Browsing by Author "Sehgal, Anika"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework
    (2024-04-29) Sehgal, Anika; Henderson, Rita; Murry, Adam; Crowshoe, Lynden (.; Barnabe, Cheryl
    Abstract Background Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. Methods A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. Results A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. Conclusions The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
  • Thumbnail Image
    ItemOpen Access
    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.
  • Thumbnail Image
    ItemOpen Access
    Improving the health of Indigenous peoples: Exploring patient health complexity among urban Indigenous patients in Canada
    (2023-04-20) Sehgal, Anika; Barnabe, Cheryl; Crowshoe, Lindsay (Lynden); Henderson, Rita; Murry, Adam
    Patient complexity is deemed to arise from a combination of personal, social, and external factors that can complicate medical approaches to care. Formal tools called patient complexity assessment tools (PCATs) have been developed to help identify and address these factors. However, current PCATs are not inclusive of the unique determinants of health impacting Indigenous peoples, including those which arise from a legacy of colonialism. The current thesis aimed to address this gap by identifying the domains and components that should be included in a PCAT designed specifically for Indigenous patients. The first study of this thesis was a scoping review that explored the extent to which existing PCATs are inclusive of the realities that shape the health of Indigenous peoples. Findings identified a major gap in the capacity of existing PCATs to effectively address the realities that shape the health of Indigenous patients. The second study of this thesis was a qualitative study that explored how health complexity is experienced by urban Indigenous peoples and the contexts that allow health complexity to persist. Findings revealed material resource disparities and adverse interpersonal interactions within the healthcare environment to be sources of health complexity. The third study of this thesis aimed to determine the critical components that are indicative of health complexity among Indigenous patients. An Indigenous-centered patient complexity assessment framework was developed to serve as a source of reference for healthcare providers, and policy/decision makers. This thesis presents a framework to understand the root causes of health complexity among Indigenous patients, identify where there may be gaps in healthcare systems to effectively address complexity, and provide reference for future clinical tools that will assess complexity among Indigenous patients.