Browsing by Author "Montesanti, Stephanie"

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    An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries
    (2023-04-13) Nykiforuk, Candace I. J.; Belon, Ana P.; de Leeuw, Evelyne; Harris, Patrick; Allen-Scott, Lisa; Atkey, Kayla; Glenn, Nicole M.; Hyshka, Elaine; Jaques, Karla; Kongats, Krystyna; Montesanti, Stephanie; Nieuwendyk, Laura M.; Pabayo, Roman; Springett, Jane; Yashadhana, Aryati
    Abstract Background Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. Methods The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. Results The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people’s financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. Conclusions The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.
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    Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool
    (2024-04-29) Montesanti, Stephanie; Sehgal, Anika; Zaeem, Lubna; McManus, Carrie; Squires, Suzanne; Silverstone, Peter
    Abstract Background Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta’s PHC settings by exploring readiness factors. Methods An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators. Results Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta. Conclusion The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.
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    Decade of Turmoil: A Characterization of a Specialized Refugee Health Clinic 2011-2020
    (2023-05-03) Norrie, Eric Culham; Fabreau, Gabriel; McBrien, Kerry; Ronksley, Paul; Montesanti, Stephanie
    Background: Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals may have led to changes in clinic use, demographics, clinic policy, or may impact provider wellness. Refugees are a vulnerable population with specific biopsychosocial health needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical. Methods: We used a mixed methods sequential explanatory case study design to investigate changes (including patient demographic characteristics, clinic utilization, and care adaptations), at a specialized refugee health clinic in Calgary from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts, IFHP Cuts, Syrian Surge, Yazidi Period, and COVID-19. We used segmented linear regression (SLR), Kruskal-Wallis, and chi-square analyses to assess quantitative changes to utilization and demographics across these time periods. Then we conducted semi-structured interviews with clinic leadership which we analyzed thematically. Finally, we merged our quantitative and qualitative findings, by assessing which of our qualitative themes converged with our quantitative findings during each time period. Results: We included 10,661 patients in our quantitative analysis; 48.2% were female and the mean age was 24.4 years (SD: 17.0). The most common region of origin was first East Africa, and then West Asia after the Syrian period. Total monthly appointments increased 576% from 478/month to 2752/month over 10 years. The mean appointments/month increased significantly (p<0.05) during each time period, but the rate of increase varied. Our qualitative and merged results converged with and expanded upon these quantitative results, especially by emphasizing the impact of health system upheavals on provider wellness. Conclusion: Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. Qualitative participants consistently indicated that the stress of these upheavals negatively impacted staff wellness and patient care. Canada and other countries of resettlement should consider how health policies and other upheavals may have downstream consequences.
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    Designing a framework for primary health care research in Canada: a scoping literature review
    (2018-08-29) Montesanti, Stephanie; Robinson-Vollman, Ardene; Green, Lee A
    Abstract Background Despite significant investments to improve primary health care (PHC) delivery in Canada, provincial health care systems remain fragmented and uncoordinated. Canada’s commitment to strengthening PHC should be driven by robust research and evaluation that reflects our health policy priorities and responds to the needs of the population. One challenge facing health services researchers is developing and sustaining meaningful research priorities and agendas in an overburdened, complex health care system with limited capacity for PHC research and support for clinician researchers. Methods A scoping review of the literature was conducted to examine PHC research priorities in Canada. We compared national research priorities for PHC to research priorities being considered in the province of Alberta. Our scoping review was guided by the following questions: (1) What are the research priorities for PHC in Canada?; and (2) What process is used to identity PHC research priorities? Results Six key theme areas for consideration in setting a PHC research agenda were identified: research in practice, research on practice, research about practice, methods of priority setting, infrastructure, and the intersection of PHC and population/public health. These thematic areas provide a new framework for guiding PHC research in Canada. It was developed to generate best practices and new knowledge (i.e., innovation), transform PHC clinical practice or support quality improvement (i.e., spread), and lead to large-scale health care system transformation (i.e., scale). Conclusions Priority-driven research aims to answer questions of key importance that are likely to have a significant impact on knowledge or practice in the short to medium term. Setting PHC research priorities ensures funded research has the greatest potential population health benefit, that research funding and outputs are aligned with the needs of practitioners and decision makers, and that there is efficient and equitable use of limited resources with less duplication of research effort. Our findings also suggest that a common research priority framework for PHC research in Canada would ensure that research priority-setting exercises are grounded in an evidence-based process.
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    Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada
    (2023-03-31) Montesanti, Stephanie; MacKean, Gail; Fitzpatrick, Kayla M.; Fancott, Carol
    Abstract Introduction During the pandemic many Canadian hospitals made significant changes to their ‘open family presence’ and ‘visitor policies’ to reduce the spread of COVID-19 by instituting restrictive or ‘zero visiting’ policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. Results Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. Conclusions The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no “one-size-fits-all” caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.
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    Moving the Agenda Forward Together: Innovating Indigenous Primary Care in Alberta, Strategic Event Report 2016
    (2016) Henderson, Rita Isabel; Crowshoe, Lynden (Lindsay); Montesanti, Stephanie; Leduc, Charles
    Practitioners, policy-makers, and planners in Alberta note that quality primary care for Indigenous people is undermined by significant structural gaps and deficiencies. In spite of some recent innovations, Alberta seems to lag behind similar jurisdictions, such as Ontario and British Columbia, in mobilizing structures to improve primary care delivery that is culturally safe, acceptable and equitable for Indigenous people. In January 2016, the University of Calgary’s Department of Family Medicine in the Cumming School of Medicine convened Indigenous community members and leaders, as well as provincial health system leaders, primary care practitioners and researchers near Calgary, Alberta to share and explore these barriers. The aim was to optimize the potential for creative change stirred in the province following provincial and federal elections in 2015 that shifted policy landscapes. This report highlights innovations shared from other jurisdictions in Canada, and the opportunities that these innovations present to the Alberta context. The event convened 65 Alberta-based stakeholders, with guest presenters from across Canada, from the: Vancouver Native Health Society (VNHS); Tui’kn Partnership in Cape Breton, Nova Scotia; and Cree Board of Health and Social Services of James Bay (CBHSSJB), Quebec. In small groups, presenters provided overviews of innovations in primary care developed by their organizations, including big picture strategies, and barriers/facilitators to innovation. Small group participants then reflected and explored how such innovations might make sense or be translated into Alberta’s diverse Indigenous contexts. Guest speakers and facilitators from Alberta Health Services (AHS), Health Canada, the Public Health Agency of Canada (PHAC), Siksika Health Services, and the Indigenous Physicians Association of Canada (IPAC) helped to integrate knowledge and experiences shared. The models presented were broadly grouped into urban, reserve, and system-level innovations. A physician lead and Elder from the VNHS presented their agency’s VIP Elder program that offers spiritual and emotional support to interested clientele; the health director from Eskasoni First Nation’s health centre shared the story of forging the Tui’kn Partnership with neighbouring communities for ownership and control of health data for improved care; and a lead physician gave an overview of the CBHSSJB’s life-cycle approach structuring all aspects of care.
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    Perspectives on delivering safe and equitable trauma-focused intimate partner violence interventions via virtual means: A qualitative study during COVID-19 pandemic
    (2022-10-04) Ghidei, Winta; Montesanti, Stephanie; Wells, Lana; Silverstone, Peter H.
    Abstract Background The COVID-19 pandemic has been linked with increased rates of intimate partner violence (IPV) and associated experiences of compounded trauma. The emergence of this global pandemic and the public health measures introduced to limit its transmission necessitated the need for virtually delivered interventions to support continuity of care and access to interventions for individuals affected by IPV throughout the crisis. With the rapid shift to virtual delivery, understanding the barriers to accessing virtually delivering trauma-focused IPV interventions to these individuals was missed. This study aimed to qualitatively describe the challenges experienced by service providers with delivering virtually delivered IPV services that are safe, equitable, and accessible for their diverse clients during the COVID-19 pandemic. Methods The study involved semi-structured interviews with 24 service providers within the anti-violence sector in Alberta, Canada working with and serving individuals affected by IPV. The interviews focused on the perspectives and experiences of the providers as an indirect source of information about virtual delivery of IPV interventions for a diverse range of individuals affected by IPV. Interview transcripts were analyzed using inductive thematic analysis. Results Findings in our study show the concepts of equity and safety are more complex for individuals affected by IPV, especially those who are socially disadvantaged. Service providers acknowledged pre-existing systemic and institutional barriers faced by underserved individuals impact their access to IPV interventions more generally. The COVID-19 pandemic further compounded these pre-existing challenges and hindered virtual access to IPV interventions. Service providers also highlighted the pandemic exacerbated structural vulnerabilities already experienced by underserved populations, which intensified the barriers they face in seeking help, and reduced their ability to receive safe and equitable interventions virtually. Conclusion The findings from this qualitative research identified key determining factors for delivering safe, equitable, and accessible virtually delivered intervention for a diverse range of populations. To ensure virtual interventions are safe and equitable it is necessary for service providers to acknowledge and attend to underlying systemic and institutional barriers including discrimination and social exclusion. There is also a need for a collaborative commitment from multiple levels of the social, health, and political systems.
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    Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review
    (2023-03-29) Fitzpatrick, Kayla M.; Ody, Meagan; Goveas, Danika; Montesanti, Stephanie; Campbell, Paige; MacDonald, Kathryn; Crowshoe, Lynden; Campbell, Sandra; Roach, Pamela
    Abstract Background Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. Methods We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? Results We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. Conclusion These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.