Service Provider Perspectives on Exploring Social Determinants of Health Impacting Type 2 Diabetes Management for South Asian Adults in Peel Region, Canada

Background Individuals from South Asian communities are known to have a higher likelihood of developing type 2 diabetes (T2D) which is often attributed to individual lifestyle and behavioral factors. This focus on individual responsibility can position communities as complicit in their illness, compounding stigmatization and systemic discrimination. This manuscript explores the social determinants of health (SDOH) that influence health behaviors among South Asian adults with T2D from a service provider perspective. Methods Using a qualitative descriptive design, we conducted semi-structured interviews with 12 community, social, and healthcare service providers. We used thematic analysis and the analytical concept of intersectionality to explore how different social locations and SDOH impact T2D management for South Asian adults. Results Three themes were identified including: 1) Managing challenges with settlement process, labour policies and job market disparities take priority over T2D management; 2) Poor working conditions and socioeconomic status reduce access to health care and medication; and 3) Social, economic, and cultural barriers to implementing diet and exercise recommendations. Discussion Service providers identified social, economic, and systemic factors as influencing the higher prevalence of T2D among South Asian individuals. They also spoke to their important roles in providing culturally appropriate supports to address SDOH and advocating for changes to policies and practices that reinforce systemic racism. Service providers suggested that more equitable employment policies and practices are needed in order to address the systemic factors that contribute to higher risk of T2D among South Asian adults in Peel

Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes

Purpose of Review: This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. Recent Findings: The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Summary: Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth’s motivation, but further research is needed

Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes

PURPOSE OF REVIEW: This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. RECENT FINDINGS: The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth's motivation, but further research is needed.status: publishe

Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Canada. Among our 37 participants (14 adolescents, 23 caregivers), most (n = 27; 73.0%) reported FN could improve their access to obesity management. Participants recommended several activities to support healthcare access and use, including appointment reminders, evening/weekend appointments, parking/transportation support, and in-clinic childcare, all of which help families to attend appointments over an extended period to support obesity management. Most participants preferred FN be offered by healthcare professional ‘navigators’ who were approachable, empathic, and compassionate since issues regarding health and obesity can be sensitive, emotional topics to discuss. Overall, families supported integrating FN into multidisciplinary pediatric obesity management to improve healthcare access and use by navigators who apply a range of practical strategies and relational skills to enhance long-term access and adherence to care

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada

Abstract Background The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. Methods An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. Results Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. Conclusions We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. Trial registration ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019

sj-docx-1-his-10.1177_11786329231200863 – Supplemental material for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

Supplemental material, sj-docx-1-his-10.1177_11786329231200863 for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity by Geoff DC Ball, Marcus G O’Neill, Mitchell Rath, Maryam Kebbe, Arnaldo Perez, Ian Zenlea and Josephine Ho in Health Services Insights</p

sj-docx-2-his-10.1177_11786329231200863 – Supplemental material for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

Supplemental material, sj-docx-2-his-10.1177_11786329231200863 for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity by Geoff DC Ball, Marcus G O’Neill, Mitchell Rath, Maryam Kebbe, Arnaldo Perez, Ian Zenlea and Josephine Ho in Health Services Insights</p

sj-docx-3-his-10.1177_11786329231200863 – Supplemental material for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

Supplemental material, sj-docx-3-his-10.1177_11786329231200863 for Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity by Geoff DC Ball, Marcus G O’Neill, Mitchell Rath, Maryam Kebbe, Arnaldo Perez, Ian Zenlea and Josephine Ho in Health Services Insights</p

Using community-based participatory research methods to build the foundation for an equitable integrated health data system within a Canadian urban context

Abstract Health inequalities amplified by the COVID-19 pandemic have disproportionately affected racialized and equity-deserving communities across Canada. In the Municipality of Peel, existing data, while limited, illustrates that individuals from racialized and equity-deserving communities continue to suffer, receive delayed care, and die prematurely. In response to these troubling statistics, grassroots community advocacy has called on health systems leaders in Peel to work with community and non-profit organizations to address the critical data and infrastructure gaps that hinder addressing the social determinants of health in the region. To support these advocacy efforts, we used a community-based participatory research approach to understand how we might build a data collection ecosystem across sectors, alongside community residents and service providers, to accurately capture the data about the social determinants of health. This approach involved developing a community engagement council, defining the problem with the community, mapping what data is actively collected and what is excluded, and understanding experiences of sociodemographic data collection from community members and service providers. Guided by community voices, our study focused on sociodemographic data collection in the primary care context and identified which service providers use and collect these data, how data are used in their work, the facilitators and barriers to data use and collection. Additionally, we gained insight into how sociodemographic data collection could be respectful, safe, and properly governed from the perspectives of community members. From this study, we identify a set of eight recommendations for sociodemographic data collection and highlight limitations. This foundational community-based work will inform future research in establishing data governance in partnership with diverse and equity-deserving communities