Browsing by Author "Tang, Karen"

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    A Qualitative Descriptive Exploration of the Determinants of Subjective Social Status and the Pathways Through Which Subjective Social Status Shapes Health and Well-Being
    (2024-03-26) Naser, Aruba; Olstad, Dana Lee; Tang, Karen; McClain, Amanda
    Abstract Introduction: Socioeconomic position (SEP) is traditionally measured using objective indicators (i.e. income, occupation, education) which may not capture the many pathways through which health inequities are generated. The MacArthur Scale of Subjective Social Status (SSS) is a subjective measure of SEP thought to reflect individuals’ perceptions of their social position, with high predictive utility for health. Despite the scale’s utility, there is limited research investigating the factors and reference groups that shape SSS. The mechanisms through which SSS shapes health also remain unclear, with literature suggesting both materialistic and psychosocial explanations. Objectives: Our study explored the factors and reference groups that working-aged adults consider when evaluating their SSS, and the pathways through which they perceive these factors shape their health and well-being. Methods: Our study employed qualitative descriptive methodology. We recruited 25 adults living in Alberta, aged 30-50, to participate in think-aloud style, semi-structured interviews. Data was analyzed using a semi-deductive, directed content analysis approach. Results: Four major themes summarized participants’ experiences: 1) The significance of reference groups in shaping SSS; 2) The big 3 determinants of SSS - Income, occupation, education; 3) Unique circumstances lead to unique conceptualizations of SSS; and 4) SSS affects mental wellbeing Conclusions: The primary determinants of SSS in working-aged adults in Canada are income, occupation and education. Additional determinants include gender, health and disability, and racial identity. Reference groups also significantly shaped SSS and differed across individuals. Study findings demonstrated that SSS shaped mental well-being through both materialist and psychosocial pathways, which suggests that researchers and policymakers must act upon structural SDH, especially income, education, and occupation, as well as upon the psychosocial stress resulting from social comparisons to reduce inequities in health.
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    An Examination of Patients’ Experiences with Navigation Services in Alberta’s Healthcare System
    (2024-06-20) Rabi, Sarah; Tang, Karen; Santana, Maria; McBrien, Kerry; Dimitropoulos, Gina
    Background: The concept of patient navigation (PN) was first envisioned to assist marginalized cancer patients access appropriate and timely healthcare resources. While this understanding of PN may still hold for a subgroup of programs today, the expansion of PN over the past 30 years has resulted in a diverse set of interventions with distinct care settings, patient eligibility criteria, navigator training, and program objectives. Noting this, our study sought to better understand how PN has evolved by gathering information on patients’ perspectives and interactions with PN programs across Alberta. Our objectives were to (i) explore patients’ current experiences with PN programs, and (ii) identify the features of PN felt to be of particular value to patients. Methods: To address these objectives, we conducted an interpretive descriptive study to collate the experiences of adult patients with longitudinal exposure to Albertan PN programs (involvement for greater than or equal to one month). Participant recruitment occurred via key informant sampling with navigators across Alberta. One-on-one semi-structured interviews were conducted to explore patient experiences with PN and their understanding of it as a broader concept. Inductive thematic analysis and interpretive exercises were subsequently performed to construct a coherent message from the data. Continued collaboration with two patient partners was maintained throughout the study to ensure responsiveness to patient priorities. Results: This study involved 23 participants with experience using nurse navigators, transition navigators, and lay community health navigators. Irrespective of navigation type, the participants’ stories were tethered by their navigators’ promotion of seamless and personalized care, as well as their ability to seemingly humanize the healthcare system. This was accomplished through a set of participant-identified navigator characteristics, including approachability, accessibility, and comprehensive systems knowledge. While the identified functions and characteristics of navigators were consistent across participants, how these components were operationalized varied based on the program’s setting and the particular needs of each patient. Conclusion: As a patient-centred intervention, understanding patients’ experiences and valuations of PN is critical to distilling the essence of the intervention. This research directly addresses ongoing knowledge gaps surrounding contemporary understandings of PN, particularly from patients’ perspectives.
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    Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?
    (Foundation for the Sociology of Health and Illness [Associate Organisation], Wiley [Commercial Publisher], 2022-03-08) Olstad, Dana Lee; Nejatinamini, Sara; Vanderlee, Lana; Livingstone, Katherine M; Campbell, David J. T.; Tang, Karen; Minaker, Leia M.; Hammond, David
    We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.
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    Barriers to data quality resulting from the process of coding health information to administrative data: a qualitative study
    (2017-11-22) Lucyk, Kelsey; Tang, Karen; Quan, Hude
    Abstract Background Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders. Methods We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality. Results The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations. Conclusions This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality.
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    Epidemiology of Alcohol-Related Hepatitis, Alcohol-Related Cirrhosis, and Non-Alcohol-Related Cirrhosis in Alberta, Canada: An Administrative Data Validation and Population-Based Study
    (2024-07-22) Swain, Liam Andrew; Shaheen, Abdel-Aziz; Godley, Jenny; McLaren, Lindsay; Tang, Karen; Brenner, Darren
    Background: Population-based studies evaluating the epidemiology of chronic liver diseases rely on accurate case definitions. This thesis aimed to develop new coding algorithms for alcohol- (AC) and non-alcohol-related cirrhosis (NAC) to use alongside a previously validated alcohol-related hepatitis (AH) coding algorithm to examine population-level AC, NAC, and AH hospitalization rate trends from 2012-2022, in Alberta, Canada. Methods: Using a randomly selected cohort of 700 admissions with diagnostic codes for alcohol- and cirrhosis-related conditions from the 2008-2022 Calgary Discharge Abstract Database (DAD), we validated (using electronic medical record review) newly developed and commonly used AC/NAC case definitions. The newly validated coding algorithms were used to select all adult AC/NAC/AH hospitalizations in the Alberta DAD from 2012-2022. All admissions were postal code matched to the 2016 Alberta Census data aggregated to the DA level. Temporal trends in annual sex/age-standardized hospitalization rates per 100,000 Alberta population were examined using Joinpoint analysis stratified by sex, age, area-level income quartile, and rural/urban residency. Results: Our new AC algorithm selecting codes for AC, alcohol-related hepatic failure, or alcohol use disorder (AUD) with a decompensated cirrhosis condition or NAC code provided higher accuracy than previous methods (AUROC 0.88 vs. 0.50-0.81, p<0.001). Our new NAC algorithm, excluding AUD codes and selecting for a NAC or a primary decompensated cirrhosis condition code provided higher accuracy than previous approaches (AUORC 0.87 vs. 0.58-0.76, p<0.001). Using these new algorithms, we determined that between 2012-2022, AC hospitalization rates increased only for urban females, those <35 years of age, and for those living in regions with the highest area-level income. AH hospitalization rates increased predominantly for people <35 years and for females. During the COVID-19 pandemic AC/AH hospitalization rates significantly increased for those from rural and low-income areas. NAC hospitalization rates were not impacted by the COVID-19 pandemic, only increasing in people ≥65 years. Conclusions: The new case definitions exhibit enhanced AC/NAC identification accuracy compared to previous methods. Over the past decade, AC/AH hospitalizations increased in younger and female populations, and NAC hospitalizations steadily increased in older populations.
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    Patient-Reported Outcome Measures to Inform Measurement-based Care for Youth Living with Mental Health Concerns: A mixed method study
    (2024-03-19) Thapa Bajgain, Kalpana; Santana, Maria; Zwicker, Jennifer; Aghajafari, Fariba; Tang, Karen
    Measurement-based care (MBC) describes the process of routinely using outcome measurement to guide treatment decisions supporting Patient-centered Care (PCC). Patient-reported Outcome Measures (PROMs) play a vital role in MBC supporting the delivery of PCC. Despite the evidence on the benefits of using PROMs in clinical care, some barriers hinder the selection of the PROMs, such as the different age groups for youth and poor consensus on which measurements are best practices and most appropriate for this population. This mixed-methods, multi-phased study addresses some of these gaps by focusing on identifying, selecting, and prioritizing the PROMs to be implemented in the clinical care of youth with depression and/or anxiety to inform the MBC program at the Summit Center. The first phase of this thesis work includes three stages: 1) a systematic review to identify, evaluate, and synthesize the global evidence on the use of PROMs in youth mental health clinical care 2) In the second stage, we create and combine a database of PROMs from different sources. In the third step, we selected the top 10 PROMs to prioritize in Phase 2. The selected top 10 PROMs were: Beck Depression Inventory (BDI), Child Behavioral Checklist (CBC), Child Health Questionnaire (CHQ), KIDSCREEN 10, Pediatric Quality of Life Inventory (PedsQL), Revised Children's Anxiety and Depression Scale (RCAD 25), Spence Children’s Anxiety Scale (SCAC), Screen for Child Anxiety Related Disorder (SCARED), Strength and Difficulties Questionnaires (SDQ), and The Young Person’s Core (YP-CORE). Then, in Phase 2, we conducted the Nominal Group Technique (NGT) with youth living with depression and anxiety and their family caregivers to prioritize these top 10 PROMs. The top PROMs ranked by youth were RCAD 25, BDI, YP-CORE, SCAS, SCARED, CBCL, PedsQl, SDQ, KIDSCREEN 10, and CHQ, while families/caregivers top-ranked RCAD 25, SCARED, YP-CORE, KIDSCREEN 10, SCAS, CBCL, PedsQl, SDQ, BDI, and CHQ. In summary, the findings of this study informed the MBC program at the Summit Center and presented an excellent opportunity to leverage the findings of this study to support the scale-up implementation of PROMs in the clinical care for youth living with mental health in Alberta.
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    Patient-reported outcome measures used to improve youth mental health services: a systematic review
    (2023-02-14) Thapa Bajgain, Kalpana; Amarbayan, Mungunzul; Wittevrongel, Krystle; McCabe, Erin; Naqvi, Syeda F.; Tang, Karen; Aghajafari, Fariba; Zwicker, Jennifer D.; Santana, Maria
    Abstract Background Patient-reported outcome measures (PROMs) are standardized and validated self-administered questionnaires that assess whether healthcare interventions and practices improve patients’ health and quality of life. PROMs are commonly implemented in children and youth mental health services, as they increasingly emphasize patient-centered care. The objective of this study was to identify and describe the PROMs that are currently in use with children and youth living with mental health conditions (MHCs). Methods Three databases (MEDLINE, EMBASE, and PsycINFO) were systematically searched that used PROMs with children and youth < 18 years of age living with at least one diagnosed MHC. All methods were noted according to Preferred Reporting Items for Systematic reviews and Meta-Analysis. Four independent reviewers extracted data, which included study characteristics (country, year), setting, the type of MHC under investigation, how the PROMs were used, type of respondent, number of items, domain descriptors, and the psychometric properties. Results Of the 5004 articles returned by the electronic search, 34 full-texts were included in this review. This review identified both generic and disease-specific PROMs, and of the 28 measures identified, 13 were generic, two were generic preference-based, and 13 were disease-specific. Conclusion This review shows there is a diverse array of PROMs used in children and youth living with MHCs. Integrating PROMs into the routine clinical care of youth living with MHCs could improve the mental health of youth. Further research on how relevant these PROMs are children and youth with mental health conditions will help establish more uniformity in the use of PROMs for this population.
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    Prioritizing Patient Reported Outcome Measures (PROMs) to use in the clinical care of youth living with mental health concerns: a nominal group technique study
    (2024-02-21) Bajgain, Kalpana Thapa; Mendoza, Justino; Naqvi, Farwa; Aghajafari, Fariba; Tang, Karen; Zwicker, Jennifer; Santana, Maria-Jose
    Abstract Background In the past few decades, particularly in the mental health setting, there has been growing interest in using Patient Reported Outcome Measures (PROMs) to assess the efficacy of the treatments in healthcare systems. Despite recent initiatives for global harmonization, there remains a lack of consensus on which PROMs are best practice and appropriate. Engagement of the service users, such as patients and family members/caregivers, is vital at this stage to ensure the selected PROMs are feasible, relevant, and acceptable to them. This study aimed to prioritize PROMs by youth and family/caregiver based on feasibility, relevance, and overall importance to be used in the clinical care of youth living with anxiety and/or depression. Methods Ten validated and widely used PROMs were presented to the patients and family/caregivers. Nominal group techniques were employed to prioritize the PROMs based on feasibility, relevance, and overall importance. Results For patients and families/caregivers, the PROMs, Revised Child Anxiety and Depression Scale (RCAD 25), and The Young Person’s Core (YP-CORE) were the highest priorities. Both felt that RCAD 25 was comprehensive, short, easy, and quick to complete, whereas regarding YP-CORE, patients and family/caregivers thought it was also short and relevant. Due to some specific concerns, the Strength and Difficulties Questionnaire and Child Health Questionnaire were the lowest prioritized by patients and family/caregivers. Conclusion It is of utmost importance that patient’s and family/caregivers’ voices or opinions are considered while selecting and implementing PROMs in mental health settings. Our study provides practical recommendations around measures best suited to achieve this.
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    Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways
    (Elsevier, 2021-10-07) Olstad, Dana Lee; Nejatinamini, Sara; Kirkpatrick, Sharon I; Vanderlee, Lana; Livingstone, Katherine M; Campbell, David J T; Tang, Karen; Minaker, Leia M; Hammond, David
    Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. Objective: This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. Design: Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Participants and setting: Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Main outcome measures: Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Statistical analyses performed: Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. Results: There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. Conclusions: Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.
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    Subjective social status and its associations with social vulnerabilities and health
    (2017) Tang, Karen; Ghali, William; Manns, Braden; Rabi, Doreen; Santana, Maria
    BACKGROUND: Subjective social status (SSS) is the perception of where one stands in a social hierarchy, distinct from one’s actual, objective position in this hierarchy. SSS may influence health through behavioral and psychosocial mechanisms. METHODS: We conducted three sub-studies to examine whether SSS affects risk of and outcomes in chronic disease, and to explore the role of health care access and experience of social vulnerabilities in the SSS-health pathway. RESULTS: We found that low SSS is associated with increased risk of 1) cardiovascular disease; 2) hospital readmissions and barriers to health care access; and 3) social vulnerabilities that affect health care access. Having high perceived status in the community appears to mitigate the experience of social vulnerabilities through the ability to mobilize social supports. CONCLUSION: Subjective social status has important associations with health and clinical outcomes. These findings have implications to the development of interventions that aim to reduce disparities.