Sexe, genre et contexte : Une compréhension en matière de promotion de la santé sexuelle et prévention du VIH/ITS auprès des jeunes autochtones au Nouveau-Brunswick

Au Canada, les jeunes autochtones sont confrontés de plus en plus aux taux importants d’infections transmissibles sexuellement (ITS) et à une épidémie du virus de l’immunodéficience humaine (VIH). Des expériences historiques et les conditions sociales actuelles interagissent pour avoir une incidence sur la vulnérabilité de la population autochtone. Le but de cette étude ethnographique était d’améliorer la compréhension de la santé publique des jeunes autochtones et leurs expériences en matière de promotion de la santé sexuelle et de prévention de VIH/ITS. Un devis qualitatif axé sur l’approche communautaire et culturelle a servi à comprendre l’expérience des jeunes pour accéder à des services de dépistage. Vingt jeunes ont participé à l’étude. L’analyse thématique a permis d’identifier quatre thèmes : financement et législation; intergénération et santé sexuelle; contexte de santé sexuelle et éducation; perceptions des services de santé sexuelle et dépistage du VIH/ITS. Il est essentiel que les prestataires de santé et les décideurs adoptent une approche culturellement adéquate et respectueuse des genres en matière de promotion et de prévention.In Canada, young Aboriginal men and women are faced with growing sexually transmitted infection (STI) rates and a human immunodeficiency virus (HIV) epidemic. Historical and present day social conditions interact and impact on the vulnerability of the Aboriginal population. The purpose of this ethnographic study was to enhance the public health understanding of Aboriginal youths’ experiences with sexual health services. A culture and community-based qualitative process sought to understand youths’ lived experiences of accessing sexual health services and HIV/STI testing. A purposeful sample of twenty Aboriginal youths was used for this study. Thematic analysis was informed by all data sources was carried out to interpret the data for themes. Four themes were identified in regard to access: funding and legislative bodies, intergenerational shaping of sexual health, sexual health places and education, and perceptions of sexual health services and HIV/STI testing. It is vital that health care providers and policy makers work with a culturally competent and gender-based approach that is sensitive to the many processes that interact to influence health promotion and disease prevention

What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada

Abstract Background Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. Methods One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. Results Fifteen family members/family of choice and 16 community-based organization staff members participated ( n  = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. Conclusions Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention

Expériences de la stigmatisation en lien avec la santé mentale chez des jeunes de trois communautés au Nouveau-Brunswick

Cette étude vise à comprendre comment les jeunes recourant à des services en santé mentale (SM) perçoivent la stigmatisation en SM et comment cela a été vécu durant leur parcours de soins et de rétablissement. Des groupes de discussion avec 25 jeunes ont été réalisés dans trois communautés (autochtone dans une région isolée, francophone rurale et anglophone urbaine). L’analyse thématique révèle que leurs expériences de la stigmatisation sont marquées par diverses formes de discrédit et par le traitement différentiel déshumanisant qui les conduit à rechercher des alternatives non stigmatisantes et comblant mieux leurs besoins. Ainsi, ces jeunes orientent activement leurs parcours de soins en SM selon la stigmatisation perçue. D’importantes nuances socioculturelles ont également été identifiées quant aux expériences et stratégies des jeunes et éléments favorisant ou atténuant la stigmatisation. Leurs perspectives sont riches d’enseignements pour déstigmatiser les services de SM pour les jeunes de différents groupes culturels.This study aims to understand how youth who receive mental health (MH) services perceive stigma related to mental illness and how this was experienced during their trajectory toward care and recovery. Discussion groups were carried out with 25 youths in three New Brunswick communities (remote Indigenous, rural Francophone and urban Anglophone). Thematic analysis reveals that youth’s experiences of stigma reflect various forms of discrediting as well as differential, dehumanising treatment, which lead them to look for stigma-free alternatives that better meet their needs. This shows that youth actively select their options for MH support depending on the stigma they perceive. Results also show important socio-cultural nuances with regards to youth’s experiences and to the strategies and factors that enable or mitigate stigma. Their accounts hold valuable lessons for destigmatizing mental illness and the access to youth MH services for different cultural groups

An Online Application to Explain Community Immunity with Personalized Avatars: A Randomized Controlled Trial

Abstract accepted for presentation at the Society for Medical Decision Making Annual Meeting 2022, presentation date October 25, 2022 (awarded Lee B. Lusted Trainee Award on October 26, 2022) Purpose: To evaluate the effects of an intervention conveying the concept of community immunity (herd immunity) on risk perception, emotions, knowledge and vaccination intentions. Methods: We previously developed an online application showing how community immunity works through a user-centered design process with 110 participants across 4 cycles. In our application, people personalize a virtual community by making avatars (themselves, 2 vulnerable people in their community, and 6 others.) The application integrates these avatars in a 2-minute narrated animation. The present study evaluated this intervention in a randomized controlled trial among adults in Canada. We collected participants’ sociodemographic details and a validated measure of individualism and collectivism. We analyzed the application’s effects on primary outcome risk perception, divided into comprehension (accuracy) and feelings (subjective sense of risk) and secondary outcomes emotions (worry, anticipated guilt), knowledge and vaccination intentions, using analyses of variance for continuous outcomes and logistic regressions for dichotomous outcomes. We pre-registered our trial, depositing all study materials (including pre-scripted analysis code) on Open Science Framework, then ran the trial March 1-July 1, 2021. Results: Study participants (N=5516) approximately reflected Canadian adult population statistics, with median age 42 years (interquartile range 32-58), 50% women, 49% men (1% other answers), 79% white, 16% born outside Canada, 20% French-speaking, and 59% with college/higher education. The application had positive effects on all outcomes. People assigned to the application were more likely to score high on risk perception as comprehension (Chi-squared(1)=134.54, p<0.001) and risk perception as feelings (F(1,3875)=28.79, p<0.001) compared to those assigned to a control condition. The application also increased emotions (F(1,3875)=13.13, p<0.001), knowledge (F(1,3875)=36.37, p<0.001), and vaccination intentions (Chi-squared(1)=9.4136, p=0.002). Overall, participants with more collectivist orientations demonstrated more responsiveness to arguments about the collective benefits of widespread vaccination. Comparing our application to others available online, other interventions had weaker effects for named diseases (measles, flu) but stronger effects in the context of an unnamed, ‘vaccine- preventable disease.’ Conclusions: An online application about community immunity can contribute to higher- quality decision making (i.e., more accurate risk perception, greater knowledge, more concern for others, higher vaccination intentions) about recommended vaccines