Co-leads:
- Lise Olsen
UBC
- Lois McNary
Special Olympics BC
- Tara Nault
Indigenous Sport Physicial Activity and Recreation Council
- Jean-Paul Collet
UBC
- Stephanie Glegg
BC Children’s Hospital Research Institute /Â BC Children’s Hospital and Sunny Hill Health Centre for Children /Â UBC
- Mojgan Gitimoghaddam
UBC
- William McKellin
UBC
|
Executive sponsor:
- Matt Herman
BC Ministry of Health
- Anne Fuller
Ministry of Children and Family Development
|
Few physical recreation programs exist for children with neurodevelopmental challenges, particularly in rural settings and in Indigenous communities.
This project’s goal is to study the implementation of a new physical activity coaching approach (NPAC) for children with neurodevelopmental challenges and their families.
Key components of the approach include personalized child-centred coaching; home-based activity components (using an app); an online networking site for parents and coaches; and social activities for parents. This approach has previously been tested with families in urban settings. The aim is to assess how it can be implemented for those living in rural and Indigenous communities in BC.
The project objectives will be to assess different ways to implement NPAC in diverse communities and to develop a model that outlines the key steps and strategies that can be used with other Indigenous and rural communities. The team will use an Indigenous-inclusive approach and a framework for developing and sharing knowledge that includes community members through all stages of the process. Over the course of three years, the team expects to implement and evaluate the NPAC in a total of 16 sites in close collaboration with their provincial and community-level project stakeholders and partners.
The team seeks to:
- Measure the impacts that implementation of the NPAC across the sites will have on health and well-being at child, family and community levels.
- Examine factors that helped or hindered implementation of the NPAC across the sites and how this information can help to generate a model or set of guidelines to help other rural and Indigenous sites use the NPAC.
- Increase abilities among community members to support physical activity for children and families living with neuro-developmental challenges.
They anticipate the project will contribute to more inclusive and equitable participation in physical recreation for rural and Indigenous families in BC and contribute to their improved health and well-being.
| Co-leads:
|
Executive sponsor:
- Heather Davidson
BC Ministry of Health
|
Too often, promising technological innovations are not adopted, are abandoned or face other serious challenges to their uptake, spread and sustainability in real-world contexts (including in peopleâs homes, community settings, or health systems more broadly). This project aims to apply a new framework for theorizing and evaluating this phenomenon to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.
By using a community-based participatory research methodology, the team will bring researchers, key health system decision-makers, technology developers, caregivers and older adults together into an inquiry team, focused on overcoming challenges to embedding ATs in end-usersâ real-world contexts and identifying positive factors that support their uptake, spread and sustainability.
This project will directly address two BC health system priorities. Focusing on patients with complex medical conditions as well as the commitment to keeping seniors in their homes as long as safely possible (aging in place), the ATs are focused on improving the health and quality of life of older adults living with complex care needs and multiple chronic health conditions, as well as the onset of frailty.
The research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for enhancing access to primary health care, as many of the innovations are aimed at making communication and interventions between older adults and their primary health-care practitioners, including physicians, nurses and home support workers more effective.
The projectâs objectives are to:
- Contribute to the body of knowledge concerning effective implementation science approaches to the uptake, spread and sustainability of assistive technologies in home and community care settings.
- Provide the provincial health system with a more effective framework for innovative technology assessment and evaluation and to give BC Ministry of Health and provincial health authority staff training opportunities in using the framework.
- Directly improve the uptake, spread and sustainability of promising ATs in British Columbia.
- Develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.
Co-leads:
- Sonia Singh
Fraser Health
- Larry Funnell
Patient partner
- Tania Bubela
SFU
|
Executive sponsor:
- Linda Dempster
Fraser Health
|
Low-trauma fractures (which occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis and can lead to significant disability, and even death, for patients. One low-trauma fracture often leads to a cycle of recurrent fracture. For example, approximately 50 percent of patients who suffer a hip fracture have a history of past fracture.
In BC, the annual cost for osteoporosis-related fractures has been estimated at $269 million for hospital care, Medical Services Plan and Pharmacare alone. Despite the availability of effective treatments that reduce future fracture risk by up to 50 percent, less than 20 percent of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.
The evidenced-based Fracture Liaison Services (FLS) model has been adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who captures the patient at the point of orthopedic care for the low-trauma fracture and integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link fracture patients with community family physicians to ensure sustainability and follow-through of initiated interventions to prevent another fracture.
In 2012, the Secondary Fracture Prevention Research Team in Fraser Health (FH) brought together osteoporosis and fall prevention experts to develop an FLS model that fit the context of the BC health-care environment. In 2015, the model was implemented at Peace Arch Hospital (PAH).
A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions taken up by low-trauma fracture patients in the FLS group compared with a control group. FLS is now a permanent program at PAH. In this project, the team will explore how the FLS model implemented at one hospital can be successfully adapted and scaled-up to other hospital sites within FH.
Consolidated Framework for Implementation Research (CFIR) 16 will inform the teamâs implementation strategy and the RE-AIM 17 model will frame the process and outcome evaluation. The key outcome is to inform an FLS implementation strategy that can be used to spread the FLS model across BC, thereby improving patientsâ quality of life after low-trauma fractures and decreasing health care costs related to recurrent fracture.
| Co-leads:
|
Executive sponsor:
- Matt Herman
BC Ministry of Health
|
A large proportion of Canadians are approaching older age. Those older than 65 will comprise more than 30 percent of Canadaâs population by 2050. An increasing number of older adults are unable to sustain their health and are negatively affected by chronic disease, social isolation or mobility issues.
Despite the inextricable link between physical activity and chronic disease prevention, older adults are the least active Canadians. Thus, strategies that effectively enhance physical activity are key for preserving older adultsâ health and independence.
In partnership with the BC Ministry of Health, the team developed an effective health promotion intervention for older adults called Choose to Move (CTM) that was scaled-up across BC. In CTM, older adults work with an activity coach to choose physical activities they like and are able to do. The scale-up study demonstrated that CTM increased older adultsâ physical activity, mobility and social connectedness.
For this project, the team will focus on a part of implementation science called the âscale-outâ which is defined as an extension of âscale-upâ; it refers to the use of strategies to implement an evidence-based intervention to new populations and/or through new delivery systems. Simply speaking, the team will adapt CTM so that it can be implemented by different community organizations (delivery partners) in 16 rural and remote communities across BC, as well as with older adults of low income in Vancouver. With delivery partners, the team will monitor changes that enable a âbest fitâ for CTM in older adults who live in different communities across BC. The team is guided by the Framework for Successful Implementation.
The projectâs specific research objectives are to:
- Describe implementation strategies that support CTM at scale-out.
- Describe how CTM is adapted for scale-out.
- Assess the impact of CTM on older adultsâ physical activity, mobility, social connectedness and loneliness.
The guideline document that will be created through this project will be able to be used to direct processes, strategies and evaluation of health promotion initiatives for other programs and practices within public health and health services sectors.
| Co-leads:
|
| Executive sponsor:
|
Each year, 30 percent of seniors have at least one fall â half of whom fall more than once. In fact, nine out of 10 hip fractures result from falls.
Fortunately, falls are preventable. There is strong evidence that the Otago Exercise Program, which consists of strength and balance training delivered by a physiotherapist, can reduce falls in this population. Seniors who are at risk of a fall are the prime population to benefit from the Otago program, but as little as 25 percent of people who start the program continue with it over time.
The research team recently demonstrated that exercise coaching with the use of a consumer wearable, such as a Fitbit, was feasible and could help older adults with chronic disease to stay active. A key element was to empower the person to develop realistic exercise goals.
In this project, the team will test two methods of delivering the Otago program, which includes a new coaching approach by a physiotherapist and the use of a Fitbit to provide feedback (versus the traditional delivery, which is the current standard).
The team will measure success by the degree to which the program is delivered as intended, and the degree to which it is followed by seniors at 12, 18 and 24 months. The number of falls, risk of falling, and participation in walking activities between the two groups will also be assessed over time. In addition, the team will assess whether the coaching approach is a cost-effective option for delivering the Otago program.
Given the serious consequences, fall prevention is a high priority in BC. To this end, the team has brought together a team of national leaders in fall prevention and implementation science, as well as health system partners and a prominent national patient group to address this important issue.
|
Co-leads:
- Gina Ogilvie
UBC
- Marette Lee
BC Cancer
|
|
Executive sponsor:
- Dirk van Niekerk
BC Cancer
|
Cervical cancer is caused by persistent infection with human papillomavirus (HPV). It can be prevented with early detection through regular screening. Irregular or non-attendance to screening is one of the key barriers to further reducing cervical cancer rates in BC. HPV DNA testing is an evidence-based, highly sensitive, and effective way to screen for cervical cancer, where women can collect the sample for testing at home (HPV self-collection).
This project will look to HPV DNA testing as the best way to implement at-home cervical cancer screening for under-screened populations in BC.
Two implementation approaches will be used:
- CervixCheck, an online service for at-home cervical cancer screening for women who do not regularly attend screening, piloted in selected family medical clinics in Surrey, BC and in northern BC in partnership with Métis Nation BC.
- At-home screening piloted in First Nations community health centres in partnership with Carrier Sekani Family Services in rural northern BC.
By offering women an alternative to clinician collected samples for screening, this work can address many of the personal, geographic, historical and system-level barriers women face. However, as with other screening programs, HPV screening identifies women most at risk for progressing to cervical cancer, and is not a diagnostic tool in itself. Therefore, it is necessary to examine implementation and evaluate engagement in the full pathway of screening, diagnosis, treatment, and follow-up.
Through an implementation science approach, this project aims to:
- Determine strategies to optimally engage under-screened women through the full pathway of screening, diagnosis, treatment and follow-up, primarily with colposcopy.
- Assess the needs, gaps, and facilitators at the user, clinical, and health system levels to inform adaptability for other settings and contexts in the province.
Quantitative and qualitative methods will be applied, using the Quality Implementation Framework to inform evaluation design.
The outcomes for this project will be adoption, penetration, fidelity, and safety. Planning and development is already underway for the pilot implementation of CervixCheck. A critical aspect of this approach will be to assemble a team of stakeholders at the community level in pilot sites including patient advocates and physician and nursing leads, as well as at the health system level at the BC Cancer Cervical Cancer Screening Program and the BC Colposcopy Program.
|
Co-leads:
- William McKellin
UBC
- Lois McNary
Special Olympics BC
- Jean-Paul Collet
UBC
|
|
Executive sponsor:
- Matt Herman
BC Ministry of Health
|
Parents of up to 60,000 children with neurodevelopmental disabilities (NDD) in BC are searching desperately for interventions that could improve their child’s condition with the profound desire to reach normal communication and integration. Previous work has found that attending community-based physical activity programs (PAPs) improves motor performance, cognitive functioning, social integration, emotional well-being and daily functioning for children with NDD. Families also became more resilient by developing social PAP-related networks. The same studies, however, also showed huge variations in coaching practice and gaps with regard to best practice.
This project will involve the implementation of an evidence-informed, goal-oriented coaching approach to optimize the health benefits of community-based PAPs for children with NDD. The development of the coaching intervention is funded by Kids Brain Health Network.
The community-based PAP sites for children and their families provide contexts in which to tailor coaching supports, examine community implementation and KT processes and support long-term sustainability.
The implementation intervention for this project will involve coach and parent training, the development of a community of practice for coaches and parents to support sustainability, and the establishment of an evaluation process related to both implementation and its proposed outcomes.
Over three years, this research will examine PAP implementation at over 80 sites in BC, including rural and Indigenous communities. Employing the CIHR iKT framework, strengths and barriers for PAP implementation will be assessed, and research will be conducted on the best ways to involve stakeholders, educate coaches and parents, and develop efficient communication processes. An analysis of cost-effectiveness will provide insight into the benefits of different approaches.
If successful, this project will lead directly to:
- A PAP implementation model with precise methodology, processes and tools to guide future implementation in other settings.
- A community of practice to support a PAP provincial network.
- Capacity building in the communities in which the PAP intervention is implemented.
- More equitable services to remote communities, including Indigenous communities.
- Better engagement of Indigenous communities around a neglected problem.
- Improved health and educational outcomes for both children with NDD and their parents.
|
Co-leads:
- Tricia Tang
UBC
- Alan Ruddiman
Rural Coordination Centre of BC
- Deanne Taylor
Interior Health
- Marshall Dahl
UBC
- Ramya Hosak & Danielle Hessler University of California, San Francisco
- Lawrence Fisher
University of California, San Francisco
- William Polonsky
University of California, San Diego
|
|
Executive sponsor:
|
Psychological distress is often overlooked in diabetes care. In fact, British Columbia’s medical services plan fails to cover this patient-identified health care priority, allowing only those with means or extended health care access to these services.
Among the different emotional struggles that patients with diabetes experience, it is diabetes distress that is most strongly associated with poor glycemic control and worse diabetes-related health outcomes.
Diabetes distress refers to the unique and often hidden emotional burdens, relentless worries, and ongoing concerns that are part of the spectrum of patients’ experience while managing this demanding disease. In 2027, it is estimated there will be 69,700 British Columbians diagnosed with type 1 diabetes (T1D), of which almost 50% will likely experience clinically significant levels of diabetes distress.
Research shows that in the absence of any type of targeted intervention, elevated distress levels will continue to persist. Given the shortage of diabetes-trained physicians and psychologists in rural and remote settings, T1D patients living in these communities have the least access to specialized health and psychological care. Accordingly, BC has identified mental health and rural and remote health care services as two of the five provincial health care priorities.
This project will seek to address three major gaps in BC’s diabetes care: the availability, affordability, and accessibility of psychosocial support for T1D patients living in low-resource settings. Specifically, this study will adapt an evidence-based, low-cost peer support model using an interactive social media platform to reduce diabetes distress among T1D adults living in the Interior Health region.
The intended outcomes are to:
- Demonstrate reductions in diabetes distress in rural and remote populations using a social media-delivered peer support intervention.
- Establish a recruitment and training infrastructure to support a sustainable peer supporter “workforce”.
- Engage key stakeholders including Interior Health, Diabetes Canada, Young and Type 1, Joint Standing Committee on Rural Issues, and BC Rural Coordination Centre.
If successful, this innovative approach to reaching the “hard to reach” can be adopted across Canada, targeting and improving quality of life for the most vulnerable, high-risk, and geographically marginalized patients.
| Co-leads:
|
Executive sponsor:
- Matt Herman
BC Ministry of Health
|
In Canada, there are more older adults than children, and the proportion of seniors is projected to exceed 30% by the year 2050. Despite the inextricable link between physical activity and chronic disease prevention, older adults are the least active Canadians. Thus, strategies that effectively enhance physical activity are key for preserving older adultsâ health and independence.
In partnership with BC Ministry of Health, the Choose to Move (CTM) program was designed and implemented. CTM is an evidence-based, scalable upstream solution that effectively enhances older adult physical activity and mobility and reduces social isolation.
Two delivery partners were engaged who had the experience and reach to deliver CTM in primarily urban centres across BC. Together we implemented CTM in urban centres, but there is a dearth of literature about how best to effectively scale out health promotion strategies outside of urban centres.
The aim of this project is to evaluate âscale outâ of CTM adapted for rural, remote and small urban communities across BC. This work will build upon lessons learned in CTM and engage an array of community organizations to assist in creating an implementation strategy and action plan.
The overall research objectives are to:
- Describe adaptation, and factors that promote or inhibit scale out of CTM.
- Describe contextual factors that influence implementation of CTM at scale out sites.
- Create a general guideline document that supports effective implementation of upstream health initiatives in remote and rural settings.
- Assess the health impact of the CTM program adapted for rural, remote and small urban settings.
Our target rural, remote and small urban communities are those who were in receipt of Choose to Move community grants (2018-2020), from the tiny, rural Village of Granisle near Smithers, to transport-limited older adults on Hornby and Denman Islands and marginalized elders from Missionâs Seabird Island Band.
| Co-leads:
|
| Executive sponsor:
|
What are the barriers and facilitators to optimizing HIV Pre-Exposure Prophylaxis (PrEP) implementation in different geographies and priority populations across BC?
HIV PrEP is now universally covered in BC for those deemed at high risk for HIV; however, there is still sub-optimal uptake and adherence of PrEP for a wide range of reasons, including a lack of understanding of PrEP effectiveness, low perception of HIV risk, lack of awareness, and social stigma.
This project will synthesize available surveillance, administrative, and survey data to provide quarterly reports for different regions to provide crucial information on uptake of PrEP at initiation of program/intervention, changes over time, and trend analyses. For example, data from the BC Centre for Excellence in HIV/AIDS (BCCfE) DTPPrEP database on PrEP program users could be linked to inform PrEP referral and uptake based on risk indicators.
This research could also link to qualitative interviews and focus groups with providers and patients regarding health care, social and other barriers. Social community mapping activities could also be used within different communities/regions to better understand the health care networks and community membersâ experience trying to navigate these to access PrEP.
Key outcomes from this project will be supporting health authorities, community groups, health care providers, and patients to use PrEP; and contributing towards HIV elimination.
