Browsing by Author "Leal, Jenine Rocha"

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    An Evaluation of an Online Learning Module to Increase the Confidence and Self-Efficacy of Canadian Healthcare Trainees in Vaccine Communication, Advocacy, and Promotion.
    (2023-06) Doucette, Emily Jayne; Kellner, James Duncan; Constantinescu, Cora-Mihaela; Leal, Jenine Rocha; MacDonnald, Shannon Elizabeth; McNeil, Deborah Ann
    Introduction: Vaccine hesitancy is a significant threat to public health. Healthcare providers (HCPs) are well positioned to address vaccine hesitancy, however there are few accessible and multidisciplinary educational tools available to teach HCPs how to engage in challenging vaccine conversations. Based on this need, virtual simulation games (VSGs) were developed to improve the confidence and self-efficacy of HCP learners to prepare them for future roles in vaccine advocacy, delivery, and promotion. The objectives of this thesis were to 1) evaluate the impact of the VSGs on HCP learners’ confidence and self-efficacy; and 2) explore HCP learners’ previous experiences and qualitatively evaluate the VSGs prior to dissemination. Methods: This study, which utilized a pragmatic sequential embedded mixed-methods design, involved quantitative evaluation of the effectiveness of the VSGs through a pre-post study with 72 HCP learners, followed by qualitative focus groups with a subset of 22 participants. HCP learners in nursing (n=24), pharmacy (n=30), and medicine (n=18) were included from the University of Calgary and the University of Waterloo. Three key themes were identified through pragmatic thematic analysis. Results: No significant differences in baseline confidence and self-efficacy were identified across the three HCP disciplines. Only 54.2% of participants reported previously learning about vaccine communication in their programs. The VSGs significantly improved these attributes in all disciplines (P<0.001). During focus groups, participants expressed 1) their previous education lacked training on holding vaccine conversations, resulting in uncomfortable experiences; 2) the VSGs increased their confidence by providing novel tools and skills; and 3) participants provided feedback to improve the VSGs. Conclusions: This study supports the use of the VSGs as an effective educational tool as HCP learners showed significant improvement in their self-assessed confidence, self-efficacy, and willingness to engage in vaccine conversations. In particular, the VSGs introduced innovative strategies for HCP to initiate these conversations, and participants appreciated the emphasis on resilience and managing emotions. In combination with existing immunization training, these and future VSGs can be designed and implemented to allow HCP to address vaccine hesitancy more effectively to increase vaccine confidence and uptake.
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    The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services
    (2019-04-30) Leal, Jenine Rocha; Manns, Braden; Henderson, Elizabeth Ann; Conly, John M.; Ronksley, Paul Everett; Loeb, Mark; Noseworthy, Tom W.
    The clinical and economic burden of hospital-acquired Clostridioides difficile infection (HA-CDI) is significant, however there is uncertainty in the cost-effectiveness of implementing probiotics for the primary prevention of HA-CDI among hospitalized patients prescribed antibiotics. In this thesis we examined the predictors of mortality and length of stay among this patient population in Alberta. We determined the attributable cost of HA-CDI and applied these estimates in a cost-effectiveness analysis of probiotics for the primary prevention of HA-CDI in Alberta from the perspective of a publicly-funded healthcare system. We conducted three studies: a population-based, retrospective cohort study using clinical surveillance, administrative and laboratory databases to determine the predictors of 30-day all-cause and attributable mortality and length of stay; a propensity score-matched study to compare patients with HA-CDI to patients without CDI to determine the attributable cost of HA-CDI in Alberta; and a cost-effectiveness analysis using decision analytic modelling to evaluate the costs and consequences related to probiotic use for the primary prevention of CDI. We found that the incidence and mortality rates of HA-CDI are declining, though the latter was not statistically significant. Advancing age was associated with all outcomes after adjusting for a number of baseline factors. Increased baseline white blood cell counts were associated with a lower risk of mortality. Hospital-acquired CDI total adjusted costs were 27% higher and length of stay was 13% higher than non-cases of CDI. Oral probiotics as a preventive strategy for CDI resulted in a lower risk of CDI and cost-savings. Previous studies on the burden of HA-CDI have been limited in their size and scope. Our first study was the largest population-based cohort study evaluating predictors of mortality; while our second study was the first to use propensity score-matching and a micro-costing approach for the estimation of costs associated with HA-CDI. We were the first to conduct an economic evaluation of probiotics for the primary prevention of CDI. This work will be presented to Alberta Health Services to support the evaluation of probiotics as a preventive strategy against CDI and whether to scale up probiotics to all provincial hospitals.
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    ItemOpen Access