Cancer is a leading cause of death among Inuit. A legacy of colonialism, residential schools, and systemic racism has eroded trust among Inuit and many do not receive culturally safe care. This study aimed to explore the meaning of culturally safe cancer survivorship care for Inuit, and barriers and facilitators to receiving it in an urban setting in Ontario Canada. As Inuit and Western researchers, we conducted a descriptive qualitative study. We held two focus groups (n = 27) with cancer survivors and family members, and semi-structured interviews (n = 7) with health providers. Data were analysed using thematic content analysis.Three broad themes emerged as central to culturally safe care: access to traditional ways of life, communication, and family involvement. Family support, patient navigators, and designated spaces were facilitators; lack of support for traditional ways, like country food, was a barrier. Participants were clear what constituted culturally safe care, but major barriers exist. Lack of direction at institutional and governmental levels contributes to the complexity of issues that prevent Inuit from engaging in and receiving culturally safe cancer care. To understand how to transform healthcare to be culturally safe, studies underpinned by Inuit epistemology, values, and principles are required.

Street nurses who serve people experiencing homelessness and substance abuse are at risk of vicarious trauma and long-term mental health challenges. These risks have increased during the COVID-19 pandemic due to a concomitant spike in opioid overdoses and deaths in Canada, fewer available support services and worsening social challenges. This article describes innovative interdisciplinary and participatory research currently being undertaken to develop and evaluate a multifaceted support program to promote the holistic well-being of street nurses and their front-line colleagues.

Plain English summary There have been many attempts to improve how healthcare services are developed and delivered. Despite this, we know that there are many gaps and differences in practice and that these can lead to poor patient outcomes. In addition, there are also concerns that research is being undertaken that does not reflects the realities or needs of those using healthcare services, and that the use of research findings in practice is slow. As such, shared approaches to research, such as integrated knowledge translation, are being used. Integrated knowledge translation (IKT) is a research approach that brings together researchers, along with other stakeholders that have knowledge about a particular healthcare issue. Stakeholders may include healthcare providers and policy-makers. More recently, there has been a growing awareness of the need to include patients and members of the public within research processes. These collaborative and patient-oriented research approaches are seen as a way to develop research that tackles ongoing gaps in practice and reflect the insights, needs and priorities of those most affected by health research outcomes. Despite great support, little is known about how these major research approaches are connected, or how they may bring about improvements in the development and use of research evidence. In this paper, we examine how IKT and patient engagement processes are linked, as well as exploring where differences exist. Through this, we highlight opportunities for greater patient engagement in IKT research and to identify areas that need to be understood further. Abstract Healthcare organizations across the world are being increasingly challenged to develop and implement services that are evidence-based and bring about improvement in patient and health service outcomes. Despite an increasing emphasis upon evidence-based practice, large variations in practice remain and gaps pervade in the creation and application of knowledge that improves outcomes. More collaborative models of health research have emerged over recent years, including integrated knowledge translation (IKT), whereby partnerships with key knowledge users are developed to enhance the responsiveness and application of the findings. Likewise, the meaningful engagement of patients, in addition to the inclusion of patient-reported outcomes and priorities, has been hailed as another mechanism to improve the relevance, impact and efficiency of research. Collectively, both IKT and patient engagement processes provide a vehicle to support research that can address health disparities and improve the delivery of effective and responsive healthcare services. However, the evidence to support their impact is limited and while these approaches are inextricably connected through their engagement focus, it is unclear how IKT and patient engagement processes are linked conceptually, theoretically, and practically. In this paper, we will begin to critically examine some of the linkages and tensions that exist between IKT and patient-engagement for research and will examine potential opportunities for IKT researchers as they navigate and enact meaningful partnerships with patients and the public.

HIV treatment in Canada has rapidly progressed with the advent of new drug therapies and approaches to care. With this evolution, there is increasing interest in Canada in understanding the current delivery of HIV care, specifically where care is delivered, how, and by whom, to inform the design of care models required to meet the evolving needs of the population. We conducted a cross-sectional survey of Canadian care settings identified as delivering HIV care between June 2015 and January 2016. Given known potential differences in delivery approaches, we stratified settings as primary care or specialist settings, and described their structure, geographic location, populations served, health human resources, technological resources, and available clinical services. We received responses from 22 of 43 contacted care settings located in seven Canadian provinces (51.2% response rate). The total number of patients and HIV patients served by the participating settings was 38,060 and 17,678, respectively (mean number of HIV patients in primary care settings = 1,005, mean number of HIV patients in specialist care settings = 562). Settings were urban for 20 of the 22 (90.9%) clinics and 14 (63.6%) were entirely HIV focused. Primary care settings were more likely to offer preventative services (e.g., cervical smear, needle exchange, IUD insertion, chronic disease self-management program) than specialist settings. The study illustrates diversity in Canadian HIV care settings. All settings were team based, but primary care settings offered a broader range of preventative services and comprehensive access to mental health services, including addictions and peer support.

Plain English summary Patient engagement (or patient and public involvement) in health research is becoming a requirement for many health research funders, yet many researchers have little or no experience in engaging patients as partners as opposed to research subjects. Additionally, many patients have no experience providing input on the research design or acting as a decision-making partner on a research team. Several potential risks exist when patient engagement is done poorly, despite best intentions. Some of these risks are that: (1) patients’ involvement is merely tokenism (patients are involved but their suggestions have little influence on how research is conducted); (2) engaged patients do not represent the diversity of people affected by the research; and, (3) research outcomes lack relevance to patients’ lives and experiences. Qualitative health research (the collection and systematic analysis of non-quantitative data about peoples’ experiences of health or illness and the healthcare system) offers several approaches that can help to mitigate these risks. Several qualitative health research methods, when done well, can help research teams to: (1) accurately incorporate patients’ perspectives and experiences into the design and conduct of research; (2) engage diverse patient perspectives; and, (3) treat patients as equal and ongoing partners on the research team. This commentary presents several established qualitative health research methods that are relevant to patient engagement in research. The hope is that this paper will inspire readers to seek more information about qualitative health research, and consider how its established methods may help improve the quality and ethical conduct of patient engagement for health research. Abstract Background Research funders in several countries have posited a new vision for research that involves patients and the public as co-applicants for the funding, and as collaborative partners in decision-making at various stages and/or throughout the research process. Patient engagement (or patient and public involvement) in health research is presented as a more democratic approach that leads to research that is relevant to the lives of the people affected by its outcomes. What is missing from the recent proliferation of resources and publications detailing the practical aspects of patient engagement is a recognition of how existing research methods can inform patient engagement initiatives. Qualitative health research, for example, has established methods of collecting and analyzing non-quantitative data about individuals’ and communities’ lived experiences with health, illness and/or the healthcare system. Included in the paradigm of qualitative health research is participatory health research, which offers approaches to partnering with individuals and communities to design and conduct research that addresses their needs and priorities. Discussion The purpose of this commentary is to explore how qualitative health research methods can inform and support meaningful engagement with patients as partners. Specifically, this paper addresses issues of: rigour (how can patient engagement in research be done well?); representation (are the right patients being engaged?); and, reflexivity (is engagement being done in ways that are meaningful, ethical and equitable?). Various qualitative research methods are presented to increase the rigour found within patient engagement. Approaches to engage more diverse patient perspectives are presented to improve representation beyond the common practice of engaging only one or two patients. Reflexivity, or the practice of identifying and articulating how research processes and outcomes are constructed by the respective personal and professional experiences of researchers and patients, is presented to support the development of authentic, sustainable, equitable and meaningful engagement of patients as partners in health research. Conclusions Researchers will need to engage patients as stakeholders in order to satisfy the overlapping mandate in health policy, care and research for engaging patients as partners in decision-making. This paper presents several suggestions to ground patient engagement approaches in established research designs and methods.

Women with disabilities consider exercise an important health promotion activity. A lack of accessible facilities within the community has been identified as a major limiting factor to exercise participation among women with disabilities. To increase exercise participation among women with disabilities, we need to understand the structural and social barriers that they face within community recreation and fitness facilities. Interviews were conducted with 15 women living with disabilities in Toronto, Canada, to explore their experiences with accessibility in community recreation and fitness facilities. Qualitative content analysis resulted in the development of two key themes that describe how women negotiated their exercise participation in community facilities. The first theme describes how women negotiated barriers in the built environment of community exercise facilities by making trade-offs to their personal safety in favour of autonomous exercise participation The second theme describes how staff members' assumptions and lack of knowledge about disabilities created social barriers that affected women's exercise participation. These findings suggest that simply removing structural barriers and providing 'accessible' equipment is not sufficient to truly increase facility accessibility. Although accessibility features within the built environment of community facilities (e.g. elevators, pool-chair lifts and grab bars) can provide increased safety and accessibility to participants, a lack of maintenance and/or inadequate staff training in their use may limit women's autonomous use of facilities. Training of staff members to work with women with disabilities is also necessary to address social barriers to women's exercise participation in community recreation and fitness facilities.

AIM:To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada.BACKGROUND:Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature.DESIGN:We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods.  From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis.FINDINGS:Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'.CONCLUSION:Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.

Rationale, aims and objectives Understanding how to structure educational interventions and resources to facilitate physical therapists' application of the research literature is required. The objective of this study was to explore physical therapists' preferences for strategies to facilitate their access to, evaluation and implementation of the stroke research literature in clinical practice.Methods In-depth, qualitative telephone interviews were conducted with 23 physical therapists who treat people with stroke in Ontario, Canada and who had participated in a previous survey on evidence-based practice. Data were analysed using a constant comparative approach to identify emergent themes.Results Participants preferred online access to research summaries or systematic reviews to save time to filter and critique research articles. To enable access in the workplace, an acceptable computer-to-staff ratio, permission to access web sites and protected work time were suggested. Participants considered personal digital assistants as excellent tools for quick access to online resources but were unsure of their advantage over a desktop computer. Therapists favoured use of non-technical language, glossaries of research terms and quality ratings of studies to ease understanding and appraisal. Teleconferencing or videoconferencing overcame geographical but not scheduling barriers to accessing education. To achieve behaviour change in clinical practice, therapists preferred multiple interactive, face-to-face education sessions in a group format, with opportunities for case-based learning and practice of new skills.Conclusion Physical therapists prefer technology-assisted access to resources and education and favour attending multiple interactive, expert-facilitated education sessions incorporating opportunities for case-based learning and practice of new skills to change behaviour related to evidence-based practice.

Women are less likely than men to participate in cardiac rehabilitation (CR) and physical activity (PA). However, the impact of CR on PA participation and other health promotion (HP) practices in community settings is unknown. The aims of this study were to (1) describe the HP and PA practices and preferences of older women with CVD, and (2) determine how HP activities (including PA and CR) are prioritized, and PA information accessed. We determined whether older women with CVD differ in their PA practices (1) based on their CR attendance, and (2) compared to the population of older Ontario women. Mail surveys were distributed to 252 eligible past female patients at the University of Ottawa Heart Institute (UOHI). Survey completion rate was 50% (N = 127). Analyses described women's PA and HP practices and priorities, and compared PA participation and CR referral rate between (i) survey respondents and older Ontario women, and (ii) CR attendees and non-attendees. Survey respondents (mean age = 75.8 years) were more active than Ontario's population of older women in terms of daily activities, and walking for transportation and exercise (P< .01); CR attendees and non-attendees did not differ in these activities. Seventy two % of women (N = 103) reported participating in PA in their home, and this location was preferred (70%). The most important reason for PA participation is to improve overall health and wellbeing (68%, N = 103), versus other reasons, i.e., 'to manage or prevent health conditions'(13.6%). Women were most likely to consult their physician for PA information or advice (45.3%, N = 53), but 40% (N = 113) reported their physician 'never' or 'rarely' discusses their level of PA or helps them to increase their level of PA (60%, N = 111). Despite an automatic referral policy at UOHI, only 60% (N = 119) reported receiving a referral to CR. Fifty four % of respondents (N = 120) attended CR which is greater than the 37% of eligible older Ontario women who attend CR (P< .01). Women who attended CR were more likely to have received physician referral (P< .01), and less likely to report transportation and a lack of available PA programs in their communities as challenges to PA participation. Since little is known about how women not attending CR prioritize and participate in HP and PA practices, this research can be used to better understand and provide the necessary supports and desirable contexts for women in both hospital and community settings.

BACKGROUND AND RESEARCH OBJECTIVE:The health benefits of cardiac rehabilitation (CR) for women living with heart disease are well documented, yet women remain underrepresented in traditionally structured CR programs. This health service delivery gap has been attributed to a number of sex-related factors experienced by women, including lower rates of physician referral, travel-related barriers, competing work and caregiving responsibilities, greater cardiovascular disease severity, and number of comorbid health conditions. Whether a program specifically designed for women is able to address these barriers and facilitate women's participation is a question that has seldom been explored in the CR literature. As part of a larger study exploring whether 6 predefined principles of women's health (empowerment of women, accessible programs, broad definition of health care, high-quality of care, collaborative planning, and innovative and creative approaches) are reflected in the practices of the Women's Cardiovascular Health Initiative (WCHI) (a comprehensive CR and primary prevention program designed for women), the objective of this analysis was to explore how the principle of "accessible programs" is experienced by women participating in the WCHI.PARTICIPANTS AND METHOD:Fourteen women previously enrolled in the WCHI program participated in a single, in-person qualitative interview. Transcripts were analyzed using a constant-comparative approach to identify relevant themes related to program accessibility.RESULTS:Key themes identified included participants' experiences with acquiring physician referral, negotiating transportation issues, and navigating program schedules. Women discussed how peer support and staff members' willingness to address their health-related concerns facilitated their participation.CONCLUSION:While a women-centered CR/primary prevention program may facilitate and encourage women's participation by providing flexible program schedules as well as peer and professional support, efforts are still required to address persistent barriers for women related to physician referral and transportation to programs.

Scientific papers, special interest papers and education sessions to be presented at the Canadian Physiotherapy Association national congress (2010).

Exercise participation among women living with disabilities can be limited as a result of pain, decreased muscle strength, and limited mobility. More "disabling" than these symptoms, however, is a lack of accessible exercise facilities in women's communities. Our study explores how material and social structures and functions existing and operating within women's communities and at community-based exercise facilities affect their participation. Interviews with 15 women living with disabilities were conducted and qualitatively analyzed. Participants discuss the benefits of their exercise participation, in addition to how they experience and negotiate structural and attitudinal barriers within community-based facilities.

ASSOCIATION ANNUAL MEETING: Canadian Association of Cardiac Rehabilitation (Association canadienne de réadaptation cardiaque) 19th Annual Meeting and Scientific Abstracts: October 23–25, 2009, Edmonton, Alberta, Canada: 11: 00 AM–12: 00 PM: Saturday, October 24, 2009: Concurrent Scientific Oral Presentations

ASSOCIATION ANNUAL MEETING: Canadian Association of Cardiac Rehabilitation (Association canadienne de réadaptation cardiaque) Annual Meeting and Scientific Abstracts: October 24–26, 2008, Toronto, Ontario, Canada: Scientific Poster Presentations: Saturday, October 25, 2008: CACR Showcase: Posters available for viewing: 9: 30 AM–5: 00 PM: Authors present: 9: 30 AM–10: 00 AM; 3: 00 PM–3: 30 PM: Sunday, october 26, 2008: CACR Showcase: Posters available for viewing: 9: 30 AM–2: 00 PM: Authors prese

Background: Cancer-related fatigue, anemia, bone pain, treatment toxicities, depression, and advanced age contribute to debilitation in myeloma. Myeloma pts are reluctant to exercise due to lack of disease-specific exercise guidelines and fear of injury. At our centre, a disease-modified, supervised exercise pilot program has been evaluated with 20 subjects.