Browsing by Author "Hetherington, Erin"

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    Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta
    (2018-06-26) Winn, Anika; Hetherington, Erin; Tough, Suzanne
    Abstract Background Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women’s trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. Methods We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Results Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient’s care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. Conclusion Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.
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    Developing non-response weights to account for attrition-related bias in a longitudinal pregnancy cohort
    (2023-12-14) Pitt, Tona M.; Hetherington, Erin; Adhikari, Kamala; Premji, Shainur; Racine, Nicole; Tough, Suzanne C.; McDonald, Sheila
    Abstract Background Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the “All Our Families” longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models to predict study continuation versus drop-out from baseline to the three-year data collection wave. Methods Two methods of variable selection took place. One method was a knowledge-based a priori variable selection approach, while the second used Least Absolute Shrinkage and Selection Operator (LASSO). The ability of each model to predict continuing participation through discrimination and calibration for both approaches were evaluated by examining area under the receiver operating curve (AUROC) and calibration plots, respectively. Stabilized inverse probability weights were generated using predicted probabilities. Weight performance was assessed using standardized differences of baseline characteristics for those who continue in study and those that do not, with and without weights (unadjusted estimates). Results The a priori and LASSO variable selection method prediction models had good and fair discrimination with AUROC of 0.69 (95% Confidence Interval [CI]: 0.67–0.71) and 0.73 (95% CI: 0.71–0.75), respectively. Calibration plots and non-significant Hosmer-Lemeshow Goodness of Fit Tests indicated that both the a priori (p = 0.329) and LASSO model (p = 0.242) were well-calibrated. Unweighted results indicated large (> 10%) standardized differences in 15 demographic variables (range: 11 − 29%), when comparing those who continued in the study with those that did not. Weights derived from the a priori and LASSO models reduced standardized differences relative to unadjusted estimates, with the largest differences of 13% and 5%, respectively. Additionally, when applying the same LASSO variable selection method to develop weights in future data collection waves, standardized differences remained below 10% for each demographic variable. Conclusion The LASSO variable selection approach produced robust weights that addressed non-response bias more than the knowledge-driven approach. These weights can be applied to analyses across multiple longitudinal waves of data collection to reduce bias.
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    Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
    (2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
    This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
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    Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania
    (2017-02-07) Hetherington, Erin; Eggers, Matthijs; Wamoyi, Joyce; Hatfield, Jennifer; Manyama, Mange; Kutz, Susan; Bastien, Sheri
    Abstract Background Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene. Methods Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene. Results The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term. Conclusions The Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.
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    Using the social entrepreneurship approach to generate innovative and sustainable malaria diagnosis interventions in Tanzania: a case study
    (BioMed Central, 2010-02-03) Allen, Lisa K; Hetherington, Erin; Manyama, Mange; Hatfield, Jennifer M.; van Marle, Guido