Out of School Factors Affecting Indigenous Girls’ Educational Attainment: A Theory of Change for the Opening Opportunities Program in Rural Guatemala

Guatemalans have the lowest education rates in Latin America, and within Guatemala, Indigenous, rural and poor girls have much lower education rates than their peers. The ‘Opening Opportunities’ program attempts to invest in the poorest girls from rural Guatemala to build their personal, social, health and economic assets. Realist evaluation attempts to understand the key mechanisms in complex social interventions, and is under-used in education research. Based on data from life history interviews from graduates, this paper presents a Theory of Change to understand the contexts, mechanisms and outcomes of the ‘Opening Opportunities’ Program relating to educational attainment. The four mechanisms most discussed by program graduates are: leadership and participation create confidence; greater networks (models, mentors, peers); opportunities created to participate in novel paid work; and desire for later marriage and childbearing. This is the first Theory of Change that explains out of school factors affecting educational attainment

Enhancing the care experiences of Black women along the breast cancer journey: Meaningfully engaging breast cancer survivors to co-create a targeted, culturally relevant resource hub

There is very little tailored and culturally relevant information available for Black women in Canada around breast cancer. For those who are diagnosed, and who undergo their own breast cancer journey, many feel isolated while navigating care programs that centre around whiteness and perpetuate medical and anti-Black racism. Although it is well-documented that Black women in the United States are often diagnosed with more aggressive forms of cancer and at a younger age, the lack of race-based data in the Canadian context makes it difficult to know for certain how women in Canada are affected. In order to provide trusted, reliable and tailored information, The Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, in partnership with the Olive Branch of Hope, developed a resource hub that was the first of its kind in Canada, and launched during Black Liberation Month in 2022. Presented in the form of a website and disseminated to over 50 cancer centres and hospitals across the country, components of this resource included, a.) a synthesis of all available evidence on breast cancer disparities for Black women in Canada, mapped to actionable steps b.) representative images and videos of Black clinicians explaining concepts in plain language (from risk factors to reconstruction), c.) community resources compiled from the Olive Branch of Hope and d.) a list of relevant research studies and clinical trials. Guided by principles of Black Feminism and Participatory Action Research, this resource was co-created in partnership with four Black women who were breast cancer survivors (‘co-creators’) who channeled their lived experiences into the project direction. This paper aims to highlight our process with co-creators, discuss key reflections to guide future work and highlight the need for ongoing work in this area

BETTER LIFE- guidelines for chronic disease preventive care for people aged 18–39 years: a literature review

Abstract Background The original ‘BETTER’ (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40–65 years and a “Prevention Practitioner” (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of guidelines in preparation for adapting the ‘BETTER HEALTH’ approach for younger adults aged 18–39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income. Methods We searched multiple electronic databases and grey literature for clinical practice guidelines on prevention/screening and included those that met the following criteria: published in English from 2008–2020 in Canada or any of the following countries (Australia, Ireland, New Zealand, Scotland, United States and England); and addressed prevention or screening. We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and extracted data (publication details, recommendations, and Quality/Level of evidence as reported by authors) from sources with overall scores of 5 or higher. Final recommendations were compiled after harmonization with input from diverse stakeholders (co-investigators, PPs, and the Community Advisory Committee). Results We included a total of 85 guidelines, and developed a final list of 42 recommendations for 18–39 year-olds across 21 topics. Specific recommendations fell under the following topics: cancers, cardiovascular disease, diabetes, obesity, lifestyle (alcohol; healthy nutrition/physical activity); healthy relationships and healthy sexuality, immunization, oral health, social determinants of health, and substance use. Conclusion We identified evidence-based guidelines on individual-level prevention/screening actions for adults 18–39 years old and relevant for those living with lower income which will directly inform development and implementation of the BETTER LIFE intervention