Knowledge mobilization for reducing stigma and creating culturally safe primary care

Co-leads:

  • Bernadette Pauly
    University of Victoria
  • Bill Bullock
    Victoria Division of Family Practice
  • Karen Urbanoski
    CISUR / UVic

Trainee:

  • TBC

People who use substances (PWUS) face stigma and discrimination when accessing primary care. Cultural safety has been proposed to reduce provider and system-based stigma. Recently, this team completed a CIHR Strategy for Patient Oriented Research grant, which investigated the meaning of culturally safe primary care for PWUS, with a focus on those also experiencing structural disadvantages (e.g. poverty, racialization). This team comprises of PWUS (community researchers), academic researchers and knowledge users from the Victoria Division of Family Practice and Island Health. Findings included a concept map of cultural safety with eight core areas for reducing substance use related stigma in primary care.

The knowledge translation (KT) objectives are to:

  1. Raise awareness of the stigma experienced by PWUS in primary care.
  2. Share understandings of culturally safe primary care for this population.
  3. Support PWUS to advocate for their own primary care.
  4. Encourage PWUS, physicians and health planners to collaborate on strategies to improve cultural safety.
  5. Facilitate the participation of PWUS, physicians and health planners in developing and implementing policies and practices to improve cultural safety in primary care.

Besides local and provincial presentations with knowledge users, a postcard summarizing the findings was produced and distributed it to the community to support PWUS in advocating for their own primary care. We will complete additional plain-language KT materials for this population.

With this Reach award, the team will extend their reach to physicians, other healthcare providers, medical students, and senior level policy makers through two additional activities.

A video will be created to communicate the findings from the perspective of community researchers; it will be available on YouTube and actively promoted for use by senior level health executives and in healthcare curricula in BC post-secondary institutions.

An interactive workshop for primary care providers will be developed and delivered to address barriers and have facilitators implement culturally safe care. This workshop will be developed by the existing team and will be led by PWUS in collaboration with other team members. The workshop will be delivered through newly developed interdisciplinary primary care networks in Nanaimo, Campbell River and Port McNeil with a focus on identifying local practice changes. Besides enhancing the reach of findings from this completed project, the community researchers and graduate trainee will build their personal and organizational capacity for KT.

Develop a web-based childhood healthy weights early intervention program

Co-leads:

  • Sam Liu
    University of Victoria
  • Karen Strange
    Childhood Obesity Foundation

Trainee:

  • TBC

Childhood obesity is a major public health challenge in Canada. The BC Ministry of Health funded the knowledge-user (Childhood Obesity Foundation) to design and implement a “made in BC” community-based Childhood Healthy Weights Early Intervention Program (EIP) for children 8-12 years old. However, it has proven challenging to reach families who can’t attend in person. But with improved access to the Internet, web-based lifestyle programs may be well-suited to meet this challenge. In this project, the team will build an interactive web-based childhood obesity prevention program based on the EIP curriculum.

Aims:

  1. Develop an interactive web-based version of EIP for families whose children are off the healthy weight trajectory.
  2. Conduct usability testing to further enhance user experience.
  3. Collaborate with co-lead to disseminate the program across BC.

The web-based program will address major gaps in existing interventions, such as making the program accessible to non-traditional families; this includes Indigenous families, families from multi-cultural or intercultural backgrounds, and those of lower socioeconomic status. The program will also include sessions on sleep hygiene and screen use. This project will consist of three phases. In the first phase (0-5 months), an integrated-KT approach will be used to develop a web-based program (Aim 1). Integrated-KT helps ensure the web-based program is relevant and useful to all stakeholders (e.g. knowledge users, researchers, end-users). At the end of phase two (month 7), it is expected there will be a functional interactive web-based program that has undergone usability testing (Aim 2). In phase three (8-12 months), work will be done with the research user to disseminate the web-based intervention to diverse groups of families with children off the healthy weight trajectory (Aim 3).

This project has potential to be incredibly impactful as a web-based intervention can extend the reach of the Childhood Healthy Weights EIP across BC.

Optimizing PrEP and TasP adherence among substance using gay, bisexual, and other men who have sex with men

While increased access to HIV treatment and other health services has contributed to significant declines in HIV among several key populations in British Columbia (BC), it is estimated that as many as 1 in 6 gay, bisexual, and other men who have sex with men (gbMSM) will be diagnosed with HIV in their lifetime.

To address this health equity concern, BC recently expanded access to a once-a-day pill, called pre-exposure prophylaxis (PrEP), that can prevent HIV acquisition. However, gbMSM who use drugs report reduced adherence to PrEP, as well as to other antiretroviral therapies (ART) that could prevent transmission—thus reducing the overall efficacy of these policy-driven interventions.

Recognizing the diverse experiences of substance-using gbMSM, Dr. Card, along with an interdisciplinary team at the Community Based Research Centre for Gay Men’s Health, will leverage data from the Sex Now Survey to improve our understanding of:

  1. Which patterns of substance use contribute to poor adherence.
  2. How we can best address the factors that negatively impact this population.
  3. What obstacles might limit successful intervention among this population (e.g., feasibility and acceptability).

Working with community members and front-line service providers, Dr. Card will also participate in community consultations to develop an empirically-valid and community-based intervention that will improve adherence among gbMSM who use drugs.

Phosphoinositide kinases: Molecular determinants for their regulation and role in human disease

Lipids are the primary constituent of all cellular membranes, however, they also can play key roles as signaling molecules that controls how a cell responds to its environment.  Almost every aspect of a cell's decision to live and die is impacted by the role of lipid signals called phosphoinositides. These signals are generated in the correct location and at the appropriate time by proteins in our body called phosphoinositide kinases (PI kinases). Misregulation of PI kinases is a key driver of disease, including cancer and immunodeficiencies.

Intriguingly host PI kinases are frequently hijacked by pathogenic viruses to mediate viral replication, and targeted inhibition of parasite PI kinases is a promising therapeutic strategy for treatment of malaria and cryptosporidiosis (a diarrheal disease caused by microscopic parasites). Therefore, understanding the molecular basis for how PI kinases are regulated is of extreme biomedical importance.

Dr. Burke's research is focused on understanding the molecular basis for regulation of PI kinases, and how they are involved in human disease. He and his team have revealed fundamental insight into how these enzymes are involved in cancer and immunodeficiences, and how viruses manipulate them to mediate infection. Overall this work is important in understanding how lipid signals mediate disease, and will be critical in the design of inhibitors as novel therapeutics.

Evaluation of the role of FRMP on BDNF expression and signaling

Fragile-X syndrome (FXS) is the most common form of inherited intellectual disability and is the best characterized form of autism spectrum disorder. This genetic condition is caused by a mutation in the FMR1 gene, leading to the functional loss of FMR1 protein (FMRP). Besides being important for neuronal development, this protein also exerts a strong influence on synaptic plasticity. As a matter of fact, FMRP is highly expressed in the dentate gyrus (DG) of the hippocampus, one of the few regions of the adult brain where the birth of new neurons takes place. 

To understand this relationship, it is important to clarify the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of FXS. BDNF is an important regulator of neural circuit development and function, and is thus strongly implicated in the development and treatment of several neurological conditions. Interestingly, it has been shown that BDNF and FMRP may reciprocally regulate each other.

However, BDNF is a complex signaling molecule, and its pro- and mature forms can elicit opposing biological effects. Thus, to fully understand the interaction between FMRP and BDNF it is important to study both its pro- and mature forms. Dr. Bettio will investigate how FMRP regulates BDNF/pro-BDNF expression in distinct brain regions and how changes in BDNF expression contribute to hippocampal circuit dysfunction and plasticity defects in FXS. 

The results of this study will expand scientific knowledge about the molecular mechanisms implicated in FXS, and will be key in the development of future BDNF-based therapeutic strategies.

 

Addressing HIV/AIDS, sexual health, and substance use among gay and other men who have sex with men

New HIV diagnoses are 71 times higher among gay, bisexual and other men who have sex with men (GBM) than other men in Canada. Since 2010, BC has adopted Treatment as Prevention (TasP) as a policy to increase HIV testing and engage more HIV-positive individuals in effective treatment to reduce transmission at a population level. However, the number of new diagnoses among GBM in BC has remained largely unchanged. Further, surveillance shows an increase of HIV diagnoses among the youngest birth cohorts of GBM. HIV pre-exposure prophylaxis (PrEP) is a new preventive tool for HIV-negative GBM, but inaccurate information, sub-optimal adherence or risk-compensation could result in a false sense of security, paradoxically leading to increased HIV transmission. In addition to HIV, infectious syphilis is now epidemic among GBM in BC.

This research program will address the HIV and sexually transmitted infection (STI) epidemics among GBM in Metro Vancouver and BC. Dr. Lachowsky will measure HIV risk behaviour over time, determine how PrEP affects bacterial STI incidence, and analyze shifting attitudes about HIV, challenges with HIV prevention and treatment, and changes in sexual negotiation and practices. Results will directly inform population-specific, age-relevant public health policy, programming, and interventions to reduce the burden of HIV for GBM, especially young GBM.

Dr. Lachowsky will employ a bidirectional, integrated knowledge translation approach, with a Community Engagement Committee and key academic, public health, and community partners. An interactive Web 2.0 hub will allow for knowledge dissemination and generation with community and service providers, and will be complemented with more traditional presentations, workshops, and publications.This single research project is part of a larger program of research examining health disparities amongst GBM in BC and Canada using interdisciplinary, community-based approaches.

The Effect of Psychosocial Stressors on Health Behaviours and Indicators of Cardiometabolic Risk in the Transition to Young Adulthood

Adolescence and young adulthood are critical periods for health promotion and disease prevention. Cardiometabolic risk (CMR) refers to a set of indicators that increase an individual’s risk for diabetes, heart disease or stroke. These indicators start to show predictive variability in adolescence and identification and implementation of early strategies for risk management can have significant long-term health benefits. Much of what we know about CMR comes from studies of adults; therefore, research focusing on earlier age groups is needed.

The first objective of the proposed research is to describe the frequencies of select, non-invasive CMR indicators, including body mass index (BMI), systolic and diastolic blood pressure (BP), and waist circumference in young adulthood (ages 22-29). Research in psychoneuroimmunology documents the deleterious effects of stress on physical health; however, less attention has been given to adolescents and young adults.

The second objective is to examine how psychosocial stressors that become salient in adolescence (e.g. internalizing symptoms and interpersonal stress) predict CMR.

The third objective is to examine how these stressors compromise the enactment of key health behaviours (e.g. physical activity, eating habits, sleep duration) leading to increased CMR.

The project will use six waves of the Victoria Healthy Youth Survey (V-HYS), a 10-year longitudinal study that surveyed youth (N = 662) biannually from 2003 (T1; ages 12-18) to 2014 (T6; ages 22-29). In-person measurements of CMR (BMI, systolic and diastolic BP, waist circumference) were collected at T6. Measurements of internalizing symptoms, interpersonal stress (e.g. peer victimization), and health behaviours were collected at each wave.

Findings will highlight the variability in CMR in young adulthood and increase knowledge on the effects of two salient stressors on CMR from adolescence to young adulthood, providing new information about targets for prevention and interventions. The results will also inform guidelines for early identification and preventative healthcare.

Knowledge translation efforts will include 1) peer-reviewed publications, conference presentations, media reports, and policy formats; 2) creating an infographic about CMR in young adulthood to release to the media; and 3) developing a training tool to educate healthcare professionals about the relations between stress and CMR in these young age groups.

Improving health equity through cross-cultural collaboration: Learning from Indigenous-developed programs to strengthen public health systems in preventing the harms of substance use in BC

A function of public health systems and services is to reduce health inequities. The harms of substance use impact British Columbians differently based on their social position and access to resources. Over the last decade, BC has had renewed interest in health equity as demonstrated by several key policy documents. Initial research findings however, have demonstrated that the application of a health equity lens is a challenge for public health decision makers and practitioners. However, for many public health service providers, First Nations and Aboriginal health organizations and service providers are seen as leaders in the understanding and application of health equity principles.

Accordingly, there is an immense opportunity in BC for collaboration and learning with First Nations and Aboriginal health partners to optimize health equity for all British Columbians. Despite these opportunities, little is known about the synergies between Indigenous knowledge and health equity strategies related to the reduction of harms of substance use in BC. In particular, more research is needed to understand if Indigenous approaches to health and wellness can be imported into the current BC public health system and to  explore how Indigenous-developed programs and services can inform health equity strategies related to reducing the harms of substance use in BC public health systems and services.

This research project will be one of the first to systematically examine how health equity strategies in the BC public health system could benefit from Indigenous knowledge and worldviews. This project has the potential to impact the health of all British Columbians by informing the development of more equitable health programs and services. In addition, by prioritizing Indigenous ontologies and processes, this project also has implications for how Aboriginal communities in BC are perceived and esteemed, thereby having the potential also to specifically improve the well-being of those communities. In addition, this prioritization has the potential to mitigate epistemological colonialism and shift power relations which are integral in promoting health equity for Indigenous peoples.

Dr. Shahram received a 2017 Health Policy Fellowship to promote Indigenous health in BC’s southern interior by integrating cultural safety and health equity assessments into the fabric of the Interior Health. Her 2016 Trainee Award will placed on hold during her health policy fellowship assignment.

Treatment of drug-resistant influenza: Rationally designed inhibitors of viral neuraminidase

Each year the influenza virus infects approximately 10% of the human population, resulting in hundreds of thousands of deaths. Even in North America, nearly 40,000 annual “excess deaths” are attributed to influenza or to secondary bacterial infections. Despite a World Health Organization-monitored vaccine program, the disease remains a significant global health issue, requiring the use of antiviral drugs like oseltamivir (Tamiflu). A significant problem in controlling the spread of influenza is the emergence of oseltamivir-resistant strains.

To address this problem, Dr. Jeremy Wulff is taking a collaborative approach to develop potent new influenza virus inhibitors. With Professor Martin Boulanger's group at the University of Victoria Department of Biochemistry, Dr. Wulff has developed a new class of antiviral agents that function by a similar mechanism to oseltamivir. His research group is working to further improve the efficacy of these agents through structural and kinetic means. Finally, Dr. Wulff will test the potency of the new anti-influenza compounds in collaboration with Dr. Terrence Tumpey, from the U.S. Centers for Disease Control in Atlanta.

Identifying and developing new drugs to fight oseltamivir-resistant influenza is anticipated to have wide-reaching impacts on global health. In addition to creation of new influenza drugs, Dr. Wulff’s research interests include the development of novel methodologies for the synthesis of complex molecules, and the invention of new kinds of inhibitors that specifically block interactions between certain proteins involved in pancreatic cancer and HIV.

Mechanisms of impaired functional recovery in diabetic mice following stroke

Diabetics are two to four times more likely than non-diabetics to suffer a stroke during their lifetime, and their prognosis for recovery from stroke is poor. Diabetes is known to negatively affect blood vessels throughout the body, including the eye, heart, kidney, and limbs, leading to a heightened risk of stroke in diabetics. Poor circulation and peripheral nerve damage can lead to blindness, hearing loss, foot injury and amputation. High blood pressure is common in diabetics and increases the risk of heart disease and stroke. However, little is known about how the vascular changes associated with diabetes affect the brain and contribute to poorer recovery of function following stroke.

Dr. Kelly Tennant's research will determine why diabetics suffer from greater impairments following strokes. She will monitor changes in neurons and blood vessels over time following a stroke in diabetic mice and assess the relationship between these changes and recovered use of the forelimb. Dr. Tennant will employ cutting edge in vivo imaging technologies such as intrinsic optical signal, two-photon, and voltage sensitive dye imaging, combined with behavioural testing of forelimb function.

These experiments will shed light on how neurons and blood vessels of diabetics respond differently to ischemic stroke and how these differences contribute to poor behavioural recovery in diabetic stroke survivors. This research will aid understanding of the greater impairment caused by stroke in diabetic patients and lead towards development of treatments that ameliorate the negative effects of diabetes on the brain.