enacted, and Embodied by Inuinnait and the Killinikmiut Tuktuit
    (2024-05-13) Hanke, Andrea; Kutz, Susan; Adams, Cindy; Henderson, Rita; Blue, Gwendolyn; Leclerc, Lisa-Marie; Wilson, Warren; Snook, Jamie; Dumond, Amanda
    The fields of environmental and wildlife conservation are working to increase the complexity of their approaches to knowledge in the face of increasing conservation precarity and recognition of the rights of Indigenous Peoples. Epistemic plurality, the focus of many strategies and initiatives, acknowledges the validity and value of multiple ways of knowing, recognizing that a more holistic understanding may be reached by drawing from multiple ways of knowing. In the central Canadian Arctic, Inuinnait share a rich cultural history as a distinct collective of Inuit, including their connection to the Killinikmiut Tuktuit. This herd, also known as the “Dolphin and Union” (DU) caribou herd or Island caribou, is a unique ecotype of caribou who characteristically summers on Victoria Island (Killinik), winters on the adjacent mainland, and crosses the adjoining sea ice during their fall and spring migrations. Conservation of this herd occurs under co-management and must incorporate multiple ways of knowing to make the best decisions for the caribou, the people, and the land. In this thesis, I sought to support the co-management partners for the Killinikmiut Tuktuit by advancing our collaborative understanding of the status and trends of the Killinikmiut Tuktuit with Inuinnait Knowledge and how Inuinnait Knowledge around the Killinikmiut Tuktuit is situated. Through a series of interviews with Inuinnait in Kugluktuk, Ekaluktutiak, and Ulukhaktok, I documented information on Inuinnait systems of knowing caribou, their expected variations, and their combined strengths. This information provides insight into how Inuinnait knowledge must be treated and respected when considered in management decisions. I also documented information on caribou systems, their expected variations, and their current adaptations. This information addresses knowledge gaps in the Killinikmiut Tuktuit management plan and has already supported important conservation decisions. This thesis provides important examples in the processes of negotiations and accommodation, both which are necessary for community-based, collaborative research. More broadly, the research advances the practice of epistemic plurality and supports the implementation of Indigenous/Inuit-led policy documents.
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    Improving the health of Indigenous peoples: Exploring patient health complexity among urban Indigenous patients in Canada
    (2023-04-20) Sehgal, Anika; Barnabe, Cheryl; Crowshoe, Lindsay (Lynden); Henderson, Rita; Murry, Adam
    Patient complexity is deemed to arise from a combination of personal, social, and external factors that can complicate medical approaches to care. Formal tools called patient complexity assessment tools (PCATs) have been developed to help identify and address these factors. However, current PCATs are not inclusive of the unique determinants of health impacting Indigenous peoples, including those which arise from a legacy of colonialism. The current thesis aimed to address this gap by identifying the domains and components that should be included in a PCAT designed specifically for Indigenous patients. The first study of this thesis was a scoping review that explored the extent to which existing PCATs are inclusive of the realities that shape the health of Indigenous peoples. Findings identified a major gap in the capacity of existing PCATs to effectively address the realities that shape the health of Indigenous patients. The second study of this thesis was a qualitative study that explored how health complexity is experienced by urban Indigenous peoples and the contexts that allow health complexity to persist. Findings revealed material resource disparities and adverse interpersonal interactions within the healthcare environment to be sources of health complexity. The third study of this thesis aimed to determine the critical components that are indicative of health complexity among Indigenous patients. An Indigenous-centered patient complexity assessment framework was developed to serve as a source of reference for healthcare providers, and policy/decision makers. This thesis presents a framework to understand the root causes of health complexity among Indigenous patients, identify where there may be gaps in healthcare systems to effectively address complexity, and provide reference for future clinical tools that will assess complexity among Indigenous patients.
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    Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies
    (2021-07-28) Henderson, Rita; McInnes, Ashley; Mackey, Leslee; Bruised Head, Myles; Crowshoe, Lindsay; Hann, Jessica; Hayward, Jake; Holroyd, Brian R.; Lang, Eddy; Larson, Bonnie; Leonard, Ashley J.; Persaud, Steven; Raghavji, Khalil; Sarin, Chris; Virani, Hakique; Wadsworth, Iskotoahka W.; Whitman, Stacey; McLane, Patrick
    Abstract Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD.
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    Participant-reported effect of an Indigenous health continuing professional development initiative for specialists
    (2021-02-18) Barnabe, Cheryl; Kherani, Raheem B; Appleton, Tom; Umaefulam, Valerie; Henderson, Rita; Crowshoe, Lynden
    Abstract Background Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients.
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    The Role of Sport in Promoting Wellness Among Indigenous Youth: A Qualitative Study for Policy and Practice
    (2023-09-25) Mortimore, Emma; Henderson, Rita; Crowshoe, Lynden (Lindsay); Roach, Pamela; Murry, Adam
    This work builds on a multi-year community outreach platform led by the Indigenous, Local and Global Health Office at the University of Calgary’s Cumming School of Medicine, to investigate how sport may be supportive of wellness in Indigenous youth. It builds on literature that has shown the promise of sport as a population-level approach for promoting wellness among youth. For this qualitative study, we interviewed eight Indigenous individuals involved in sport, either in their youth or in a leadership capacity as an adult, asking: how do sports support Indigenous youth wellness? Two rounds of iterative thematic analysis were conducted, first investigating how participants described wellness, then assessing how sport acted to promote their concepts of wellness. Participants described the concept of wellness through four core components: i) belonging to something greater than yourself, ii) developing identity, iii) overcoming adversity, and iv) belonging and contributing to a community of support. In investigating how sport supports wellness, one major theme emerged that crosscut all others: connectedness. This manifested at the personal, interpersonal, and wider social levels in the lives of participants. This work culminates in considering how existing frameworks for youth wellbeing can be expanded to better include Indigenous perspectives. Findings are oriented to policy action in the Cumming School of Medicine, as well as aim to influence change of practice for those working with Indigenous youth in sport more broadly.
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    “There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic
    (2020-11-25) Loyola-Sanchez, Adalberto; Pelaez-Ballestas, Ingris; Crowshoe, Lynden; Lacaille, Diane; Henderson, Rita; Rame, Ana; Linkert, Tessa; White, Tyler; Barnabe, Cheryl
    Abstract Background Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.
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    Truth and Reconciliation in the Workplace: Indigenous Employment Experiences and Perceptions of Organizational Support
    (2023-09-22) Grier, Melanie Ann; Murry, Adam; Bourdage, Josh; Markides, Jennifer; Henderson, Rita
    Background: Truth and reconciliation with Indigenous people in Canada is of paramount importance, but despite initiatives like the Truth and Reconciliation Commission of Canada’s Calls to Action in 2015, progress is sluggish, particularly in sectors related to employment. Since poverty and underemployment directly impact disparities in all other sectors (e.g., education, health, and criminal justice), employment must remain a focus of truth and reconciliation efforts. Unfortunately, barriers like organizational ignorance of how to support Indigenous employees impede meaningful Indigenous participation in the workforce, highlighting the need for intervention. Responding to these calls, this pragmatic, action research-oriented qualitative investigation identifies sources of organizational support for Indigenous post-secondary employees using theoretical concepts from organizational psychology to support leaders in effectively and appropriately supporting Indigenous employees. Methods: Using a purposive sampling approach, 18 self-identified Indigenous staff and faculty members at public post-secondary research institutions in southwestern Canada agreed to participate in the study. I conducted semi-structured interviews with participants to discuss their work experiences and perceptions of organizational support. Iterative inductive and deductive thematic analysis was used to describe common themes within the interview transcripts. Results: Three prominent themes emerged: Stay Factors (encompassing Reciprocity and Belonging), Retention Factors (comprising Institutional, Cultural, Individual, and Relational Support Factors), and Leave Factors (consisting of Workload, Discrimination, and Organizational Dysfunction). Participants reported supportive attributes of their work directly from their institution, such as monetary rewards and benefits, as well as indirect supports that provide new ideas for organizationally supportive policies and services, such as culturally responsive performance review and advancement policies. These findings highlight various retention factors, emphasizing opportunities for organizational leaders to strengthen support for Indigenous post-secondary employees. Conclusion: This study offers theoretical contributions and provides concrete recommendations for how organizations can support Indigenous employees in post-secondary institutions and beyond. Using these findings as a stepping stone, organizations can more effectively support Indigenous employees and contribute to tangible truth and reconciliation progress.