Resilience has traditionally been understood as the interplay between individual traits and environmental factors. Those environmental factors encompass systems and structures that impact individuals which in some instances can perpetrate structural violence, harming individuals by preventing them from meeting basic needs. This purpose of this longitudinal, mixed-methods study was to explore how severity of exposure to parental gender-based violence impacts perceptions and experiences of structures and the resilience of children across Canada. Primary caregivers of 170 children exposed to violence across Canada completed a series of online surveys at baseline and 1-year follow-up, while a sub-set of 40 caregivers shared their lived experiences via semi-structured interviews. Using decision tree modelling, caregivers reported that societal systems, such as schools and police, were helpful for children exposed to low-severity violence while the same systems were perceived as less helpful when violence was more severe. Qualitatively, using interpretive description methods, structural violence was described as manifesting through distrust of institutional systems (social), financial exclusion (economic), and limited personal agency that undermined decision making (political). These findings highlight the urgent need for Canadian systems to adopt trauma- and violence-informed care approaches that prioritize child-centered, integrated, and adequately resourced services. Without systemic reform, children will continue to encounter structural violence within the very institutions meant to protect them, undermining their resilience.
Background. Children exposed to parental gender-based violence (GBV) in Canada face significant emotional and social challenges, increasing their risk of short- and long-term health consequences. Despite this reality, some children demonstrate resilience – the ability to survive, grow and/or thrive when exposed to adversity – suggesting that protective factors may play a critical role in mitigating the effects of exposure to GBV. Objectives. This study examined extracurricular activities (ECAs) as protective factors that supported resilience among Canadian children aged 5-12 years who were previously exposed to parental GBV, from the perspective of their primary caregivers. Methods. Using interpretive description methodology, baseline semi-structured interviews with primary caregivers (n = 20) were analyzed. Results. Three main themes were identified: (1) Mechanisms of ECA Participation as Protective Factors – peer dynamics, sense of community and emotional relief, self-expression, leadership and skill-building; (2) Barriers of ECA Participation – systemic and violence-related; and (3) Caregivers’ Recommendations for Tailored ECAs – suggestions for improving ECAs. Implications. This study offers new insights into how ECAs function as protective factors by fostering peer connections, emotional relief, self-expression, and skill-building that support resilience among children exposed to parental GBV.
Sports are integral to a child’s health and well-being, and yet, children with hearing loss often do not have access to this crucial activity due to the limitations of their devices. One of the biggest issues comes from the interference that helmets cause with hearing aids, bone conduction devices, and cochlear implants. From muffling the sound of teammates to not being able to fit under the helmet in the first place, helmets’ interaction with hearing aids is a serious issue. This project aims to explore problems and their potential remedies related to hearing aid fit while wearing a helmet. The problem is examined through a series of meetings with about ten partners, all of whom play sports and use hearing aids or are the parents of children in those situations. Through four structured meetings that vary from interviews to design activities and feedback sessions, participants will explore how helmet fit impacts their ability to communicate on a team and play the sport that they love. This project is currently in round two, where participants are using different materials to create prototypes to address the issues they shared in round one. The next stage of the project will look for feedback based on the designs created individually and in small groups, such that one may be chosen to move forward for further development.
Background: Most care for persons living with dementia (PLWD) is provided by family caregivers (henceforth called caregivers) who experience psychological, social, and physical challenges. These challenges frequently go unrecognized by healthcare professionals, and this population displays more unmet needs than other caregivers. The PLWDs’ abilities, the living arrangement, and the resources available define the care-context and influence the needs of caregivers. How various care-context configurations shape caregiver needs is highly under-explored which inhibits accurate intervention.
Objectives: This multiple case study explored: 1) how variations in the care-context shape caregiver responsibilities; 2) how caregivers interpret their identities over time; and 3) what needs emerge from different care-context configurations over time.
Methods: Participants were 10 caregivers of PLWD. Interviews and questionnaires were conducted at two time points, six weeks apart. Interpretive description was used to assess interview data. Means and standard deviations detected changes in questionnaire responses across time. Qualitative data was supplemented by quantitative data to provide a comprehensive depiction of care contexts.
Results: Caregivers held many responsibilities when supporting PLWD. Typically, caregivers assisted with personal care, offering meaningful activities, and addressing responsive behaviors. Caregivers tended to take on leadership roles, provide guidance, ensure safety, and/or ‘set up’ the PLWD for tasks (e.g., showering). The pressure of the continually increasing caregiver role often outweighed the family member role at both times. Caregiver’s desired professional approval of their care strategies and wanted to learn more about dementia and progression.
Implications: Future interventions should consider diverse care-context configurations to accurately address caregiver needs.
Background: Upper extremity orthoses are commonly used in rehabilitation to reduce pain, improve alignment, and support daily activities. These benefits depend on appropriate and consistent use, yet adherence is influenced by personal, environmental, and device-related factors. A clinician-developed checklist of adherence-related items exists, but it has not been evaluated from the patient perspective. Understanding how patients interpret these items is essential before using the checklist to inform development of a patient-reported outcome/process measure (PROM).
Objective: To explore how individuals with lived experience of upper extremity orthosis use understand and respond to checklist items, and to identify areas needing improvement in content, wording, or structure.
Methods: Cognitive interviews were conducted with adults who had used an upper extremity orthosis. Using a think-aloud approach and follow-up probes, participants explained how they interpreted each item and selected responses. Directed content analysis categorized issues related to clarity, relevance, and reference point.
Results: Thirteen participants were interviewed. Most items were considered meaningful and easy to answer. However, several terms were unclear or overly technical (e.g., “customizability,” “aesthetics,” “undue strain”). Some items were context-dependent, such as “breathability” and “flexibility.” “Affordability” was not relevant for many participants due to insurance coverage, suggesting the need for a “not applicable” option. Participants generally described adherence as following instructions rather than a multidimensional concept.
Conclusion: Cognitive interviewing highlighted specific opportunities to improve the checklist, including simplifying language, adding contextual cues, and refining response options. These refinements will support development of a patient-centred PROM for measuring adherence to upper extremity orthoses.
Dysarthria refers to a group of neurogenic speech disorders that are classified by abnormalities regarding the strength, speed, steadiness, tone, accuracy, or range of movements that are required for various aspects of speech production. These abnormalities can adversely affect the intelligibility and/or naturalness of one’s speech (Duffy, 2020). The use of Patient Reported Outcome Measures (PROMs) in the assessment of dysarthria captures the patient’s perspective related to the impact of dysarthria. It is unclear, however, how we are measuring the psychosocial consequences of dysarthria with PROMs and how they are categorized. A scoping review was conducted to provide a contemporary inventory of PROMs, an analysis of uptake in the literature, and an analysis of gaps or limitations in these PROMs as categorized using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) conceptual framework, with an emphasis of the Participation, Personal Factors, and Environmental Factors domains (WHO, 2001). A total of 64 articles were included, yielding 17 unique PROMs. The Voice Handicap Index (VHI) had the highest uptake, with 20 studies, while seven PROMs were identified in only one study. Overall, PROM categorization was most frequently within the Participation domain. By synthesizing and organizing the breadth of available PROMs and categorizing their content according to the relevant ICF domains, this review will highlight trends, gaps, and future opportunities for research and clinical applications to strengthen psychosocial measurement in this clinical population.
Caregiver-mediated interventions are widely used to support social communication development in young autistic children. While many such interventions are evidence-informed, limited information exists about their shared and unique elements, making it challenging for caregivers and clinicians to tailor program selection to individual wants and needs. This scoping review with content analysis examined 18 commercially available, caregiver-mediated social communication interventions to identify similarities and differences in child skills targeted and caregiver-coached strategies. Data were extracted from program manuals, fidelity tools, published literature, and program websites. The results indicated that the programs’ theoretical foundations were relatively evenly distributed, with eight programs based on developmental social pragmatic (DSP) models and 10 aligned with naturalistic developmental behavioral interventions (NDBIs). Programs varied in scope, with some supporting a broad range of child skills and others focusing on specific areas. Across all programs, 71 caregiver-coached strategies were identified, then thematically grouped into eight developmental skills categories. Although some strategies were common across all programs, unique strategies were also identified, and there were notable differences in how these strategies were implemented. These findings will provide a foundation for future research identifying active ingredients of interventions and enable families and clinicians to make an informed choice about intervention selection.
Mother–child separation is one of the most profound yet underexamined consequences of women’s homelessness, particularly within contexts shaped by gendered poverty, violence, and systemic neglect. While existing research has largely focused on high-income countries, far less is known about how these experiences unfold across diverse socio-economic and cultural settings. This study explores how women narrate and cope with child separation during experiences of homelessness in a high-income country (Canada) and a low-income country (Nigeria).
Guided by a critical feminist intersectional framework, the study employs narrative inquiry methods drawing on in-depth interviews with twenty women who had experienced homelessness and separation from one or more children. Participants were recruited through community-based organizations in Ontario, Canada, and Lagos State, Nigeria.
Findings reveal three interconnected themes. Describing Reality captures women’s lived experiences of navigating overlapping crises, illustrating how socioeconomic hardship, family rupture, and psychological strain destabilize family life. Driving Forces that Intensify the Reality examines how violence, institutional neglect, and social stigma deepen marginalization and perpetuate cycles of separation. The Impact of the Reality explores the emotional and psychological consequences of separation, highlighting both profound hopelessness and women’s resilience as they struggle to survive, and maintain bonds with their children.
Across contexts, child separation was associated with deep psychological distress, grief, and loss of maternal identity, while also revealing women’s resistance and strategic decision-making within severely constrained circumstances. By centering women’s voices across diverse settings, this study calls for trauma- and violence-informed, culturally responsive policies that prioritize housing stability and family preservation rather than punitive intervention.
Background d/Deaf and/or Hard of Hearing (DHH) students in mainstream (hearing) educational settings need additional supports to reach their full academic potential. DHH students benefit from curriculum-based assessment and instruction, but these resources are often lacking. Specialist teachers of the DHH support these students and can contribute valuable information to the development of a spoken language assessment tool and intervention kit for DHH students. Objectives We aimed to collaboratively develop, test, improve, and implement a curriculum-based spoken language assessment tool for use by Specialist Teachers of the DHH to support their DHH students’ academic spoken language skills. Methods Using a Design Research approach and collaborating with the intended end-users, an assessment tool and intervention kit prototype were developed. For each of the assessment tool and intervention kit, following the initial development, iterative cycles of testing, providing feedback, and revising took place. Results A 4-part spoken language assessment tool and corresponding intervention kit/template were developed, tested by end-users in the real-world context, revised, and implemented into practice. Implications An assessment tool and intervention kit/template developed specifically for use by specialist teachers for supporting their DHH students have been developed and are now in use with this population across North America. These resources are based on evidence and their use in the real-world, are flexible for use with students with a wide range of skills, and are freely available for download, limiting barriers to access and use.
Background and Objectives: Healthy futures are built early, and with physical activity (PA) levels among young children remaining suboptimal, childcare settings are critical for shaping movement habits. Early childhood educators (ECEs) influence children’s health not only through what they teach but through what they model. However, ECEs’ own PA patterns have not been clearly synthesized. This systematic review and meta-analysis aimed to describe ECEs’ engagement in moderate-to-vigorous physical activity (MVPA), determine the proportion meeting the World Health Organization’s (WHO) adult 24-Hour Movement Guidelines, and examine whether educators’ activity levels are associated with children’s PA.
Methods: Searches of seven electronic databases identified 21 studies including 5,291 educators. Studies reporting at least one quantitative PA outcome for ECEs were eligible. Random-effects models pooled weekly MVPA from 11 studies and guideline adherence from a separate 11. Associations between educator and child PA were synthesized narratively from six studies.
Results: On average, ECEs accumulated 223.6 minutes of MVPA per week (95% CI: 83.6–363.5), with substantial heterogeneity (I² = 97.6%). Just over half (52.64%; 95% CI: 35.9%–68.8%) of educators met the adult 24-Hour Movement Guidelines, with wide variation (21%–100%) by setting and measurement approach. Narrative synthesis suggested small but consistently positive relationships between educators’ and children’s PA.
Implications: While many ECEs achieve adequate MVPA, the educator–child PA relationship remains less clear. Supporting ECEs through professional development, workplace policies, and leadership that encourages active practices is needed to create movement-rich settings and strengthen healthy trajectories for educators and children.
Background: For individuals with Parkinson’s disease (IWPD), the ability to communicate is often compromised due to a motor speech disorder known as hypokinetic dysarthria (HD). Speech therapy plays a crucial role in maximizing speech production abilities and communicative participation. Most speech therapy interventions, however, are often evaluated from objective, impairment-based perspectives, and from the perspective of the clinician. Despite these interventions, there continues to remain limited understanding of how IWPD perceive the benefits and challenges of speech therapy interventions.
Purpose: The purpose of this scoping review is to systematically map and synthesize the existing qualitative literature describing how IWPD and HD perceive the benefits and challenges of speech therapy. A content analysis of qualitative findings will be conducted to identify overarching themes and patterns related to patient perspectives of speech therapy across studies.
Methods: This research follows the scoping review methodology outlined by the Joanna Briggs Institute (JBI) manual. In collaboration with a research librarian, four databases (Scopus, MEDLINE, Embase and CINHAL) were searched, and a web-based review management software (Covidence) was used. Content and thematic analysis will follow approaches described by Hsieh and Shannon, and Butler and colleagues.
Preliminary results: Full-text screening is currently underway. The title/abstract screening phase has identified 85 studies that have used qualitative methods to capture patients’ experiences of speech therapy.
It is anticipated that this scoping review will identify the patient-reported benefits and challenges of speech therapy in this clinical population and uncover gaps in the existing qualitative literature that will inform future research.
It is common for some public health interventions to be characterized as ‘coercive,’ which carries negative moral connotations that often fuel opposition. Yet, coercion admits of myriad definitions and justifications. This lack of conceptual clarity not only risks the inconsistent implementation and evaluation of policy, but can also undermine public trust and weaken the legitimacy of public health governance. A scoping review was conducted to understand (1) how coercion is defined in the public health literature and (2) which justificatory conditions, if any, the literature identifies to support the use of coercion for public health purposes. The search strategy covered five databases and results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. 56 publications that explicitly define coercion were included and analyzed. Definitions appeared most within the contexts of infectious disease (n=30) and public health ethics (n=34). Despite the ubiquity of the term ‘coercion,’ definitions lacked consistency, and often, conceptual precision. This review contributes a consolidated repository of definitions of coercion as used in the public health literature, identifies common elements and justificatory conditions, and discusses implications for the public health community.
Background: Standardized measures are used to evaluate the health impact of primary progressive aphasia (PPA). However, the extent to which these measures capture the breadth of functioning and context described by the World Health Organization International Classification of Functioning, Disability, and Health (ICF) remains unclear.
Objectives: To link commonly used PPA measures to the ICF framework and examine the distribution of ICF components represented.
Methods: Items (i.e., prompts and/or questions) from 10 standardized instruments administered at baseline in the Communication Bridge™-2 (CB2) randomized controlled trial were independently linked to the ICF by two reviewers using established ICF linking rules and codes from the ICF browser. Code assignments were compared to assess agreement. A consensus meeting with a third reviewer, a speech-language pathologist and field expert, resolved disagreements and finalized ICF code assignments.
Results: A total of 369 items were linked, resulting in 1,617 ICF code assignments. Most codes mapped to Body Functions (63.3%) and Activities and Participation (28.1%). Environmental (5.3%) and personal (2.8%) contextual factors were comparatively underrepresented, and concepts not captured by the ICF were coded as “Not Covered” (0.6%). Pre-consensus item-level agreement between reviewers was high (93.22%).
Discussion: This exercise shows that PPA measures emphasize impairment and activity-related domains, with limited attention to contextual factors. Underrepresentation of these factors may contribute to under-measurement of supports and barriers shaping everyday communication participation. ICF linking offers a systematic approach to identify and strengthen content gaps and validity, with implications for measure development that better reflect lived experience.
Personal autonomy is widely recognized as central to person-centered care and the well-being of persons living with dementia. However, current research and care practices often implicitly rely on traditional Kantian models that equate autonomy with full rationality and independence, which are standards that inherently disadvantage those with cognitive impairments. This project addresses the critical need for conceptual clarity to improve research synthesis and clinical application.
We conducted a scoping review of 65 qualitative studies to assess how autonomy is currently defined in empirical literature. The results revealed significant conceptual ambiguity: 77% (n=50) of studies provided no definition of autonomy, often conflating it with "agency" or "independence." To address this gap, we synthesized findings from philosophical and social science literature to propose a distinct, empirically informed framework. This account distinguishes between decisional autonomy (making choices), executional autonomy (enacting choices), and authenticity (acting in character).
This framework posits that autonomy is not a solitary trait but a socially embedded phenomenon. With adequate relational support, autonomy remains an achievable goal even in moderate to severe dementia. We are currently validating this framework through an interpretative phenomenological analysis and a grounded theory study. By moving beyond the "rational agent" model toward a nuanced, multidimensional definition, this research offers a pathway to more accurate and comparable health research and the development of genuine autonomy-supporting interventions in dementia care.
Background: Serious games and gaming are increasingly used as therapeutic interventions in the rehabilitation of the upper extremities (UE) among individuals with musculoskeletal (MSK) conditions. However, gaps exist in literature syntheses regarding the characteristics of gaming technology used for rehabilitation of MSK conditions.
Objectives: To describe and summarize the characteristics of gaming technology used for UE rehabilitation of MSK conditions.
Methods: We conducted a scoping review and searched four databases (Medline Ovid, Embase, CINAHL, and PubMed). Three reviewers screened articles and included those with at least one participant with an MSK condition, using a gaming intervention, and focused on UE rehabilitation indicated by a UE outcome measure. Data on study, patient, and gaming characteristics were extracted and descriptively summarized. Stakeholder consultations with experts and therapists provided feedback on results.
Results: Forty-one articles were included. Gaming technology demonstrated participation benefits (motivation, adherence) and therapeutic benefits (improving range of motion, muscle strength). Conditions included fractures (n=8), amputation (n=8), arthritis (n=5), and shoulder impingement syndrome (n=3). Frequently used technologies included Kinect (n=6), Oculus (n=5), Myo (n=4), Leap Motion (n=4), and Nintendo Wii (n=4). Gaming was used as standalone (51%) or adjunct to conventional therapy (49%). Limitations related to technology, hardware, games, therapeutics, and costs were identified.
Implications: This review summarizing the characteristics of gaming technology can help therapists and researchers make decisions on which ones to use for UE rehabilitation of MSK conditions, although some may be currently unavailable due to rapid technological advancement.
Background: Tiered service delivery models are used in health and educational systems to address growing demands for care in the face of resource constraints. However, limited evidence exists to inform their application in preschool speech and language (PSL) settings. Objectives: (1) To identify existing tiered service models relevant to PSL programs and (2) to engage clinical program leaders in assessing the identified models’ relevance and applicability. Methods: In phase one, researchers conducted a Rapid Review following Cochrane guidelines to identify potential tiered service models. Eligibility screening was conducted by two reviewers in Covidence. In phase two, 30 clinical program leads from 24 Ontario PSL program regions participated in 50-minute virtual focus groups facilitated by the research team. Qualitative focus group data was analyzed using a deductive content analysis. Results: The rapid review yielded 2620 results. Of these, 9 were identified as potentially relevant tiered service models. Researchers grouped these models into broad categories according to their primary goal: building capacity, prevention, reducing wait times, and service planning. Summaries were developed for each category, including an exemplary model and list of key components, and results were disseminated to focus group participants. Focus group participants rated the building capacity category as the most relevant and identified several applicable components from multiple categories, indicating the need for a tailored approach. Future Directions: Results will be used to develop a framework for tiered service delivery planning for PSL programs and support the creation of a service delivery model tailored to Ontario’s PSL program.
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