Title: Mental Health Stigma: Mental Health experiences of Older Adults Living with HIV in Ghana and Canada
Abstract
Background: Mental health stigma remains a critical barrier to HIV care and wellbeing, particularly among older people (≥50 years) living with HIV (PLHIV50+). Globally, this population is growing rapidly, yet their mental health needs remain underexplored, especially in Low-or-middle income countries (LMICs) including Ghana and in marginalised populations in High income countries (HICs) such as among African, Caribbean, and Black (ACB) communities in Canada. Despite global calls to integrate mental health into HIV care, research addressing stigma and mental health among older PLHIV in community-based settings is scarce. Objective: The aim of this study is to examine mental health experiences of older adults living with HIV in Ghana and Canada. Proposed Methods: An explanatory sequential mixed methods will be utilized. Phase 1 will involve a cross-sectional survey using standardized scales (DASS-42; HIV self-stigma scale) to examine the prevalence of depression, anxiety and stress and their association with HIV-related stigma among older PLWH in Ghana and Canada. Phase 2 involves in-depth qualitative interviews; purposively sampled from community-based HIV organizations in both countries, to contextualize quantitative findings. Analysis will integrate descriptive and bivariate statistics and thematic coding with integration occurring at the interpretation stage. Future applications/direections: By situating mental health within multilevel determinants and community contexts, findings will enrich culturally grounded interventions and policy reforms to reduce HIV-related stigma and enhance access to mental health services/support. This study will also generate insights to support global efforts to integrate mental health into HIV care. Additionally, the study will generate scholarly insights into how HIV-related stigma is enacted and experienced by older PLWH.
Title: Dental Care under Universal Health Coverage for Adults with Intellectual Disabilities: A Cross-Country Equity Analysis
Abstract
Background: United Nations Member States and the World Health Organization have made near-global commitments to universal health coverage, grounded in the idea of equity. However, unlike physician care in hospitals, dental care delivery and financing vary widely across countries. Within this uneven landscape, adults with intellectual disabilities face barriers because they require accommodated care (e.g., longer appointments, adapted communication and behavioural supports), making gaps in dental benefit design and service organization especially consequential. Hypotheses/Objectives: I hypothesize that entitlement language and nominal coverage will not reliably predict usable access; instead, differences will hinge on whether systems operationalize accommodation through special delivery and referral pathways. Methods: This interim analysis uses structured data extraction from publicly available benefit packages, system documents, and service descriptions, supplemented by peer-reviewed and grey literature. Eight countries were purposively selected, enabling comparison across the World Bank’s four income settings. Evidence is coded using the Five A’s framework (availability, accessibility, affordability, accommodation, acceptability). Preliminary results: Early synthesis suggests that the key constraint is often not the presence of “some” public dental coverage, but the absence of clear routes for accommodated care, resulting in fragmented navigation, delayed treatment until crises, and greater out-of-pocket risk for families. Future directions/implications: Ongoing extraction will finalize a cross-country matrix and derive actionable universal design levers (minimum adapted package, commissioned special care capacity, explicit referral/escalation responsibilities, and disability-relevant monitoring). This policy analysis is one of two papers in my MSc thesis; the second paper will extend the program of research using a complementary systematic review.
Title: Career Comes at A Cost: A Qualitative Study Exploring Work-Related Reproductive Health Concerns of Canadian Female Firefighters
Abstract
Background: Female firefighters face unique occupational exposures that may elevate reproductive health risks. Physical exertion during firefighting has been linked to increased stress hormones and elevated blood pressure, while prior studies associate firefighting with adverse pregnancy outcomes, including preterm births and miscarriages. Mental and emotional demands further compound these risks, yet reproductive health concerns among female firefighters remain underexplored in Canada. Methods: This qualitative study employed an interpretive descriptive approach to examine reproductive health concerns and outcomes among Canadian female firefighters. Data were collected through in-depth interviews and were analyzed thematically to identify key experiences and challenges. Results: Based on emerging themes from the study, the ECORSE framework was introduced, showing that their experiences as firefighters lay the foundation for concerns that later require coping strategies. Based on the codes, the following themes emerged: I.) Participants reported uncertainty regarding the impact of hazardous exposures on reproductive health, ii) policy gaps addressing female-specific needs; iii) challenges with delayed motherhood; iv) navigating the invisibility of menopause and perimenopausal symptoms, and v) limited access to resources or information on reproductive risks. Physical exertion and occupational stress were perceived as contributing to adverse reproductive outcomes, while mental and emotional stressors heightened vulnerability. Conclusion: Findings show that their concerns are multifaceted and underscore the urgent need for targeted policies, resources, and interventions to address reproductive health risks among female firefighters. Supporting female firefighters is essential to improving well-being and promoting healthier reproductive outcomes within the fire service.
Title: Exploring Power, Identity, and Nature in Youth Mental Wellness Care: A Qualitative Study on Nature-Based Prescriptions and Facilitator-Participant Relationships
Abstract
Background: Youth mental wellness care is increasingly exploring alternatives to traditional clinical models, particularly those that address social, relational, and environmental determinants of mental health. Nature-based prescriptions, structured referrals to nature-based activities facilitated by trained leaders, are emerging as a promising approach. However, limited research has examined how power dynamics, identity, and facilitator–participant relationships shape youths’ experiences within these programs, particularly from a qualitative and critical perspective. Objectives: This study aims to explore how youth participants and facilitators understand and navigate power, identity, and relationships within nature-based mental wellness programs. Specifically, it seeks to examine how facilitator roles, relational practices, and connections to nature influence youths’ sense of agency, belonging, and well-being. The study is guided by the objective of centring youth voices while critically examining the social and structural contexts of care. Proposed Methods: This qualitative study will employ semi-structured interviews with youth participants and program facilitators involved in nature-based prescription initiatives. A reflexive thematic analysis approach will be used to identify patterns related to power, identity, relational dynamics, and experiences of nature. The study is informed by critical health promotion and relational frameworks, emphasizing reflexivity, positionality, and ethical engagement with youth participants. Future Applications and Directions: Findings from this study are intended to inform the design and implementation of more equitable, relational, and youth-centred nature-based mental wellness programs. The research may also contribute to broader discussions on upstream mental health care, facilitator training, and the role of nature-based interventions within public health and community-based mental wellness systems.
Title: Mental Health and Its Impact on Long-Term Care Workers: A Scoping Review
Abstract
Background: Long-term care (LTC) workers experience sustained mental and emotional strain that threatens workforce sustainability and retention. These challenges reflect organizational inequities, including unfair workloads, inadequate staffing, limited autonomy, and low psychological safety. Psychological hazards are harmful aspects of work design and practices (e.g., excessive workload, low autonomy, and moral distress) that are linked to attrition. Evidence also points to inequitable workplace cultures that may marginalize racialized and gendered care workers, highlighting the need to synthesize these impacts. Theoretical Framework: A biopsychosocial paradigm emphasizes system-level strategies that address organizational causes of stress and turnover beyond individual coping. Objective: To identify psychological hazards in LTC care work and develop a conceptual framework to define and analyze hazards experienced by LTC health care workers. Methods: A scoping review guided by Arksey and O’Malley’s methodology will include LTC workers across roles (e.g., nurses, PSWs, allied health professionals). CINAHL, MEDLINE, PsycINFO, and Scopus will be searched using keywords related to psychological hazards, inequities, work disparities, and LTC. Studies will be screened, charted, and thematically synthesized. Extracted data will include organizational factors (e.g., leadership, workload), psychological hazards (e.g., stress, burnout, moral distress), and outcomes (e.g., retention, attrition). Analysis: A thematic synthesis will examine psychological hazards across organizational and structural levels and their relationship to workplace attrition. Significance: Findings will inform psychological safety and retention strategies in LTC and identify priorities for future prevention-focused research. Findings will be shared through infographics and presentations and discussed with sector partners (e.g., RPNAO) to support strategies for change.
Title: Exploring Representations of Responsive Behaviours Using Critical Interpretive Synthesis
Abstract
Background: The term ‘responsive behaviour’ is used to describe how persons living with dementia may communicate unmet needs, feelings, or goals and is defined as actions, words or gestures presented by a person with dementia in response to something negative, frustrating or confusing in their social and physical environment. However, this term continues to be associated with and reproduce harmful misconceptions about persons living with dementia such as stigmatizing labels (e.g., ‘aggressive’) and assigning the ‘problem’ of these behaviours to the person living with dementia and/or their caregiver. Despite these issues, research has yet to critically explore how the term responsive behaviour is discursively constructed in the literature. Objective: This paper aims to critically investigate representations of responsive behaviours within academic and grey literature. It considers the influence of such representations on the conceptualization of persons living with dementia and the proposed solutions to address responsive behaviours. Methods: Underpinned by a critical social paradigm and guided by Foucault’s theory of discourse, this paper employed a critical interpretive synthesis (CIS). Scopus, Medline(Ovid), Embase, and CINALH databases were searched on January 5th, 2026. Studies eligible for inclusion included those with a significant focus on the concept of responsive behaviours, specific to dementia, written or translated in English, and published between 2005 – 2026. Grey literature included clinical practice guidelines published by influential dementia organizations. Future Directions/Implications: Critically analysing how the term responsive behaviour circulates through knowledge and practice and the meanings it generates is crucial for disrupting harmful discourses and improving dementia care.
Title: Elementary School Staff Perspectives on Socioemotional Needs Following the COVID-19 Pandemic in Canada (RESTORE): Preliminary Results
Abstract
Background: The COVID-19 pandemic significantly disrupted elementary education worldwide, with over 1.5 billion students experiencing school closures that limited opportunities for social development, emotional regulation, and mental health support. The rapid shift to remote instruction exacerbated existing technological and financial inequities and constrained socioemotional learning. Given that critical development for children occurs during elementary school, and given the established health and socioemotional effects, there is limited research on the pandemic’s impacts on children’s socioemotional development. Objective: This study explores elementary school staff perspectives on (1) the socioemotional needs of students experiencing multiple, intersecting health and social disparities following the COVID-19 pandemic in Canada, and (2) the mental health, well-being, and support needs of elementary staff. Methods: This ongoing study draws on qualitative data from semi-structured in-depth interviews (n = 16) with teachers, principals, and elementary support staff. Analysis will be guided by Thorne’s Interpretive Description approach, examining experiences, challenges, and support needs in children's socioemotional development across Canada. Preliminary Results: Staff indicate notable discrepancies in students' socioemotional development pre- and post-pandemic, including greater dependence on adults, heightened behavioural challenges, poorer mental health, and reduced life skills. Staff also report feeling under-resourced to address these challenges, highlighting gaps in staffing, training, and system-level support. Implications: These findings offer critical insight into the current socioemotional landscape of students from the perspectives of elementary staff. This work aims to highlight actionable strategies to strengthen staff capacity, enhance student well-being, and inform interventions and policy initiatives that support sustainable, healthy educational environments.
Title: Clinical Pathways and Interprofessional Collaboration: Building Healthier Care Together
Abstract
Background: Fragmentation across health and rehabilitation services remains a persistent challenge, often resulting in poor continuity, unclear professional roles, and disrupted care experiences for patients. Clinical pathways are structured, multidisciplinary care plans that coordinate key steps in care for specific patient groups and are intended to reduce fragmentation by aligning interprofessional teams around shared processes. However, evidence suggests that while clinical pathways may improve the organisation of care, their capacity to consistently strengthen interprofessional collaboration in everyday practice is variable. Understanding how clinical pathways function in practice is important because everyday care processes shape the coordination and continuity of care experienced by patients. Objectives: The objective of this proposed study is to explore how clinical pathways support coordinated care in everyday practice and how interprofessional collaboration within pathways influences continuity of care and patient experience relevant to health and rehabilitation. The study focuses on how pathways are enacted in practice rather than how they are intended to operate in theory. Proposed Methods: This study will use a qualitative design to examine pathway-based care within interprofessional health care teams. Data will be collected through semi-structured interviews with health care professionals and analysis of pathway-related documents, including care maps and referral, discharge, and follow-up guidelines. Data will be analysed using thematic analysis to identify patterns in teamwork and coordination that support or disrupt continuity of care. Future Applications and Directions: Findings will inform the design and implementation of clinical pathways that more effectively support interprofessional collaboration and continuity of care, and will guide future evaluative research.
Title: International Models of Long-Term Care at Home for Older Adults: A Scoping Review
Abstract
Background: Population aging is a global phenomenon that increased the demand for long-term care (LTC) defined as a range of supportive services that address personal, social, and medical needs. Many LTC services can be provided at home. According to the WHO, 142 million older adults globally cannot meet their basic needs independently and require LTC services. As the demand for LTC at home increases, it is important to better understand characteristics of the existing LTC at home models.Objective: This scoping review aims to summarize the broad evidence about the provision, patterns, outcomes, and recipient experiences of long-term care delivered at home to older adults around the world. Methods: Arksey and O’Malley methodological framework for scoping reviews will be followed together with the PRISMA Sc-R checklist. The protocol will be registered with the Open Science Framework. PubMed, Web of Science, and Scopus databases will be searched in addition to grey literature sources such as ProQuest dissertations & theses, conference abstracts, and Google Scholar. There are no time or study design limits. Inclusion criteria are: population of adults 65 years and older, models of LTC at one’s own home, and context of independent community dwelling. Sources will be screened and extracted using Covidence by third reviewers. Data will be summarized and analyzed thematically. Future applications: Findings will provide a breath of existing knowledge in the field, identify gaps, summarize major LTC at home models, determine areas for further research, and generate evidence to inform future policies.
Title: From Evidence to Best Practices: Audiological Monitoring in Pediatric Diabetes
Abstract
Background: Emerging evidence indicates that children and youth living with Type 1 diabetes are at risk for early and progressive sensorineural hearing loss, which may negatively affect communication, learning, psychosocial well-being, and quality of life. Despite these risks, audiological monitoring is not routinely integrated into pediatric diabetes care, creating a gap between research evidence and best practices in child and youth health.
Objective: To synthesize current evidence on the early detection and monitoring of hearing loss in children living with diabetes and to identify care pathways that support integration of audiological services within interdisciplinary pediatric health care. Design: A systematic scoping review was conducted using the Joanna Briggs Institute methodology to map and summarize existing evidence. Results / Conclusion: Findings revealed considerable variability in monitoring recommendations, limited guidance on referral pathways, and inconsistent integration of hearing healthcare professionals within pediatric diabetes teams. These gaps highlight the need for standardized, evidence-informed audiological monitoring protocols. This dataset will inform the development of clinical monitoring guidelines, interdisciplinary care pathways, and future research focused on implementation, feasibility, and outcomes of integrated hearing care models to advance best practices and promote child and youth well-being.
Title: Utilizing generic vs. disease-specific patient-reported outcomes measures to guide head and neck cancer survivorship care
Abstract
Among cancer survivors, individuals treated for head and neck cancer (HNC) are disproportionately burdened by significant treatment effects. Treatment of these cancers that arise in the mouth and/or throat leads to speech and swallowing impairments, changes to appearance, and myriad psychosocial effects, all of which significantly diminish health-related quality of life. As such, symptom burden measurement is an important element of HNC survivorship care to capture the treatment effects faced by patients and facilitate the delivery of patient-focused survivorship care. This retrospective study will compare data gathered using two symptom burden tools, the Edmonton Symptom Assessment System (ESAS) and the M.D. Anderson Symptom Inventory – Head & Neck (MDASI-HN) to explore 1) differences in baseline symptom burden using general (ESAS) and disease-specific (MDASI-HN) tools, and 2) symptom burden change from baseline to 3-months post-treatment. The alignment between the items captured by each tool and the symptoms known to impact function and quality of life in HNC will also be explored. A local cohort of HNC patients (n=85) completed the ESAS as part of usual care and the MDASI-HN through clinical trial participation. A subgroup of these patients (n=20) also completed both tools at 3-months post-treatment. Descriptive statistics and paired t-tests will be used to analyze study data. Qualitative content analysis methodology will be guided by a cancer survivorship care framework. Findings could support the implementation of a disease-specific measurement tool to enhance HNC survivorship care, with the ultimate goal of improving functional outcomes and health-related quality of life in HNC patients.
Title: Examining representations of caregiving of disabled children in the literature: A critical conceptual review
Abstract
Background. Caregiving is overwhelmingly represented as being a burdensome, stressful, and negative occupation in health-focused literature, especially prevalent in empirical studies from the fields of psychology, gerontology, and nursing. This perception of caregiving as burdensome is understood as a taken-for-granted truth in society as demonstrated by government resources, services, and policies that are aimed at addressing what has come to be known as ‘caregiver burden’, as well as demonstrated through the general discourses surrounding caregiving. Embedded in this discourse is the assumption that caring for a child with a disability is a negative experience. Study objective. The purpose of this study is to critically examine how caregiving of disabled children has been explicitly or implicitly conceptualized within the literature, uncovering the assumptions that underlie these representations as well as the effects these can have on caregivers and disabled children. Study design & methods. A critical conceptual review of peer-reviewed health-focused literature that pertains to informal or family caregiving of disabled children will be conducted. This review allows for the challenging of the dominant assumptions that are explicit or implicit within the literature and the generation of a new theory can allow for a re-conceptualization of a topic, creating space for a new kind of understanding that can be promoted for future research to adopt. Significance. The results of my review will contribute towards encouraging different ways of thinking about caregiving and caring for disabled children specifically important for caregiving research, services, and programs.
Title: Lived experience of physical functioning in people with chronic low back pain: An interpretative phenomenological analysis
Abstract
Background: Chronic low back pain is a prevalent and disabling condition that can lead to persistent limitations in physical functioning in daily life. Physical functioning is a core outcome domain in low back pain research and clinical practice; however, is most often assessed using patient-reported outcome measures and performance-based tests. These approaches may not fully capture how people experience change in physical functioning over time. A deeper understanding of these lived experiences is needed to inform more person-centered assessment and care. Objectives: To explore how people with chronic low back pain experience changes in physical functioning over a 12-month period following entry into a low back pain Rapid Access Clinic care pathway. Methods: Guided by an interpretivist paradigm, this qualitative study uses Interpretative Phenomenological Analysis. A purposive sample of 6-10 adults with chronic low back pain who entered the care pathway 12-months prior will be recruited from the SPINA registry. Data will be collected through semi-structured, one-on-one interviews, guided by a topic guide structured around IMMPACT domains of physical functioning and grounded in the ICF conceptualization of physical functioning, to support in-depth exploration of lived experience. Interviews will be audio-recorded, transcribed verbatim, and analyzed using an idiographic IPA approach. Preliminary Results: Preliminary results are not yet available, as data collection is ongoing.Future Directions/Implications: This study will provide in-depth insight into the aspects of physical functional change that matter most to people. Findings may inform more patient-centered outcome assessment and clinical care approaches for people living with chronic low back pain.
Title: Clinical Diagnosis of Lumbar Intervertebral Disc Degeneration: A Systematic Review
Abstract
Background: Lumbar intervertebral disc degeneration (IVDD) is a major cause of lower back pain, affecting an estimated 400 million people annually. Previous literature reviews have identified magnetic resonance imaging (MRI) as the gold standard for diagnosing IVDD, although MRI findings of IVDD have been reported to lack correlation with patient-reported outcomes. There remains a gap in our understanding of the reliability of imaging techniques for diagnosing IVDD and of potential diagnostic methods that could complement imaging findings. Objectives: The objectives of this review are to examine current diagnostic approaches for lumbar IVDD (e.g., imaging) and to evaluate their associations with other novel or established diagnostic tools (e.g., patient history, physical measures, biomarkers). Proposed Methods: Observational studies involving adults diagnosed with lumbar IVDD will be included, while studies focused on cervical or thoracic IVDD and other spinal conditions will be excluded. A systematic search of CINAHL, EMBASE, MEDLINE, AMED, Web of Science, Scopus, key journals, and grey literature will be performed from inception to July 31, 2026. Two independent reviewers will perform study selection, data extraction, and risk-of-bias assessment using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines. In the event that the studies demonstrate sufficient homogeneity, a meta-analysis will be performed. Future Applications: This review will inform clinicians and researchers about the strength of current diagnostic evidence for IVDD and identify promising diagnostic methods requiring further investigation.
Title: Beyond the Ears: Exploring Spatial Hearing Difficulties in Children with Auditory Processing Disorder
Abstract
As many as 8% of school-aged children have difficulty understanding speech in noisy classrooms, even if they have normal hearing, a common symptom of Auditory Processing Disorder (APD). APD can negatively affect everyday listening abilities, including understanding speech in group conversations and meeting academic demands. Children with APD often face challenges in classrooms, where background noise and competing talkers are common. Although their ears function normally, their brains have difficulty making sense of sounds, making listening exhausting and stressful. These difficulties are frequently misunderstood as inattention or lack of effort, when in fact APD is a neurological disorder affecting how sound is processed in the brain. A key difficulty for children with APD is impaired spatial hearing, the ability to detect and use differences in the location of sounds to separate target signals from competing noise. Weaknesses in spatial hearing make multi-talker environments, such as classrooms particularly challenging. For children with reduced spatial hearing abilities, these conditions increase listening effort, and make it harder to maintain attention during learning activities. My research investigates whether spatial hearing deficits and speech-in-noise difficulties are causally related and evaluates the effectiveness of targeted training programs designed to improve these listening abilities. Accurate assessment of spatial hearing is essential for identifying children whose listening difficulties are driven by spatial processing deficits rather than linguistic or cognitive factors. By improving early diagnosis and developing evidence-based, spatially focused interventions, this work aims to help Canadian children with APD succeed academically and improve their overall quality of life.
Title: Addressing Gaps in Augmentative and Alternative Communication Services for Children: What do Speech-Language Pathologists Need?
Abstract
Augmentative and Alternative Communication (AAC) includes any method of communication used in addition to or in place of spoken language, such as gestures, picture-based systems, and speech-generating devices. AAC use is associated with improved communication and social engagement outcomes for children with speech and language differences; however, in Canada, many children access AAC later than recommended and often use it infrequently. Although AAC service provision falls within the scope of practice for speech-language pathologists (SLPs), many report feeling under-prepared to implement AAC. Existing research has primarily focused on SLPs working in specialized AAC settings, leaving a gap in understanding on AAC use in non-specialized clinical contexts. This study aims to explore: (1) how SLPs in Canada currently use AAC in their clinical practice with children and youth, (2) factors influencing AAC service delivery, and (3) the supports and resources SLPs need to enhance their confidence in and capacity to provide AAC services. A national, online survey will be conducted with SLPs in Canada working with populations aged 0-18 years, through snowball sampling recruitment via social media, professional organizations, and SLP professional training programs. The survey will include closed and open-ended questions; quantitative data will be analyzed using descriptive statistics, while qualitative responses will be analyzed to the Capability, Opportunity, Motivation-Behaviour (COM-B) framework. This study will generate new knowledge about AAC service delivery in Canada and inform the development of targeted training and resources for SLPs, with the goal to expand early AAC access for children and youth across Canada.
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